The Outpatient Prescribing Pattern of Topical Lidocaine in Al Seih

Aim: The present study aimed to describe the prescribing pattern of topical lidocaine in the outpatient setting in Al Seih. Methodology: This is a retrospective study that includes reviewing the electronic prescriptions that contained topical lidocaine among outpatients in a public hospital in Al Seih. Results: More than 52% of the patients who received topical lidocaine were males and the age of 36.84% of them was between 30 and 39 years. Most of the patients who received topical lidocaine for 7 days (64.47%). Topical lidocaine prescriptions were written mainly by residents (96.05%). More than 55% of the topical lidocaine prescriptions were prescribed by the emergency department and 38.16% of the prescriptions were prescribed by general surgery department. Conclusion: The present study showed that the prescribing of topical lidocaine was uncommon in Al Seih. Further studies are required to investigate the pattern and the frequency of topical lidocaine and other topical anesthetics in the outpatients setting and in other settings.

19 Anxiolysis for laceration repair in children: A survey of pediatric emergency providers in Canada

Primary Subject area Emergency Medicine - Paediatric Background Laceration repair accounts for half of procedures performed in pediatric emergency departments. Although commonly used, topical anesthetics do little to alleviate emotional distress, particularly in young children. Intranasal midazolam is frequently used but is not consistently effective. Intranasal dexmedetomidine (IND) is a new and potentially effective anxiolytic but clinical uptake is limited by a lack of pediatric data. Objectives Our objective was to understand pediatric emergency providers’ willingness, preferences, and perceived barriers surrounding anxiolysis for laceration repair in children, to inform the design of a future clinical trial of IND. Design/Methods This was an online survey of Canadian pediatric emergency providers listed in the Pediatric Emergency Research Canada database. The survey was developed according to published guidelines and featured a vignette of a 3-year-old distressed child requiring laceration repair. It was hosted on the Research Electronic Data Capture platform in English and French, and was disseminated from September to December 2020. The primary outcome was the proportion of respondents that would provide anxiolysis. Secondary outcomes included perceived barriers to IND use. Data were reported using summary statistics. Results The response rate was 155/225 (68.9%), of which 98/141 (70%) were Royal College accredited pediatric emergency physicians. For 129/147 (88%) of respondents, 80-100% of their patients were children. 123/146 (84%) had > 6 years independent practice experience and 126/146 (86%) performed > 4 laceration repairs per month. 127/148 (86%) believed that > 25% of children experienced distress significant enough to require physical restraint during laceration repair. 116/148 (78%) indicated they would provide anxiolysis, mainly as intranasal benzodiazepines, such as midazolam (100/109, 92%). 95/148 (64%) indicated that they would consider IND if evidence suggested it was effective. Common perceived barriers included inadequate personal (114/145, 79%) and nursing (109/145, 75%) experience with IND, and lack of formulary access to IND (60/145, 41%). Conclusion Most pediatric emergency providers believe that laceration repair in a young child is distressing and would provide anxiolysis. Most providers would consider IND if there was evidence of benefit, suggesting that favourable findings from a clinical trial would have good clinical uptake.

Effect of epinephrine on the absorption of lidocaine following application to the oral mucosa in rats

Background We investigated the role of epinephrine in prolonging the localization of lidocaine on the oral mucosa and inhibiting its absorption in the blood of rats. Methods We used 7–8-week-old pathogen-free Wistar male rats (n = 128) for our study. We divided them into the control group administered with 14C-labeled lidocaine hydrochloride gel only and the study group administered with 14C-labeled lidocaine hydrochloride gel with epinephrine. The medications were administered in the palatal mucosa of the rats. The amount of mucosa, palatine bone, and serum lidocaine was measured by radioactivity using a liquid scintillation counter and was observed using autoradiograms. Results Initially, there was no significant difference in the lidocaine levels between the lidocaine and lidocaine with epinephrine groups in the palatal mucosa (751.9 ± 133.8 vs. 669.8 ± 101.6 ng/mg [2 min]). After 4 min, the values were significantly lower in the lidocaine with epinephrine group (1040.0 ± 142.8 vs. 701.2 ± 109.0 ng/mg [20 min]). After 40 min, the lidocaine level became significantly higher in the lidocaine with epinephrine group (586.8 ± 112.4 vs. 1131.3 ± 155.2 ng/mg [40 min]). Similar results were observed in the palatine bone and serum. Conclusion Epinephrine prolonged the localization of lidocaine applied to the mucosa and inhibited its absorption into the bloodstream of rats. Clinical studies are required to evaluate the use of epinephrine-containing topical anesthetics on the oral mucosa.

EARLY EJACULATION

Information on the epidemiology, etiology and treatment of premature ejaculation is reviewed. Evidence of the prevalence of premature ejaculation indicates that subjective concern about rapid ejaculation is a common concern worldwide. The hypotheses regarding the pathogenesis of premature ejaculation include: 1.) that it is a learned model of ejaculation maintained by interpersonal anxiety and 2.) that it is a dysfunctional result of the central or peripheral mechanisms that regulate ejaculatory thresholds and 3.) that it is a normal variant in latency ejaculation. Current evidence-based treatment interventions include behavioral psychotherapy and the use of pharmacological agents, including topical anesthetics and selective serotonin reuptake inhibitors. The purpose of this paper is to review the existing knowledge base on the definition, prevalence, etiology and treatment of premature ejaculation.

Effectiveness of Topical Anesthetics in Pain Management for Dermal Injuries: A Systematic Review

The treatment of dermal injuries is associated with pain in both adult and pediatric populations. We reviewed traditional treatments for controlling the pain of these lesions, such as infiltrated local anesthetics and topical local anesthetics. The objective of this review was to elucidate the efficacy of topical anesthetics in reducing the pain of dermal injuries, as well as the efficacy of topical anesthetics versus other anesthetics, or versus a placebo. Methodology: a systematic review was carried out by searching Medline (PubMED), Scopus, Cinahl, Cochrane, Lilacs, and ENFISPO for randomized clinical trials on the control of pain in dermal lesions through the use of topical anesthetics, versus a placebo or versus another anesthetic. Results: twelve randomized clinical trials with a total of 952 patients were included. Seven studies analyzed the efficacy of topical anesthetics compared to a placebo, and six of them observed statistically significant differences in favor of the experimental group. Five studies analyzed the efficacy of topical anesthetics compared to other anesthetics or sedatives; three of them observed statistically significant differences in favor of the experimental group, and two found no difference between the anesthetics analyzed. Conclusion: topical anesthesia is a useful method for pain control, is safe compared to other traditional methods, and offers a satisfactory form of pain relief in relation to infiltration anesthesia and compared to placebo.

Topical anesthetics and analgesics

Topical administration of anesthetics and analgesics can allow for the efficient, painless delivery of medications that may reduce systemic side effects associated with the medication, whilst providing clinical advantages over injected or oral administration for the same clinical situation. Topical anesthetics have become widely used prior to a variety of painful procedures in children, including venous access, laceration repair, and injections. Topical administration of nonsteroidal anti-inflammatory drugs, lidocaine, capsaicin, and other agents also are useful for a range of conditions, including acute and chronic musculoskeletal pain, and neuropathic pain.

Current Practices On Diagnosis And Management Of Women With Vulvodynia

Introduction and hypothesis: To describe clinical characteristics, previous medical assessment, past treatments and vulvar pain relief among women with vulvodynia.Methods: Brazilian women with vulvodynia (n=144) were assessed for vaginal infection and vulvar pain intensity by means of a cotton swab test based on a numerical rate scale (NRS). All women answered the Female Sexual Function Index questionnaire and a structured instrument about present vulvar symptoms and previously experienced treatments. Vulvar pain relief achieved with previous treatments was qualified through a 4-point Likert-scale.Results: Previous vulvar pain duration was 5.8 (±4) years. More than 50% consulted with three or more physicians and 49% remained without a conclusive diagnosis. Diagnosis and treatment vulvovaginal infection was very common. The most commonly used treatments were lubricants (66%), topical anesthetics (36%) and vulvar care techniques (36%). All of then provided only low pain relief. Physical therapy and oral gabapentin provided strong vulvar pain relief.Conclusion: Prolonged duration of vulvar pain, multiple visits to healthcare professionals and poor relief of pain are common aspects in the clinical history of women with vulvodynia. Vulvovaginal symptoms other than pain are common, highlighting the importance of the screening tests in order to avoid misdiagnosis.Brief summary: Women suffering with vulvodynia symptoms are frequently missdiagnosed. This study described symptoms, diagnosis and treatment received by women with chronic vulvar pain.