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Needle Insertion (needle + insertion)

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Medical Sciences	100%

Selected Abstracts

A Randomized, Double-blind Controlled Study of Jet Lidocaine Compared to Jet Placebo for Pain Relief in Children Undergoing Needle Insertion in the Emergency Department

ACADEMIC EMERGENCY MEDICINE, Issue 5 2009
Marc Auerbach MD
Abstract Objectives:, The objectives were to determine whether pretreatment with needleless jet-delivered lidocaine decreases self-reported pain in children undergoing needle insertion in the emergency department (ED) and to explore whether pretreatment with a jet device decreases self-reported pain in children undergoing needle insertion in the ED. Methods:, This study examined needle insertion pain in children 5,18 years of age. In the first phase of this study, children received either pretreatment with jet-delivered lidocaine (0.2 mL of buffered 1% lidocaine; n = 75) or pretreatment with jet-delivered placebo (0.2 mL of preservative-free normal saline; n = 75) 60 seconds before undergoing needle insertion. This phase of the study had a randomized, double-blind, placebo-controlled design. In the second phase, an unblinded, nonconcurrent, nonintervention control group (n = 47) was examined to describe any effect of using the jet device. Patients reported pain upon administration of the jet device and at needle insertion using a 100-mm color analog scale (CAS). Patients also reported their satisfaction with this device. The physicians and nurses performing needle insertions were asked to rate their ability to visualize the vein and their satisfaction with the device. Results:, The mean (±standard deviation [SD]) needle insertion pain score for jet lidocaine, 28 (±7) mm, was similar to the mean needle insertion pain score for jet placebo, 34 (±7) mm. The mean needle insertion pain score for both the jet lidocaine and the jet placebo groups were lower than the needle insertion pain scores for the no device group, 52 (±8) mm. The majority of patients receiving the jet device reported that they would request this device for future needle insertions. Providers' ratings of their ability to visualize veins and the patient cooperation were similar in all three groups. Conclusions:, Jet-delivered lidocaine is no more effective than jet-delivered placebo in providing local anesthesia for needle insertion. Jet lidocaine and jet placebo may provide superior analgesia compared to no local anesthetic pretreatment. [source]

Ice Minimizes Discomfort Associated with Injection of Botulinum Toxin Type A for the Treatment of Palmar and Plantar Hyperhidrosis

DERMATOLOGIC SURGERY, Issue 2007
KEVIN C. SMITH MD
BACKGROUND The value of botulinum toxin type A (BTX-A) for treatment of palmar and plantar hyperhidrosis (HH) has been limited by injection pain, which in the past has generally required administration of a nerve block. We describe the successful use of ice applied to the intended injection point followed immediately by application of either ice or vibration to skin adjacent to the injection point to reduce discomfort associated with injection of BTX-A for the treatment of palmar and plantar HH. RESULTS During needle insertion and injection of BTX-A, both the application of ice to the intended injection point followed by application of ice adjacent to the injection point (ice+ice) and the application of ice to the intended injection point followed by application of vibration adjacent to the injection point have been preferred by our patients to nerve block. These two techniques allow efficient treatment of both hands and/or both feet in a single session. CONCLUSION By eliminating the need for nerve blocks, the techniques described here will enlarge the pool of physicians who can administer BTX-A for palmar and plantar HH, and will enlarge the pool of patients who are willing to have this treatment. [source]

Digital versus Local Anesthesia for Finger Lacerations: A Randomized Controlled Trial

ACADEMIC EMERGENCY MEDICINE, Issue 10 2006
Stuart Chale MD
Abstract Objectives To compare the pain of needle insertion, anesthesia, and suturing in finger lacerations after local anesthesia with prior topical anesthesia with that experienced after digital anesthesia. Methods This was a randomized controlled trial in a university-based emergency department (ED), with an annual census of 75,000 patient visits. ED patients aged ,8 years with finger lacerations were enrolled. After standard wound preparation and 15-minute topical application of lidocaine-epinephrine-tetracaine (LET) in all wounds, lacerations were randomized to anesthesia with either local or digital infiltration of 1% lidocaine. Pain of needle insertion, anesthetic infiltration, and suturing were recorded on a validated 100-mm visual analog scale (VAS) from 0 (none) to 100 (worst); also recorded were percentage of wounds requiring rescue anesthesia; time until anesthesia; percentage of wounds with infection or numbness at day 7. Outcomes were compared by using Mann-Whitney U and chi-square tests. A sample of 52 patients had 80% power to detect a 15-mm difference in pain scores. Results Fifty-five patients were randomized to digital (n= 28) or local (n= 27) anesthesia. Mean age (±SD) was 38.1 (±16.8) years, 29% were female. Mean (±SD) laceration length and width were 1.7 (±0.7) cm and 2.0 (±1.0) mm, respectively. Groups were similar in baseline patient and wound characteristics. There were no between-group differences in pain of needle insertion (mean difference, 1.3 mm; 95% confidence interval [CI] =,17.0 to 14.3 mm); anesthetic infiltration (mean difference, 2.3 mm; 95% CI =,19.7 to 4.4 mm), or suturing (mean difference, 7.6 mm; 95% CI =,3.3 to 21.1 mm). Only one patient in the digital anesthesia group required rescue anesthesia. There were no wound infections or persistent numbness in either group. Conclusions Digital and local anesthesia of finger lacerations with prior application of LET to all wounds results in similar pain of needle insertion, anesthetic infiltration, and pain of suturing. [source]

Randomized controlled trial of an instructional DVD for clinical skills teaching

EMERGENCY MEDICINE AUSTRALASIA, Issue 3 2007
Joon C Lee
Abstract Objective:, To determine the efficacy of clinical skills teaching using a DVD-based teaching medium (interventional group) compared with the traditional, four-step, face-to-face approach (control group). The clinical skill selected for the study was that of paediatric intraosseous (IO) needle insertion. Methods:, Thirty-six candidates who had no exposure to IO needle insertion experience within the past 12 months were randomly allocated into two groups. The interventional group (n = 18) was shown a 10 min instructional DVD and then allowed 10 min each to practise IO insertion with a paediatric training mannequin. The control group (n = 18) was given a 20 min, four-step, face-to-face teaching session with practical exposure and individual use of an IO needle on a training mannequin facilitated by an instructor. Each candidate was assessed using a checklist of critical steps for successful IO needle insertion and given a score out of 10. A modified Likert score reflecting candidates' subjective perceptions of the whole experience was completed after the test. Results:, The interventional group obtained a mean score of 7.56 (SD 1.65) and the control teaching group a mean score of 6.00 (SD 1.84). The mean difference was ,1.56 (P < 0.01, 95% CI ,2.74 to ,0.37). There was no difference in the candidates' perception on the satisfaction, anxiety and confidence level about the teaching experience. Conclusion:, The study suggests that the use of instructional DVD for clinical skills teaching results in improved learning outcomes compared with the traditional face-to-face didactic teaching method. [source]

Real-time ultrasound-guided spinal anesthesia in patients with a challenging spinal anatomy: two case reports

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2010
K. J. CHIN
Spinal anesthesia may be challenging in patients with poorly palpable surface landmarks or abnormal spinal anatomy. Pre-procedural ultrasound imaging of the lumbar spine can help by providing additional anatomical information, thus permitting a more accurate estimation of the appropriate needle insertion site and trajectory. However, actual needle insertion in the pre-puncture ultrasound- assisted technique remains a ,blind' procedure. We describe two patients with an abnormal spinal anatomy in whom ultrasound-assisted spinal anesthesia was unsuccessful. Successful dural puncture was subsequently achieved using a technique of real-time ultrasound- guided spinal anesthesia. This may be a useful option in patients in whom landmark-guided and ultrasound-assisted techniques have failed. [source]

Effect of needle insertion site on ilioinguinal-iliohypogastric nerve block in children

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2006
P. Kundra
Background:, Three different sites of needle insertion have been proposed for ilioinguinal-iliohypogastric (ILIH) nerve block. This double-blind study was designed to assess the quality of analgesia produced from these different sites. Methods:, One hundred and thirty-two children of ASA grade I and II were randomly allocated into four groups to receive no nerve block (control group, n = 30) or ILIH block at 1 cm inferio-medial to the anterior superior iliac spine (ASIS) in group IM (n = 34), 1,2 cm medial to the ASIS in group M (n = 34) and 2 cm superio-medial to the ASIS in group SM (n = 34) with 0.25 ml/kg of 0.25% bupivacaine after induction of anaesthesia. Pain was assessed using the All India Institute of Medical Sciences (AIIMS) pain discomfort scale (APDS) score. The amount and pattern of fentanyl consumed over the ensuing 24-h period was noted. Results:, APDS score and fentanyl requirement were similar in all the study groups but significantly higher until 8 h after surgery in the control group, P < 0.05. Twenty-two out of 102 children in the study groups and all patients in the control group received additional fentanyl during the post-operative period. Only 6 out of 22 children required additional fentanyl supplementation beyond the 30-min interval. Overall failure rate of ILIH nerve block was 6%. Conclusion:, ILIH block can be successfully accomplished from any point if the needle bevel lies between the two muscle planes above and below the internal oblique. [source]

Ultrasound-guided training in the performance of brachial plexus block by the posterior approach: an observational study

ANAESTHESIA, Issue 10 2007
G. J. Van Geffen
Summary The application of ultrasonography in guiding and controlling the path of the stimulating needle to the brachial plexus via the posterior approach (Pippa technique) was studied. In 21 ASA physical status 1 and 2 patients, scheduled for surgery of the shoulder or upper arm, needle insertion was monitored by ultrasonography and the interaction between needle, surrounding structures and brachial plexus was followed. During injection, the spread of local anaesthetic was visualised and a prediction of block success was made. One failure was predicted. Complete block was achieved in 20 (95%) patients. One potential complication, puncture of the carotid artery, was prevented using ultrasound. Ultrasound is a useful tool in the training and performance of a neurostimulation-guided brachial plexus block by the posterior approach. Ultrasonographic guidance may prevent serious complications associated with this approach to the brachial plexus. [source]

Prediction by computerised tomography of distance from skin to epidural space during thoracic epidural insertion

ANAESTHESIA, Issue 7 2002
J. Carnie
Summary In this single group observational study on 29 patients, we describe a technique that predicts the depth of the epidural space, calculated from the routine pre-operative chest computerised tomography (CT) scan using Pythagorean triangle trigonometry. We also compared the CT-derived depth of the epidural space with the actual depth of needle insertion. The CT-derived and the actual depths of the epidural space were highly correlated (r = 0.88, R2 = 0.78, p < 0.0001). The mean (95% CI) difference between CT-derived and actual depths was 0.26 (0.03,0.49) cm. Thus, the CT-derived depth tends to be greater than the actual depth by between 0.03 and 0.49 cm. There were no associations between either the CT-derived or the actual depth of the epidural space and age, weight, height or body mass index. [source]

A Randomized, Double-blind Controlled Study of Jet Lidocaine Compared to Jet Placebo for Pain Relief in Children Undergoing Needle Insertion in the Emergency Department

Activated coagulation times in normal cats and dogs using MAX-ACTTM tubes

AUSTRALIAN VETERINARY JOURNAL, Issue 7 2009
AM See
Objective, To establish reference values for activated coagulation time (ACT) in normal cats and dogs, by visual assessment of clot formation using the MAX-ACTTM tube. Subjects, We recruited 43 cats and 50 dogs for the study; 11 cats and 4 dogs were excluded from the statistical analysis because of abnormalities on clinical examination or laboratory testing including anaemia, prolonged prothrombin time (PT) or activated partial thromboplastin time (APTT), or insufficient plasma volume for comprehensive laboratory coagulation testing. Procedure, Blood samples were collected via direct venipuncture for MAX-ACT, packed cell volume/total solids, manual platelet estimation and PT/APTT measurement. Blood (0.5 mL) was mixed gently in the MAX-ACT tube at 37°C for 30 s, then assessed for clot formation every 5 to 10 s by tipping the tube gently on its side and monitoring for magnet movement. The endpoint was defined as the magnet lodging in the clot. The technique was tested with 10 dogs by collecting two blood samples from the same needle insertion and running a MAX-ACT on each simultaneously. Results, In normal cats the mean MAX-ACT was 66 s (range 55,85 s). In normal dogs the mean was 71 s (range 55,80 s). There was no statistical difference between the first and second samples collected from the same needle insertion. Conclusions and Clinical Relevance, In both cats and dogs, a MAX-ACT result >85 s should be considered abnormal and further coagulation testing should be performed. Additionally, failure to discard the first few drops of the sample does not appear to significantly affect results. [source]

A Randomized, Double-blind Controlled Study of Jet Lidocaine Compared to Jet Placebo for Pain Relief in Children Undergoing Needle Insertion in the Emergency Department