Presumptive Non-Ischemic Priapism in a Cat

A 14-year-old neutered male British shorthair cat presented with a 21-day history of persistent erection and dysuria, along with overgrooming of the perineal region. Mild palpation induced pain and rigid corpora cavernosa with flaccid glans were observed during physical examination. Ultrasonography of the penis did not detect significant blood flow in the penile cavernosal artery. The drawing of aspirate blood from cavernosal bodies for gas analysis was impossible because of the anatomically small penis size of cats. Conservative management, including topical steroid ointment, lidocaine gel, gabapentin, and diazepam, was prescribed for supportive management. The clinical signs resolved, and ultrasonographic examination of the penis revealed no abnormalities. The cat remains clinically well without recurrence during the 6 months after treatment. To our knowledge, this is the first report of non-ischemic priapism in a cat.

Dysmenorrhoea as a risk factor for pain with intrauterine device insertion

BackgroundUnderstanding predictors of pain with gynaecological procedures may facilitate individualised counselling and pain management. We aimed to study the effect of dysmenorrhoea on intrauterine device (IUD) insertion pain.MethodsThis was a planned secondary analysis of a randomised trial evaluating self-administered lidocaine gel versus placebo for IUD insertion pain. We included those participants who reported menses in the past 3 months. We assessed dysmenorrhoea (in the past 3 months) and procedural pain using a 100 mm visual analogue scale (VAS). We categorised dysmenorrhoea as none/mild (<40 mm), moderate (40–69 mm) or severe (≥70 mm). We assessed participant pain scores at speculum insertion, tenaculum placement, IUD insertion, and overall. We compared median procedural pain scores by dysmenorrhoea group with three-way and post hoc pairwise analyses.ResultsWe analysed 188 participants. Demographic characteristics were similar among the three dysmenorrhoea groups. Pairwise comparisons revealed higher median procedural pain scores in the severe dysmenorrhoea group compared with the none/mild dysmenorrhoea group at speculum insertion (25 mm vs 8 mm; p=0.007), tenaculum placement (51 mm vs 31 mm; p=0.04) and IUD insertion (74 mm vs 61 mm; p=0.04). Overall pain did not differ among the three groups (p=0.32).ConclusionsPatients with severe dysmenorrhoea experienced increased pain with all aspects of IUD insertion, including speculum and tenaculum placement, compared with those with only mild or no dysmenorrhoea. Clinicians may consider this finding when providing individualised counselling and pain management for patients undergoing IUD insertion and other gynaecological procedures. Larger studies are needed to validate the effect of dysmenorrhoea severity on pain throughout IUD insertion.

Comparison of the Effects of Diltiazem Gel with Lidocaine Gel on reducing pain and discomfort in Patients Undergoing Rectosigmoidoscopy: A Randomized double-blinded Clinical Trial

Background: Flexible rectosigmoidoscopy is an easy and accessible exam to diagnose distal colon diseases, although many patients refuse undergoing it due to pain and discomfort during the procedure. Studies show that the application of local lidocaine, as an analgesic, has no effect on pain relief in patients undergoing rectosigmoidoscopy. The current study aimed at comparing the effects of diltiazem gel, an antispasmoic drug with local pain-reducing effects, with lidocaine gel in patients undergoing flexible rectosigmoidoscopy. Materials and Methods: The current double-blinded, randomized, clinical trial was performed to compare the effect of two topical drugs, lidocaine and diltiazem, on pain relief in patients undergoing rectosigmoidoscopy. A total of 80 patients who were potential candidates for rectosigmoidoscopy were enrolled in the study after obtaining the informed consent, and then randomly assigned to one of the lidocaine gel (2 mL) or diltiazem gel (2 mL) group, 10 minutes prior to rectosigmoidoscopy. The level of pain in the patients during the procedure was measured using the visual analogue scale (VAS) and the results were recorded. The data were analyzed using paired samples t-test and independent t-test as well as analysis of covariance (ANOVA) with SPSS version 18. P-value <0.05 was considered the level of significance. Results: Of 80 patients, 35 (43.75%) were male and 45 (56.25%) female. The mean age and body mass index (BMI) of the patients were 51.45 ± 15.21 years and 25.95 ± 7.47 kg/m2 , respectively, and there was no significant difference between the groups. The most frequent indications for rectosigmoidoscopy were abdominal pain (46.3%) and rectorrhagia (31.3%). The mean VAS score for pain reported by the patients in the lidocaine and diltiazem groups were 3.97 ± 2.89 and 2.60 ± 2.36, respectively. The VAS score for pain in the diltiazem group was significantly lower than of the lidocaine group (P = 0.023). Conclusion: The application of local diltiazem gel around the anus, in spite of no side effects, can effectively reduce the pain and discomfort in patients during rectosigmoidoscopy.

COMPARISON OF PAIN INTENSITY BETWEEN LIDOCAINE GEL AND INTRAURETRAL TRAMADOL WITH LIDOCAINE GEL IN THE DJ STENT REMOVAL

Objective: To determine the difference in pain intensity between the administration of a combination of tramadol and intraurethral lidocaine gel with only lidocaine gel during the removal of DJ stents. Material & Methods: This study was a prospective randomized clinical trial with 22 patients that were divided into 2 groups. Group 1 was given a combination of tramadol and lidocaine gel urethral injection 3 to 5 minutes before DJ stent removal, whereas group 2 was given lidocaine gel urethral injection 3-5 minutes before the removal. The inclusion criteria in this study was all patients with a DJ stent placement with 1 to 3 months prior to release who were willing to participate. The Wong-Baker scale was used directly to determine the scale of pain during the procedure. Mann Whitney analysis was used to analyze the findings. Results: Most patients in group 1 are shown to have a pain rating of 2. There are 2 patients with a high pain rating scale of 6 and 7. In group 2, most patients claimed that the procedure was painless. The average Wong-Baker pain scale in group 1 (2.9) compared to group 2 (0.36) was significantly different. Conclusion: The combination of intraurethral tramadol and 2% lidocaine gel can significantly decrease pain during DJ stent removal more effectively than sole intraurethral 2% lidocaine gel based on the Wong-Baker pain scale.