A randomized controlled trial of three different local anesthetic methods for minor hand surgery

Purpose: Hemostasis and local anesthetic injection are essential for minor hand surgeries under local anesthesia (LA). Wide awake local anesthesia no tourniquet (WALANT) became popular for achieving hemostasis without a tourniquet. However, a recent study reported that injection is more painful than tourniquet use in minor hand surgery. Therefore, this study aimed to compare three LA methods that differ according to injection and hemostasis, namely, the combination of a tourniquet and buffered lidocaine solution (CTB), WALANT, and conventional LA. Methods: This randomized prospective single-center study included 169 patients who underwent minor hand surgery between 2017 and 2020. We randomly allocated the patients to each group and recorded the pain and anxiety score during the surgery, as well as satisfaction after the surgery. Results: Pure lidocaine injection was significantly more painful than buffered lidocaine and WALANT solution injection ( p < 0.001). Local anesthesia injection was significantly more painful than tourniquet use in all groups ( p < 0.001). The intraoperative anxiety score was significantly lower in the CTB group than in the conventional LA and WALANT groups ( p < 0.001). The satisfaction score was significantly higher in the CTB and WALANT groups than in the conventional LA group ( p < 0.001). Conclusion: CTB for minor hand surgery under LA is associated with less injection pain and patient anxiety. The tourniquet is tolerable without much pain and waiting time. Thus, CTB in minor hand surgery is a good alternative to WALANT and conventional LA.

Use of Remifentanil Associated with Lidocaine for Feticides in Late Terminations of Pregnancy: A Randomized Clinical Trial

<b><i>Introduction:</i></b> In France, performance of a termination of pregnancy is legally possible without any gestational age limit. After 22 weeks of gestation, a feticide is ethically performed using usually sufentanil and lidocaine. The aim of this study was to compare the use of remifentanil, a fast-acting morphine-derivating product, instead of sufentanil. <b><i>Methods:</i></b> This 2-center randomized, controlled, single-blinded phase-III treatment trial had 2 parallel arms: an experimental group using remifentanil with lidocaine versus a control group receiving sufentanil associated with lidocaine. This trial took place over a 40-month period. The primary outcome was time to fetal asystole after lidocaine injection. The secondary outcome measures were the procedure’s success rate, the rate of serious maternal side effects, and the presence of cellular or tissue modifications. <b><i>Results:</i></b> The study included 66 women, randomized into 2 groups of similar size and characteristics. Time to fetal asystole did not differ significantly between the groups, with a delay of 4 min (Q1−Q3, 2–11) in the sufentanil group and 4 min (Q1−Q3, 1–10) in the remifentanil group (<i>p</i> = 0.84). Similarly, the success rate of the procedure did not differ significantly. Fetal asystole was procured in &#x3c;2 min and persisted &#x3e;1 min for 16 (25.8%) women in our total population: 7 (22.5%) in the sufentanil group and 9 (29.0%) in the remifentanil group, <i>p</i> = 0.77. No severe maternal side effects were observed. Among the 49 fetopathological examinations performed, the few tissue and cell modifications observed did not cause any interpretation difficulties in either group. <b><i>Discussion/Conclusion:</i></b> Use of remifentanil instead of sufentanil for feticide procedure did not improve time to fetal asystole. No harmful effect was observed for either maternal tolerance or interpretation of the histologic slides.

Intractable Muscle Tension Dysphonia Treated by Injection Laryngoplasty and Lidocaine Injection

Muscle tension dysphonia (MTD) is a voice disorder characterized by excessive tension of the laryngeal muscles during phonation. Voice therapy is the gold standard of treatment for MTD. However, patients with MTD do not always respond to voice therapy. Multidisciplinary approaches have been attempted to treat intractable MTD such as lidocaine instillation, lidocaine injection to recurrent laryngeal nerve, botox injection and excision of false ventricle using CO2 laser. Recently, injection laryngoplasty is suggested that assists in more efficient phonation and voice therapy to MTD patients. A patient with intractable MTD underwent lidocaine injection and injection laryngoplasty showed improved voice quality and remained stable until postoperative 3 months without any complications.

Arthroscopic Bennett Lesion Resection: A Novel Technique

Background: Bennett lesion is ossification of the posterior inferior glenohumeral ligament complex. Though often asymptomatic, these lesions can become painful and interfere with throwing ability. Indications: The Bennett lesion is relatively common among elite throwers, present in 22% to 25% of asymptomatic pitchers. Suggested causes of this lesion include traction on the posterior joint and posterior impingement in the late cocking phase. These lesions can become painful due to displacement and irritation of the joint capsule and axillary nerve. Therefore, efficient arthroscopic treatment of symptomatic lesions is essential. Technique Description: The patient is positioned in the lateral decubitus position, and the glenohumeral joint is accessed via posterior and anterior portals. Once the lesion is identified, it may be probed and debrided via the posterior portal. A posterior capsular release is performed, and 4.0 mm burr resection of the lesion is started, viewing from the anterior portal with a 70° arthroscope. Direct visualization through the posterior portal can be used to verify complete lesion resection. If there is a true tear of the posterior labrum, this can be repaired with a knotless suture anchor back to the glenoid, but usually there is delamination that can be left alone after addressing the Bennett lesion. Results: We have found good success treating Bennett lesions via the above technique. This is supported by previous literature as well, with return to preinjury levels ranging from 69% to 85% following arthroscopic resection. Discussion/Conclusion: Four diagnostic criteria have been described to ensure accurate diagnosis: detection of a bony spur at the posterior glenoid rim on plain x-ray films, best seen on Stryker notch and Bennett view; posterior shoulder pain while throwing; tenderness at the posteroinferior aspect of the glenohumeral joint; and improvement in pain following lidocaine injection. Magnetic resonance imaging is also an excellent diagnostic tool to detect early enthesopathic changes in the posterior glenoid or periosteum, as well as labral pathology. Following arthroscopic resection, 88% of patients were satisfied with their treatment when using these diagnostic criteria. Accurate diagnosis and efficient treatment of Bennett lesions are imperative in the throwing athlete, and when performed correctly, our technique provides significant and lasting improvement for patients.

Effectiveness of saline water and lidocaine injection treatment of intractable plantar keratoma: a randomised feasibility study

Background An intractable plantar keratoma (IPK) is a conical thickening of the epidermis’ stratum corneum and a common cause of foot pain which can have a significant, detrimental impact on the mobility, quality of life and independence of individuals. Conservative treatments are currently offered to patients with IPK, but they are unsatisfactory since they do not offer a sufficient or permanent reduction of symptoms. The purpose of this study was the evaluation of the feasibility, safety and effectiveness of innovative treatments for intractable plantar keratoma (IPK). Methods A randomized single blind trial with 40 patients divided with block randomization in four parallel groups was conducted to compare treatment combinations: conservative sharp debridement only or sharp debridement with needle insertion, physiological water injection or lidocaine injection. All patients obtained the same treatment four times at a four-week interval. At each visit, visual analog scale (VAS), Foot Function Index (FFI) and IPK size were evaluated. VAS and FFI were also completed at a six and twelve-month follow-up. Results Our findings in regards to feasibility demonstrated recruitment challenges because of the anticipated pain that would be provoked by needle insertion may not be worth the potential pain relief compared to debridement alone from the patient’s perspective. This was also the principal cause of drop out. Our preliminary results show no main effect of group for any of the clinical outcomes: pain felt on VAS, FFI score, IPK’s size (p > 0.05). However, the analysis revealed a statistically significant effect of time on VAS (p < 0.001), FFI score (p < 0.001) and IPK’s size (width and depth (p < 0.001); length (p = 0.001)), but no group x time interaction was found (p > 0.05). Conclusions This study demonstrates that IPK treatment consisting of sharp debridement with needle insertion, physiological saline water injection or lidocaine injection is feasible and safe. There was a non-statistically significant trend toward diminishing pain intensity compared to scalpel debridement alone. The pain provoked by needle insertion and injection treatments must be addressed with a scientifically proven protocol to make it more comfortable for patients before these treatments could be considered in further studies. Trial registration ClinicalTrials.gov, NCT04777227. 2 March, 2021 - Retrospectively registered (All participants were recruited prior to registration).

Evaluation of Blood Pressure Changes after IAN Block Injection with Lidocaine and Epinephrine 1:80000 and its Relation with Anxiety

Introduction: Many patients experience anxiety when they visit a dentist and anxiety causes an increase in the patient's blood pressure, as well as an injection of epinephrine, is also effective in increasing the blood pressure of the patients. The aim of this study was to investigate changes in blood pressure following injection of lower jaw blocking with lidocaine containing 1: 80000 epinephrine and its association with anxiety level in patients Materials and Methods: In this cross sectional study, 129 patients referred to the dental school of Islamic Azad University of Khorasgan were selected and their blood pressure was measured before injection of anesthetic drug and ten minutes later. The anxiety level of the patients was determined using a dental anxiety inventory and the relationship between the level of anxiety and blood pressure in the patients before and after injection was measured. Data were analyzed by T-paired statistical test, regression and Pearson test. Results: There is a positive correlation between the patient's systolic and diastolic blood pressure before the injection and the anxiety score is significant (p value < 0.001). There was also a significant association between the degree of correlation between mean pressure and anxiety score (p value < 0.001). There was a positive and significant correlation between injection pressure and anxiety scores. (p value < 0.001). Conclusion: Lidocaine injection containing epinephrine 1: 80,000 in patients undergoing mandibular block is associated with a significant increase in patients' systolic blood pressure. There was also a significant relationship between patients 'levels of anxiety and blood pressure, which had a greater effect on patients' blood pressure than epinephrine injections.

Effects of Radial Extracorporeal Shockwave Therapy Versus 1% Lidocaine Injection for Myofascial Trigger Points Measured with Elastic Index

Purpose: To compare the efficacy of radial extracorporeal shockwave therapy (rESWT) versus injection of 1% lidocaine for active myofascial trigger points (MTPs) at upper trapezius muscle (UTM) objectively with elastic index analysis. Patients and methods: A prospective, randomised, single-blinded clinical trial was done. 60 patients with active MTPs of UTM were randomised to receive either rESWT (n = 30); three rESWT sessions; one session per week; 2000 rESWT impulses per session; positive energy flux density = 0.10 mJ/mm2) or 1% lidocaine (4 ml) injection (n = 30) (three injections; one injection per week). The outcome measure was the elastic index of MTPs, visual analogue score (VAS score) of pain, and pressure pain threshold (PPT) three weeks after baseline. Results: Both rESWT and injection of 1% lidocaine resulted in statistically significant (P < 0.05) reduced elastic index and VAS of pain of UTM and PPT significantly (P < 0.05) at three weeks after baseline. The mean differences between rESWT and injection of 1%lidocaine showed no statistically siginificance. Conclusion: Both rESWT and 1% lidocaine injection had efficacy for active MTPs of UTM measured with elastic index, VAS of pain and PPT.

Projection-specific dopamine neurons in the ventral tegmental area participated in morphine-induced hyperalgesia and anti-nociceptive tolerance in male mice

Background: Long-term morphine use is associated with serious side effects, such as morphine-induced hyperalgesia and analgesic tolerance. Previous investigations have documented the association between dopamine (DA) neurons in the ventral tegmental area (VTA) and pain. However, whether VTA DA neurons are implicated in morphine-induced hyperalgesia and analgesic tolerance remains elusive. Methods: Initially, we observed behavioural effects of lidocaine administration into VTA or ablation of VTA DA neurons on morphine-induced hyperalgesia and anti-nociceptive tolerance. Subsequently, c-Fos expression in nucleus accumbens (NAc) shell-projecting and medial prefrontal cortex (mPFC)-projecting VTA DA neurons after chronic morphine treatment was respectively investigated. Afterwards, the effects of chemogenetic manipulation of NAc shell-projecting or mPFC-projecting DA neurons on morphine-induced hyperalgesia and anti-nociceptive tolerance were observed. Additionally, effects of chemogenetic manipulation of VTA GABA neurons on c-Fos expression in VTA DA neurons were investigated. Results: Lidocaine injection into VTA relieved established hyperalgesia and anti-nociceptive tolerance whereas ablation of VTA DA neurons prevented the development of morphine-induced hyperalgesia and anti-nociceptive tolerance. Chronic morphine treatment increased c-Fos expression in NAc shell-projecting DA neurons, rather than in mPFC-projecting DA neurons. Chemogenetic manipulation of NAc shell-projecting DA neurons had influence on morphine-induced hyperalgesia and tolerance. However, chemogenetic manipulation of mPFC-projecting DA neurons had no significant effects on morphine-induced hyperalgesia and anti-nociceptive tolerance. Chemogenetic manipulation of VTA GABA neurons affected the c-Fos expression in VTA DA neurons. Conclusions: These findings revealed the involvement of NAc shell-projecting VTA DA neurons in morphine-induced hyperalgesia and anti-nociceptive tolerance, and may shed new light on the clinical management of morphine-induced hyperalgesia and analgesic tolerance. Perspective: This study demonstrated that NAc shell-projecting DA neurons rather than mPFC-projecting DA neurons in the VTA were implicated in morphine-induced hyperalgesia and anti-nociceptive tolerance. Our findings may pave the way for the discovery of novel therapies for morphine-induced hyperalgesia and analgesic tolerance.