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Background: Despite common use, the benefit of adding steroids to local anaesthetics (SLA) for chronic non-cancer pain (CNCP) injections is uncertain. We performed a systematic review and meta-analysis of English-language RCTs to assess the benefit and safety of adding steroids to local anaesthetics (LA) for CNCP.Methods: We searched MEDLINE, EMBASE, and CENTRAL databases from inception to May 2019. Trial selection and data extraction were performed in duplicate. Outcomes were guided by the Initiative in Methods, Measurements, and Pain Assessment in Clinical Trials (IMMPACT) statement with pain improvement as the primary outcome and pooled using random effects model and reported as relative risks (RR) or mean differences (MD) with 95% confidence intervals (CIs).Results: Among 5097 abstracts, 73 trials were eligible. Although SLA increased the rate of success (42 trials, 3592 patients; RR=1.14; 95% CI, 1.03-1.25; number needed to treat [NNT], 13), the effect size decreased by nearly 50% (NNT, 22) with the removal of two intrathecal injection studies. The differences in pain scores with SLA were not clinically meaningful (54 trials, 4416 patients, MD=0.44 units; 95% CI, 0.24-0.65). No differences were observed in other outcomes or adverse events. No subgroup effects were detected based on clinical categories. Meta-regression showed no significant association with steroid dose or length of follow-up and pain relief.Conclusions: Addition of cortico steroids to local anaesthetic has only small benefits and a potential for harm. Injection of local anaesthetic alone could be therapeutic, beyond being diagnostic. A shared decision based on patient preferences should be considered. If used, one must avoid high doses and series of steroid injections.Clinical Trial Registration: PROSPERO #: CRD42015020614. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has meant a halt to elective oral and maxillofacial procedures under local anaesthetic. As oral and maxillofacial departments enter the recovery phase of the COVID-19 pandemic there are many considerations to make regarding standard operating procedures. Thus, this survey was conducted to identify areas of consensus and divergence in practice during the recovery phase of the pandemic for local anaesthetic procedures in oral and maxillofacial units. Our findings show there are some areas of inconsistency of practice particularly in preoperative risk management and self-isolation as well as fallow time between patients for aerosol generated procedures and non-aerosol generated procedures. [ABSTRACT FROM AUTHOR]

Objectives: To report the prospective multicentre clinical evaluation of a first-in-man disposable device, Cambridge Prostate Biopsy Device, to undertake local anaesthetic outpatient transperineal prostate biopsies. Material and methods: Disposable single-use Cambridge Prostate Biopsy devices were manufactured based on a previous prototype. The lead site developed a user training course and disseminated the method to other sites. The Cambridge Prostate Biopsy Device (CamPROBE) was offered as an alternative to transrectal ultrasound guided biopsy to men due for a biopsy as part of their clinical management. Data on safety (infections and device performance), clinical utility, patient reported experience, biopsy quality and cancer detection were collected. Procedure time and local anaesthetic use was recorded in the lead site. The study was funded by a United Kingdom National Institute for Health Research (NIHR) i4i product development award. Results: A total of 40 patients were recruited (median age 69 y) across six sites; five sites were new to the procedure. Overall, 19/40 were first prostate biopsies and 21/40 repeat procedures. Both image-targeted and systematic biopsy cores taken. There were no infections, device deficiencies or safety issues reported. The procedure was well tolerated with excellent patient-reported perception and low pain scores (median of 3, scale 0–10). Histopathology quality was good and the overall cancer diagnosis rate (first diagnostic procedures) was 68% (13/19) and for significant cancers (⩾ histological Grade Group 2), 47% (9/19). In the lead centre (most experienced), median procedure time was 25 minutes, and median local anaesthetic use 11 ml (n =17). Conclusions: Data from this device evaluation study demonstrate that the United Kingdom-developed Cambridge Prostate Biopsy Device/method for transperineal biopsies is safe, transferable and maintains high diagnostic yields. The procedure is well tolerated by patients, suited to the local anaesthetic outpatient setting and could directly replace transrectal ultrasound guided biopsy. Level of evidence: Level III [ABSTRACT FROM AUTHOR]

Background: Local anaesthetics are being combined clinically with amikacin in intravenous regional limb perfusion (IVRLP), with limited knowledge on the analgesia provided and its onset and duration of action after tourniquet application and release. Objective: To evaluate the systemic clinical effect, limb withdrawal to nociceptive stimulation, and plasma and synovial fluid concentrations after IVRLP with lidocaine or mepivacaine in standing sedated horses. Study design: Prospective, controlled, randomised, cross‐over study. Methods: Six healthy adult horses were sedated and received IVRLP with lidocaine, mepivacaine or saline (negative control), or perineural anaesthesia of the medial and lateral palmar and palmar metacarpal nerves (positive control) in one forelimb with a 3‐week washout period between trials. Electrical and mechanical stimuli were used to test nociceptive threshold of the limb before and after IVRLP/perineural anaesthesia. For lidocaine and mepivacaine trials, blood was collected from the jugular vein and synovial fluid from the radiocarpal joint before, during and out to 24 hours after IVRLP. Drug concentrations were measured using high‐performance liquid chromatography. Results: Nociceptive thresholds for lidocaine, mepivacaine and perineural anaesthesia trials were significantly increased compared with saline and baseline values at 10, 20 and 30 minutes, with no differences between anaesthetic trials. During this time, horses had lower heart rates than IVRLP with saline. After tourniquet release at 30 minutes, nociceptive thresholds for lidocaine and mepivacaine trials gradually returned to baselines, whereas perineural anaesthesia trial remained unchanged out to an hour. Plasma lidocaine and mepivacaine concentrations were ≤50 ng/mL while the tourniquet was in place, significantly increasing 10 minutes after tourniquet release. Maximal lidocaine and mepivacaine concentrations in synovial fluid were reached 25 minutes after IVRLP injection. Main limitations: Amikacin was not included in the perfusate. Conclusion: Similar to perineural anaesthesia, IVRLP with lidocaine or mepivacaine provides anti‐nociception to the distal limb in standing sedated horses while a tourniquet is applied with concentrations remaining below toxic levels in plasma and synovial fluid. [ABSTRACT FROM AUTHOR]

Introduction: Ultrasound (USG)-guided Transversus-Abdominis- Plane (TAP) block is recommended due to its safety and reliability. Echogenic needles provide better needle visibility and might result in better postoperative analgesia after USG-guided TAP block. Aim: To compare visibilty and block-characteristics (including postoperative analgesia) of echogenic vs. non echogenic needle for USG-guided TAP block. Materials and Methods: This randomised double-blind study was carried out at King George's Medical University, Lucknow over a period of one year (November 2018 to October 2019). Seventy patients undergoing abdominal surgeries were enrolled and randomly allocated to one of two groups Group-E (echogenic) and Group-NE (non echogenic). Bilateral TAP block was performed postoperatively in all the patients and 20 mL of 0.25% Bupivacaine was deposited on each side. In Group-E, echogenic needle was used and in Group-NE, non echogenic needle was used for TAP block. Research assistant documented the start and finish time of the block procedure, number of attempts and redirections based on predetermined criteria. Visibility of needle tip and shaft were graded on a 3-point scale based on recorded and de-identified video-clips. Total procedure-time, number of needle redirections and skin punctures, incidence of vascular punctures, Visual Analogue Scale (VAS) scores and rescue analgesia requirement were also noted. Statistical analysis was done using SPSS Version 21.0. Results: Needle visibility on USG was significantly better in Group-E than Group-NE (X2=57.24, p<0.001). Mean time to reach the TAP plane (t=-16.89, p<0.001) and total procedure time (t=-15.76, p<0.001) were also significantly lesser in Group-E. Mean number of needle redirections (t=-11.21, p<0.001), mean number of skin punctures (t=-2.12, p=0.038) and postoperative VAS scores throughout the study were found to be significantly lesser in group-E as compared to group-NE. Postoperative analgesia required in 24 hour was lesser in group-E and time of first rescue analgesia required was earlier in group-NE (p<0.001). Patients in both the groups were haemodynamically stable throughout the study. Conclusion: Use of echogenic needle for USG-guided TAP block provides much better needle-visibility resulting in better block-performance. It also provided better analgesia in our study as evident by lesser VAS-scores and lesser requirement of rescue analgesia postoperatively. So, use of echogenic needle should be advocated in all the patients undergoing USG-guided TAP blocks provided there are no financial constraints. [ABSTRACT FROM AUTHOR]

Background: High concentrations of local anaesthetic have an anti‐proliferative effect on colonic cancer in vitro. Intraperitoneal local anaesthetic (IPLA) has shown analgesic benefit and improved recovery in the perioperative setting. The long‐term effects of IPLA in colon cancer resection have not been examined. This study aims to review the survival and oncological outcomes of a previously conducted trial that compared perioperative IPLA with placebo. Methods: Sixty patients underwent colonic resection for benign and malignant disease as part of a double‐blinded, randomized, placebo‐controlled study between September 2008 and November 2009. The IPLA group received instillation of intraperitoneal ropivacaine before dissection followed by a 3‐day infusion. The placebo group was treated identically but with 0.9% saline solution. A follow‐up analysis was conducted to evaluate overall survival, disease‐free survival and recurrence specifically for patients undergoing resection for stages I–III colon cancer. Kaplan–Meier analysis was performed, and the log‐rank test was used to evaluate difference in survival between groups. Results: Thirty‐seven of the 60 patients had stages I–III colon cancer and were included in this analysis. Nineteen patients were in the placebo group. There was no significant difference in overall survival or all‐cause mortality. There was a higher incidence of cancer‐specific mortality in the local anaesthetic group (P < 0.046). Conclusion: It does not appear that IPLA is associated with a significant survival benefit in patients with colonic malignancy undergoing colectomy. Other studies are needed to analyse the long‐term outcomes. [ABSTRACT FROM AUTHOR]

Background: Advanced-stage ovarian cancer has a poor prognosis; surgical resection with the intent to leave no residual tumour followed by adjuvant chemotherapy is the standard treatment. Local anaesthetics (LA) have anti-inflammatory and analgesic effects. We hypothesised that intraperitoneal LA (IPLA) would lead to improved postoperative recovery, better pain relief, and earlier start of chemotherapy.Methods: This was a prospective, randomised, double-blind, placebo-controlled pilot study in 40 women undergoing open abdominal cytoreductive surgery. Patients were randomised to receive either intraperitoneal ropivacaine (Group IPLA) or saline (Group Placebo) perioperatively. Except for study drug, patients were treated similarly. Intraoperatively, ropivacaine 2 mg ml-1 or 0.9% saline was injected thrice intraperitoneally, and after operation via a catheter and analgesic pump into the peritoneal cavity for 72 h. Postoperative pain, time to recovery, home discharge, time to start of chemotherapy, and postoperative complications were recorded.Results: No complications from LA administration were recorded. Pain intensity and rescue analgesic consumption were similar between groups. Time to initiation of chemotherapy was significantly shorter in Group IPLA (median 21 [inter-quartile range 21-29] vs 29 [inter-quartile range 21-40] days; P=0.021). Other parameters including time to home readiness, home discharge and incidence, and complexity of postoperative complications were similar between the groups.Conclusions: Intraperitoneal ropivacaine during and for 72 h after operation after cytoreductive surgery for ovarian cancer is safe and reduces the time interval to initiation of chemotherapy. Larger studies are warranted to confirm these initial findings.Clinical Trial Registration: NCT02256228. [ABSTRACT FROM AUTHOR]

Background: Breast cancer surgery under local anaesthesia (LA) can be challenging due to limitation of dose and quantity of anaesthetic agent that can be used safely. Elderly patients with breast cancer and with multiple co-morbidities are often prevented from having a standard treatment as they are considered unfit for general anaesthesia. We describe a technique of surgery under local anaesthesia without sedation that employs dilution to generate large volumes of LA and infiltration under ultrasound guidance.Methods: We present a case series by a single surgeon of breast cancer patients who underwent surgery under LA. 40 mls of 1% lignocaine with 1:200,000 adrenaline was diluted with 160 mls of normal saline to make a total of 200 mls, resulting in dilution to a concentration of 0.2% lignocaine. Radioactive isotope having been injected before patient's arrival in theatre, 1 ml of diluted anaesthetic solution is used with 2 mls of 2.5% patent blue to inject in the sub-areolar space. Local anaesthetic is infiltrated at operative site under ultrasound guidance using a long echogenic needle.Results: A total of 71 patients with breast cancer underwent surgery under the LA between September 2015 and October 2018. 64 (90%) patients had wide local excisions and 7 (10%) had mastectomies. All had axillary surgery, 65 (91.5%) had dual technique sentinel lymph node biopsy as a day case and 6 (8.5%) patients had axillary clearance. 8 patients had re excision (12.5%). All patients had '0' pain score and no postoperative analgesia was required in recovery. Local anaesthetic used did not exceed the maximum safe dose in any of the cases. One patient returned to theatre for postoperative wound bleeding. No other postoperative complication was observed.Conclusion: Ultrasound guided infiltration allows accurate placement of large volume of diluted local anaesthetic solution safely and provides effective anaesthesia. [ABSTRACT FROM AUTHOR]

Background: Haemorrhoidal rubber band ligation (RBL) is a well‐established, safe and cost‐effective treatment for bleeding haemorrhoids. It is generally well tolerated; however, some patients may require narcotic analgesia or even admission to hospital for pain management. This comparative cohort study reports on the difference in peri‐procedural analgesia administration and post‐operative recovery time between patients who received local anaesthetic (LA) infiltration in addition to RBL, compared with patients treated only with RBL. Methods: Consecutive patients with haemorrhoids treated over a 3‐month period with LA infiltration in addition to RBL were compared to a consecutive control group who received RBL alone in the preceding 3 months. Clinical data were collected prospectively for LA group and retrospectively for the control group. Data collected included analgesia administered during the procedure and in recovery, as well as the mean time to discharge. Results: A total of 32 patients treated with LA infiltration following RBL for haemorrhoids were compared with 22 patients who were treated with RBL alone. There was a reduction in the administration of intra‐procedural parecoxib in the LA group (P < 0.001). Following the procedure, there was a reduction in the administration of both oral and intravenous opioid analgesia (P = 0.009) and reduced mean time to discharge in the LA group (P < 0.001). Conclusion: Infiltration of LA proximal to the band following RBL for haemorrhoids reduced the administration of analgesia both during the procedure and in recovery, as well as mean time to discharge following the procedure. [ABSTRACT FROM AUTHOR]

There are numerous possible techniques for delivering local anaesthetic through peripheral nerve catheters. These include continuous infusions, patient-controlled boluses and programmed intermittent boluses. The optimal delivery regimen of local anaesthetic is yet to be conclusively established. In this review, we identified prospective trials of delivery regimens through peripheral nerve catheters. Our primary outcome was visual analogue scale scores for pain at 48 h. Secondary outcomes were: visual analogue scores at 24 h; patient satisfaction scores; rescue opioid use; local anaesthetic consumption; and nausea and vomiting. Network meta-analysis was used to compare these outcomes. Predefined sub-group analyses were performed. Thirty-three studies enrolling 1934 participants were included. In comparison with continuous infusion, programmed intermittent boluses improved visual analogue pain scores at both 48 and 24 h, the weighted mean difference (95%CI) being -0.63 (-1.12 to -0.14), p = 0.012 and -0.48 (-0.92 to -0.03), p = 0.034, respectively. Programmed intermittent boluses also improved satisfaction scores, the weighted mean difference (95%CI) being 0.70 (0.10-1.31), p = 0.023, and reduced rescue opioid use, the weighted mean difference (95%CI) in oral morphine equivalent at 24 h being -23.84 mg (-43.90 mg to -3.77 mg), p = 0.020. Sub-group analysis revealed that these findings were mostly confined to lower limb and truncal catheter studies; there were few studies of programmed intermittent boluses for upper limb catheters. Programmed intermittent boluses may provide optimal delivery of a local anaesthetic through peripheral nerve catheters. Further research is warranted, particularly to delineate the differences between upper and lower limb catheter locations, which will help clarify the clinical relevance of these findings. [ABSTRACT FROM AUTHOR]

Acute pain management in the neonatal period remains a challenge for the clinician. Responses to pain and analgesic intervention are developmentally influenced and cannot be directly extrapolated from the older child. Successful and safe intervention will minimize acute physiological and behavioural distress, reduce pain scores and potentially improve short- and long-term outcomes. This requires an understanding of the physiology and pharmacology in this age group alongside a multi-modal approach to treatment using both pharmacological and non-pharmacological interventions. [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]

Abstract Background Chondrotoxic effects of local anaesthetics are well reported in humans and some animal species but knowledge on their toxic effects on synoviocytes or equine chondrocytes or the effects on cellular production of inflammatory cytokines is limited. The purpose of this study was to evaluate the in vitro effects of local anaesthetics, morphine, magnesium sulphate (MgSO4) or their combinations on cell viability and pro-inflammatory cytokine gene expression of equine synoviocytes and chondrocytes. Equine synoviocytes and cartilage explants harvested from normal joints in a co-culture system were exposed to mepivacaine (4.4 mg/ml), bupivacaine (2.2 mg/ml), morphine (2.85 mg/ml) and MgSO4 (37 mg/ml) alone or each local anaesthetic plus morphine or MgSO4 or both together. Chondrocyte and synoviocyte cell viability was assessed by CellTiter-Glo Luminescent Cell Viability Assay. Synoviocyte gene expression of IL-1β, IL-6 or TNF-α was measured and compared using the ∆∆CT method. Results Morphine alone, MgSO4 alone or their combination did not alter cell viability or the expression of IL-1β, IL-6 or TNF-α. However, local anaesthetics alone or in combination with morphine and/or MgSO4 reduced cell viability and increased the gene expression of IL-1β, IL-6 or TNF-α. Single short exposure to local anaesthetics is toxic to both chondrocytes and synoviocytes and their combination with morphine and/or MgSO4 enhanced the cytotoxic effects. Conclusions This in vitro study gives further evidence of the absence of cytotoxic effects of morphine alone, MgSO4 alone or their combination on normal articular tissues. However, local anaesthetics alone or in combination with morphine and/or MgSO4 have cytotoxic effects on equine articular tissues.

Abstract Background Epidural anaesthesia is one of the most commonly used locoregional techniques in ruminants. The lumbosacral epidural technique is reasonably easy to perform and requires low volumes of local anaesthetic drug to allow procedures caudal to the umbilicus. However, surgical procedures in the flank of the animal would require an increased volume of drugs. The anaesthetized area provided by thoracic epidural technique is larger than the lumbosacral technique; however the former is rather challenging to perform. Therefore, access through lumbosacral area to introduce a catheter into the thoracolumbar space is a potential alternative to thoracic access. Epidural anaesthesia is achieved with local anaesthetics; opioids can be added to improve analgesia. This study aimed to evaluate the effects of 0.5% bupivacaine with or without methadone, administered through an epidural catheter inserted through the lumbosacral access and advanced to the thoracolumbar space, on thoracolumbar epidural anaesthesia in goats. Methods Six animals received two treatments each in a randomized crossover study: BUP treatment consisted of 0.5% bupivacaine (1 mL per each 10 cm of spine column; 1 ± 0.2 mg/kg BW) and BMT treatment was the same; however 1 mL of bupivacaine was replaced by 1 mL (0.22 ± 0.03 mg/kg BW) of methadone (10 mg/mL). The treatments were administered near to T11-T12 through an epidural catheter. Motor blockade and analgesia were evaluated by electrical stimulation. Results Heart rate, respiratory rate, ruminal motility and rectal temperature were evaluated before and after the treatment. Motor blockade was observed on both treatments, up to 6 h post-treatment. Analgesia was observed on BUP up to 4 h and on BMT up to 6 h post-treatment. Physiological values did not change at any moment. Conclusions Bupivacaine-methadone combination promoted longer-lasting analgesia in goats compared to bupivacaine alone when administered through an epidural catheter into the thoracolumbar space.

Background/Objective: The purpose of this study was to evaluate supraspinatus tenocyte viability and metabolism in explants exposed to various local anaesthetics and corticosteroids. Our hypothesis was that the tendons exposed to these common injectates would have significantly decreased cell viability and metabolism compared with controls. Methods: Supraspinatus tendon explants were obtained from dogs, placed in a culture media, and randomly assigned to one of the following groups: culture media only (control), 1% lidocaine, 0.5% lidocaine, 0.25% bupivacaine, 0.125% bupivacaine, 0.0625% bupivacaine, betamethasone acetate (5 mg), methylprednisolone acetate (40 mg), or triamcinolone acetonide (40 mg). Cell viability was determined on Days 1 and 7 after culture treatment using calcein AM (live cell) and Sytox Blue (dead cell) stains. Tissue metabolism was assessed on Days 1 and 7 using the resazurin blue metabolic assay. Significant differences were evaluated using a one-way analysis of variance with Tukey post hoc analysis. Results: Compared with the controls, there were significant decreases in cell viability noted at Days 1 and 7 in tenocytes exposed to 1% lidocaine, betamethasone, and methylprednisolone. Significant decreases in cell metabolism were also noted at Days 1 and 7 in those groups. Treatment with 0.125% bupivacaine, 0.0625% bupivacaine, and triamcinolone demonstrated no decrease in cell viability or metabolism when compared with controls at any time point. Conclusion: This data confirms that peritendinous injection of commonly used local anaesthetics and corticosteroids results in significant supraspinatus tenotoxicity in vitro. Further in vivo studies are required before making definitive clinical recommendations.

Background and Aims: Successful awake fibreoptic intubation (AFOI) depends on adequate topical anaesthesia of the airway. We aimed to compare efficacy of atomised local anaesthetic versus transtracheal topical anaesthesia for AFOI. Methods: It was a prospective, randomised controlled study of 33 patients with the American Society of Anesthesiologists' physical status 1–3 with anticipated difficult airway requiring AFOI. The primary objective was to compare the patient comfort after topical anaesthesia of the airway using atomiser with transtracheal injection of the local anaesthetic agent for AFOI in patients with anticipated difficult airway. The secondary objectives were to compare the ease of intubation, time required to intubate and the haemodynamic changes during intubation. After topical anaesthesia of nostrils, patients in Group T received transtracheal injection of 4 ml of 4% lignocaine whereas Group A patients received 4-5mL of 4% atomised lignocaine using DeVilbiss atomiser before AFOI. Patient comfort assessed objectively by the anaesthetic assistant during the procedure, ease of intubation assessed using cough and gag reflex score, time taken to intubate and the haemodynamic changes during the procedure were compared. Results: Ease of intubation, patient comfort and the time taken to intubate were significantly better in Group T patients, with P = 0.001, 0.009 and 0.019, respectively, compared with the patients in Group A. There were no significant changes in haemodynamic parameters. Conclusion: Topical anaesthesia by transtracheal injection in patients with anticipated difficult airway made AFOI easier and faster with better patient comfort compared to atomiser with no clinically significant untoward side effects.

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The objectives of this study was to evaluate the hospital occurrence of various radiographic lesions of the distal limb (bones and joints) lameness in equine and to evaluate the role of nerve and joint blocks for the localization of lameness in equine. All the equine lameness cases (117), presented during the one year study period that were subjected to radiographic evaluation, were investigated. Out of these, 20 equine lameness cases were subjected to systematic evaluation including nerve / joint blocks to confirm, whether the clinically or radiographically detected lesion was the primary cause for the lameness or not. Out of 117, 78 equine (66.67%), were diagnosed with 124 radiographic lesions involving 101 limbs. The majority (62.8%) of the equines had single radiographic lesion, whereas the remaining animals were detected with multiple lesions involving one (15.4%) or more limbs (21.8%). Majority cases of equine lameness were recorded in winter season. Highest per cent lesions were recorded in hoof region (25.81%) with more common involvement of fore feet (68.75%) and in mares (54.54%). Hock and fetlock regions were second (22.6%) and third (21.8%) most common regions for occurrence of equine lameness. Fetlock joint of hindlimb (63%) was more commonly affected than that of the forelimb. In this study, 16 nerve / joint blocks were applied in 15 horses and these were found helpful in confirming the lameness lesions in 66.7% cases. In conclusion, high prevalence of multiple lesions involving one or more limb poses great diagnostic challenge. Forelimb hoof and the hock were most frequently involved in distal limb lameness in equine. Periostitis and arthritis were most prevalent lameness causing lesions in equine. Physical examinations, nerve/ joint bocks and radiography complement each other in confirming the site of lesion causing lameness.

Introduction: ENTUK guidelines recommend that manipulation of nasal bones (MNB) should be performed within 14 days of injury. However, evidence suggests treatment under general anaesthetic remains effective up to 5 weeks after injury. With the SARS-CoV-2 pandemic leading to delays in referral and limited access to theatre, local practice changed to offer delayed MNB under local anaesthetic. This prospective study assesses the effectiveness of MNB delayed until 3 weeks or later from time of injury when performed mostly under local anaesthetic., Methods: Data was prospectively collected between April and November 2020. All patients referred to ENT with a new nasal bone deformity presenting more than 21 days after injury were included. Demographic information, injury details and patient satisfaction was recorded for each patient., Results: 11 patients were included. Average age was 32.6 years (Range 8-65 years). 10 procedures (91%) were performed under local anaesthetic, with 1 (9%) performed under general anaesthetic. 9 patients (82%) gained complete reduction of the deformity, and 1 patient (9%) gaining partial reduction. 10 patients (91%) patients were satisfied with the cosmetic outcome., Conclusion: This study supports the small volume of recent literature showing that delayed manipulation of nasal bones is effective and additionally demonstrates that efficacy is maintained when performed under local anaesthetic., (Copyright © 2024 Ulster Medical Society.)

Background: The role of continuous wound infusion catheters as part of a multimodal analgesia strategy after Caesarean delivery is unclear. We introduced continuous wound infusion catheters to our multimodal analgesia regimen to evaluate the impact on analgesic outcomes after Caesarean delivery., Methods: After institutional review board (IRB) approval, a 4-month practice change was instituted as a quality improvement initiative. In addition to multimodal analgesia, continuous wound infusion catheters for up to 3 days were offered on alternate weeks for all women undergoing Caesarean deliveries. The primary outcome was postoperative in-hospital opioid consumption. Secondary outcomes were static and dynamic pain scores at 24 and 72 h, time until first analgesic request, opioid-related side-effects, length of stay, satisfaction (0-100%), and continuous wound infusion catheter-related complications., Results: All women scheduled for Caesarean delivery ( n =139) in the 4-month period were included in the analysis, with 70 women receiving continuous wound infusion catheters, and 69 in the control group. Opioid consumption (continuous wound infusion catheter group 11.3 [7.5-61.9] mg morphine equivalents vs control group 30.0 [11.3-48.8] mg morphine equivalents), pain scores (except 24 h resting pain scores which were higher in the control group 2 [1-3] vs 1.5 [0-3] in the continous wound infusion catheters group; P =0.05), side-effects, length of stay, and complications were similar between groups. Satisfaction scores at 24 h were higher with continuous wound infusion catheters (100% [91-100%] vs 90% [86-100%]; P =0.003) with no differences at 72 h. One patient demonstrated symptoms of systemic local anaesthetic toxicity which resolved without significant harm., Conclusions: The addition of continuous wound infusion catheters to a multimodal analgesia regimen for post-Caesarean delivery pain management demonstrated minimal clinically significant analgesic benefits. Future studies are needed to explore the use of continuous wound infusion catheters in populations that may benefit most from this intervention., (© 2023 The Authors.)

Injection of sodium hypochlorite (NaOCl) solution instead of local anaesthetic (LA) solution is an iatrogenic error with serious consequences including medico-legal implications. Such cases have been reported despite recommended precautionary measures. The purpose of this article is to review the literature on such cases and present clinical preventive recommendations. Electronic search was conducted in PubMed/Medline, Google Scholar, Cochrane, Scopus, Lilacs, ScienceDirect, and Crossref databases for articles reporting accidental or mistaken or inadvertent injection of NaOCl instead of LA during dental or endodontic treatment. Articles reporting NaOCl accident due to extrusion or injection of NaOCl beyond root confines were excluded. A total of 11 articles were found and reviewed. Data pertaining to the patient, injected NaOCl, cause, clinical manifestations, management, hospitalization, healing and recovery, and long-term or residual effects were extracted, compiled, and analysed for interpretation and discussion. Injection of NaOCl instead of LA into the soft tissues leads to varying clinical manifestations with unpredictable extent, outcome, and recovery period. The onus lies with the clinician to prevent it. Therefore, a clinician must take all the precautionary measures and confirm the identity of LA and NaOCl solutions before delivering them. The presented clinical recommendations assist clinicians to prevent it, including its potential medico-legal consequences. However, in case of such an unfortunate event, it is crucial to immediately identify and quickly manage it to limit the tissue damage or complications., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Tri-Solfen® is a combination topical anaesthetic and antiseptic solution containing lidocaine, bupivacaine, adrenaline and cetrimide. Applied to wounds, it is reported to reduce the pain experienced by calves following thermocautery disbudding. While lidocaine and bupivacaine are widely used in medicine, conflicting data exist on the impact of these compounds when applied directly to the surgical wound. To investigate the safety of Tri-Solfen® applied to thermocautery disbudding wounds of calves, experiments were performed to measure (i) the safety of Tri-Solfen® (including in overdose situations); and (ii) the impact of Tri-Solfen® application at recommended doses on disbudding wound healing under field conditions. Haematological, biochemical and urinalysis parameters did not show clinically significant differences between placebo and Tri-Solfen® groups (1×, 3× and 5× dose). No adverse health impacts were reported. Histopathological analysis of wounds noted a reduction in bacterial colonies in Tri-Solfen®-treated wounds. Under field conditions, no negative impacts on wound healing were noted. Conversely, there was reduced incidence of abnormal wounds, with an associated trend toward improved average daily gain at days 11–12 in Tri-Solfen®-treated animals. These data are considered to support the safety of topical anaesthesia, as formulated in Tri-Solfen®, to the thermocautery disbudding wound in calves.

Following abdominal surgery, the provision of postoperative analgesia with local anaesthetic infusion through both transmuscular quadratus lumborum block and pre-peritoneal catheter have been described. This study compared these two methods of postoperative analgesia following laparotomy. Eighty-two patients 18-85 years of age scheduled to undergo elective surgery were randomly allocated to receive either transmuscular quadratus lumborum block or pre-peritoneal catheter block. In the transmuscular quadratus lumborum group, an 18-gauge Tuohy needle was passed through the quadratus lumborum muscle under ultrasound guidance to reach its anterior aspect. A 20-ml bolus of ropivacaine 0.375% was administered and catheters placed bilaterally. In the pre-peritoneal catheter group, 20 ml of ropivacaine 0.375% was infiltrated at each of three subcutaneous sub-fascial levels, and pre-peritoneal plane catheters were placed bilaterally. Both groups received an infusion of ropivacaine 0.2% at 5 ml.h-1 , continued up to 48 h along with a multimodal analgesic regime that included regular paracetamol and patient-controlled analgesia with fentanyl. The primary end-point was postoperative pain score on coughing, assessed using a numerical rating score (0-10). Secondary outcomes were pain score at rest, fentanyl usage until 48 h post-operation, satisfaction scores and costs. There was no treatment difference between the two groups for pain score on coughing (p = 0.24). In the transmuscular quadratus lumborum group, there was a reduction in numerical rating score at rest (p = 0.036) and satisfaction scores on days 1 and 30 (p = 0.004, p = 0.006, respectively), but fentanyl usage was similar. In the transmuscular quadratus lumborum group, the highest and lowest blocks observed in the recovery area were T4 and L1, respectively. The transmuscular quadratus lumborum technique cost 574.64 Australian dollars more per patient than the pre-peritoneal catheter technique. [ABSTRACT FROM AUTHOR]

Aim: Postoperative pain remains a major factor in recovery from colorectal resection. There is increasing interest in opioid‐sparing analgesia, and intraperitoneal local anaesthetic (IPLA) has recently been shown to be useful in minor laparoscopic and open colorectal procedures. The aim of this study was to evaluate the impact of IPLA on functional recovery following major laparoscopic surgery. In this controlled trial, mobility, as measured by the De Morton Mobility Index (DEMMI), was used as a surrogate for postoperative functional recovery. Method: Patients undergoing laparoscopic colorectal resection were randomized either to continuous ropivacaine (0.2% at 4–6 ml/h) or to saline (0.9%) which were administered via intraperitoneal catheter for 3 days postoperatively. Results were analysed in a double‐blind manner. DEMMIs were assessed on postoperative days 1, 2, 3, 7 and 30, and data on pain, opioid consumption, gut and respiratory function, length of stay (LOS) and complications were recorded. Results: Ninety‐six patients were recruited. There was no difference in primary outcome (i.e., functional recovery) between IPLA and placebo groups. Opioid consumption and LOS were similar between groups, and no differences were found for any secondary outcome measure. There were no adverse events related to ropivacaine. Conclusion: Infusional intraperitoneal local anaesthetic appears to be safe but does not improve functional recovery or analgesic consumption following elective laparoscopic colorectal surgery, in the setting of an established enhanced recovery programme. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of formulation parameters on the preparation of transfersomes as sustained‐release delivery systems for lidocaine and to develop and validate a new high‐performance liquid chromatography (HPLC) method for analysis. Method: Taguchi design of experiment (DOE) was used to optimise lidocaine‐loaded transfersomes in terms of phospholipid, edge activator (EA) and phospholipid : EA ratio. Transfersomes were characterised for size, polydispersity index (PDI), charge and entrapment efficiency (%EE). A HPLC method for lidocaine quantification was optimised and validated using a mobile phase of 30%v/v PBS (0.01 m) : 70%v/v Acetonitrile at a flow rate of 1 ml/min, detected at 255 nm with retention time of 2.84 min. The release of lidocaine from selected samples was assessed in vitro. Key findings: Transfersomes were 200 nm in size, with PDI ~ 0.3. HPLC method was valid for linearity (0.1–2 mg/ml, R2 0.9999), accuracy, intermediate precision and repeatability according to ICH guidelines. The %EE was between 44% and 56% and dependent on the formulation parameters. Taguchi DOE showed the effect of factors was in the rank order : lipid : EA ratio ˃ EA type ˃ lipid type. Optimised transfersomes sustained the release of lidocaine over 24 h. Conclusion: Sustained‐release, lidocaine‐loaded transfersomes were successfully formulated and optimised using a DOE approach, and a new HPLC method for lidocaine analysis was developed and validated. [ABSTRACT FROM AUTHOR]

Background: Trigeminal neuralgia (TN) can have a significant impact on wellbeing and quality of life. Limited data exist for treatments that improve TN pain acutely, within 24 h of administration. This systematic review aims to identify effective treatments that acutely relieve TN exacerbations.Methods: We searched Medline and Cochrane Central Register of Controlled Trials (CENTRAL) for relevant English language publications. The reference list for all articles was searched for other relevant publications. All studies that satisfied the following PICO criteria were included: (i) Population-adults with acute exacerbation of primary TN symptoms; (ii) Intervention-any medication or intervention with the primary goal of pain relief within 24 h; (iii) Comparator-usual medical care, placebo, sham or active treatment; (iv) Outcome-more than 50% reduction in pain intensity within 24 h of administration.Results: Of 431 studies, 17 studies were identified that reported immediate results of acute treatment in TN. The evidence suggests that the following interventions may be beneficial: local anaesthetic, mainly lidocaine (ophthalmic, nasal or oral mucosa, trigger point injection, i.v. infusion, nerve block); anticonvulsant, phenytoin or fosphenytoin (i.v. infusion); serotonin agonist, sumatriptan (s.c. injection, nasal). Other referenced interventions with very limited evidence include N-methyl-d-aspartate receptor antagonist (magnesium sulphate infusion) and botulinum toxin (trigger point injection).Conclusions: Several treatment options exist that may provide fast and safe relief of TN. Future studies should report on outcomes within 24 h to improve knowledge of the acute analgesic TN treatments. [ABSTRACT FROM AUTHOR]

Background: Percutaneous nephrolithotomy (PNL) is associated with severe postoperative pain. The current study aimed to investigate the analgesic efficacy of transmuscular quadratus lumborum (TQL) block for patients undergoing PNL surgery.Methods: Sixty patients were enrolled in this single centre study. The multimodal analgesic regime consisted of oral paracetamol 1 g and i.v. dexamethasone 4 mg before surgery and i.v. sufentanil 0.25 μg kg-1 30 min before emergence. After operation, patients received paracetamol 1 g regularly at 6 h intervals. Subjects were allocated to receive a preoperative TQL block with either ropivacaine 0.75%, 30 ml (intervention) or saline 30 ml (control). Primary outcome was oral morphine equivalent (OME) consumption 0-6 h after surgery. Secondary outcomes were OME consumption up to 24 h, pain scores, time to first opioid, time to first ambulation, and hospital length of stay. Results were reported as mean (standard deviation) or median (inter-quartile range).Results: Morphine consumption was lower in the intervention group at 6 h after surgery (7.2 [8.7] vs 90.6 [69.9] mg OME, P<0.001) and at 24 h (54.0 [36.7] vs 126.2 [85.5] mg OME, P<0.001). Time to first opioid use was prolonged in the intervention group (678 [285-1020] vs 36 [19-55] min, P<0.0001). Both the time to ambulation (302 [238-475] vs 595 [345-925] min, P<0.004) and length of stay (2.0 [0.8] vs 3.0 [1.2] days, P≤0.001) were shorter in the intervention group.Conclusions: This is the first blinded, RCT that confirms that unilateral TQL block reduces postoperative opioid consumption and hospital length of stay. Further study is required for confirmation and dose optimisation.Clinical Trial Registration: NCT02818140. [ABSTRACT FROM AUTHOR]

Background: Arthroscopic knee surgery is a common technique used in Australia. Post‐operative pain is common and can lead to delayed discharge and impair early mobilization. Use of local anaesthesia can reduce pain while avoiding systemic side effects. This systematic review and meta‐analysis aimed to establish the use of tramadol as an adjunct to intra‐articular local anaesthetic infiltration in knee arthroscopy in the current literature. Methods: Two independent reviewers performed a systematic search of four databases, where 24 articles were identified with six studies (four high‐quality and two low‐quality randomized controlled trials), with a total of 334 patients were included for analysis. RevMan 5.3 software (The Nordic Cochrane Centre, Copenhagen, Denmark) was used to perform the data analysis. The studies included focused on outcomes such as pain scores, breakthrough analgesia, total analgesia, time to discharge and adverse events related to the use of tramadol as an adjunctive therapy. Results: This study found that using tramadol as an adjunct to intra‐articular local anaesthetic infiltration in arthroscopic knee surgery reduced post‐operative pain and increased time to breakthrough analgesia without an increase in side effects. Conclusion: This meta‐analysis suggests that tramadol is an efficacious adjunct for use in intra‐articular local anaesthetic infiltration following arthroscopic knee surgery. [ABSTRACT FROM AUTHOR]

Aim: To compare the incidence of complication rates as a result of third molar surgery when performed under local versus general anaesthesia. Materials and methods: Data were collected using a combination of computer database and patient records. A total of 277 patients were included in the study (130 local anaesthesia, 147 general anaesthesia). Several variables were collected and assessed including age, gender, method of anaesthesia, radiographic grading and complications. Results: Five hundred and twenty‐three mandibular third molars were removed, 284 being removed under general anaesthesia and 239 under local anaesthesia. There were a total of 20 complications (3.8%), nine of those from procedures performed under local anaesthesia and 11 from procedures performed under general anaesthesia. There was a statistically significant increase of alveolar osteitis for procedures performed under LA. However, when assessing overall complication rate, there was no statistically significant difference in LA versus GA. Conclusions: Teeth more severely impacted or angulated tend to be removed under general anaesthesia for reasons such as surgical access and patient experience. Our study suggests there is an increase in alveolar osteitis when third molars are removed under LA. However, there was no significant correlation found between the method of anaesthesia and overall complication rate when combining all complications. The present study indicates that other variables, such as gender and age may be more important in determination of post‐surgical complication rates after wisdom teeth removal. It is therefore reasonable for clinicians and patients to base their decision for modality of anaesthesia on patient preference, surgical difficulty, medical background and economic factors. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficiency of laparoscopically guided transversus abdominis plane block (LTAP) versus port-site local anaesthetic infiltration (LAI) in reducing postoperative pain following laparoscopic excision of endometriosis.Design: A prospective, double-blind randomised controlled trial.Setting: A tertiary referral centre for endometriosis and minimally invasive gynaecological surgery.Population: Women undergoing laparoscopic excision of endometriosis from December 2015 through July 2016.Methods: Participants were randomised to receive: port-site infiltration with bupivacaine and placebo LTAP (LAI group, n = 21); placebo port-site infiltration and LTAP with bupivacaine (LTAP group, n = 24); placebo port-site infiltration and placebo LTAP (placebo group, n = 25).Main Outcome Measures: Post-operative pain at 2-4, 6-8, 10-12 and 24 hours, analgesic requirements, TAP block-related complications and opioid-related adverse effects.Results: There were no differences in patient characteristics between the groups. In comparison with placebo, both LTAP and LAI groups had significantly less pain at 2-4, 6-8, and 10-12 hours (median 3, 3, 3.5 versus 3, 6, 4 versus 8, 8, 7 for LTAP, LAI, and placebo, respectively, P < 0.05). Median differences (and 95% confidence intervals) were as follows; LTAP versus placebo -5 (-6 to -4), -4 (-5 to -3), -3 (-4 to -0.5); LAI versus placebo -4 (-5 to -2), -2 (-3 to -0.5), -1 (-4 to -0.5) at 2-4, 6-8 and 10-12 hours, respectively. There were no statistically significant differences between the LTAP and LAI groups.Conclusions: Laparoscopically guided transversus abdominis plane block and LAI both reduce postoperative pain in patients undergoing laparoscopic excision of endometriosis, compared with placebo. We found no differences in effect between LTAP and LAI.Tweetable Abstract: TAP block and port-site local infiltration are both effective in reducing postoperative pain in major gynaecological laparoscopic surgery. [ABSTRACT FROM AUTHOR]

Summary Introduction Non-melanoma skin cancer incidence is increasing in New Zealand. Increased cost of care has led to service pressure and a review of models of care. A high-volume skin surgery service at Waikato Hospital has been developed to reduce service costs. This study examines the oncological safety of the new model. Methods Prospective data for all skin lesions excised were collected from December 2014 to December 2016. Primary outcomes were rate of complete excision, rate of incomplete excision and rate of narrow excision. Results A total of 2076 lesions were excised: 92% were complete, 4.2% were narrow and 3.2% were incomplete. Conclusion The rate of narrow and incomplete excisions was low in a service delivered by supervised surgical registrars. The Skin Shop model is safe, inexpensive and suitable for adaptation to safely reduce the cost of skin cancer surgery. [ABSTRACT FROM AUTHOR]

Procaine (PRC) is a local anaesthetic used in the treatment of several disease related to ageing, asthma, and arthritis. In this study, we describe a rapid, sensitive, simple, and accurate method for the determination of PRC in milk, using an immunochromatographic test strip. For the immunochromatographic test, antigen (PRC-bovine serum albumin) and goat anti-mouse IgG were drawn onto a nitrocellulose membrane representing the control line and test line. The test was developed with a sensitive monoclonal antibody specific for PRC, generated by immunizing BALB/c mice with a well-characterized PRC- Keyhole limpet hemocyanin conjugate, produced in our laboratory. Under optimized conditions, the semi-quantitative test strip was able to detect PRC at concentrations down to 1 ng/mL in both 0.01 M phosphate buffer saline (pH 7.4) and milk samples. All results were obtained within 5 min. Our data indicate that the immunochromatographic assay is capable of sensitive, rapid, and specific on-site screening of PRC. [ABSTRACT FROM AUTHOR]

In this study, a new method has been developed for the simple determination of mepivacaine (carbocaine). The method is based on the enhancement effect of mepivacaine in the chemiluminescence (CL) reaction of tris(1,10 phenanthroline)ruthenium(II) with cerium(IV). A mechanism for the CL reaction has been proposed on the basis of UV-Vis, fluorescent and CL spectra. Under optimum conditions, the CL intensity was proportional to the concentration of the drug in solution over the range 0.45-226.25 µg mL-1 (R2=0.9996). The limit of detection (LOD) (S/N=3) was 0.34 µg mL-1. LOD was about 10 times lower than the therapeutic concentration of mepivacaine. The percent of relative standard deviation for determination of 11 replicates at level of 9.05 μg mL-1 and 90.50 μg mL-1 of mepivacaine were 1.8 and 3.7%, respectively. The proposed method was applied successfully for the determination of mepivacaine in human plasma and injectable solutions.

New Zealand deer farming centres on the production of meat and velvet antler. Velvet antler removal is a painful procedure and currently, New Zealand Animal Welfare regulations dictate surgical removal of velvet antlers under lignocaine anaesthesia. To improve our knowledge on the efficacy and duration of other local anaesthetics to mitigate pain after antler removal, it is important to accurately assess and quantify pain arising from antler removal. Therefore, the current study was designed to validate mechanical nociceptive threshold (MNT) testing using a Wagner hand-held algometer, and to apply this methodology to assess the efficacy and duration of action of articaine for antler removal in deer. Baseline force (N) required to elicit the nociceptive response was recorded in 40 yearling male red deer on three alternate days. Ten of the 40 animals were selected for antler removal after administration of 4% articaine hydrochloride as a ring block. The duration of analgesic efficacy of articaine was assessed by algometry across 5 time points. There was a significant difference in MNTs among the three days (day 3 versus day 1 (p < 0.0001), day 2 versus day 1 (p < 0.0001), and day 1 versus day 2 (p < 0.01)). Positive correlations were observed between weight, antler length and thresholds. The MNT values remained above 20N for 6 h after removal of velvet antlers under the articaine ring block. This study provides valuable information about the use of MNT in red deer. These findings lay a foundation for future studies in the topics of peri-operative and postoperative pain management in deer antler removal, and a possible alternative use for articaine.