Home About us Contact
|
Home About us Contact | ||
|
|
||
Local Anaesthesia (local + anaesthesia)
Selected AbstractsDIAGNOSTIC VALUE OF THORACOSCOPIC PLEURAL BIOPSY FOR PLEURISY UNDER LOCAL ANAESTHESIAANZ JOURNAL OF SURGERY, Issue 8 2006Motoki Sakuraba Background: We find pleural effusion in clinical practice frequently. However, it is difficult to make a diagnosis definitively by thoracocentesis or closed pleural biopsy. We directly examine the thoracic cavity by thoracoscopy under local anaesthesia, carry out pleural biopsy and make a definitive pathological diagnosis in pleurisy. Method: A retrospective study of 138 patients who had been diagnosed by thoracoscopy in our hospital was carried out between January 1995 and January 2005. Results: The patients were 114 men and 24 women, ranging in age from 21 to 85 years, with a mean of 59 years. The right side was involved in 83 patients and the left side in 55. The operations took 11,145 min, with a mean of 46 min. Thoracoscopy directly without thoracocenteses was carried out in 28 of 138 patients. Lung cancer with pleural dissemination was diagnosed in 27, malignant pleural mesothelioma in 10, tuberculous pleurisy in 32, non-specific pleurisy in 58, other tumour in 2 and pyothorax in 9 patients. The overall diagnostic efficacy was 97.1% (134/138). The diagnostic efficacy in the cases of carcinoma was 92.6% (25/27), in malignant pleural mesothelioma it was 100% (10/10) and in tuberculosis it was 93.8% (30/32). No major complications occurred during the examination. Conclusion: Pleural biopsy by thoracoscopy under local anaesthesia should be actively carried out in patients with pleurisy, because the technique has a high diagnostic rate and can be easily and safely carried out. [source] Influence of local anaesthesia on the quality of class II glass ionomer restorationsINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 4 2007NANDA VAN DE HOEF Objective., To investigate the influence of local anaesthesia on the quality of class II glass ionomer restorations with discomfort as cofactor. Material and methods., The study population consisted of 6- to 7-year-old schoolchildren in Paramaribo and its environs. To be included, each child needed to have a proximally situated cavity in a primary molar that was accessible to hand instruments and where no pulp exposure was expected. They were randomly divided into four treatment groups: conventional method with and without local anaesthesia and atraumatic restorative treatment method (ART) with and without local anaesthesia. The restoration quality was scored using the evaluation criteria for ART restorations (successful if restoration is correct or has a minor defect and fails if defects are larger than 0.5 mm, if secondary caries is observed, if the restoration is fractured, partly or totally lost or if the pulp is involved) at 6 and 30 months after treatment. The extent of discomfort was registered by assessing the behaviour (modified Venham score) and observing the heart rate during treatment. Results., For this study 153 children were treated with hand instruments (ART) and 146 children with rotary instruments (conventional method). A total of 198 restorations were evaluated during follow-up periods. There were no significant differences in patient discomfort between the ART and the conventional group and between the anaesthesia and the non-anaesthesia group. The conventional restorations demonstrated significantly higher success rates than ART restorations after 6 (P = 0.001) and 30 months (P = 0.032). There were no significant differences in success rate between the anaesthesia and the non-anaesthesia group. Conclusion., Local anaesthesia has no influence on discomfort during treatment. Furthermore, discomfort during treatment does not affect the success rate of restorations. [source] R2 The pattern of extraction of first permanent molars: results from three dental hospitalsINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 2006S. S. ALBADRI Objective:, To determine and compare the reasons and pattern of extraction of first permanent molars (FPM) in 3 UK dental hospitals. Design:, Data were collected prospectively from 300 children attending Manchester Dental Hospital (MDH), Liverpool Dental Hospital (LDH) and Charles Clifford Dental Hospital, Sheffield (CCDH) who required extractions of at least one FPM. Information recorded included age, FPM extracted, reason for extractions, previous treatment, method of extraction, and whether patients had previous extractions. Result:, The mean age in months was 129 (Std 22.7), 139 (Std 29.4), and 133 (Std 26.8) for MDH, LDH, CCDH respectively. 45% and 48% of children had four FPM extracted at MDH & CCDH, respectively, compared to 25% in LDH. The main reason for extraction (70%) was caries with poor prognosis, followed by caries and compensating extraction (14%). Molar Incisal Hypoplasia was the reason for extraction in 11% of cases. General anaesthesia was the main anaesthetic method used with 77%, 55%, and 47% in MDH, LDH and CCDH, respectively. Local anaesthesia was used in 43% of cases in LDH in comparison to 12% and 22% in MDH and CCDH, respectively. 68% of children had received no previous treatment to the FPM and only 5% had fissure sealants placed. 40% of children had previous extractions. Conclusion:, The children who are attending our hospitals for extractions of FPM tend to be older than the recommended age for achieving maximum space closure. This study highlights the need for extensive prevention programs targeted at those children with high caries risk. [source] Local anaesthetics and adjuvants , future developmentsANAESTHESIA, Issue 2010M. D. Wiles Summary The introduction of local anaesthesia some years after the first public demonstration of general anaesthesia not surprisingly created less excitement and interest amongst both the public and the medical profession. However, in its own way, a new revolution was happening. Local anaesthesia produced an increase in the choice of anaesthetic techniques available to practitioners and patients. In common with general anaesthesia, the choice of agents remained very limited for the first six decades, and interest in the practice of local, regional or central neuraxial blockade and the development of new techniques and drugs were hampered by perceived safety issues even as late as the second half of the 20th century. It is only in the last few years that, with an apparent renaissance in the use of local anaesthesia, the pace of development has picked up. As the use and range of techniques has increased, so has interest in solving some of the longstanding problems with the available drugs. [source] Paediatric dentistry in outreach settings: an essential part of undergraduate curricula?EUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 4 2009M. L. Hunter Abstract Introduction:, Although placements in primary care settings remote from dental schools are becoming a common feature of undergraduate dental curricula, little evidence is available regarding the experience of paediatric dentistry gained in this way. Materials and methods:, Treatment logs relating to salaried primary care placements undertaken by the Class of 2007 at Cardiff University School of Dentistry were examined, particular attention being paid to paediatric-specific procedures. Results:, Forty-nine logs relating to placements undertaken in South East Wales and 51 relating to those in North Wales were retrieved. In South East Wales, 90% of students gained experience of primary tooth restoration, 61% carrying out primary endodontics. Sixty-three percent of students undertaking placements in South East Wales and 69% of those placed in North Wales gained experience of primary tooth extraction under local anaesthesia. All but three students gained experience of administering inhalation sedation. Discussion:, The findings of this study should go some way towards reassuring those who have expressed concern that recruitment difficulties within dental schools inevitably lead to increasing numbers of students qualifying without clinical experience of paediatric dental procedures considered to be within the remit of a newly qualified dental practitioner. However, there remains wide variation in the breadth and depth of experience of individual students and it is still possible for some students to graduate without what might be considered core experience in paediatric dentistry. Conclusion:, Salaried primary care settings are ideally placed to provide students with experience of paediatric-specific procedures. Clinical education in paediatric dentistry should, therefore, incorporate the strengths of dental school and placement education. [source] The Neurogenic Vasodilator Response to Endothelin-1: A Study in Human Skin In VivoEXPERIMENTAL PHYSIOLOGY, Issue 6 2000Ruwani Katugampola We have investigated the mediators and mechanisms underlying the vasodilator effects of the potent vasoactive peptide, endothelin-1 (ET-1) and its isomers ET-2 and ET-3 in human skin, in vivo, using cutaneous microdialysis to quantify the release of mediators within the dermal response and scanning laser Doppler imaging to measure changes in blood flux. The effects of local anaesthesia, inhibition of nitric oxide synthase (NOS) by L-NAME and ET receptor blockade on the ET-induced vascular response were also investigated. ET-1, -2 and -3 all caused a dose-dependent area of pallor surrounded by a long-lasting flare which was accompanied by a short-lived burning pruritus. The concentration of nitric oxide (NO) in dialysate collected within the pallor response to 5 ,M ET-1 (1.43 ± 0.64 ,M, n = 5) was not significantly different from baseline levels collected prior to injection (0.86 ± 0.38 ,M) whilst that in the flare increased to reach a peak value of 2.28 ± 0.61 ,M at between 4 and 10 min after intradermal injection (P < 0.004). Pretreatment with local anaesthetic slowed the development of the flare and significantly reduced its size by up to 52% at 20 min after injection (P < 0.05) but had no significant effect on the central pallor. L-NAME, delivered by dialysis also caused a significant reduction in the ET-1-induced flare (P < 0.005). Bosentan, the non-selective ETA/ETB antagonist, when given by dialysis at the site of injection, reduced the area of both the ET-1-induced pallor and surrounding flare by 41 and 26%, respectively. No significant increase in tissue histamine was measured within either the pallor or flare response to ET-1, -2 or -3. Together these data confirm that the vasodilator response to endothelin-1 in human skin is neurogenic in origin and that it is in part mediated by the local release of nitric oxide. There appears to be little evidence for the involvement of mast cell-derived histamine in the initiation or modulation of ET-induced vasodilatation, in vivo. [source] In vivo real-time diagnosis of nasopharyngeal carcinoma in situ by contact rhinoscopyHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 11 2005Martin Wai Pak FRCSEd(ORL) Abstract Background. Nasopharyngeal dysplasia or nasopharyngeal carcinoma in situ (NPCIS) lesions have rarely been reported. Timely diagnosis of the preinvasive lesion may improve prognosis. Contact endoscopy has been documented to accurately differentiate normal cells of the nasopharynx from malignant cells and allows a real-time diagnosis of primary and recurrent nasopharyngeal carcinoma (NPC) in a clinical setting. However, the role of contact endoscopy in the diagnosis of NPCIS is unknown. Methods. The superficial cells of the nasopharynx in a patient with NPCIS were examined in vivo under local anaesthesia by use of a contact rhinoscope. The contact endoscopic findings were correlated with the histologic findings of the biopsy. Results. The atypical cells of the lesion were magnified and visualized under contact endoscopy. Histopathologic analysis of the biopsied tissue confirmed the presence of NPCIS staining positively for Epstein-Barr virus (EBV),encoded RNA (EBER). No cell-free EBV DNA was detected in the sera of the patient. Conclusions. Contact endoscopy can accurately identify the atypical cells of a tiny preinvasive lesion in the nasopharynx in a clinical setting, which may not be evident in routine imaging examination. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source] The efficacy of pain control following nonsurgical root canal treatment using ibuprofen or a combination of ibuprofen and acetaminophen in a randomized, double-blind, placebo-controlled studyINTERNATIONAL ENDODONTIC JOURNAL, Issue 8 2004K. A. Menhinick Abstract Aim, To compare ibuprofen, to an ibuprofen/acetaminophen combination in managing postoperative pain following root canal treatment. It is hypothesized that the drug combination will provide more postoperative pain relief than the placebo or ibuprofen alone. Methodology, Patients presenting at the Texas A&M Baylor College of Dentistry's graduate endodontic clinic, experiencing moderate to severe pain, were considered potential candidates. Fifty-seven patients were included based on established criteria. Following administration of local anaesthesia, a pulpectomy was performed. The patients were administered a single dose of either: (i) placebo; (ii) 600 mg ibuprofen; or (iii) 600 mg ibuprofen and 1000 mg of acetaminophen. Patients recorded pain intensity following treatment on a visual analogue scale and a baseline four-point category pain scale as well as pain relief every hour for the first 4 h then every 2 h thereafter for a total of 8 h. A general linear model (GLM) analysis was used to analyse the outcome. Results, Based upon the GLM analysis, there was a significant difference between the ibuprofen and the combination drug group, and between placebo and combination drug groups. There was no significant difference between the placebo and the ibuprofen. Conclusion, The results demonstrate that the combination of ibuprofen with acetaminophen may be more effective than ibuprofen alone for the management of postoperative endodontic pain. [source] Age-related changes in blood capillary endothelium of human dental pulp: an ultrastructural studyINTERNATIONAL ENDODONTIC JOURNAL, Issue 6 2003A. I. Espina Abstract Aim, To describe the ultrastructural changes that occur in pulpal blood capillaries as a result of ageing. Methodology, Thirty samples of healthy dental pulps were obtained from functional human permanent teeth. Two age groups were examined: young (10,17 years) and old (>60 years). The teeth were extracted under local anaesthesia using mepivacaine without adrenaline (Scandonest 3%, Septodont, Saint-Maur des Fossés, France) and split longitudinally in a bench press. The pulps were gently removed, immersed in fixative solution, sectioned and processed by conventional transmission electron microscopic techniques. Micrographs were taken from the endothelium, and the whole capillary area of each vessel was examined. Results, In young pulps, the endothelial cell layer was characterized by the presence of numerous pinocytotic vesicles and microvesicles, RER cisterns, free ribosomes, a small Golgi complex, centrioles, microtubules, microfilaments and mitochondria. In the endothelial cell cytoplasm of older pulpal vessels, pinocytotic vesicles and microvesicles, as well as microfilaments, were more numerous. In addition, lipid-like vacuoles, monogranular glycogen granules and extensive Golgi complexes with dilated cisterns were also present. Weibel-Palade bodies were observed in both age groups without showing variations related with age. Conclusions, The results obtained in capillaries of aged pulpal tissue suggest that the endothelium experiences morphological changes that could be associated with advancing age. [source] In vivo determination of root canal length: a preliminary report using the Tri Auto ZX apex-locating handpieceINTERNATIONAL ENDODONTIC JOURNAL, Issue 7 2002F. Grimberg Abstract Aim The aim of this study was to assess the clinical perfomance of a cordless handpiece with a built-in apex locator , the Tri Auto ZX , designed for root canal preparation with nickel-titanium rotary files. Methodology Twenty-five human maxillary incisor and canine teeth scheduled for extraction with mature apices were selected for the study. Informed written consent was obtained from each patient before treatment. After administration of local anaesthesia, the teeth were isolated and the pulp cavities accessed. The Tri Auto ZX along with a size 15 K-file was used in its electronic apex locating function based on the manufacturer's recommendations. A periapical radiograph with the file at the electronically determined constriction was taken, the file removed and the measurement registered as the electronic length (EL). To test the auto reverse function, a size 20 ProFile .04 taper NiTi rotary instrument was mounted in the handpiece. The point for the auto apical reverse function was preset on the panel at the 0.5 mm level. After the file was introduced into the canal and reached the predetermined level, the file automatically stopped and rotated in the opposite direction. A reference point was marked and this measurement was registered as the auto reverse length (ARL). All measurements were made twice by two different investigators. Teeth were then extracted and immersed in a 20% formalin solution for 48 h. After fixation, a size 15 file was inserted into the canal to measure the actual root canal length from the same reference point obtained with the Tri Auto ZX to the apical foramen, as seen in the stereo microscope. When the file tip was visible at the anatomical end of the canal it was withdrawn 0.5 mm and this measurement was registered as the actual length (AL). All measurements were expressed in mm and the measuring accuracy was set to 0.5 mm. The significance of the mean differences between EL and ARL and between EL and AL measurements at the 5% confidence level was evaluated. Results EL measurements were coincident to ARL in all instances. EL and ARL were coincident to AL in 10 (40%) canals, in the remaining 15 canals (60%) the AL measurements were longer than EL and ARL (+0.5 mm) in 14 instances and shorter (,0.5 mm) in one case. Overall, the AL was longer than the EL or ARL, the mean difference being ,0.23 mm ± 0.32 (P < 0.05). Conclusions It was concluded that the Tri Auto ZX was useful and reliable. The Tri Auto ZX measurements protected against overpreparation. [source] Endovenous laser ablation for superficial venous insufficiencyINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 1 2010R. Durai Summary Background:, Endovenous laser ablation (EVLA) is a new minimally invasive alternative to conventional surgery for superficial venous insufficiency and varicose veins, where laser energy is used to ablate the incompetent veins. Discussion:, Endovenous laser ablation avoids the need for surgical incisions, and the complications of surgical exploration of the groin or popliteal fossa, and stripping. The procedure is commonly performed under local anaesthesia, with immediate mobilisation and rapid return to normal activity. Severe varicosity of tributaries may require adjunctive procedures such as microphlebectomy or sclerotherapy. Conclusion:, Early outcomes and cosmesis are superior, and long-term data is accumulating that recurrence of EVLA rates may be lower. [source] Analysis of factors affecting pain in intravenous catheter placement: a survey of 925 patientsINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 6 2005S. Soysal Summary The aim of the study was to determine some factors affecting pain during intravenous (i.v.) catheter placement in an emergency department (ED). A cross-sectional, observational study was conducted at an academic ED. Nine hundred and twenty five adult patients who had a 20 gauge i.v. catheter placed were enrolled the study. Patients were excluded for the following conditions: more than one i.v. attempt, altered mental status, head trauma, lack of contact due to visual impairment, hearing or speech disorder, intoxication, distracting injury or physical abnormality at the i.v. site. The magnitude of pain of i.v. catheter placement was not related to age, sex, experience of the individual placing the i.v. catheter, site of i.v. catheter insertion and use of analgesic or antidepressive drugs (p > 0.05). Patients with a history of depression reported significantly higher pain than non-depressive patients (p = 0.001). Depressive patients reported higher severity of pain during i.v. catheter placement than nondepressed ones. This may influence the decision on whether or not to use local anaesthesia for catheter insertion. [source] Dental hygiene students' part-time jobs in dental practices in the NetherlandsINTERNATIONAL JOURNAL OF DENTAL HYGIENE, Issue 2 2010JHG Poorterman To cite this article: Int J Dent Hygiene DOI: 10.1111/j.1601-5037.2009.00415.x Poorterman JHG, Dikkes BT, Brand HS. Dental hygiene students' part-time jobs in dental practices in the Netherlands. Abstract:, Objective:, Many students have paid employment while studying. In the Netherlands, the Individual Health Care Professions Act (IHCP Act) allows dental hygiene students to work under certain conditions in a dental practice. The aim of the study was to determine how many dental hygiene students have part-time job employment in dental practice and which professional tasks they carry out. We also asked the dental hygiene students their opinion of the IHCP Act. Methods:, All the enrolled dental hygiene students (n = 341) at a School of Health in the Netherlands received a questionnaire by email. Results:, The response was 52% (176 students). Of the responding students, 75% had paid employment in addition to their study. A proportion of the students (35%) worked in a dental practice. The median number of hours worked per week was eight. Study year, age and prior education were positively related to working part-time in dental practice. Activities frequently performed were giving oral hygiene instruction, fluoride applications, scaling and root planning, providing chair side assistance and giving local anaesthesia. Although the self-reported knowledge about the IHCP Act was high, almost half of the students expressed the need for more detailed legal information. Conclusions:, Many dental hygiene students work in a dental practice, taking over a number of tasks usually performed by the dentist. More information in the dental hygiene curriculum about the requirements of the IHCP Act seems desirable. [source] Suspected allergy to local anaesthetics: follow-up in 135 casesACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2010T. HARBOE Background: Local anaesthetics (LA) are generally considered safe with respect to allergy. However, various clinical reactions steadily occur. Even though most reactions are manifestations of reflexes to perceptive stimuli, uncertainty often remains regarding a possible allergic mechanism. This uncertainty later leads to an avoidance of local anaesthesia and unnecessarily painful interventions, resource-consuming general anaesthesia or even the risk of re-exposure to other yet unidentified allergens. In the present study, follow-up procedures at an allergy clinic were analysed to examine the frequency of identified causative agents and pathogenetic mechanisms and evaluate the strength of the diagnostic conclusions. Method: The medical records of 135 cases with alleged allergic reactions to LA were reviewed. Diagnoses were based on case histories, skin tests, subcutaneous challenge tests and in vitro IgE analyses. Results: Two events (1.5%) were diagnosed as hypersensitivity to LA, articaine,adrenaline and tetracaine,adrenaline, respectively. Ten reactions (7%) were diagnosed as IgE-mediated allergy to other substances including chlorhexidine, latex, triamcinolone and possibly hexaminolevulinate. As challenge testing was not consistently performed with the culprit LA compound, follow-ups were short of definitely refuting hypersensitivity in 61% of the cases. The reported clinical manifestations were in general diagnostically unspecific, but itch and generalised urticaria were most frequent in test-positive cases. Conclusion: Reactions during local anaesthesia are rarely found to be an IgE-mediated LA allergy. Whenever the clinical picture is compatible with allergy, other allergens should also be tested. [source] Influence of local anaesthesia on the quality of class II glass ionomer restorationsINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 4 2007NANDA VAN DE HOEF Objective., To investigate the influence of local anaesthesia on the quality of class II glass ionomer restorations with discomfort as cofactor. Material and methods., The study population consisted of 6- to 7-year-old schoolchildren in Paramaribo and its environs. To be included, each child needed to have a proximally situated cavity in a primary molar that was accessible to hand instruments and where no pulp exposure was expected. They were randomly divided into four treatment groups: conventional method with and without local anaesthesia and atraumatic restorative treatment method (ART) with and without local anaesthesia. The restoration quality was scored using the evaluation criteria for ART restorations (successful if restoration is correct or has a minor defect and fails if defects are larger than 0.5 mm, if secondary caries is observed, if the restoration is fractured, partly or totally lost or if the pulp is involved) at 6 and 30 months after treatment. The extent of discomfort was registered by assessing the behaviour (modified Venham score) and observing the heart rate during treatment. Results., For this study 153 children were treated with hand instruments (ART) and 146 children with rotary instruments (conventional method). A total of 198 restorations were evaluated during follow-up periods. There were no significant differences in patient discomfort between the ART and the conventional group and between the anaesthesia and the non-anaesthesia group. The conventional restorations demonstrated significantly higher success rates than ART restorations after 6 (P = 0.001) and 30 months (P = 0.032). There were no significant differences in success rate between the anaesthesia and the non-anaesthesia group. Conclusion., Local anaesthesia has no influence on discomfort during treatment. Furthermore, discomfort during treatment does not affect the success rate of restorations. [source] Administering local anaesthesia to paediatric dental patients , current status and prospects for the futureINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 2 2002D. Ram Summary .,Fear-related behaviours have long been recognized as the most difficult aspect of patient management and can be a barrier to good care. Anxiety is one of the major issues in the dental treatment of children, and the injection is the most anxiety-provoking procedure for both children and adults. There is a constant search for ways to avoid the invasive, and often painful, nature of the injection, and to find more comfortable and pleasant means for anaesthesia before dental procedures. Objective. The purpose of the present review is to summarize relevant data on topics connected with the administration of local anaesthesia. Methods. The review will survey the current available methods, viz. electronic anaesthesia, lidocaine patch, computerized anaesthesia (the Wand), and the syrijet as well as the conventional injection, used for paediatric patients. Conclusions. Usually new techniques for locally anaesthetizing dental patients are tested on adults. However, despite recent research in the field, the injection remains the method of choice. It is necessary to continue to conduct studies using new techniques on adults and children, so that a more acceptable technique can be found. [source] Sedation with midazolam versus local anaesthesia with lignocaine for transrectal prostate biopsiesINTERNATIONAL JOURNAL OF UROLOGICAL NURSING, Issue 2 2008Ilana Golan Abstract Transrectal ultrasound-guided needle biopsy of the prostate is the only method for diagnosing prostate cancer. Although tolerated by most patients, 65,90% of patients complain of pain during the procedure. Most urologists utilize ultrasound-guided transrectal injection of lignocaine. Intravenous sedation with short-acting medications such as midazolam has been successfully used during many invasive ambulatory procedures, reducing discomfort and anxiety. The aim of this study was to compare the efficacy of pain and anxiety reduction using intravenous sedation with midazolam versus local anaesthesia with lignocaine during transrectal biopsies of the prostate in a cross-sectional study. Ninety consecutive candidates for transrectal prostate biopsy were divided into 2 groups. Group A received periprostatic block with 2% lignocaine and group B received sedation with intravenous injection of 4 mg midazolam prior to insertion of the probe. Side-effects and patient satisfaction were documented by questionnaires, which included a pain visual analogue scale (VAS). Significant differences were found between the two groups with respect to the patient's perceived intensity of pain. Pain level expressed by a VAS was 4·2 in group A and 1·9 in group B (P < 0·001). Eighty-seven per cent of the patients in group B stated that they would be willing to repeat the procedure if necessary compared with 55% in group A (P = 0·002). There were no complications or side-effects as a result of midazolam sedation. Midazolam is more effective in relieving pain and anxiety during transrectal prostate biopsies and as safe as a local injection of lignocaine. [source] Chronic, painful lower extremity wounds: postoperative pain management through the use of continuous infusion of regional anaesthesia supplied by a portable pump deviceINTERNATIONAL WOUND JOURNAL, Issue 3 2010Christy L Scimeca Reducing and preventing postoperative pain are currently a topic of great interest. There are different modalities for providing analgesia that can provide an alternative or adjunct to opioid therapy. One mode of therapy involves the use of portable pain pump devices that can deliver continuous local anaesthesia directly to the site of interest. A considerable amount of attention in literature has been dedicated to using regional anaesthesia postoperatively for various surgical applications. However, to our knowledge, little or no work has been published concerning the use of infusion of regional anaesthesia in the treatment of painful lower extremity wounds. We present a case report of a 55-year-old gentleman with a complex past medical history, 2-year history of opioid dependency and a 2-week history of intractable pain associated with the combination of debilitating painful diabetic neuropathy and painful lower extremity wounds. After surgical debridement of the lower extremity wounds, substantial analgesia was achieved postoperatively through the implantation of a portable direct infusion pump device. The device supplied 2 ml/hour of 0·25% bupivacaine and resulted in a reduction in pain within the first hour of implantation. Although the device achieved maximal analgesia at 6 hours, we found that this could have been likely reduced through the use of a 5-ml bolus dose of 0·25% bupivacaine at the time of implantation. The device provided sufficient analgesia to the patient without any observed adverse effects, and showed significant potential in avoiding an increase in his requirement for other systemic analgesia including opioids. [source] Unilateral paravertebral block: an alternative to conventional spinal anaesthesia for inguinal hernia repairACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2010P. BHATTACHARYA Background: Inguinal herniorrhaphy can be successfully performed using general, regional or local anaesthesia. Paravertebral block (PVB) has been used for unilateral procedures such as thoracotomy, breast surgery, chest wall trauma, hernia repair or renal surgery. Methods: We compared unilateral lumbar PVB with conventional spinal anaesthesia (SA) in 60 consenting ASA I and II males aged 18,65 years, scheduled for unilateral inguinal hernia repair. Patients were randomly assigned into two groups, P (n=30) or S (n=30) to receive either PVB or SA, respectively. Two patients (7%) in group P had to be converted to general anaesthesia due to block failure. During surgery, patients of both groups received intravenous infusion of propofol titrated to light sedation. Results: The time to first post-operative analgesic requirement (primary outcome measure) as 342 ± 73 min in group P and 222 ± 22 min in group S (P<0.0001). Time to ambulation was 234 ± 111 min in group P and 361 ± 32 min in group S (P<0.0001). Urinary retention requiring catheterization were found in zero (0%) patients in group P compared with five (16%) in group S (P=0.024). Conclusion: It can be concluded that unilateral PVB is more efficacious than conventional SA in terms of prolonging post-operative analgesia and reducing morbidities in patients undergoing elective unilateral inguinal hernia repair. [source] Long-lasting infiltration anaesthesia by lidocaine-loaded biodegradable nanoparticles in hydrogel in ratsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2009Q.-Q. YIN Background: Infiltration of a long-lasting anaesthetic is helpful during the post-operative period. The recently developed local drug delivery system, biodegradable nanoparticles in a thermo-sensitive hydrogel (nanogel system), may possibly provide an extended duration of drugs. Therefore, we evaluated whether prolonged infiltration anaesthesia could be achieved by loading lidocaine into this delivery system. Methods: Thirty male rats were randomized into five groups of six rats each: saline; 2% hydrochloride lidocaine solution; lidocaine-loaded nanogel system and its compositing formulations, namely lido,nano gel; lido,nano; and lidogel. Durations of local anaesthesia with subcutaneously injected agents were measured by tail flick latency tests in a randomized, blind fashion. Results: Lido,nano gel produced effective anaesthesia for 360±113 min, compared with 150±33 min by lidogel, 180±37 min by lido,nano, and 110±45 min by lidocaine solution (P<0.001, means±SD), and elicited complete sensory blockade for 300±114 min, compared with 75±37 min by lidogel, 105±53 min by lido,nano, and 60±33 min by lidocaine solution (P<0.001, means±SD) without severe skin/systemic toxicity. Conclusion: Lidocaine-loaded biodegradable nanoparticles in hydrogel produced prolonged infiltration anaesthesia in rats without severe toxicity, indicating a possible way to develop long-lasting local anaesthetics. [source] Modelling emergency decisions: recognition-primed decision making.JOURNAL OF CLINICAL NURSING, Issue 8 2006The literature in relation to an ophthalmic critical incident Aims., To review and reflect on the literature on recognition-primed decision (RPD) making and influences on emergency decisions with particular reference to an ophthalmic critical incident involving the sub-arachnoid spread of local anaesthesia following the peribulbar injection. Background., This paper critics the literature on recognition-primed decision making, with particular reference to emergency situations. It illustrates the findings by focussing on an ophthalmic critical incident. Design., Systematic literature review with critical incident reflection. Methods., Medline, CINAHL and PsychINFO databases were searched for papers on recognition-primed decision making (1996,2004) followed by the ,snowball method'. Studies were selected in accordance with preset criteria. Results., A total of 12 papers were included identifying the recognition-primed decision making as a good theoretical description of acute emergency decisions. In addition, cognitive resources, situational awareness, stress, team support and task complexity were identified as influences on the decision process. Conclusions., Recognition-primed decision-making theory describes the decision processes of experts in time-bound emergency situations and is the foundation for a model of emergency decision making (Fig. 2). Figure 2. ,Influences and processes of RPD making. Relevance to clinical practice., Decision theory and models, in this case related to emergency situations, inform practice and enhance clinical effectiveness. The critical incident described highlights the need for nurses to have a comprehensive and in-depth understanding of anaesthetic techniques as well as an ability to manage and resuscitate patients autonomously. In addition, it illustrates how the critical incidents should influence the audit cycle with improvements in patient safety. [source] The temporal course of mucoperiosteal flap revascularization at guided bone regeneration-treated implant sites: a pilot studyJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 10 2009Dan M. J. Milstein Abstract Aims: To investigate post-operative capillary density regeneration in healing mucoperiosteal flaps at guided bone regeneration-treated implant sites. Material and Methods: A non-invasive post-operative investigation was performed in 10 patients using orthogonal polarization spectral (OPS) imaging for assessment of capillary density during the course of mucoperiosteal flap wound healing for 6 weeks in patients receiving dental implants. Results: The greatest increase in capillary regeneration occurred in the early wound-healing phase, during weeks 1 and 2, and recovery to baseline was achieved between weeks 4 and 5. A comparison of adjacent OPS measurements indicated that differences between the time point immediately following administration of local anaesthesia and directly post-operatively ( p=0.002), between a directly post-operative time point and after 1 week (p=0.009), and between post-operative weeks 1 and 2 (p=0.036) were statistically significant. Conclusions: The early healing phase of mucoperiosteal flaps is characterized by rapid capillary regeneration. OPS imaging enabled the possibility to monitor and quantify the temporal development of mucoperiosteal flap revascularization following periodontal surgery. [source] Acellular dermal matrix allograft used to gain attached gingiva in a case of epidermolysis bullosaJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 11 2003Eralp Buduneli Abstract Background: Epidermolysis bullosa (EB) is an acquired disease or inherited as either autosomal dominant or recessive with an incidence of 1/50,000. The prominent clinical characteristic of the disease is the development of bullae or vesicles in mucosa or skin in response to minor trauma. Aim: A female patient with a dystrophic type of EB had been put in a maintenance regimen after completion of the initial phase of periodontal therapy and followed for 7 years. The purpose of this report is to document acellular dermal matrix allograft application to increase the width of the attached gingiva in this patient experiencing difficulty in chewing and performing plaque control due to the dramatic loss of attached gingiva after 7 years of supportive periodontal therapy. Methods: Under local anaesthesia and antibiotic coverage, the acellular dermal matrix allograft was applied in the anterior region of the upper jaw in order to increase the width of attached gingiva, thereby improving patient comfort. Results: The healing was uneventful and a significant gain in attached gingiva dimensions was observed 9 months after the periodontal surgery. The procedure avoided a second surgical site, provided satisfactory results from an aesthetic point of view, and improved patient comfort. Conclusion: Acellular dermal matrix allograft may be regarded as an alternative in the treatment of EB cases to increase the width of attached gingiva and facilitate maintenance of the dentition. Zusammenfassung Hintergrund: Die Epidermolysis bullosa (EB) ist eine erworbene oder eine autosomal dominant oder rezessiv vererbte Krankheit mit einer Incidenz von 1:50,000. Die hervorstechenden klinischen Symptome dieser Erkrankung sind die Entwicklung von Blasen oder Vesikeln in der Mukosa oder in der Haut auf geringste Traumen. Ziel: Eine Frau mit dem dystrophischen Typ von EB wurde in der Erhaltungsphase seit 7 Jahren geführt, nachdem die initiale Phase der parodontalen Therapie beendet worden war. Der Zweck dieser Studie ist die Dokumentation der Applikation eines azellulären Hautmatrixtransplantats für die Verbreiterung der fest angewachsenen Gingiva bei dieser Patientin, die nach 7 Jahren der erhaltenden parodontalen Therapie Probleme beim Kauen und bei der Durchführung der Plaquekontrolle durch einen starken Verlust an fest angewachsener Gingiva hatte. Methoden: Unter lokaler Anästhesie und antibiotischer Abschirmung wurde das azelluläre Hautmatrixtransplantat in die anteriore Region des Oberkiefers appliziert, um die Breite der fest angewachsenen Gingiva zu vergrößern und so das Befinden der Patientin zu verbessern. Ergebnisse: Die Heilung war komplikationslos, und ein signifikanter Gewinn an fest angewachsener Gingiva 9 Monate nach der parodontalen Operation wurde beobachtet. Die Methode vermied eine zweite chirurgische Region, erbrachte zufriedenstellende Ergebnisse aus ästhetischer Sicht und verbesserte das Befinden der Patientin. Schlussfolgerung: Das azelluläre Hautmatrixtransplantat kann als eine Alternative in der Behandlung von EB betrachtet werden, um die Breite der fest angewachsenen Gingiva zu vergrößern und zur Möglichkeit der Erhaltung der Dentition beizutragen. Résumé La bullose épidermolysie (EB) est une maladie contractée ou héritée qui peut être aussi bien autosomale dominante que récessive avec une fréquence de 1/50,000. La caractéristique clinique importante de la maladie est le développement de bulles ou de vésicules au niveau de la muqueuse ou de la peau comme réponse à un traumatisme mineur. Une femme avec un type dystrophique de EB a été placée dans un régime de maintenance après la fin de la phase initiale du traitement parodontal et suivie durant sept années. Le but de ce rapport est de documenter le placement d'un allographe de la matrice dermique acellulaire visant à augmenter la largeur de la gencive attachée chez cette patiente qui avait des problèmes aux niveaux masticatoire et du contrôle de la plaque dentaire vu la perte dramatique de la gencive attachée après sept années de maintenance parodontale. Sous anesthésie locale et sous couverture antibiotique, l'allographe de la matrice dermique acellulaire a été placé dans la région antérieure de la mâchoire supérieure pour augmenter la largeur de la gencive attachée afin d'améliorer le confort de la patiente. La guérison s'est déroulée sans problème et un gain significatif de gencive attachée a été observé neuf mois après la chirurgie parodontale. Ce processus chirurgical élimine la nécessité d'avoir un site donneur, apporte des résultats satisfaisants du point de vue esthétique et améliore le confort du patient. L'allographe de la matrice dermique acellulaire peut donc être considéré comme une alternative dans le traitement des cas de EB afin d'augmenter la largeur de la gencive attachée et faciliter le maintien de la dentition. [source] Subgingival debridement of root surfaces with a micro-brush: macroscopic and ultrastructural assessmentJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 9 2001Helen M. Carey Abstract Aim: The aim of this study was to assess the use of a micro-brush to remove plaque deposits from subgingival, periodontally involved root surfaces in vivo. Methods: 30 periodontally involved teeth requiring extraction for periodontal or prosthetic reasons in 26 adult patients were utilised. For inclusion, teeth had to display at least 30% bone loss radiographically. Following the establishment of local anaesthesia, grooves were cut on the proximal root surface adjacent to the gingival margin at the line angles. For each tooth, 1 proximal root surface was rubbed with the micro-brush for 2 min to the depth of the pocket whilst the other root surface acted as an undebrided control. The teeth were then extracted, rinsed in 0.85% NaCl, stained with 2% erythrosine solution and photographed. The amount of erythrosine staining on each subgingival, periodontally involved root surface was assessed by tracing the areas of stain on a colour photograph and scanning the tracings into a computerised image tracing program. Results: Results were expressed as the % of the periodontally involved root-surface area that exhibited staining. Stained areas were further examined with the scanning electron microscope (SEM). The undebrided root surfaces each displayed 100% staining. The debrided surfaces (with probing pocket depths of 4,10 mm) displayed mean staining of 16.1% (SD ±7.1%) of the proximal surface area. SEM assessment showed that undebrided root surfaces were covered with thick deposits of bacteria. On debrided surfaces, stain-free areas were free of plaque whilst areas of faint staining exhibited either no plaque, calculus deposits or scanty, isolated islands of bacteria. Bacteria had been partially removed from the surface of calculus in some areas. Conclusions: The findings indicate that subgingival debridement with a micro-brush is effective in removing plaque deposits from periodontally involved root surfaces. Zusammenfassung Das Ziel dieser Studie war es, den Gebrauch eines Mikrobürstchens zur subgingivalen Entfernung von Plaqueablagerungen an parodontal befallenen Wurzeloberflächen in vivo zu bewerten. An 26 erwachsenen Patienten wurden 30 parodontal befallene Zähne verwendet, die aus parodontalen oder prothetischen Gründen extrahiert werden sollten. Um in die Studie eingeschlossen zu werden mussten die Zähne mindestens 30% röntgenologischen Knochenabbau aufweisen. Nach Durchführung der Lokalanästhesie wurden an den Kanten der Approximalfläche neben dem Gingivarand Rillen angebracht. An jedem Zahn wurde eine Approximalfläche für 2 Minuten bis in die Tiefe der Tasche mit dem Mikrobürstchen abgerieben, während die andre Wurzeloberfläche als unbearbeitete Kontrolle fungierte. Die Zähne wurden anschließend extrahiert, mit 0.85% NaCl gespült, mit 2% Erythrosinlösung gefärbt und photographiert. Die Fläche jeder subgingivalen Erythrosinfärbung der parodontal befallenen Wurzeloberfläche wurde bewertet, indem die Flächen mit Färbung auf einer Farbphotographie mit einem computerisierten Bildauswertungsprogramm gescannt wurden. Die Ergebnisse wurden als Prozentsatz der parodontal befallenen Wurzeloberfläche, die eine Färbung aufwies, dargestellt. Des weiteren wurden die gefärbten Bereiche mit einem Rasterelektronenmikroskop (SEM) untersucht. Die unbearbeiteten Wurzeloberflächen zeigten jeweils eine 100%ige Färbung. Die bearbeiteten Wurzeloberflächen (mit klinischer Sondierungstiefe von 4,10 mm) zeigten einen durchschnittlichen Anteil der Färbung von 16.1% (SD±7.1%) der Approximalfläche. Die SEM-Untersuchung zeigte, dass die unbearbeiteten Wurzeloberflächen mit dicken bakteriellen Ablagerungen bedeckt waren. Auf den bearbeiteten Oberflächen waren die Flächen ohne Färbung auch frei von Plaque, während die Flächen mit schwacher Färbung entweder keine Plaque, Zahnsteinablagerung oder vereinzelte, isolierte Inseln mit Bakterien zeigten. In einigen Bereichen wurden die Bakterien teilweise von den Zahnsteinoberflächen entfernt. Die Ergebnisse zeigen, dass das subgingivale Debridement mit einem Mikrobürstchen, bei der Entfernung der Plaqueablagerungen auf parodontal befallenen Wurzeloberflächen, effektiv ist. Résumé Le but de cette étude a été d'évaluer in vivo l'utilisation d'une micro-brosse lors d'enlèvement de dépôts de plaque dentaire sous-gingivaux au niveau de surfaces radiculaires avec parodontite. 30 dents avec problèmes parodontaux requérant l'avulsion pour des raisons parodontales ou prothétiques chez 26 adultes ont été utilisées. Les critères d'inclusion étaient que les dents devaient avoir au moins 30% de perte osseuse jugée radiographiquement. A la suite de l'anesthésie, des marques ont été placées sur la surface radiculaire interproximale adjacente à la gencive marginale dans l'angle de la dent. Pour chaque dent, une surface radiculaire proximale a été nettoyée avec cette micro-brosse pendant deux minutes à la profondeur de la poche tandis que l'autre surface radiculaire servait de contrôle non-nettoyé. Ces dents ont ensuite été avulsées, rincées avec du NaCl 0.85%, colorées avec une solution d'érythrosine 2% et photographiées. La quantité de coloration sur chaque surface radiculaire sous-gingivale avec parodontite a été analysée en traçant les zones de coloration sur une photographie couleur et en effectuant un balayage des tracés par ordinateur. Les résultats ont été exprimés en pourcentage de surface radiculaire avec parodontite ayant une coloration. Les zones colorées ont ensuite été examinées à l'aide du MEB. Les surfaces radiculaires non-traitées avaient 100% de coloration. Les surfaces nettoyées qui avaint une profondeur de poche de 4 à 10 mm avaient une coloration moyenne de 16±7% de l'aire de surface interproximale. L'analyse au MEB a montré que les surfaces radiculaires non-nettoyées étaient recouvertes de dépôts épais de bactéries. Sur les surfaces nettoyées des zones libres de coloration se retrouvaient sans plaque dentaire tandis que les zones avec une faible coloration montraient de la plaque dentaire, des dépôts de tartre ou des petits îlots de bactéries. Celles-ci avaient été enlevées partiellement de la surface du tartre à certains endroits. Un nettoyage sous-gingival avec cette micro-brosse s'avère donc efficace à enlever les dépôts de plaque dentaire des surfaces radiculaires avec parodontite. [source] Chemomechanical caries removal in primary teeth in a group of anxious childrenJOURNAL OF ORAL REHABILITATION, Issue 8 2003G. Ansari summary Chemomechanical removal of dental caries has considerable potential in the treatment of patients with management problems, especially in paediatric dentistry. The aim of this study was to assess the acceptance and success of the technique in young nervous patients. A group of 20 patients, aged between 4 and 10 years with a high level of dental anxiety was selected. The study achieved a success rate of over 90% in acceptance of cavity preparation by this procedure followed by placement of a restoration. The length of time required for cavity preparation was comparable with conventional methods. The need for local anaesthesia was reduced or eliminated and the children did not complain of any pain during the procedure. It is concluded that chemomechanical caries removal in vivo in primary teeth is an effective alternative to conventional mechanical caries removal and is advantageous in patients who have a phobia to the dental handpiece and/or injections. [source] Anaesthesia and post-operative morbidity after elective groin hernia repair: a nation-wide studyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2008M. BAY-NIELSEN Background: Randomised studies suggest regional anaesthesia to have the highest morbidity and local infiltration anaesthesia to have the lowest morbidity after groin hernia repair. However, implications and results of this evidence for general practice are not known. Methods: Prospective nation-wide data collection in a cohort of n=29,033 elective groin hernia repairs, registered in the Danish Hernia Database in three periods, namely July 1998,June 1999, July 2000,June 2001 and July 2002,June 2003. Retrospective analysis of complications in discharge abstracts, identified from re-admission within 30 days post-operatively, prolonged length of stay (>2 days post-operatively) or death. Results: Complications after groin hernia repair were more frequent in patients 65+ years (4.5%), compared with younger patients (2.7%) (P<0.001). In patients 65+ years, medical complications were more frequent after regional anaesthesia (1.17%), compared with general anaesthesia (0.59%) (P=0.003) and urological complications were more frequent after regional anaesthesia (0.87%), compared with local infiltration anaesthesia (0.09%) (P=0.006). Seventeen prostatectomies occurred after post-operative urinary retention, but with no case after local anaesthesia. Mortality within 30 days after elective groin hernia repair was 0.12%. Regional anaesthesia was disproportionately more often used in patients dying within 1 week post-operatively. Conclusion: Choice of the anaesthetic technique should be adjusted to available procedure-specific scientific evidence and the use of regional anaesthesia in elderly patients undergoing groin hernia repair is not supported by existing evidence. [source] Anxiety and pain experience of patients undergoing intra-oral buccal mucosa biopsyORAL SURGERY, Issue 3 2009C.S. Barrett Abstract Aim:, The aim of this study was to investigate anxiety levels, expected pain and actual pain experienced by patients undergoing intra-oral biopsy. Materials and methods:, Forty-four patients who required a single site, buccal mucosa biopsy under local anaesthesia as their first ever oral biopsy were recruited. Data were collected immediately before and after their biopsy procedure. This included demographic information, state and trait sections of Spielberger's State Trait Anxiety Inventory and 100 mm visual analogue scales for expected pain and actual pain. Data were analysed using paired t -tests, independent t -tests and Pearson's product moment correlation coefficient. Results and conclusions:, Patients were anxious pre-operatively (mean s-anxiety 42.02), which was a highly statistically significant rise above baseline (P < 0.001). Patients expected (40.4) significantly (P < 0.001) higher pain from the procedure than they actually experienced (4.5). There were some indicators that women and patients with high trait anxiety were more likely to be anxious pre-operatively. [source] Prospective evaluation of flex-rigid pleuroscopy for indeterminate pleural effusion: Accuracy, safety and outcomeRESPIROLOGY, Issue 6 2007Pyng LEE Objective: This study aimed to assess prospectively the accuracy, safety and outcome of flex-rigid pleuroscopy in the diagnosis of patients with indeterminate pleural effusions. Methods: Included in the study were all patients with unilateral exudative pleural effusions of unknown aetiology who underwent diagnostic flex-rigid pleuroscopy from July 2003 to June 2005, and were followed until December 2005. The procedure was conducted in the endoscopy suite under local anaesthesia and, where indicated, talc poudrage was carried out at the same time. Clinical data, length of hospitalization, chest tube drainage, outcome, diagnostic accuracy of pleuroscopy and procedure-related adverse events were recorded prospectively. Results: Fifty-one patients were recruited (20 male and 31 female). Median age was 53 years (range 45,67). Flex-rigid pleuroscopy was 96% accurate and yielded a diagnosis in 49 out of 51 patients. It was safely carried out without need for surgical intervention, blood transfusion or endotracheal intubation. Culture-negative fever was observed in eight patients (16%), and five patients (10%) required additional analgesia for postoperative pain. Duration of chest tube drainage and length of stay for patients who underwent diagnostic pleuroscopy were 1 and 2 days, respectively, while they were both 3 days when talc poudrage was carried out. Success rates with pleuroscopic talc pleurodesis for malignant pleural effusions were 94%, 92% and 89.5% at 3, 6 and 12 months, respectively, and the 30-day mortality was 0%. Conclusion: Flex-rigid pleuroscopy is a safe procedure with a high diagnostic accuracy and should be considered for the evaluation of indeterminate pleural effusion. [source] Evidence that the human cutaneous venoarteriolar response is not mediated by adrenergic mechanismsTHE JOURNAL OF PHYSIOLOGY, Issue 2 2002C. G. Crandall The venoarteriolar response causes vasoconstriction to skin and muscle via local mechanisms secondary to venous congestion. The purpose of this project was to investigate whether this response occurs through ,-adrenergic mechanisms. In supine individuals, forearm skin blood flow was monitored via laser-Doppler flowmetry over sites following local administration of terazosin (,1 -antagonist), yohimbine (,2 -antagonist), phentolamine (non-selective ,-antagonist) and bretylium tosylate (inhibits neurotransmission of adrenergic nerves) via intradermal microdialysis or intradermal injection. In addition, skin blood flow was monitored over an area of forearm skin that was locally anaesthetized via application of EMLA (2.5 % lidocaine (lignocaine) and 2.5 % prilocaine) cream. Skin blood flow was also monitored over adjacent sites that received the vehicle for the specified drug. Each trial was performed on a minimum of seven subjects and on separate days. The venoarteriolar response was engaged by lowering the subject's arm from heart level such that the sites of skin blood flow measurement were 34 ± 1 cm below the heart. The arm remained in this position for 2 min. Selective and non-selective ,-adrenoceptor antagonism and presynaptic inhibition of adrenergic neurotransmission did not abolish the venoarteriolar response. However, local anaesthesia blocked the venoarteriolar response without altering ,-adrenergic mediated vasoconstriction. These data suggest that the venoarteriolar response does not occur through adrenergic mechanisms as previously reported. Rather, the venoarteriolar response may due to myogenic mechanisms associated with changes in vascular pressure or is mediated by a non-adrenergic, but neurally mediated, local mechanism. [source] ORIGINAL ARTICLE: Analgesic efficacy of intracapsular and intra-articular local anaesthesia for knee arthroplastyANAESTHESIA, Issue 9 2010L. Ø. Andersen Summary The optimal site for wound delivery of local anaesthetic after total knee arthroplasty is undetermined. Sixty patients having total knee arthroplasty received intra-operative infiltration analgesia with ropivacaine 0.2% and were then were randomly assigned to receive either intracapsular or intra-articular catheters with 20 ml ropivacaine 0.5% given at 6 h and again at 24 h, postoperatively. Analgesic efficacy was assessed for 3 h after each injection, using a visual analogue score, where 0 = no pain and 100 = worst pain. There was no statistically significant difference between groups. Maximum pain relief (median (IQR [range])) at rest observed in the 3 h after the 6 and 24 h postoperative injections was 17 (7,31 [0,80]) and 10 (4,27 [0,50]) p = 0.27 for 6,9 h; and 17 (7,33 [0,100]) and 13 (3,25 [0,72]) p = 0.28 for 24,27 h, for intracapsular and intra-articular, respectively. Intracapsular local anaesthetic has similar analgesic efficacy to intra-articular after total knee arthroplasty. [source] | ||||||||||||||||||||||||||||||||||