Determination of the Effect of Two Different Methods of Dental Anaesthesia on Pain Level in Pediatric Patients: A Cross-Over, Randomised Trial

ObjectiveTo compare intraosseous (IOA) and needle-free dental anaesthesia (NFA) methods that painless anaesthesia.Materials and MethodsTwenty patients aged 8–10 years were included in this cross-over study. To determine the anxiety levels and pain experienced by the patients, Face, Legs, Activity, Cry, Consolability (FLACC) and Frankl Behavioural scales were used. The pulse rate (PR) and salivary opiorphin levels (SOL) determined. The Friedman and Wilcoxon signed-rank tests were used. p<0.01 was considered significant.ResultsAccording to FLACC scores, IOA and NFA exhibited significantly pain alteration patterns in during local and topical anaesthesia, respectively (p=0.004,0.001; p<0.01). Also, only NFA showed significantly decreased SOL values in 5- and 10- minutes after local anaesthesia periods compared to the before levels (p=0.004, p=0.001; p<0.01).ConclusionsPatients feel similar pain perceptions during local anaesthesia application in both injection systems. According to the SOL values, NFA may provide more higher anaesthetic efficiency than IOA.Clinical RelevanceThis study provides to compare two different new anaesthetic systems for pain reduction during local anesthesia for pediatric population.

COMPARISON OF ULTRASOUND GUIDED MODIFIED PECTORAL NERVE BLOCK WITH LOCAL ANAESTHESTIC INFILTRATION FOR ANALGESIA IN BREAST CANCER SURGERY

Objective: To compare the frequency of pain and mean analgesia requirement after breast surgery under general anaesthesia when comparing pectoral nerve block with local anaesthesia infiltration. Study Design: Comparative prospective study. Place and Duration of Study: Combined Military Hospital, Rawalpindi from Mar 2018 to Sep 2019. Methodology: A total of 60 patients undergoing modified radical mastectomy were included in the study. Group A (n=30) received pectoral nerve blocks while Group B (n=30) received local anaesthetic infiltration. Outcome was assessed at 12 hours after injection of local anaesthetic. Results: Pain in 7 (23.33%) patients in Group A (Pectoral nerve blocks) and in 20 (66.67%) patients in Group B (Local anaesthetic infiltration), p-value of 0.001 which was considered statistically significant. Mean analgesic requirement was found to be 80 ± 33.73 mg in the Group A (pectoral nerve blocks) compared with 141.67 ± 47.50 mg in Group B (Local anaesthesia infiltration) patients with a p-value of <0.001 which was statistically significant. Conclusion: Pectoral nerve block significantly reduces early postoperative pain and analgesia requirement when compared with Local anaesthesia infiltration after breast surgery.

Anaesthesia Choice for Creation of Arteriovenous Fistula (ACCess) study protocol : a randomised controlled trial comparing primary unassisted patency at 1 year of primary arteriovenous fistulae created under regional compared to local anaesthesia

IntroductionArteriovenous fistulae (AVF) are the ‘gold standard’ vascular access for haemodialysis. Universal usage is limited, however, by a high early failure rate. Several small, single-centre studies have demonstrated better early patency rates for AVF created under regional anaesthesia (RA) compared with local anaesthesia (LA). The mechanistic hypothesis is that the sympathetic blockade associated with RA causes vasodilatation and increased blood flow through the new AVF. Despite this, considerable variation in practice exists in the UK. A high-quality, adequately powered, multicentre randomised controlled trial (RCT) is required to definitively inform practice.Methods and analysisThe Anaesthesia Choice for Creation of Arteriovenous Fistula (ACCess) study is a multicentre, observer-blinded RCT comparing primary radiocephalic/brachiocephalic AVF created under regional versus LA. The primary outcome is primary unassisted AVF patency at 1 year. Access-specific (eg, stenosis/thrombosis), patient-specific (including health-related quality of life) and safety secondary outcomes will be evaluated. Health economic analysis will also be undertaken.Ethics and disseminationThe ACCess study has been approved by the West of Scotland Research and ethics committee number 3 (20/WS/0178). Results will be published in open-access peer-reviewed journals within 12 months of completion of the trial. We will also present our findings at key national and international renal and anaesthetic meetings, and support dissemination of trial outcomes via renal patient groups.Trial registration numberISRCTN14153938.SponsorNHS Greater Glasgow and Clyde GN19RE456, Protocol V.1.3 (8 May 2021), REC/IRAS ID: 290482.

Correction of whistle deformity secondary to cleft lip repair by V-Y plasty: a simple and effective technique

Several techniques are available for the surgical repair of the cleft lip, however, avoiding secondary deformities and achieving consistent results remains a challenge. The whistle deformity is a secondary lip deformity characterised by inadequate fullness of the central upper lip with abnormal exposure of the central incisors when the lips are at rest, giving a whistling appearance. The causes include scarring of the vermilion and failure to restore the mucosal or muscular continuity. Various surgical options are available ranging from simple procedures like V-Y plasty and Z-plasty to complex procedures like complete lip redo, locoregional flaps, fillers and grafts. V-Y plasty is a simple, effective procedure for lip lengthening that can be performed under local anaesthesia as an outpatient procedure. It is less technique sensitive and also allows for some degree of muscle repair. We present a case of whistle deformity satisfactorily corrected with V-Y plasty.

Urodynamic studies and features of anaesthesia during intradetrusor botulinum therapy in the context of the COVID-19 pandemic (literature review)

The coronavirus pandemic has had a severe impact on the health care system. It is also changing the appointment and conduct of diagnostic procedures, emergency and routine medical care. According to the medical guidelines of the European Society of Urology (EAU) for the provision of urological care during the current epidemic situation, various levels of urgency have been proposed for diagnostic and therapeutic measures depending on the type of disease. Urodynamic studies refer to studies with a priority level from P2 (for neurogenic dysfunction of the urinary tract) to P4 (for lower urinary tract dysfunction without the risk of damage to the upper urinary tract). The question arises regarding the safety of these studies, both for patients and medical staff, and possible measures to reduce the risk of infection in a viral pandemic. Because of the increased workload of hospitals that have not been redesigned for the fight against coronavirus infection and provide routine and emergency urological care, an even greater need has arisen to find effective and safe methods of local anaesthesia for performing urodynamic studies and intradetrusive injections of botulinum toxin type A under local anesthesia in outpatient and outpatient settings (for example, in a short-term hospital). This article presents a literature review on the principles and features of performing urodynamic studies in the context of the Covid-19 pandemic and the effectiveness and safety of using various methods of local anaesthesia when performing intradetrusor injections of botulinum toxin with detrusor hyperactivity of a neurogenic and non-neurogenic nature. There were evaluated forms of local anaesthesia such as intradetrusor instillation of lidocaine, electrophoresis, and the use of alternative solutions for urinary bladder irrigation (for example, Ringer’s solution).