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Purpose: Inguinal hernia repair remains one of the most common elective general surgical procedures. Previous studies have suggested high rates of chronic pain afterwards. The aim of this study was to evaluate changes in quality of life after local anaesthetic (LA) inguinal hernia surgery performed in a primary care setting. Methods: Quality of life (QoL) was measured in all patients both pre-operatively and at 6-months post-operatively using the European Hernia Society Scoring tool. Data was analysed by tertile grouping according to initial symptom score. Results: 497 patients filled out pre-operative QoL forms between June 2020 and May 2022. Post-operative QoL scores were received from 179 patients (164 male (91.6%)). Median pre-operative score was 33 (IQR 20–48). Median post-operative score was 4 (IQR 1–11). Mean improvement in QoL score was 27.8. Nine patients had a worse score at 6-months compared to pre-op (5%). When the data was analysed by pre-op QoL group as expected the low symptom group (score 0–10) had minimal improvement in QoL (0.23) and 5 out of 13 patients (38%) had a worse score. The medium group (score 11–40) had a mean improvement in QoL of 17.25 with 3 out of 92 (3.2%) experiencing a worse score. The high symptom group (score 41–90) had a mean improvement in QoL of 45.4 with only 1 of 76 (1.3%) experiencing a worse score. Conclusions: LA Inguinal hernia repair improves QoL substantially 6-months after surgery. However, in those patients with low pre-operative scores (< 11) the gain is minimal and rates of chronic symptoms following surgery are very high. We recommend avoiding surgery in this group and instead adopting a surveillance approach. [ABSTRACT FROM AUTHOR]

Background: Rubber band ligation (RBL) is a widely accepted intervention for the treatment of haemorrhoids. However, post procedure pain is a common complaint. The aim of this study was to determine whether the addition of local anaesthetic (LA) to the haemorrhoid pedicle base, post RBL, aids in reducing early post-procedure pain. Additionally, to compare perceived perianal numbness, oral analgesia usage and total consumption, and adverse events. Methods: This study was a prospective, single-blinded randomised controlled trial. Patients were recruited from colorectal clinics in two Australian hospitals between 2018–2019. Patients randomised to the intervention (LA) group received 2mls bupivacaine 0.5% with adrenaline 1:200,000 to each haemorrhoid base. Patients in the control group were not administered LA. Pain scores were recorded over 48 h using visual analogue scales. Analgesia consumption was documented and other secondary objectives were recorded dichotomously (yes/no). Results: At 1 h post-procedure, patient reported pain scores were significantly lower in the LA group compared to the control group (p = 0.04). There were no significant differences in pain scores between the groups at 4, 24 or 48 h. Additionally, there were no significant differences between groups with respect to oral analgesia usage, perianal numbness or adverse events. Conclusions: LA to the haemorrhoid pedicle post RBL may significantly reduce early post procedure pain without any increased risk of adverse effects. [ABSTRACT FROM AUTHOR]

Aims: To assess all available data and determine the success rates and tolerability of local anaesthetic myringoplasty in comparison with those undertaken under general anaesthetic myringoplasty. Materials and methods: The study was designed following a PRISMA-P protocol and registered with the PROSPERO database. MEDLINE, Cochrane Library (CDSR/Central), EMBASE and CINHAL—were directly searched for studies, which met the inclusion criteria. Objectives: Primary objective was to compare perforation closure rates between patients undergoing myringoplasty under local anaesthetic and those under general anaesthetic from all available published data. Secondary outcomes include complications, such as 'any minor complications', infection rates in the first 6 month post-op, facial nerve weakness, dysgeusia and patient satisfaction. Results: 27 studies were included in the final analysis and found that myringoplasty had an overall perforation closure rate of 89%. The pooled proportion of closures after myringoplasty under local anesthesia was 87% and for myringoplasties under general anesthesia was 91%. Analysis of myringoplasty under local anaesthesia focusing on 'in-office' performed procedures only, found a closure rate of 88%. Conclusions: There is no significant difference in the success rate of myringoplasty surgery when performed under local or general anaesthetic as measured by perforation closure rates. However, there are other factors, which can drive choosing local anaesthetic surgery, such as minimising anaesthetic risks, reducing costs and reducing environmental impact. [ABSTRACT FROM AUTHOR]

Background: Local anaesthesia (LA) is used widely in several clinical scenarios in hospital practice. A number of minor trauma wounds are treated under LA at the North Bristol Trust, and on most occasions, these patients are admitted to the emergency department (ED) and treated there. On other occasions, more complex wounds may be treated by the plastic surgery team. The aim of this study is to compare the preferences of LA agents between these departments in cases of minor trauma. The authors also present a narrative review of the literature and determine best practice. Methods: A single-centre clinical practice survey was developed and distributed to both departments which involved two case scenarios, one involving a head injury to the occiput (scenario 1) and one nailed repair (scenario 2) both requiring treatment under LA. Results: In both scenarios ED favoured lidocaine (89%) whereas the plastic surgery team preferred to mix solutions. In scenario 1, 89% of ED participants chose lidocaine 1%, but only 38% of the plastic surgery team chose it. Forty-two percent of ED chose to use adrenaline but 100% plastic surgery team chose it. Both teams refrained from using adrenaline in digits, but 23% of the plastic surgery team chose it. Eighty-four percent of ED chose 25G needles, and the plastic surgery team's choices varied. Conclusions: This study has shown marked differences in the use of LA between two specialties in a major trauma centre. There is good quality evidence to support the safety of adrenaline use in digits with the addition of sodium bicarbonate to decrease the pain inflicted to the patient upon infiltration of LA. This study serves to raise awareness of the surgical dogma around adrenaline use and provide clinicians with an evidence-based guide to managing minor trauma with LA. Level of evidence: Not ratable. [ABSTRACT FROM AUTHOR]

A homology model of Nav1.5, based mainly on the crystal structures of Nav1.2/1.5 was built, optimized and successfully inserted into the membrane bilayer. We applied steered and free MD simulation protocols for the visualization of the mechanism of Nav1.5 activation. We constrained dihedrals of S4 trigger to introduce a structural tension with further rearrangement and movement of secondary structure elements. From these, we observed an intracellular gate opening and movement of the Lys1419 residue caused by a gradual displacement of the distal S6 α-helix with the extended S4 3–10 helix of voltage-sensing domains (VSD). A construction containing the Lys1419 residue in P-loop also changed its position due to the extension of this helix and subsequent induction of the pore-forming helixes motion. From this point, a double membrane system was generated, implying a free of ligand Nav1.5 protein and on the opposite side its copy containing a docked bupivacaine molecule inside the pore channel. The system can be used for the design of selective inhibitors against the Nav1.7 channel, instead of mixed effect on both channels. [ABSTRACT FROM AUTHOR]

Aim: To determine whether there is a clinical difference between an inferior dental block (IDB) using 2% lidocaine and a buccal infiltration (BI) using 4% articaine, when anaesthetising mandibular first permanent molars in children. Methods: Patients aged 8–15 years who required invasive dental treatment on a lower molar tooth were randomised. The patient and dental operator were blind to the type of LA used. The patient used a visual analogue scale to record their experience of pain during injection and treatment. Results: Twenty six teeth were anaesthetised (13 articaine, 13 lidocaine). When using an IDB, all treatment was completed successfully. On one occasion, anaesthesia was deemed unsuccessful when using a BI of articaine. There was no statistical difference in the mean VAS for the perceived pain of injection or treatment. Conclusion: This study showed that invasive dental treatment on a mandibular molar tooth can be completed successfully in children using a BI of articaine. In addition, the perceived pain of injection and treatment when using a BI of articaine is comparable to an IDB with lidocaine. [ABSTRACT FROM AUTHOR]

Sustained lidocaine release via a thermoresponsive poloxamer-based in situ gelling system has the potential to alleviate pain following knee arthroplasty. A previously developed formulation showed a promising drug release profile in synthetic phosphate-buffered saline (PBS). To support the translation of this formulation, ex vivo characterisation was warranted. This study therefore aimed (1) to modify the previously developed formulation to reduce the burst release, (2) to compare the release behaviour into ex vivo human intra-articular fluid (IAF) and PBS and (3) to determine the formulation spread in an ex vivo human knee using magnetic resonance imaging (MRI). All formulations provided sustained release out to 72 h; polyvinyl pyrrolidone was the most effective additive yielding a small yet significant decrease (p < 0.05) in the burst release. Release of lidocaine from the formulation occurred significantly faster into IAF compared to PBS (1.4 times greater release in the first 24 h), correlating with faster rates of gel erosion in IAF. Injection was easily achieved through a 21-gauge (G) needle into the synovial space of a human cadaveric knee, and MRI scans revealed effective spreading of the formulation throughout the joint cavity. The pattern of spread is promising for the drug to reach the widespread nerve endings in the joint capsule; the effect of this spread on release in an in vivo setting will be the subject of future studies. The demonstrated properties indicate that the in situ gelling formulation has the potential to be used clinically to treat post-operative pain following knee arthroplasty. [ABSTRACT FROM AUTHOR]

The infiltration of local anaesthetic agents has been shown to reduce post-tonsillectomy pain. A number of recent studies have shown that the addition of agents such as clonidine and dexamethasone improve the efficacy of nerve blocks and spinal anaesthesia. The aim of this review was to determine whether additives to local anaesthetic agents improve post-tonsillectomy outcomes. Four major databases were systematically searched for all relevant studies published up to August 2016. All study designs with a control group receiving local anaesthetic infiltration and an intervention receiving the same infiltration with an added agent were included in this review. These studies were then assessed for level of evidence and risk of bias. The data were then analysed both qualitatively and where appropriate by meta-analysis. We reviewed 11 randomised controlled trial (RCTs) that included 854 patients. Due to inconsistencies in the methods used to report outcomes, both quantitative and qualitative comparisons were required to analyse the extracted data. Overall, we found that dexamethasone, magnesium, pethidine and tramadol reduce post-operative pain and analgesia use, with dexamethasone in particular significantly reducing post-operative nausea and vomiting and magnesium infiltration significantly reducing the incidence of laryngospasm. This systematic review of RCTs provides strong evidence that the use of dexamethasone and magnesium as additives to local anaesthetics reduces post-tonsillectomy pain and analgesia requirement. There is limited evidence that pethidine and tramadol have a similar effect on pain and analgesia requirement. The studies in this pooled analysis are sufficiently strong to make a level one recommendation that the addition of magnesium to local anaesthetics reduces the incidence of laryngospasm, a potentially lethal post-operative complication. Review level of evidence: 1. [ABSTRACT FROM AUTHOR]

The topical delivery of local anaesthetics has always been a difficult task due to the limited percutaneous absorption of local anaesthetic drugs across the various barriers of the skin. In this pursuit, a thermoresponsive mixed micellar nanogel (MMNG) system of lidocaine and prilocaine has been attempted in the current piece of work. The system relies on the ability to alter its phase state (sol-to-gel) for feasibility of the topical application in response to change in temperature. The composition of MMNG entails majorly of Pluronic® F127 and Tween 80 in a fixed combination so as to provide the desired thermoreversibility for the skin application. The gels were optimized with respect to phase transition temperature ( T ), turbidity and viscosity. The optimized systems were then characterized for particle size, spreadability, syringeability, bioadhesive strength, ex vivo skin permeation, retention and dermatokinetic studies. The skin compatibility revealed that no histological changes were observed for optimized formulation, while the conventional system showed changes in the skin-tissues. Further, the enhanced intensity of anaesthetic effect was noted in an in vivo rabbit model and tail flick model in mice. The overall results suggest that the prepared MMNG system possesses the potential in providing an efficacious, safe and acceptable alternative therapeutic system for topical anaesthesia. [ABSTRACT FROM AUTHOR]

Copyright of Der Schmerz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: An allergic reaction following a dental procedure is a rare event. A local anaesthetic (LA) may initially be suspected as a causative agent but allergy to dental LA solutions is extremely rare. Case report: This report concerns a 13 year old child who underwent dental treatment and was exposed to Lignospan Special LA, mouthwash, latex gloves, ibuprofen medication, and a Magnum (almond) ice cream all within 45 min. He subsequently developed acute symptoms of nasal rhinorrhoea, facial flushing, peri-orbital and lip angioedema, followed by throat tightness and wheeze (respiratory compromise). His acute reaction was treated by his medical practitioner with oral anti-histamines, steroid and nebulised salbutamol. The child was referred to a local allergist. The child underwent detailed allergic investigations including skin prick tests, blood tests, incremental local anaesthetic challenge and ibuprofen challenge. The patient was diagnosed with NSAID exacerbated respiratory disease (NERD), a hypersensitivity reaction to ibuprofen. Follow-up: The patient was advised to avoid NSAIDs and to wear a medic-alert (allergy) bracelet. A detailed written report was sent to the patient's dentist and GP. Conclusions: In the context of a suspected reaction post dental procedure, local anaesthetic should be considered a possible allergen but other important considerations include analgesics, antibiotics, and latex. All genuine allergic reactions need to be investigated. This report highlights NERD as a possible adverse outcome following dental treatment. [ABSTRACT FROM AUTHOR]

Background: The pain of cryosurgery for hand warts can lead to poor patient satisfaction and inadequate response to treatment. Aim: To determine if local anaesthetic infiltration using a 30-gauge needle prior to cryosurgery is acceptable to patients. Method: 20 consecutive patients were recruited over a 14-month period who attended a cryosurgery clinic and who had at least two warts between 5 and 10 mm in diameter on different parts of the hands. In each patient, two warts of approximately equal size were treated using standard cryosurgery techniques, one under local anaesthetic (LA) and the other without. Results: The average pain score of cryosurgery without LA was more than twice the pain score of administering the LA with a 30-gauge needle ( p < 0.0005). One out of 20 warts failed to clear in the LA-treated group and 2 out of 20 warts failed to clear in the non-LA-treated group. Conclusions: This research suggests that for the majority of patients with warts between five and ten millimetres in diameter, cryosurgery is significantly less painful when carried out under LA. [ABSTRACT FROM AUTHOR]

Copyright of Der Schmerz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Local anesthetic wound infusion has shown promising results in adults. Its use in children is limited to some centers and there are only a few prospective trials in this group of patients.Methods: Sub-fascial continuous local anaesthetic wound infusion (CLAWI) (0.2% Bupivacaine) plus intravenous paracetamol and rescue intravenous morphine was compared to: (a) Epidural bupivacaine (EPI) plus paracetamol and rescue intravenous morphine for patients undergoing laparotomy. (b) Intravenous morphine and paracetamol (standard post-operative analgesia-SAPA) in children undergoing Lanz incision laparotomy for complicated appendicitis. 'InfiltralLong', PANJUNK(®) catheters were placed sub-fascially after peritoneal closure for post-operative bupivacaine infusion. Pain scores were recorded regularly by the same blinded pain specialist. The primary outcomes were pain control and total morphine. The secondary outcomes were time to full feeds, mobilization requirement for urinary catheter and complications.Results: Sixty patients (18 laparotomy-CLAWI, 17 laparotomy-EPI and 12 appendectomy-CLAWI, and 13 appendectomy-SAPA) were analyzed. The average pain score was 2.5 (1-4) in the CLAWI groups, 3.0 (1-5) in the EPI group and 3.5 (2-5) in the SAPA group. Morphine requirements were markedly less for CLAWI. SAPA and EPI groups required urinary catheters for longer and took longer to mobilize (average 4 days compared to 2 days for CLAWI). There were no wound or bupivacaine complications in the CLAWI group.Conclusion: Continuous subfascial bupivacaine infusion is reliable, safe and effective in paediatric post-operative pain control with considerably reduced opiate requirements. [ABSTRACT FROM AUTHOR]

Aim: To compare a combination of oral midazolam (0.2 mg/kg body weight) and nitrous oxide-oxygen sedation with a combination of intranasal midazolam (0.1 mg/kg body weight) and nitrous oxide-oxygen sedation for effectiveness, patient acceptability and safety profile in controlling the behaviour of uncooperative children. Methods: Thirty children, 4-10 years of age, referred for dental treatment were included in the study with a crossover design. Each patient was sedated with a combination of either oral midazolam and nitrous oxide-oxygen sedation or intranasal midazolam and nitrous oxide-oxygen sedation at subsequent dental treatment visits. During the treatment procedure, the study recorded scales for drug acceptability, onset of sedation, acceptance of nasal mask, sedation, behavioural, safety, overall behaviour and alertness. Results: The grade of acceptability of midazolam in both groups was consistently good. There was a significant difference ( p < 0.001) in the time of onset of sedation, which was significantly quicker with the intranasal administration of midazolam. The mean time of onset for oral midazolam was 20.1 (17-25) min and for intranasal midazolam 12.1 (8-18) min. The efficacy profile of the present study included: acceptance of nasal mask, sedation score, crying levels, motor movements and overall behaviour scores. The results did not show any statistically significant differences. All the parameters were highly satisfactory. The difference in alertness was statistically significant ( p value <0.05), being higher in the intranasal group than the oral group and suggestive of faster recovery using intranasal midazolam. Conclusion: The intranasal route of midazolam administration has a quick onset of action and a quick recovery of the patient from sedation as compared to the oral route of midazolam administration. Midazolam administered through the intranasal route is as effective as the oral route at a lower dosage. Therefore, it is an effective alternative to oral route for a paediatric dental situation. [ABSTRACT FROM AUTHOR]

Amylmetacresol and dichloro-benzylalcohol are ingredients of lozenges used for the treatment of sore throat. In a former in vitro study, a local anaesthetic-like effect of these substances has been described. Since amylmetacresol and dichloro-benzylalcohol are co-administered in over-the-counter lozenges, the intention of this study is to evaluate the in vitro effects of the combination of these compounds on the voltage-gated sodium channel. We analysed the block of inward sodium currents induced by the combination of amylmetacresol, dichloro-benzylalcohol and the local anaesthetic lidocaine. Tonic and use-dependent block and effects on the inactivated channel state of the neuronal sodium channel were examined. Therefore, the α-subunit of the voltage-gated NaV1.2 sodium channel was heterologously expressed in HEK 293 cells in vitro. Inward sodium currents were investigated in the whole-cell configuration of the patch-clamp technique. The combination of amylmetacresol and dichloro-benzylalcohol and the combination of amylmetacresol and lidocaine induced a block of resting and inactivated sodium channels both displaying a pronounced block at the inactivated channel state. In addition, the combination of all three compounds also resulted in a voltage-dependent block of inward sodium currents. While use-dependent block by co-application of amylmetacresol and dichloro-benzylalcohol was moderate (<20 %), lidocaine and amylmetacresol induced a robust use-dependent block (up to 50 %). This study demonstrates local anaesthetic-like effects of a combination of amylmetacresol and dichloro-benzylalcohol as established ingredients of lozenges. In the presence of amylmetacresol, dichloro-benzylalcohol and lidocaine, a prominent block of inward sodium currents is apparent. [ABSTRACT FROM AUTHOR]

Purpose: While the effect of local anaesthetics on chondrocyte viability is widely documented, the effect of these medications on synoviocytes is largely unknown. The purpose of this study was to understand the effect of 0.5 % bupivacaine and 0.5 % bupivacaine with epinephrine on synoviocyte viability, cytokine and growth factor release, and breakdown product formation. Methods: Rabbit fibroblast-like synoviocyte (Type B) cultures were perfused with 0.5 % bupivacaine or 0.5 % bupivacaine with epinephrine (1:200,000) for 24 h. Cell viability was evaluated using a two-colour fluorescence assay. The supernatant was analysed using multiplex inflammatory and matrix metalloproteinase assays. Results: Synoviocytes treated for 24 h with 0.5 % bupivacaine with epinephrine demonstrated a significant decrease in viability (31.3 ± 19.4 % cell death) when compared with synoviocytes cultured in control media (3.8 ± 1.3 % cell death, p = 0.000) and those cultured in 0.5 % bupivacaine alone (12.6 ± 11.1 % cell death, p = 0.003). No significant decrease in cell viability was observed in synoviocytes treated with 0.5 % bupivacaine compared to those in control media (12.6 ± 11.1 % vs 3.8 ± 1.3 % cell death, p = 0.194). Significantly greater amounts of MMP-1 (47.0 ± 9.2 pg/ml) and MMP-3 (250.0 ± 68.8 pg/ml) were observed in 0.5 % bupivacaine cultures compared with controls (14.3 ± 14.3, p = 0.023 and 72.0 ± 84.9, p = 0.045, respectively). Conclusions: 0.5 % bupivacaine with epinephrine caused a significant increase in cell death of the synoviocytes, while 0.5 % bupivacaine alone produced cell injury and a significant release of matrix metalloproteinases, which may also lead to indirect injury of the surrounding chondrocytes. These results may help explain the onset of chondrolysis observed in patients who have been treated with intra-articular local anaesthetics. [ABSTRACT FROM AUTHOR]

Purpose: Recent reports have suggested that local anaesthetic agents have a toxic effect on articular chondrocytes. This is despite the widespread intra-articular use of local anaesthetic agents following arthroscopic procedures for a number of years. Methods: We have reviewed the available basic science literature focusing on the studies assessing the effect of exposing articular chondrocytes to local anaesthetic agents. We attempt to highlight the key findings and, where possible, extrapolate the laboratory findings to the operating theatre. Results: Basic science reports are analysed according to their setting of either in vitro, ex vivo or in vivo and according to cell line. A majority of work to date has been done using in vitro models. Only a small number of in vivo models using animal cell lines have been used and the best of these have conflicting results with regard lasting toxicity secondary to local anaesthetic exposure. Conclusions: Numerous reports suggest a toxic effect of local anaesthetic agents on articular chondrocytes, however, further work is warranted to establish the precise mechanism of toxicity and whether or not single bolus administration results in long-term deleterious outcomes. Determining the ideal in vitro model will help in extrapolating laboratory data to the operating theatre. [ABSTRACT FROM AUTHOR]

Benzocaine lozenges are popular in symptomatic treatment of acute sore throat. The aim of this study was to evaluate if sucking a benzocaine lozenge was superior to a placebo lozenge in patients with pain while swallowing. Volunteers with acute, uncomplicated sore throat received randomly and double-blind either a benzocaine 8 mg or a placebo lozenge. Pain was assessed on a numerical visual rating scale. The primary outcome measure was the sum of the pain intensity differences (SPID) over 2 h. Secondary outcome measures included the number of patients who reported 50% or more of their baseline pain score (responders) and those with worthwhile and complete pain relief, the times to worthwhile/complete pain relief and to pain recurrence and the occurrence of any adverse effects. A predefined interim analysis after including 50 patients revealed the superiority of benzocaine versus placebo in the SPID ( p = 0.0086). At this time, a total of 165 patients had been recruited (full analysis set, FAS) and underwent statistical analysis. In the FAS, median SPID had significantly more decreased in patients receiving benzocaine compared to placebo (−12 vs. − 5, p = 0.001). There were significantly more responders and patients with worthwhile pain relief in group benzocaine. The number of patients with complete pain relief was very small. Median time to worthwhile pain relief was 20 min (benzocaine) and >45 min (placebo). Adverse events were not observed. Benzocaine lozenges are superior to placebo lozenges and a useful, well-tolerated treatment option to reduce painful pharyngeal discomfort. [ABSTRACT FROM AUTHOR]

Background: Transforaminal epidural injection of steroids is used to treat lumbar radicular pain. However, there are only a few well-designed randomized, controlled studies on the effectiveness of steroid injection. Study design: Hence, this study aims to assess the effectiveness of steroid injection to treat lumbar radicular pain using a meta-analysis of transforaminal epidural injection therapy for low back and lumbar radicular pain. The comparison was based on the mean difference in the Visual Analogue Score (VAS) and Oswestry Disability Index (ODI) from baseline to the specified followed up. Methods: The available literature of lumbar transforaminal epidural injections in managing low back and radicular pain was reviewed. Data sources included relevant literature of the English language identified through searches of PubMed and EMBASE from 1966 to 2009, and manual searches of the bibliographies of known primary and review articles. Finally, the search included the Current Controlled Trials Register and the Cochrane Database of Controlled Trials. Results: The initial search identified 126 papers. After screening, five randomised controlled trials (RCTs) were studied for analysis and only three of these had followed-up patients systematically with pain and disability outcome scores to 3 months and of these, only one had follow up to 12 months. A total of 187 patients ('treatment group' receiving local anaesthetic/steroid injection) were compared with 181 patients ('control' group, receiving local anaesthetic only or saline injection). Improvement in pain (standardised mean difference in VAS 0.2 in favour of 'treatment'; 95%CI: −0.41 to 0.00, p = 0.05, I squared 0%) but not disability (standardised mean difference in ODI 0; 95%CI: −0.21 to 0.20, p = 0.99, I squared 0%) was observed between 'treatment' and 'control' groups; these differences were not significant. Additionally, the one study following patients to 12 months did not find any significant difference in VAS and ODI between treatment and control groups. Conclusion: The current meta-analysis shows that transforaminal epidural steroid injections, when appropriately performed, should result in an improvement in pain, but not disability. The three RCTs that followed patients to 3 months (and the single study to 12 months) have found no benefit by the addition of steroids. The limitations of this study include the paucity of the available literature. [ABSTRACT FROM AUTHOR]

Background: Pain following laparoscopic cholecystectomy (LC) is a barrier to early discharge. Some studies have demonstrated that local anaesthetic (LA) washed over the liver and gallbladder decreases postoperative pain. In many patients pain is partially of diaphragmatic origin which may not be treated effectively by topical wash. This study assesses the efficacy of LA injected to the peritoneum of the right hemidiaphragm or topical wash with a control group. Methods: We performed a double-blind randomized sham controlled trial of 128 consecutive subjects who underwent elective LC. Patients received subcutaneous bupivacaine, a diaphragmatic injection of bupivacaine or sham, and topical wash over the liver/gallbladder with bupivacaine or sham depending upon allocation. The primary outcome was VAS pain scores on the ward. Secondary outcomes included VRS pain scores in theatre recovery, analgesic use, physiological observations, time to eating and ambulation, and successful day-case surgery. Results: Pain scores were significantly lower in both LA groups versus control in theatre recovery but only in the subperitoneal diaphragm injection group when the patients returned to the ward. Subperitoneal diaphragm injection was associated with a reduced time in theatre recovery ( p = 0.04). Conclusions: Intraperitoneal techniques of LA during LC decrease postoperative pain and shorten time in theatre recovery. Injection of LA to the right hemidiaphragm is associated with lower pain scores for a longer period following LC than a previously validated wash technique. [ABSTRACT FROM AUTHOR]

Purpose: Local anaesthetic agents are often used as an intra-articular analgesic following arthroscopic procedures. However, there is increasing evidence of a potential toxic effect to chondrocytes within the articular cartilage. The aim of this study was to compare the effect on human chondrocyte viability of treatment with bupivacaine, levobupivacaine and ropivacaine. The second aim was to compare the effect on chondrocyte viability of the local anaesthetics with magnesium, a potential alternative analgesic agent. Methods: Chondrocytes were exposed to one of the local anaesthetic agents (levobupivacaine 0.13, 0.25, 0.5%; bupivacaine 0.13, 0.25, 0.5%; ropivacaine 0.19, 0.38, 0.75%), normal saline or 10% magnesium sulphate for 15 min. Cells exposed to cell culture media served as controls. Twenty-four hours after exposure, cell viability was assessed using the CellTiter 96 AQueous One Solution Cell Proliferation Assay. Results: There was no significant difference in chondrocyte viability after treatment with either normal saline or magnesium sulphate. With the exception of 0.13% levobupivacine, all local anaesthetic treatment showed significantly greater toxic effects than either normal saline or magnesium sulphate. Statistically significant dose-dependent responses of decreasing cell viability were found with increasing local anaesthetic concentration. Conclusions: A dose-dependent reduction in chondrocyte viability after treatment with common local anaesthetic agents was confirmed. Local anaesthetic agents had a greater deleterious effect on chondrocytes than did 10% magnesium sulphate. These findings suggest the need for continuing caution with the use of intra-articular local anaesthetic. Magnesium sulphate is a potential alternative intra-articular analgesic agent. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to investigate the effects on post-operative pain of local anaesthetic administration via a catheter placed into the operation site in patients who were undergoing upper and lower extremity paediatric orthopaedic surgery. Methods: In this randomised, double-blind and placebo study, 40 ASA I-II patients aged between 1 and 12 years were randomly allocated into two groups: study group (Group S: 0.2 ml/kg, 0.5% bupivacaine, n = 20) and control group (Group C: 0.2 ml/kg, serum physiologic, n = 20). Before the fascia was closed by the surgical team, the solution previously prepared by the chief nurse was injected into the subfascial soft tissue with the syringe as the 'injected dose' of serum physiologic or bupivacaine. After the closure, 0.2 ml/kg (1 mg/kg) bupivacaine or saline was instillated as the 'first instillated dose' into the surgical area via the catheter. Pain scores were recorded at 0, 1, 2, 4, 8, 12, 24 and 48 h post-operatively. Patients were administered 0.75 mg/kg meperidine intramuscularly post-operatively to equalise the pain scores. Results: No statistically significant difference was found between Group S and Group C in terms of demographic and other data and pain scores in the post-anaesthesia care unit, while a statistically significant decrease was found at 2, 4, 8, 12, 24 and 48 h in Group S and at 1, 2 and 4 h in Group C based on pain scores in the post-anaesthesia care unit ( P < 0.05). A statistically significant decreasing pain score was found at 4, 8, 12, 24 and 48 h in Group S ( P < 0.05). Conclusion: The local anaesthetic administered via a catheter implanted in the surgical field may provide long-term and efficient post-operative analgesia. [ABSTRACT FROM AUTHOR]

In previous studies, it was shown that the post-tonsillectomy wound infiltration of bupivacaine can reduce postoperative pain. The objective of this study is to determine whether the postoperative wound infiltration with a mixture of bupivacaine, mepivacaine and adrenaline is more effective than the sole application of bupivacaine. A prospective, double-blind, randomized, control study included 30 patients scheduled for “cold steel” tonsillectomy. All patients obtained post-tonsillectomy infiltration of 6.25 mg bupivacaine alone on one side and 3.75 mg bupivacaine, 25 mg mepivacaine and 0.0125 mg epinephrine on the other side (intra-individual study design). Intake of analgesics and postoperative pain was assessed 0–6 days after surgery by visual analogue scale in inactivity and during swallowing by the nurse staff. Bleeding, dysphagia, pain, aspiration or extraordinary pain sensation were registered by the patient. The pain scores did not differ between the groups. All patients received systemic painkillers; 6 (20%) patients needed intravenous analgesics. Postoperative haemorrhage occurred in two patients without correlation to a certain local anaesthetic. Two patients developed sinus tachycardia for 2.5 min after epinephrine infiltration. Because of cost-effectiveness and complication rates, we recommend only post-tonsillectomy wound infiltration of bupivacaine. The injection should be placed in superficial muscle and connective tissue. A stringent systemic analgesia regime is indispensable for pain relief after tonsillectomy. [ABSTRACT FROM AUTHOR]

Evidence to support the routine use of local anaesthetic in the reversal of loop ileostomy is equivocal. This randomized control study looked at the use of peri-operative infiltration of stoma with 0.25% bupivacaine with 1/200,000 epinephrine on the ease of surgery and its effect on post-operative pain and nausea. Sixty patients were randomized to receive peri-stomal infiltration with either 0.25% bupivacaine with 1/200,000 epinephrine or normal saline. The surgeon graded the surgery as straightforward, intermediate or difficult, and the time for the operation was also recorded. Post-operatively, analgesia was provided via PCA for 24 h. Post-operative pain and nausea scores and total morphine usage median (inter-quartile range) were compared using the Mann–Whitney U test with p < 0.05 considered significant. There was no difference between the local anaesthetic groups and controls with respect to opiate consumption ( p = 0.4), post-operative pain ( p = 0.72) or nausea ( p = 0.78). Shorter total anaesthetic and operative times were noted in study group, but this was not significant ( p = 0.55). However, surgery was found to be easier in the local anaesthetic group ( p = 0.0046). Peri-stomal infiltration with 0.25% bupivacaine with 1/200,000 epinephrine does not impact on post-operative pain and nausea scores or opiate analgesia use. However, its use is recommended as an aid to dissection in surgery. [ABSTRACT FROM AUTHOR]

Lozenges for the treatment of sore throat provide relief of discomfort in cases of oral inflammation. This effect has not been fully explained so far. Here, we have examined the proposition that key components of pharmaceutical preparations for the treatment of sore throat which are routinely regarded antiseptics might have sodium channel-blocking, i.e. local anaesthetic-like effects. We investigated the effects of hexylresorcinol, amylmetacresol and dichloro-benzylalcohol on voltage-operated neuronal (NaV1.2) sodium channels heterologously expressed in HEK 293 cells in vitro. Hexylresorcinol, amylmetacresol and dichloro-benzylalcohol reversibly blocked depolarisation-induced whole-cell sodium inward currents. The half-maximum blocking concentrations (EC50) at −150 mV were 23.1, 53.6 and 661.6 µM, respectively. Block induced by hexylresorcinol and amylmetacresol was increased at depolarised potentials and use-dependent during trains of depolarisations applied at high frequency (100 Hz) indicating that both drugs bind more tightly to inactivated conformations of the channel. Estimates for the inactivated state affinity were 1.88 and 35 µM for hexylresorcinol and amylmetacresol, respectively. Hexylresorcinol and amylmetacresol are 10–20 fold more potent than the local anaesthetic lidocaine in blocking sodium inward current. Both drugs show an increased effect at depolarised membrane potentials or in conditions of high-frequency discharges. [ABSTRACT FROM AUTHOR]

To compare patients over 70 years old with those under 50 years old undergoing inguinal hernia repair. Fifty patients aged >70 years (group A) and 50 patients age <50 years (group B) underwent local anaesthetic mesh repair. The mean age for group A was 77.2 years (range 70–85) and for group B it was 40.2 years (range 17–49). There were 46 patients with comorbidities in group A and seven in group B. There were 30 patients with cardiac comorbidities in group A and two in group B. There were no major complications, infections, haematomas or unplanned admissions in either group. Patients >70 years of age had less post-operative discomfort and recovered more quickly than patients aged <50 years. The number of days of analgesic use and time to return to normal activities was longer in the younger group, 6.0 versus 3.4 and 21 versus 13, respectively. There was no significant difference between the groups in patients having discomfort at 3 months post-operatively. More patients were satisfied in the older group, though the difference was not statistically significant. Elective inguinal hernia repair under local anaesthetic in the elderly has a good outcome, even if there are significant comorbidities. Ambulatory surgery is feasible in this age group and age alone or co-existing disease should not be a barrier to elective day-case inguinal hernia repair. [ABSTRACT FROM AUTHOR]

This study was undertaken to determine the effect of a restricted versus a standard intravenous fluid regimen on urinary retention and readiness for discharge after surgery for benign anorectal disease. A total of 41 ASA I–II patients were randomized into a standard fluid regimen group (group S, n=21) or a restricted fluid regimen group (group R, n=20). Spinal anaesthesia was performed with hyperbaric ropivacaine. Haemodynamic variables were noted. Hypotension, headache, analgesia requirement, nausea and vomiting, thirst and urinary retention were evaluated postoperatively. The Mann-Whitney U and chi-squared tests were used. Patient demographics were comparable between the groups. The area under heart rate versus time curve was higher in group R than in group S ( p=0.002). Additional fluid and ephedrine requirements were similar between the groups. First voiding time was longer in group R ( p=0.045). In minor anorectal surgery under spinal anaesthesia with ropivacaine, standard fluid regimen provides stable haemodynamic variables without urinary retention. [ABSTRACT FROM AUTHOR]

This study was prompted by a complaint from a patient citing he had suffered postoperative pain and scrotal bruising. We audit postoperative pain following inguinal herniorrhaphy and patient understanding of postoperative complications. A telephone survey was carried out to assess patient experience of day-case inguinal herniorrhaphy (DIH). Having identified that there was some dissatisfaction with the outcome of DIH, a prospective audit was carried out to assess causative factors. Changes in practice were made; chiefly, the provision of patient-information leaflets and the standardisation of intraoperative and postoperative analgesia. Repeat audit then assessed the effects of these changes. Ten percent of patients had a poor understanding of postoperative complications following inguinal herniorrhaphy. Thirty-eight percent had early postoperative pain; wound infiltration of local anaesthetic at the end of inguinal herniorrhaphy reduced the incidence of early postoperative pain to 23%. Audit is an important tool in surgical quality assurance for DIH. Small changes in practice with adherence to good protocols can have a marked effect on patients’ experience. [ABSTRACT FROM AUTHOR]

Outpatient laser ablation of the palatine tonsils under local anaesthetic is an alternative technique to capsular tonsillectomy for recurrent tonsillitis under general anaesthetic. Laser tonsillotomy ablates up to 70% of the tonsillar tissue and is performed when patients choose not to have a conventional tonsillectomy, or are unfit for a general anaesthetic. The technique described here is an adaptation of Krespis’ laser-assisted serial tonsillectomy (LAST) whereby only one sitting is required. Krespis’ technique effectively eliminates recurrent tonsillitis in 96% of the cases over a 4-year follow-up period and represents the only substantial study looking at treating recurrent tonsillitis with outpatient laser ablation. This study is a retrospective postal survey of 19 patients who underwent laser tonsillar ablation under local anaesthetic for recurrent chronic tonsillitis from 1997 to 2001 and was performed in liaison with the clinical audit department at Basildon Hospital. We had a response rate of 74% and an admission rate of 0%, which compares favourably with day case tonsillectomy surgery. Of the patients, 75% did not experience further episodes of tonsillitis 12 months after the procedure and 77% of the patients were glad they had the operation. Although this technique does not completely eliminate tonsillitis, it offers an alternative for those patients who prefer a procedure that is done quickly in an outpatient setting without the additional problems of general anaesthesia, overnight hospital admission and long waiting lists. [ABSTRACT FROM AUTHOR]

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Purpose. The aim of the study was to investigate the cutaneous bioequivalence of a lipophilic model drug (lidocaine) applied in a novel topical microemulsion vehicle, compared to a conventional oil–in–water (O/W) emulsion, assessed by a pharmacokinetics microdialysis model and a pharmacodynamic method. Methods. Dermal delivery of lidocaine was estimated by microdialysis in 8 volunteers. Absorption coefficients and lag times were determined by pharmacokinetic modelling of the microdialysis data. Subsequently, the anaesthetic effect of the treatments was assessed by mechanical stimuli using von Frey hairs in 12 volunteers. Results. The microemulsion formulation increased the cutaneous absorption coefficient of lidocaine 2.9 times (95% confidence interval: 1.9/4.6) compared with the O/W emulsion–based cream. Also, lag time decreased from 110 ± 43 min to 87 ± 32 min ( P = 0.02). The compartmental pharmacokinetic model provided an excellent fit of the concentration–time curves with reliable estimation of absorption coefficient and lag time. A significant anaesthetic effect was found for both active treatments compared to placebo ( P < 0.02), but the effect did not diverge significantly between the two formulations. Conclusions. The microemulsion vehicle can be applied to increase dermal drug delivery of lipophilic drugs in humans. The microdialysis technique combined with an appropriate pharmacokinetic model provides a high sensitivity in bioequivalence studies of topically applied substances. [ABSTRACT FROM AUTHOR]

We report the results of argon laser treatment in 30 patients with symptomatic ingrowing eyelashes. Permanent eyelash destruction was achieved in 71% of treated lashes. No local anaesthesia was found to be necessary. Complications were minimal and patient satisfaction was high. [ABSTRACT FROM AUTHOR]

In an 11-year-old boy severe dermatomyositis occurred a few days after injection in the jaw of a local anaesthetic of the amide type for tooth extraction. The patient's grandmother was affected by progressive scleroderma at the age of 34 years, also after injection of a local anaesthetic for dental treatment. Both cases are discussed with special reference to the immuno-genetic aspects of the origin of dermatomyositis. [ABSTRACT FROM AUTHOR]

Intra-articular administration of local anaesthetics such as bupivacaine can produce short-term postoperative analgesia in patients undergoing diagnostic arthroscopy or arthroscopic meniscectomy. A peripheral anti-nociceptive effect may also be induced by the administration of intra-articular opiates interacting with local opioid receptors in inflamed peripheral tissue. In the present study we aimed to study the analgesic effects of intra-articularly given bupivacaine and morphine sulphate (as well as the combination of both drugs) on postoperative pain. In a prospective, randomized, double-blind manner 40 patients received one of the following: (a) morphine (1 mg in 20 ml NaCl), (b) bupivacaine (20 ml, 0.375%), (c) combination of both or (d) saline (20 ml, control group) intra-articularly at the end of arthroscopic anterior cruciate ligament (ACL) reconstruction. The postoperative pain was assessed via a visual analogue scale (VAS) during the first 48 h after surgery, and supplemental analgesic requirements were noted. All comparisons were made versus the control group receiving saline. The pain scores were significantly lower in the morphine group at 24 and 48 h, and in the bupivacaine group at 2, 4 and 6 h after surgery. In the group that received a combination of both bupivacaine and morphine, the pain scores were significantly reduced throughout the whole postoperative observation period. No side-effects or complications from therapy were seen in any of the groups. The conclusion of this study is that intra-articular morphine is effective in the postoperative period after arthroscopic ACL reconstruction.(ABSTRACT TRUNCATED AT 250 WORDS) [ABSTRACT FROM AUTHOR]

We investigated the per- and postoperative pain-reducing effect of pethidine given intra-articularly (i. art.). Thirty patients subjected to knee joint arthroscopy, diagnostic and surgical procedures, were randomly assigned to one of three groups. Group A consisted of ten patients who received 250 mg prilocaine +200 μg adrenaline (i. art.) in a volume of 50 ml, group B of ten patients who received 200 mg pethidine (i. art.) in 50 ml saline, and group C of ten patients who received 200 mg pethidine +200 μg adrenaline (i. art.) in 50 ml saline. During arthroscopy the patients reported on pain intensity and discomfort using visual analogue scales. Ratings were low and did not differ significantly between the three groups. Two of three patients in each group requested additional analgesics or sedatives due to pain and discomfort, but again with no difference between the three groups. Postoperatively all patients rated their pain intensity at rest and during movement (at 0, 1, 2, 3, 4, 5, 6, 12 and 24 h). The patients receiving pethidine (group B) reported significantly less pain at rest and movement than group A patients, in general at 1-4 h postoperatively. A significant difference was detected between groups B and C at 4 h postoperatively. Calculating the total sum of pain scores, patients receiving pethidine (group B) reported significantly less pain both at rest and during movement than those receiving prilocaine (group A). Furthermore, patients in group B used significantly less analgesics than those in group A. Adrenaline did not potentiate the effect of pethidine. Reported side effects were mild and did not require clinical action. The present study provides evidence for pethidine as a potential alternative to prilocaine in arthroscopy using local anaesthetic techniques. [ABSTRACT FROM AUTHOR]

Copyright of Der Schmerz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

About 10% of patients with cancer pain do not obtain pain relief or experience unacceptable side effects with systemic opioids. In some cases a change of the route of administration can improve the balance of analgesia and adverse effects. In this paper the use of spinal opioids in such patients is discussed from various aspects: patient selection, epidural vs intrathecal administration, dosage, association with local anaesthetic agents, dosage conversion systems (for the change from systemic administration) and home use. The main problems involved are dealt with an attempt to find how to use the drugs and techniques involved to the best possible advantage. [ABSTRACT FROM AUTHOR]

Two monkeys were trained to track a continuously moving target using a joystick. One then had a cooling probe implanted in nucleus interpositus of the cerebellum ipsilateral to his tracking arm. The other had a cannula implanted in the ipsilateral cortex of the lateral cerebellum through which local anaesthetic could be infused. Both monkeys showed similar tracking deficits during temporary inactivation of the cerebellum. The main effects seen were an increase in the peak velocity of their intermittent corrective tracking movements, and a decrease in the accuracy of these movements. Linear regression analyses were undertaken of the peak velocity and amplitude of each corrective movement against a number of possible control signals (target velocity, target position, error, error velocity etc.). The initially strong correlation of the amplitude of each movement made with target velocity was severely reduced during cerebellar inactivation, and movement amplitude became better predicted by the error between target and joystick positions. The peak velocity of movements became more strongly correlated with movement amplitude and less correlated with target velocity than in the intact animal. These results are consistent with the hypothesis that intermittent tracking is achieved by the production of 'primitive' movements, that are then adjusted to the correct amplitude and velocity required to catch up with the moving target. Our findings suggest that the cerebellum may normally be responsible for these adjustments, using visual and memorised cues about the target. The velocity of each movement may be reduced, and its amplitude adjusted, by combining measures of the current error with estimates of target speed and direction. We conclude that the cerebellum has an inhibitory role in tuning movements during visuo-motor tasks and that optimal tuning using feedforward measurements of target motion cannot be made without it. [ABSTRACT FROM AUTHOR]

The structure of the local anaesthetic benzocaine was solved by direct methods and refined to an R of 0·12 for 531 observed reflections. The packing of the molecule is stabilised by N−H ... O hydrogen-bonds (2-97 Â). The alkyl chain attached to the benzene ring is in trans-trans conformation. The benzoic moiety shows a quinonoid character as found in some other local anaesthetics. [ABSTRACT FROM AUTHOR]

The F1473S mutation of the adult human skeletal muscle Na+ channel causes paramyotonia congenita, a disease characterized by muscle stiffness sometimes followed by weakness in a cold environment. The symptoms are relieved by the local anaesthetic mexiletine. This mutation, which resides in the cytoplasmic S4-S5 loop in domain IV of the α-subunit, was studied by heterologous expression in HEK293 cells using standard patch-clamp techniques. Compared to wild-type (WT) channels, those with the F1473S mutation exhibit a twofold slowing of fast inactivation, an increased persistent Na+ current, a +18-mV shift in steady-state inactivation and a fivefold acceleration of recovery from fast inactivation; slow inactivation was similar for both clones. Single-channel recordings for the F1473S mutation revealed a prolonged mean open time and an increased number of channel reopenings that increased further upon cooling. The pharmacological effects of mexiletine on cells expressing either WT, F1473S or G1306E channels were studied. G1306E is a myotonia-causing mutation located within the inactivation gate that displays similar but stronger inactivation defects than F1473S. The hyperpolarizing shift in steady-state inactivation induced by mexiletine was almost identical for all three clones. In contrast, this agent had a reduced effectiveness on the phasic (use-dependent) block of Na+ currents recorded from the mutants: the relative order of block was WT>F1473S>G1306E. We suggest that the relative effectiveness of mexiletine is associated with the degree of abnormal channel inactivation and that the relative binding affinity of mexiletine is not substantially different between the mutations or the WT. [ABSTRACT FROM AUTHOR]

Even today the ability to provide the patient with clinically adequate pain control with minimum systemic side effects is one of the major concerns all over the world. Lignocaine, the most commonly used local anesthetic agent in oral surgery due to its rapid onset & reasonably good potency, does not have adequate duration of action, unless used with Adrenaline, a drug known for its cardiovascular effects. Centbucridine, a non-ester, non-amide group local anesthetic agent developed in India at C D R I Lucknow, has advantage of inherent vasoconstrictor property. This study was planned to compare 0.5% Centbucridine and 2% Lignocaine with Adrenaline, in exodontia patients. The results were recorded for their efficacy and C V S action and statistically analyzed. Centbucridine was found to be an ideal local anesthetic agent with no effects on cardiovascular parameters and exhibiting a sufficient degree of local anesthetic activity suitable for use in routine minor surgery cases. This will be advantageous where Adrenaline is absolutely contraindicated due to systemic problems. [ABSTRACT FROM AUTHOR]

To survey the practice and reasons of use of local infiltration in prolapse and continence surgery in UK, an electronic survey of gynaecologists with special interest in urogynaecology, urogynaecologists, urologists and allied professionals who were on the email list of the International Continence Society (ICS), UK was carried out in April-July 2006. Out of the 238 questionnaires that were sent, 112 failed mail delivery and 57 questionnaires were returned, giving a response rate of 50.1%. Of the respondents, 40/46 (86.9%) used local infiltration for vaginal hysterectomy and vaginal repairs, whilst 43/46 (93.4%) used it for TVT. Of the respondents, all of 18 who performed vaginal mesh procedures used local infiltration. While 90% of respondents felt it helped reduce blood loss, only 46% were convinced that it helped reduce visceral injury. The survey reflects that the majority use local infiltration for gynaecological surgery: however, there is wide variation in the type and strengths of agents used. [ABSTRACT FROM AUTHOR]

Whilst local anaesthesia for daycase arthroscopic knee surgery has been well reported, there are few centres in the United Kingdom performing such a technique. Hyaluronidase has been widely used as an adjunct to local anaesthetic infiltration in the fields of ophthalmic and plastic surgery, but it is rarely used in orthopaedic surgery. We report our technique, which the senior author has successfully used in 121 patients having arthroscopic knee surgery over the past year, and discuss the role of added hyaluronidase to the local anaesthetic portal infiltrate. [ABSTRACT FROM AUTHOR]

A eutectic mixture of two local anaesthetics-prilocaine and lignocaine (EMLA cream)-has been investigated for its usefulness as an analgesic in the treatment of facial port-wine stains with the tunable dye laser. The cream provided adequate analgesia in eight of 10 patients assessed and was well tolerated. The results of treatment after use of EMLA cream were no different from those where conventional analgesia had been used, and EMLA cream can be recommended for analgesia during laser treatment of port-wine stains. [ABSTRACT FROM AUTHOR]

We present a novel and safe technique for insertion of ventilation tubes under local anaesthetic which we feel improves the patient's experience and shortens the overall procedural time. [ABSTRACT FROM AUTHOR]

Tissue transfer for breast reconstruction surgery using latissimus dorsi and transverse rectus abdominis myocutaneous flaps requires a degree of muscle cutting. Whether free or pedicled flaps are performed, muscles are divided and cauterised to obtain the desired tissue volume. Standard techniques of muscle cutting include monopolar or bipolar diathermy, whose electrical impulses mimic action potentials causing excessive muscle twitching. This can lead to irregular planes of dissection, potential damage to delicate perforating vessels, and difficult haemostasis. We propose localised infiltration of 0.25% bupivicaine into the muscle prior to diathermy division. This technique reliably prevents excess muscle twitching and permits controlled dissection in the desired plane. Comparative video clips of this technique are available as supplementary material. Although the ideal method for tissue transfer in breast reconstruction is to avoid muscle cutting altogether by using free tissue transfer of perforator flaps, in units where these methods are not standard it may become necessary to convert to a muscle-sparing or pedicled-flap technique, thereby necessitating a degree of muscle cutting. Whether division of muscle is preferable or not, it is occasionally unavoidable, and our proposed technique will make the process of muscle division simpler and more controlled. [ABSTRACT FROM AUTHOR]

Headache syndromes often involve occipital and neck symptoms suggesting a functional connectivity between nociceptive trigeminal and cervical afferents. Several studies have suggested that pain relief in migraine and other types of headache can be achieved by local injections of steroids, local anaesthetics or a mixture of both in the area of greater occipital nerve (GON). Usually greater occipital nerve block (GONB) is performed by using local anaesthetics alone or with steroid. The rationale of performing a GONB for the treatment of chronic headache states is on the anatomical connections between trigeminal and upper cervical sensory fibres at the level of the trigeminal nucleus caudalis. However, the reason for the improvement after GONB in primary headache is unknown. The objective of this study is to determine whether adding triamcinolone to local anaesthetics increased the efficacy of GONB and trigger point injections (TPIs) for chronic migraine (TM). Patients with TM were randomized to receive GONB and TPIs using lidocaine 2% and bupivacaine 0.5% + either saline or triamcinolone 40 mg. Particularly, a 10-ml syringe containing 4.5 ml of lidocaine 2%, 4.5 ml of bupivacaine 0.5% and 1 ml of either saline (group A) or triamcinolone 40 mg/ml (group B) was prepared for each patients. Patients were given bilateral GONB and TPIs in the cervical paraspinal and trapezius muscles bilaterally. 2 ml were injected into each GON at the medial third of the distance between the occipital protuberance and the mastoid process. In addition, 0.5 ml was injected into each of the 12 trigger points. The total injected volume was 10 ml. The primary outcome measure was the change in mean headache severity from before injection to 20 min after in the two groups. Secondary outcome measures were the change in mean neck pain, photophobia and phonofobia severity from before injection to 20 min after in the two groups. Patients documented headache and severity of associated symptoms for 4 weeks after injection. Changes in symptom severity were compared between the two groups. Thirty-seven patients were included. Twenty minutes after injection, mean headache severity decreased by 3.2 points in group A ( p < 0.01) and by 3.1 points in group B ( p < 0.01). Mean neck pain severity decreased by 1.5 points in group A ( p < 0.01) and by 1.7 points in group B ( p < 0.01). Mean duration of being headache-free was 2.7 ± 3.8 days in group A and 1.0 ± 1.1 days in group B ( p = 0.67). None of the outcome measures differed significantly between the two groups. Both treatments were full tolerated. In our study, adding triamcinolone to local anaesthetic when perfoming GONB and TPIs was not associated with improved outcome in the sample of patients with TM. In both groups, the procedure resulted in significant and rapid relief of headache, neck pain, photophobia and phonofobia. [ABSTRACT FROM AUTHOR]

We report an unusual case of peri-appendicular abscess occurring in an irreducible Amyand’s hernia, managed in a primary care setting. An 84-year-old gentleman, with severe chronic obstructive airways disease, was assessed in a Primary Care surgical clinic and found to have a moderate-sized, tender, irreducible right inguinal hernia. He underwent immediate surgery under local anaesthetic. He was found to have a peri-appendicular abscess and perforated appendix within a right indirect inguinal hernia sac. Appendicectomy and sutured hernia repair were performed under local anaesthesia. [ABSTRACT FROM AUTHOR]