ĀKĀRAKARA AS DERMAL ANAESTHETIC

Nowadays, the role of local anaesthesia in the surgical field is highly appraisable. Local anaesthetics are the drugs that produce a loss of sensation over the localised areas without producing a loss of consciousness. Humans have been using various methods to block pain for thousands of years. Controlling pain during the śhastrakarma in śalyatantra has been always challenging. There has been the introduction of various methods of local anaesthetics since the origin of medical science, topical anaesthetics being one of them. Studies have been conducted to discover novel anaesthetic agents by various scholars. Herbal extracts do not stand far in the pathway of this search. Owing to these discoveries, 30% ethanolic extract gel of Ākārakara (Spilanthes calva DC.) is selected here as a topical anaesthetic to evaluate the efficacy in facilitating the management of warts by a painful procedure agnikarma. Keywords: Dermal anaesthetic, Ākārakara, Spilanthol

73 The Use of Topical Anaesthetic in The Banding of Internal Haemorrhoids: A Feasibility Study for A Randomized Control Trial

Aim Rubber band ligation (RBL) is a procedure commonly performed in colorectal clinics for internal haemorrhoids. 90% of patients experience pain following RBL. We aimed to complete a feasibility randomized control trial assessing the role of topical anaesthetic before RBL of internal haemorrhoids. Method We performed a prospective, single-centre, single blinded, randomized(1:1) controlled feasibility trial. Patients presenting with symptomatic haemorrhoids suitable for banding were randomized to undergo the procedure with local anaesthetic or without(control). Pain scores and vasovagal symptoms were assessed at 0 minutes, 30minutes, 4 hours, and 72 hours after the procedure. Primary outcome measures were recruitment rate, participant retention rate, patient and surgeon acceptability. Secondary outcome measures were pain scores up to 72 hours, vasovagal episodes, new use of analgesia, and adverse outcomes. Results 35 patients (18 topical anaesthetic, group A; 17 no anaesthetic gel, group B) were recruited. Mean recruitment rate was 11.7 participants per month. 33(94%) participants remained in the study until completion, with 2 patients lost to telephone follow-up. The treatment was acceptable for 35(97%) eligible patients. 1 patient declined enrolment. The treatment was acceptable to all surgeons (100%). There was a significant difference in median pain scores of -2(95% CI -4.0 to -1.0, p = 0.0006) at the 30-minute time point only. There was no significant difference in vasovagal symptoms(p = 0.10) or new analgesia use(p = 0.85). Conclusions In conclusion, we have shown that a phase III clinical trial is feasible. We have demonstrated excellent patient recruitment and retention as well as patient and surgeon acceptability.

Assessment of Pain Perception in Paediatric Patients on Application of Cooled and Uncooled Topical Anaesthetic Gel before Infiltration Anaesthesia - A Pilot Study

BACKGROUND Topical anaesthesia is fundamental in enhancing pain control during the process of dental injections. The study compared the effect of cooled and uncooled topical anaesthetic gel before infiltration anaesthesia in assessing pain perception in paediatric patients undergoing dental treatment procedures. METHODS This is a split-mouth study where 16 children aged between 8 and 10 years who required bilateral local anaesthesia administration for various dental procedures were selected. Before infiltration anaesthesia, topical anaesthetic gel cooled to 40 C was applied on one side in the first visit followed by application of uncooled gel on the contralateral side in the subsequent visit. The patients were asked to individually rate their pain experience on each side using the Wong-Baker Faces Pain Rating Scale (WB-FPRS). Anxiety was assessed using pulse oximeter and FLACC scale (face, legs, activity, cry, and consolability). Data was analysed statistically using the paired ‘t’-test and a P value less than or equal to 0.05 was considered as statistically significant. RESULTS Patients reported less pain on Wong-Baker Faces Pain Rating Scale by using cooled topical anaesthetic gel. Discomfort and anxiety levels were also seen to be low when assessed using pulse oximeter and FLACC Scale for the same group (P < 0.05). CONCLUSIONS Cooling the soft tissue site with anaesthetic gel helped reduce pain perception during infiltration in children and was seen to be a more feasible technique. Hence this technique can be used as a successful adjunct to the local anaesthesia administration prior to dental procedures. KEY WORDS Anaesthesia, Cooling, Topical Gel, Injection, Pain

Methaemoglobinaemia from Vagisil creme in a 50-year-old woman

Methaemoglobinaemia is a life-threatening condition that results from increased methaemoglobin production. As methaemoglobin is unable to reversibly bind to oxygen potentially lethal hypoxia and functional anaemia can occur. Benzocaine can be used as a topical anaesthetic and can be found in many nonprescription preparations marketed for self-application. It is known to cause methaemoglobinaemia in rare cases but most reports describe the complication occurring during endoscopy procedures. Methaemoglobinaemia occurring after topical benzocaine use on the perineum of a perimenopausal woman is exceedingly rare. A 50-year-old woman with methaemoglobinaemia secondary to the perineal application of over-the counter Vagisil (benzocaine 20% and resorcinol 3%- an antiseptic and disinfectant, respectively) presented to the emergency department. She had been using Vagisil for severe, chronic vaginal itching. While methaemoglobinaemia secondary to excessive use of over-the-counter medications such as Vagisil creme is exceedingly rare, it should be included in the differential diagnosis.

A comparative study on effectiveness of mucosal vibration and topical anaesthetic gel in reducing pain during administration of local anaesthetic in paediatric patients.

Title : A comparative study on effectiveness of mucosal vibration and topical anaesthetic gel in reducing pain during administration of local anaesthetic in paediatric patients. Introduction: Anxiety related to dentistryis not uncommon in paediatric patients. Poor pain control alongside the fear and anxiety might interfere with appropriate dental management. In this study a modified mucosal vibration device is used to modify the pain perception during LA administration. Aim: To compare the effectiveness of topical anaesthetic gel and mucosal vibration during local anaestheticadministration in children in the age group8-11 years using both subjective and objective scalescales for measuring anxiety and pain. Methodology: Thirty children who required inferior alveolar nerve blockanaesthesia for routine dental procedures were included and divided equally into 3 groups Group I- control Group II- topical anaesthetic gel Group III - Mucosal vibrator Pain perception was compared, assessed and analysed during injection using Sound, Eye, Motor (SEM) scale, Doremon cartoon modified Wong Baker Faces Pain Rating Scale, MotuPatlu cartoon modified Venham scale Results: The scores of SEM scale and Doremon pain scale when subjected to statistical analysis gave a p value <0.001. Conclusion: Mucosal vibrator is an easily availablehandyand effective chair sidedevice for pain reduction during administration of local anaesthesia for paediatric patients