Search

Objective: Neuropathic pain prevalence is estimated between 7% and 10% of the population. International guidelines recommend a variety of drugs at different therapy lines for pain relief. However, side effect profiles, for example, prompted the UK government recently to classify pregabalin and gabapentin as class C drugs. Lidocaine 700 mg medicated plaster (LMP) might be a safer alternative. A systematic review assessed how LMP and pregabalin compared in terms of efficacy and safety. The review focused on pain reduction, quality of life and adverse events in peripheral neuropathic pain (PNP) i.e. post-herpetic neuralgia, diabetic peripheral neuropathy, post-surgical/trauma, or other PNP conditions.Methods: Electronic databases were searched as well as a number of other sources up to November 2018. Sensitive strategies were used, with no restriction by language or publication status. Two independent reviewers screened records and extracted data with consensus determining final decisions. Risk of bias was assessed using the Cochrane Collaboration 2011 checklist for RCTs. Full network meta-analysis was conducted to compare LMP to pregabalin 300/600 mg in terms of pain reduction, quality of life, as well as serious adverse events and selected adverse events. Trials with enriched enrolment design were excluded.Results: Searches retrieved 7,104 records. In total 111 references pertaining to 43 RCTs were included for data extraction. Bayesian network meta-analysis of several pain outcomes showed no clear difference in efficacy between treatments However, LMP was clearly advantageous in terms of dizziness and any adverse event vs. pregabalin 600 mg/day and discontinuations vs. pregabalin 300 mg/day or 600 mg/day, as well as being associated with improved quality of life (albeit in this case based on weak evidence).Conclusions: LMP was found to be similar to pregabalin in reducing pain in all populations but had a better adverse events profile. [ABSTRACT FROM AUTHOR]

The article discusses the use and results of spinal anaesthesia for ambulatory surgery. Topics discussed include historical context of spinal anaesthesia in the ambulatory setting; role of prilocaine and 2-chloroprocaine in the ambulatory setting; and information on intrathecal local anaesthetic agents relevant for ambulatory surgery.

Objective: To assess the effectiveness and adverse effects of acute cluster headache medications in a large international sample, including recommended treatments such as oxygen, commonly used medications such as opioids, and emerging medications such as intranasal ketamine. Particular focus is paid to a large subset of respondents 65 years of age or older. Background: Large international surveys of cluster headache are rare, as are examinations of treatments and side effects in older cluster headache patients. This article presents data from the Cluster Headache Questionnaire, with respondents from over 50 countries and with the vast majority from the United States, the United Kingdom, and Canada. Methods: This internet‐based survey included questions on cluster headache diagnostic criteria, which were used as part of the inclusion/exclusion criteria for the study, as well as effectiveness of medications, physical and medical complications, psychological and emotional complications, mood scores, and difficulty obtaining medications. The diagnostic questions were also used to create a separate group of respondents with probable cluster headache. Limitations to the methods include the use of nonvalidated questions, the lack of a formal clinical diagnosis of cluster headache, and the grouping of some medications (eg, all triptans as opposed to sumatriptan subcutaneous alone). Results: A total of 3251 subjects participated in the questionnaire, and 2193 respondents met criteria for this study (1604 cluster headache and 589 probable cluster headache). Of the respondents with cluster headache, 68.8% (1104/1604) were male and 78.0% (1245/1596) had episodic cluster headache. Over half of respondents reported complete or very effective treatment for triptans (54%, 639/1139) and oxygen (54%, 582/1082). Between 14 and 25% of respondents reported complete or very effective treatment for ergot derivatives (dihydroergotamine 25%, 42/170; cafergot/ergotamine 17%, 50/303), caffeine and energy drinks (17%, 7/41), and intranasal ketamine (14%, 5/37). Less than 10% reported complete or very effective treatment for opioids (6%, 30/541), intranasal capsaicin (5%, 7/151), and intranasal lidocaine (2%, 5/241). Adverse events were especially low for oxygen (no or minimal physical and medical complications 99%, 1077/1093; no or minimal psychological and emotional complications 97%, 1065/1093), intranasal lidocaine (no or minimal physical and medical complications 97%, 248/257; no or minimal psychological and emotional complications 98%, 251/257), intranasal ketamine (no or minimal physical and medical complications 95%, 38/40; no or minimal psychological and emotional complications 98%, 39/40), intranasal capsaicin (no or minimal physical and medical complications 91%, 145/159; no or minimal psychological and emotional complications 94%, 150/159), and caffeine and energy drinks (no or minimal physical and medical complications 89%, 39/44; no or minimal psychological and emotional complications 91%, 40/44). This is in comparison to ergotamine/cafergot (no or minimal physical and medical complications 83%, 273/327; no or minimal psychological and emotional complications 89%, 290/327), dihydroergotamine (no or minimal physical and medical complications 81%, 143/176; no or minimal psychological and emotional complications 91%, 160/176), opioids (no or minimal physical and medical complications 76%, 416/549; no or minimal psychological and emotional complications 77%, 423/549), or triptans (no or minimal physical and medical complications 73%, 883/1218; no or minimal psychological and emotional complications 85%, 1032/1218). A total of 139 of 1604 cluster headache respondents (8.7%) were age 65 and older and reported similar effectiveness and adverse events to the general population. The 589 respondents with probable cluster headache reported similar medication effectiveness to respondents with a full diagnosis of cluster headache. Conclusions: Oxygen is reported by survey respondents to be a highly effective treatment with few complications in cluster headache in a large international sample, including those 65 years or over. Triptans are also very effective with some side effects, and newer medications deserve additional study. Patients with probable cluster headache may respond similarly to acute medications as patients with a full diagnosis of cluster headache. [ABSTRACT FROM AUTHOR]

Background: The first metatarsophalangeal joint is the most common site of osteoarthritis (OA) in the foot and ankle. Intra-articular corticosteroid injections are widely used for this condition, but little is known about their use in practice. This study explored current practice within the UK National Health Service (NHS) relating to the administration of intra-articular corticosteroids for people with painful first metatarsophalangeal joint (MTPJ) OA., Methods: A cross-sectional survey using Qualtrics online survey platform (Qualtrics, Provo, UT, USA), distributed through professional bodies, special interest groups, and social media., Results: One hundred forty-four healthcare professionals responded, including podiatrists (53/144; 39%), orthopaedic surgeons (28/144; 19%), podiatric surgeons (26/144; 17%) and physiotherapists (24/144; 16%). Half of respondents administered up to 25 corticosteroid injections per year (67/136; 49%) but some administered more than fifty (21/136; 15%). Injections were administered across the healthcare system but were most common in hospital settings (64/136; 44%) followed by community (38/136; 26%), with less delivered in primary care (11/136; 8%). Half of respondents routinely used image-guidance, either ultrasound or x-ray/fluoroscopy (65/136; 48%) although over one third used none (52/136; 38%). Imaging guidance was more common amongst medical professionals (21/31; 68%) compared to non-medical health professionals (45/105; 43%). Overall, methylprednisolone acetate was the most common corticosteroid used. Medical professionals mostly injected methylprednisolone acetate (n = 15/27; 56%) or triamcinolone acetonide (n = 11/27; 41%), whereas premixed methylprednisolone acetate with lidocaine hydrochloride was the most common preparation used by non-medical health professionals (41/85; 48%). When injecting non premixed steroid, lidocaine hydrochloride (15/35; 43%) was the most common choice of local anaesthetic for non-medical health professionals but medical professionals showed more variation between lidocaine hydrochloride (8/23; 35%) levobupivacaine hydrochloride (9/23; 39%) and bupivacaine hydrochloride (5/23; 22%)., Conclusions: Multiple professional groups regularly administer intra-articular corticosteroids for symptomatic first MTPJ OA across a range of NHS healthcare settings. Overall, methylprednisolone acetate was the most commonly administered steroid and lidocaine hydrochloride the most common local anaesthetic. There was large variation in the use of imaging guidance, type and dose of steroid, local anaesthetic, and clinical pathways used in the intra-articular injection of corticosteroids for people with first MTPJ OA., (© 2023. The College of Podiatry and the Australasian Podiatry Council.)

It is estimated that over 90 000 people in the UK community live with an indwelling catheter (Wilson, 2016). It is essential that a lubricating gel is used during catheterisation, as this helps to reduce the risk of pain, trauma and infection (Loveday et al, 2014; National Institute for Health and Care Excellence, 2012). Chlorhexidine is an antiseptic contained in many catheterisation gels. Evidence demonstrates that increasing numbers of patients are experiencing hypersensitivity reactions to this ingredient (Australian and New Zealand College of Anaesthetists, 2014). This article considers the range of catheterisation gel choices available to clinicians and the importance of selecting the correct gel for each patient. It addresses the benefits of using OptiLube Active CHG Free (with lidocaine 2%) – the only catheterisation gel currently available in the UK that contains the benefits of local anaesthetic without chlorhexidine – and recommends that this should be the gel of choice for non-specialist staff conducting catheterisations without individual patient assessments. [ABSTRACT FROM AUTHOR]

The article examines issues related to patients living with indwelling catheter and for their caregivers. Topics covered include indications for long-term urethral catheterisation, the local anaesthetic lidocaine hydrochloride, and catheter blockage.

Extravasation is a complication of chemotherapy that occurs when a vesicant drug is accidentally administered into the tissue surrounding the intravenous access device.This may happen where chemotherapy drugs are administered via a peripheral or central venous catheter. The result can be necrosis with associated trauma and pain for the patient, but management is varied and the evidence base is poor. There has been increasing interest in the flush-out technique, which aims to flush the drug out of the tissues. This technique has been developed and carried out by plastic surgeons in the UK. The project described in this article involved working with the plastic surgical team to train nurses in the flush-out technique with the aim of offering more timely interventions and less inconvenience for patients. The technique has been successfully introduced in south west London with recent implementation in the South East London Cancer Network. [ABSTRACT FROM AUTHOR]

Background: Published analyses have demonstrated that the lidocaine (lignocaine) plaster is a cost-effective treatment for postherpetic neuralgia (PHN) relative to gabapentin or pregabalin. However, these analyses have been based on indirect comparisons from placebo-controlled trials, and there is evidence of a discrepancy between the outcomes of direct and indirect analyses. Fortunately, recent publication of the results of a head-to-head trial comparing the lidocaine plaster and pregabalin in patients with PHN or diabetic polyneuropathy allows customization of the existing model to more accurately reflect the relative cost effectiveness of these two products. Objective: To assess the cost-effectiveness of the lidocaine 5% medicated plaster compared with pregabalin for the treatment of PHN in the UK primary-care setting. Methods: AMarkov model has been developed to assess the costs and benefits of the lidocaine plaster and pregabalin over a 6-month time horizon for the treatment of patients with PHN who are intolerant to tricyclic antidepressants and in whom analgesics are ineffective or contraindicated. The model structure allows for differences in costs, utilities (derived from published data and from the head-to-head trial) and transition probabilities between the initial 30-day run-in period and maintenance therapy, and also takes account of add-in medication and drugs received by patients discontinuing therapy. The calculation was based on data from the recent head-to-head trial described above. Additional data sources included published literature, discussions with a Delphi panel, official price/tariff lists and national population statistics. The study was conducted from the perspective of the UK National Health Service (NHS). Results: The base-case analysis (1.71 lidocaine plasters per day used in the head-to-head trial for the PHN population) indicated that the total cost of treating PHN patients for 6 months with the lidocaine plaster was £980 per patient treated, compared with £784 for pregabalin (year of costing 2009). Costs for 1 month without pain and intolerable adverse events (AEs) (modified TWIST analysis) were £126 for the lidocaine plaster relative to pregabalin. The average patient treated with the lidocaine plaster experienced 0.321 quality-adjusted life-years (QALYs) over the 6-month period modelled compared with 0.254 QALYs for pregabalin. Quality-of-life benefits were attributed to the favourable AE profile of the lidocaine plaster. Subsequently, the lidocaine plaster cost £2925 per QALY gained relative to pregabalin. However, patient level longitudinal data have shown that the actual clinical usage of the lidocaine plaster is 1.1 plasters per day. If this more realistic assumption is used in the model, the total cost for a 6-month treatment period was £756 for the lidocaine plaster, which dominated treatment with pregabalin. Scenario analyses and sensitivity analyses had minimal impact on the results, confirming the robustness of the study. The incremental cost-effectiveness ratios for the lidocaine plaster remained well below £35 000 per QALY gained in all analyses. Conclusion: This analysis showed that the lidocaine 5% medicated plaster is a cost-effective method for obtaining sustained relief of localized neuropathic pain associated with PHN compared with pregabalin in a UK setting, in terms of both the cost per QALY gained and the cost per additional month without symptoms, when used for patients who do not experience sufficient pain relief from standard analgesics. [ABSTRACT FROM AUTHOR]

Abstract: Study Objective: To determine whether adding ephedrine to propofol is as effective as adding lidocaine at reducing injection pain, and its effects on hemodynamics. Design: Randomized, double-blinded, controlled trial. Setting: District general hospital in the United Kingdom. Patients: 156 adult, ASA physical status I, II, and III patients undergoing elective or emergency general anesthesia. Interventions: Patients were randomized to one of three groups to receive one mL of 1% lidocaine per 20 mL of 1% propofol (Group L), 15 mg of ephedrine per 20 mL of propofol (Group E15), or 30 mg of ephedrine per 20 mL of propofol (Group E30). Measurements and Main Results: Pain on injection, heart rate, and blood pressure at one-minute intervals for ten minutes were recorded. There was no significant difference in injection pain among groups. Group E30 had the least amount of hemodynamic change. Conclusion: Adding 30 mg of ephedrine to 20 mL of 1% propofol is as effective as adding lidocaine in preventing injection pain, and it results in a more stable hemodynamic profile. [Copyright &y& Elsevier]

Abstract: Study objective: To assess the feasibility and patient acceptability of global endometrial ablation using the Hydro ThermAblator (HTA) in an outpatient hysteroscopy clinic setting under local anaesthesia. Design: A prospective cohort study (Canadian Task Force classification II-2). Setting: University hospital in the United Kingdom. Patients: Forty patients with medication-resistant menorrhagia. Intervention: Oral mefenamic acid was administered 8 hours before the procedure. A combined cervical/paracervical block using lignocaine 1% adrenaline 1:200 000 was used before hysteroscopic endometrial ablation using the HTA device. Measurements and main results: A successful procedure was defined as a completed HTA treatment cycle. Failure was defined as premature termination or inability to carry out the HTA procedure after scheduling the patient. Pain scores were estimated at three stages during and after the procedure using a visual-analog scale. A questionnaire was used before discharge to assess acceptability. Forty patients were successfully treated. The median pain score during the ablation was 6.4 (range 4.0–8.9). Eighty-eight percent of patients found the procedure acceptable. No serious complications occurred. All patients were discharged home within 2 hours of the procedure. Conclusion: Selected patients suffering from menorrhagia may be treated with the HTA device using local anesthesia in an outpatient setting. [Copyright &y& Elsevier]

The implementation of the wide-awake local anesthetic no tourniquet (WALANT) approach to surgical procedures in Cyprus has led to significant cost savings. In the United Kingdom, the implementation of WALANT has led to shorter waiting times for hand surgical procedures, cost savings for the National Health Service, and high patient satisfaction rates. In both countries, patient education is a prerequisite for WALANT surgery. It increases the satisfaction rate among patients and enhances the patient-surgeon relationship. Patients need to know they can participate actively in a procedure, because a patient moving the hand during a procedure can improve the outcome., (Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.)

Focuses on the ineffectiveness of lignocaine against primary venticular fibrillation (PVF) in Great Britain. Failure to reduce the ventricular ectopic activity; Prevalence of PVF in younger male patients with extensive inferior infarction; Prevention of acute coronary death.