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PubMed1978

Arthroscopy of the knee. Evaluation of an out-patient preocedure under local anesthesia.

In 228 knees submitted to arthrotomy following arthroscopy, there were eleven diagnostic errors in those knees examined under general anesthesia and five diagnostic errors in those knees examined under local anesthesia with a diagnostic accuracy of 91.1 and 95.2 per cent, respectively. Therefore, we concluded that accuracy is not diminished by performing arthroscopic examinations under local anesthesia on ambulatory out-patients. In 297 knees examined under local anesthesia, no complications were encountered. In 282 knees examined under general or spinal anesthesia, there was one pulmonary embolus and two significant hemarthroses. Except when there are specific overriding considerations, local anesthesia is preferable in the performance of diagnostic arthroscopy.

Ambulatory Care↗

PubMed2001

The use of midazolam and small-dose ketamine for sedation and analgesia during local anesthesia.

UNLABELLED: Small-dose ketamine in combination with sedative drugs has increasingly been used for sedation and analgesia in local anesthesia. We compared the clinical efficacy of midazolam with two different ketamine infusion regimens during plastic surgery under local anesthesia. Sixty patients undergoing plastic surgery procedures with local anesthesia were randomly assigned to two groups of 30 patients each in a double-blinded fashion. All patients received a bolus of 0.05 mg/kg midazolam, followed by a stepwise infusion: 1.67 microg x kg(-1) x min(-1) for the first 30 min, then reduced to 1.33 microg x kg(-1) x min(-1) for 90 min and subsequently to 1 microg x kg(-1) x min(-1). Two minutes before the infiltration of local anesthetic solution, a bolus of ketamine 0.3 mg/kg IV was administered, followed by a stepwise infusion of ketamine: Group A, 16.67 microg x kg(-1) x min(-1) for 30 min, 13.3 microg x kg(-1) x min(-1) for 90 min, and subsequently 10 microg x kg(-1) x min(-1); Group B, 8.33 microg x kg(-1) x min(-1) for 30 min, 6.67 microg x kg(-1) x min(-1) for 90 min, and then 5 microg x kg(-1) x min(-1). The level of sedation was evaluated by using the modified Observer's Assessment of Alertness/Sedation scale. We observed the effects of the two ketamine infusion regimens on sedation levels, respiratory and cardiovascular variables, and perioperative side effects. In both groups, midazolam and ketamine produced adequate sedation (with Observer's Assessment of Alertness/Sedation scores of 2-4) without significant respiratory and cardiovascular depression during surgery. However, there were fewer disruptive movements and there was less postoperative vomiting in Group B (P < 0.01). In conclusion, ketamine and midazolam provided satisfactory intraoperative sedation, analgesia, and amnesia in both groups. However, side effects associated with ketamine occurred less often in the smaller-dose ketamine group. IMPLICATIONS: Sedation and analgesia are often provided during local anesthesia. This study demonstrates that a small-dose ketamine infusion in combination with midazolam provided satisfactory intraoperative sedation, analgesia, and amnesia in healthy plastic-surgery patients when it was used to supplement local anesthesia.

Adolescent↗

PubMed2006

Efficacy compared between caudal block and periprostatic local anesthesia for transrectal ultrasound-guided prostate needle biopsy.

OBJECTIVES: To investigate the clinical efficacy of a caudal block compared with periprostatic local anesthesia for transrectal ultrasound-guided multicore prostate needle biopsy. METHODS: A total of 100 patients who had undergone initial prostate biopsy using a systematic five-region biopsy by a single operator were investigated. The patients were randomly divided into two groups, with each group receiving a different anesthetic modality before biopsy. Group 1 received periprostatic local anesthesia and group 2 received a caudal block. Both groups received 10 mL 1% lidocaine before biopsy. A 10-point visual analog scale was used to assess patient pain and anxiety. The duration between anesthesia induction and the beginning of the biopsy was measured. RESULTS: Patients who received local anesthesia (group 1) reported significantly less pain immediately after biopsy, with an average score of 1.1 compared with 2.1 in group 2 (caudal block, P = 0.01). Both groups were comparable regarding age, prostate-specific antigen level, digital rectal examination findings, prostate size, number of biopsy cores, level of prebiopsy anxiety, body mass index, and histologic findings. Group 1 required a significantly shorter period of anesthesia (198.5 seconds) than did group 2 (594.5 seconds, P <0.0001). No anesthetic-related side effects occurred in either group. CONCLUSIONS: The results of our study have shown that the caudal block provides less effective anesthesia than periprostatic local anesthesia with the same dose of lidocaine for prostate biopsy. We have concluded that local anesthesia is a safe, simple, and rapid method of pain relief during prostate biopsy.

Aged↗

PubMed1991

Laparoscopic tubal sterilization under local anesthesia in women with cyanotic heart disease.

Laparoscopic tubal sterilization under local anesthesia with intravenous sedation has been shown to be a safe procedure. However, the use of laparoscopy in patients with cyanotic cardiovascular disease is controversial and is generally contraindicated. Five women were referred with uncorrectable cyanotic heart disease and pulmonary hypertension. The mean preoperative arterial oxygen pressure was 56.2 +/- 5 mmHg (N = 5). After cardiology and cardiovascular anesthesia consultation and clearance, the patients underwent laparoscopic sterilization with Silastic rings under local anesthesia using direct trocar entry. Continuous hemodynamic monitoring and pulse oximetry were employed. The patients were kept in the intensive care unit or the hospital for 24 hours for monitoring, and all did well. This hospital for 24 hours for monitoring, and all did well. This small retrospective series demonstrates that laparoscopic sterilization under local anesthesia is a sterilization technique that may be suitable and safe for such patients when appropriate monitoring is performed. Tubal sterilization may be the contraceptive method of choice in women with heart disease when pregnancy is contraindicated.

Adult↗

PubMed1984

Stress-induced release of cortisol and prolactin during dilatation and curettage under general and local anesthesia.

Comparison of the effect of general and local anesthesia on serum prolactin and cortisol concentrations in response to the stress of dilatation and curettage revealed that short surgical procedures under general anesthesia resulted in no significant change in mean serum cortisol and in a significant decrease in mean serum prolactin. By contrast, short surgical procedures under local anesthesia resulted in a significant increase in serum prolactin and cortisol concentrations. Our findings support the importance of using general anesthesia during dilatation and curettage.

Adult↗

PubMed1996

Subtenon's local anesthesia for optic nerve sheath fenestration.

PURPOSE: We used subtenon's local anesthesia for optic nerve sheath fenestration as an alternative to either general or retrobulbar anesthesia. METHODS: Thirty patients with pseudotumor cerebri, who were unresponsive to medical treatment, underwent optic nerve sheath fenestration after administration of topical and subtenon's local anesthesia. RESULTS: When topical tetracaine, in conjunction with subtenon's anesthesia, was administered at the beginning of the procedure, excellent anesthesia and maximal patient comfort were achieved. CONCLUSIONS: The use of local anesthesia allows for a pain-free, expeditious operation with fewer potential anesthetic complications.

Anesthesia, Local↗

PubMed1987

Outpatient implantation of penile prostheses under local anesthesia.

Penile implantation can be accomplished safely under local anesthesia on an outpatient basis. This reduces cost and should be considered more frequently than the current practice. The techniques and routines for performing penile implantation under local anesthesia are described.

Ambulatory Surgical Procedures↗

PubMedDate not supplied

Dental and dental hygiene students' attitudes in a joint local anesthesia course.

In 1995, the local anesthesia course was combined for dental and dental hygiene students. It was also the first time that dental hygiene students were instructed clinically in local anesthetic techniques. Faculty felt it important to evaluate student attitudes regarding these curriculum changes. This study assessed students' perceptions of the adequacy of background preparation courses, concerns about administering local anesthetics and attitudes about its administration by dental hygienists. A pre/post survey was completed by dental and dental hygiene students. T-tests were used to determine if differences in attitudes existed between groups and if changes in attitudes occurred within groups after taking the course. Results indicated that both groups believed they had adequate background preparation. Apprehensions about administering local anesthetics were similar, but the dental hygiene students felt significantly less anxiety (p < 0.01). Results also differed significantly on the issue of hygienists administering local anesthetics, with hygiene students in support of it and dental students opposed (p < 0.01). Results confirmed that no changes were needed in the existing prerequisite courses for both groups. A need to address student anxiety about local anesthetic administration has been identified. In addition, it may be beneficial to expand dental students' appreciation of dental hygiene education to foster mutually successful working relationships in the future.

Anesthesia, Dental↗

PubMed2001

One-thousand consecutive inguinal hernia repairs under unmonitored local anesthesia.

UNLABELLED: To evaluate the feasibility and safety of unmonitored local anesthesia (ULA) for elective open inguinal hernia repair, we made a prospective, consecutive data collection from 1000 operations on primary and recurrent hernias. Follow-up consisted of a questionnaire 1 mo after surgery and retrieval from the electronic patient data management system. In 921 ASA Group I and II and 79 ASA Group III and IV patients, the median age was 60 yr (range, 18-95 yr). ULA was converted to general anesthesia in 5 of 1000 cases, and 961 patients were discharged on the day of surgery after 95 min (median; interquartile range, 75-150); 29 patients had complications requiring surgical intervention. Within the first month, three patients died of causes unrelated to hernia surgery, and six had cardiovascular or respiratory events. The questionnaire was returned by 940 patients; 124 were dissatisfied with local anesthesia, day-case setup, or both, primarily because of intraoperative pain (n = 74; 7.8%). We conclude that open inguinal hernia repair can be conducted under ULA, regardless of comorbidity, with a small rate of deviation from day-case setup and minimal morbidity. It provides a safe alternative to other anesthetic techniques with an acceptable rate of satisfaction, but intraoperative pain relief needs improvement. IMPLICATIONS: Inguinal hernia repair can be safely performed under unmonitored local anesthesia with infrequent postoperative morbidity and acceptable satisfaction, but intraoperative pain may be a problem.

Adolescent↗

PubMed1992

Comparison of three different methods used to achieve local anesthesia for fiberoptic bronchoscopy.

A patient's tolerance of fiberoptic bronchoscopy depends on the effectiveness of local anesthesia. This study compares the three different methods of local anesthesia in common use After sedation, patients (n = 53) received either 4 ml of 2.5 percent cocaine by intratracheal injection (TI) (n = 18), by bronchoscopic injection (BI) (n = 19), or had 4 ml of 4 percent lidocaine delivered by nebulizer 20 min before the procedure (NEB) (n = 16). Patients and bronchoscopists scored the procedure using visual analog (VAS) and severity scales. Objective measurements of cough counts and episodes of stridor were recorded by phonopneumography. Patients' VAS scores showed a clear preference for the transtracheal method compared with either bronchoscopically injected cocaine (p less than 0.001) or nebulized lidocaine (p less than 0.001). Patients also reported that the TI method produced less cough during intubation of the larynx and inspection of the airways (BI and NEB, p less than 0.01). The TI method was also preferred by the bronchoscopists (BI and NEB, p less than 0.001); they reported less cough and easier tracheal intubation. The mean cough count was significantly lower for the TI group, 49 (43) compared with 95 (52) for BI (p less than 0.01), and 81 (43) for the NEB group (p less than 0.05). Patients' and bronchoscopists' VAS showed significant correlation with cough (r = 0.63-69, p less than 0.01). Stridor occurred in only two patients after TI, compared with 15 in the other two groups. Extra local anesthesia was required by 16 patients after BI, by all the NEB group, but by only one patient after TI. Subjective and objective measurement shows that 4 ml of 2.5 percent cocaine injected into the trachea produced excellent local anesthesia for fiberoptic bronchoscopy, there were no extra complications, and it was the method preferred by both patients and bronchoscopists.

Aerosols↗

PubMed1997

The incidence of complications associated with local anesthesia in dentistry.

Local anesthetics are frequently administered in dentistry and thus can be expected to be a major source of drug-related complications in the dental office. Additionally, the dentist will more often be confronted with the treatment of risk patients; thus, the incidence of side effects can be expected to rise. In this study, 2731 patients receiving dental anesthesia were evaluated by questionnaire for risk factors, type and dosage of local anesthetic applied, type and duration of treatment, and complications associated with the administration of the local anesthetic. Of all patients, 45.9% had at least one risk factor in their medical histories, with cardiovascular diseases and allergies being the most frequent. The overall incidence of complications was 4.5%. It was significantly higher in risk patients (5.7%) than in nonrisk patients (3.5%). The most frequently observed complications (dizziness, tachycardia, agitation, nausea, tremor) were transient in nature and did not require treatment. Severe complications (seizure, bronchospasm) occurred in only two cases (0.07%). Articaine was found to be administered in over 90% of all dental anesthesias in Germany despite the great variety of local anesthetics available. Articaine 1:100,000 caused more sympathomimetic side effects than did articaine 1:200,000. Additionally, doses of local anesthetics proved not to be strictly determined according to body weight, especially for patients weighing less than 50 kg. In summary, it can be stated that dental local anesthesia can be considered safe. Nevertheless, the incidence of complications due to dental anesthesia can be expected to be further reduced if (a) patients are routinely evaluated for risk factors with an adequate medical history prior to dental treatment, (b) doses of local anesthetics are strictly determined according to body weight, (c) anesthetics with low concentrations of epinephrine are used, and (d) the concept of a differentiated dental anesthesia is applied.

Adult↗

PubMedDate not supplied

No scalpel, no iv, no stitch, microendoscopic office laparoscopy under local anesthesia.

BACKGROUND: The medical literature is replete with articles verifying the usefulness of laparoscopic procedures under local anesthesia. Recent research has examined the efficacy of microendoscopy with local anesthesia. In this series of patients, we focused on new technology to determine if microendoscopy could be utilized in an office setting. METHODS: Between July 1994 and April 1995, we performed 51 microendoscopic office laparoscopy under local anesthesia (MICRO-OLULA) using the 1.5 mm Pixie laparoscope by Origin, a 1.7 mm laparoscope by Optimed and 5 mm laparoscope by Jarit. All cases were performed in an office operating room at the Women's Medical Plaza in Montgomery, Alabama. Only one patient was unable to have the procedure completed due to intolerance under local anesthesia. RESULTS: Fifty-one micro-olulas were performed on these patients who had an average age of 31 years and an average weight of 157 pounds. Intraoperative abdominal time averaged 3 minutes. One case was done with a 5 mm laparoscope and five cases with the 1.7 mm Optimed laparoscope. The 1.5 mm Pixie laparoscope was used in 45 patients. CONCLUSIONS: Our patients seemed to like the idea of a small device to view their pelvic cavities. The small laparoscopes provide excellent cosmesis, and laparoscopes deserve further development and clinical trial to determine their most advantageous use in the office setting.

Adult↗

PubMed1997

Office laparoscopy under local anesthesia for gamete intrafallopian transfer: technique and tolerance.

OBJECTIVE: To describe our technique for laparoscopic GIFT under local anesthesia and to evaluate patient tolerance and surgeon satisfaction in 175 consecutive procedures. DESIGN: Prospective cohort study. SETTING: University infertility practice. PATIENT(S): All GIFT candidates from 1992 to 1996 were offered the procedure. Of 119 patients, 119 chose local anesthesia for 175 procedures and 1 patient elected to have general anesthesia. INTERVENTION(S): Transvaginal ultrasound-guided egg retrieval followed by GIFT in the clinic procedure room with a 5-mm laparoscope and two accessory 3-mm trocars with local anesthesia and i.v. sedation. MAIN OUTCOME MEASURE(S): Patient tolerance and acceptance, duration of the procedure, amount of analgesics, surgeon satisfaction, and pregnancy rate (PR). RESULT(S): The laparoscopic portion lasted an average of 27 minutes, with a mean dose of 1.41 mg of midazolam and 68 micrograms of fentanyl used. Sixty-nine percent of the patients scored "very good," 20% "good," 9% "acceptable," and 2% "poor." All 38 patients undergoing 97 repeat procedures selected local anesthesia again. For women < 40 years of age, clinical PR and delivery rate were 43% and 38%, respectively. CONCLUSION(S): Routine office GIFT under local anesthesia is effective and well accepted by the surgeon and is preferred by patients. It offers a significant cost containment and scheduling flexibility in addition to high success rates.

Adult↗

PubMed2004

[Eye surface temperature after different techniques of local anesthesia--preliminary report].

PURPOSE: To assess temperature on the eye surface after local anesthesia due to phacoemulsyfication. MATERIAL AND METHODS: 15 patients treated with local anesthesia: peribulbar - 5, retrobulbar - 5 and sub Tenon anesthesia. Mean temperature on both eye surface was assessed with termovision camera (Inframetrics 760) before surgery, 20 minutes and 1 hour after anesthesia. RESULTS: In all examined groups changes in temperature values in anesthetized and contralateral eye were observed. Significant decrease of temperature was observed after sub Tenon anesthesia. CONCLUSIONS: Eye surface temperature and its changes can be considered as indirect indicator of blood supply and blood supply disturbances after local anesthesia.

Adult↗

PubMedDate not supplied

A comparison of warmed and room-temperature anesthetic for local anesthesia in children.

PURPOSE: The purpose of this study was to assess children's reactions and record their sensations while receiving a warmed local anesthetic solution for dental procedures (37 degrees C; W) compared with one at room temperature (21 degrees C; RT). METHODS: Forty-four children between the ages of 6 to 11 (mean age = 7.9 +/- 2.2 years) who were undergoing dental treatment participated in the study. A random crossover design was used. Each patient was randomly assigned to receive either a W or a RT local anesthesia on the first visit and the alternate local anesthesia on the second visit. During the injection, the modified Behavioral Pain Scale (BPS) was used. For subjective evaluation, the Wong-Baker FACES Pain Rating Scale (FPS) and the Visual Analogue Scale (VAS) were used. RESULTS: No significant difference was found between the W or RT local anesthesia when used during the first or second visit. In all parameters, children's reactions to both types of injection were similar, with no statistically significant difference. Using the FPS, 19 boys (91%) ranked the experience of local anesthesia as a positive experience (0 to 2 in the scale) while 4 boys (9%) ranked the same experience as negative. This was true for both types (W and RT). All 21 girls who participated in the study ranked the local anesthesia experience using the FPS as a positive experience (0 to 2 in the scale). No significant difference was found in the mean VAS scores between the room-temperature group and the warm group (23.4 +/- 21.8 and 20.8 +/- 18.9, respectively). CONCLUSIONS: There is no advantage to warming local anesthetic solution prior to injection.

Administration, Buccal↗

PubMedDate not supplied

[106 inguinal hernias treated under local anesthesia].

About two series of inguinal hernia, 106 operated under local anesthesia and 100 operated under general anesthesia, the authors reviewed retrospectively the local and general complications and the immediate and long-term results (1 year). The authors observed the same results in both groups; they conclude that local anesthesia can be considered as the first choice procedure in the treatment of uncomplicated hernia of high risk and geriatric patients.

Adult↗

PubMed1996

Electronic and local anesthesia: a clinical comparison for operative procedures.

The comfort on administration and effectiveness of electronic and local anesthesia for operative procedures, as perceived by clinicians and patients, were compared based on a 5-point Lickert scale, and a survey to solicit patient's feedback on the use of electronic anesthesia was conducted. Thirty patients, who required restorations on similar teeth bilaterally, and 10 clinicians were involved in the study. The two teeth in each patient were randomly restored under either electronic or local anesthesia. Administration of electronic anesthesia was perceived to be significantly more comfortable than that of local anesthesia, by both clinicians and patients. Local anesthesia was perceived to be significantly more effective by both evaluator groups, but 93.3% of the patients still preferred electronic anesthesia and would use it again. Minor after effects in some patients included redness of skin and briefly lingering sensation. All patients found electronic anesthesia easy to use, and most of the patients (93.3%) thought that the system was good to excellent.

Adult↗

PubMed1993

[Administration of 5% +EMLA cream for local anesthesia in ambulatory pediatric surgery].

The use of local anaesthesia has been advocated by most pediatric surgeons in order to cut down hospitalization costs as well as to avoid general anaesthesia. In 1992, 26 patients aged 4 to 14 years (avg. 8 years) underwent small surgical procedures with local anesthesia, obtained by the application of EMLA cream 60 to 120 minutes prior to the procedure. EMLA cream is aneutectic mixture of lidocaine and prilocaine with a meeting point at a lesser temperature than the two compounds separately. In this way, concentration of anaesthetics increases up to 80% in the emulsion droplets. This preparation enables small operations to be performed under local anesthesia even in small children who can be safely treated as outpatients. Disadvantages due to the long time necessary for optimal action can be overcome by application of the cream at home by the parents themselves.

Administration, Topical↗