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PubMed2004

A simplified endoscopic third ventriculostomy under local anesthesia.

The aim of this study is the analysis of our experience with awake endoscopic third ventriculostomy (ETVS) in hydrocephalic patients. From September 1994 to December 2001, 24 neuroendoscopic procedures were performed under local anesthesia. Local infiltration was administered using a bupivacaine and lidocaine mixture. Analgesics were titrated to the effect. A free-hand technique with a flexible endoscope was adopted in 24 patients with primitive and secondary (neoplastic) hydrocephalus. ETVS was performed successfully in all cases. No procedure needed to be discontinued due to seizures, bleeding or agitation. Dural incision/coagulation and Fogarty dilatation proved to be the most painful maneuvers requiring, sometimes, supplemental analgesic administration. No intraoperative complications were observed; however, two asymptomatic trajectory hematomas were incidentally discovered two and three days after the operation, respectively. Awake ETVS is a valuable alternative procedure that can be adopted in adult cooperative patients, provided that the procedure is done in an essential and fast way with the free-hand technique, by means of a flexible endoscope, and with the assistance of an anesthesiologist.

Adult↗

PubMed2003

Tumescent local anesthesia for the surgical treatment of burns and postburn sequelae in pediatric patients.

BACKGROUND: Tumescent local anesthesia is a technique for regional anesthesia of the skin and the subcutaneous tissue, using infiltration of large volumes of local anesthetic. The advantages of this technique are (1) simplicity, (2) prolonged postoperative analgesia, (3) low incidence of bleeding, and (4) anesthetization of a large area of the body. There are no reports on the use of tumescent local anesthesia in pediatric patients. METHODS: In 30 consecutive pediatric burn patients with American Society of Anesthesiologists physical status class I or II who were 1-120 months old (34 +/- 31.6 months), after induction of anesthesia with nitrous oxide-oxygen-sevoflurane, infiltration with 0.05% (14 ml/kg) or 0.1% (7 ml/kg) lidocaine solution was performed. Anesthesia was maintained with patients spontaneously breathing with 1.5% sevoflurane in nitrous oxide-oxygen (50%). The maximum dose of lidocaine used was 7 mg/kg. Postoperative pain was assessed by using the Children's Hospital of Eastern Ontario Pain Scale (for patients aged up to 5 yr) and by using a visual analog scale (for patients older than 5 yr). A comparison with a historic control group not treated with the tumescent local anesthesia technique was performed. RESULTS: No patients were excluded from the study, and no significant variations in the monitored intraoperative parameters were observed. Five patients had an increase in heart rate and respiratory rate at the beginning of surgery, and of these, two needed a temporary increase in sevoflurane concentration. After the initial incision, no response to painful stimulus was observed. No complications occurred. Six patients required postoperative acetaminophen administration, and 24 patients did not require analgesic treatment. CONCLUSIONS: Tumescent local anesthesia with maximum dose of 7 mg/kg lidocaine seems to be safe and the sole possible effective locoregional anesthesia technique for the surgical treatment of noncontiguous pediatric burns.

Anesthesia, Local↗

PubMed1988

Assessment of stress during periodontal surgery with intravenous sedation and with local anesthesia only.

Ten patients with moderate to advanced periodontal disease were subjected to two similar periodontal surgical procedures. Each patient received either intravenous conscious sedation with local anesthesia or local anesthesia only. The stress-reducing effects of a conscious sedation regimen consisting of pentobarbital, meperidine, and diazepam were evaluated in these patients. Stress was evaluated by monitoring changes in serum cortisol, human growth hormone, and vital signs. Blood samples were obtained at 15- to 30-minute intervals throughout each procedure and were evaluated for serum cortisol and growth hormone. The conscious sedation group had significantly lower serum cortisol levels and lower systolic blood pressure, indicating that the patients having periodontal surgery with conscious sedation experienced reduced stress. Physiologic stability was maintained for each patient, indicating that this conscious sedation regimen can be used to reduce measurable parameters of stress that patients develop during periodontal surgery.

Anesthesia, Dental↗

PubMed2001

Cervical posterior fusion with wave-shaped rod under local anesthesia for cervical spondylotic myelopathy: review of 12 patients.

STUDY DESIGN: Clinical evaluation of cervical interspinous fusion under local anesthesia in elderly patients with cervical spondylotic myelopathy. OBJECTIVES: To evaluate the effectiveness of cervical posterior fusion with wave-shaped rods inserted under local anesthesia for elderly high-risk patients with cervical spondylotic myelopathy. SUMMARY OF BACKGROUND DATA: A substantial number of patients cannot undergo surgical interventions under general anesthesia because of their general medical complications. Although such patients would become unable to walk, which might induce a worsening of their general condition, conservative treatments had been adopted as the only treatment for these patients. The authors have obtained satisfactory results by means of posterior interspinous fusion under local anesthesia even in the high-risk patients with severe cervical spondylotic myelopathy. The aims of this surgical technique were to adjust cervical alignment and to stabilize the motion segment(s) without decompression. PATIENTS AND METHODS: Between May 1989 and August 1998, 12 elderly patients (3 men and 9 women) with cervical spondylotic myelopathy were treated with posterior interspinous fusion using wave-shaped rods inserted under local anesthesia. The average age at the surgery was 76.9 years. The average follow-up period was 5 years 6 months. All patients were unable to walk without any assistance because of their advanced myelopathy. It was felt that all of them would be unable to accept general anesthesia because of their generally poor medical conditions. Preoperative severity of the clinical symptoms and postoperative recovery were evaluated by a scoring system proposed by the Japanese Orthopaedic Association, which had 17 points at full mark. RESULTS: The average duration of the surgical procedure was 122.8 minutes. The average total blood loss was 118.6 g. No instrument failures were denoted. Neither neural deterioration nor major complication was observed relating to the surgery. Radiographic bony union of the grafted bone was achieved in all patients. Progression of myelopathy was arrested in all 12 patients, and clinical symptoms were improved in 10 patients. The mean Japanese Orthopaedic Association scores had increased from 5.0 to 10.2 points. CONCLUSIONS: Twelve high-risk patients with cervical spondylotic myelopathy were treated with posterior interspinous fusion using wave-shaped rods inserted under local anesthesia. This method was evaluated as an effective surgical salvage without any mortal complications even in the elderly high-risk patients.

Aged↗

PubMed1999

[Preoperative laparoscopy by local anesthesia for advanced gastric cancer].

Preoperative laparoscopy by local anesthesia was performed in 8 patients with advanced gastric cancer, whose lesions had been diagnosed to be more than T3 or suspected to have peritoneal seeding, and its usefulness was assessed. After insertion of the trocars, the abdominal cavity was inspected, and biopsy and/or abdominal lavage sampling was performed. Three patients out of 8 were diagnosed as P3, and 5 patients were diagnosed as P0 and CY0. Based on these results, 6 patients underwent operation. The accuracy rate of diagnosis was 83% in P category, and 100% in CY category. In conclusion, it is considered that laparoscopy by local anesthesia is a useful preoperative examination for advanced gastric cancer.

Aged↗

PubMed1993

[Inguinal hernia surgery under local anesthesia. Technical note and immediate results].

The authors report their experience on local anesthesia for inguinal hernia repair in 164 patients. They describe the neuroanatomy of the inguinal region as well as the technique of loco-regional anesthesia. The Shouldice repair was most frequently employed, followed by the Bassini repair. Local anesthesia was very well tolerated by the patients, sometimes with the addition of mild sedation. The postoperative course was definitely shortened by the use of local anesthesia, and all patients were able to take a regular diet and to walk few hours after surgery.

Aged↗

PubMed2001

Colostomy closure using local anesthesia.

The feasibility of performing colostomy closures using local anesthesia was evaluated. The subjects comprised 14 patients: 2 with colostomies involving a mucous fistula and 12 with loop colostomies. Patients who had colostomies with mucous fistulas separated by 10cm or more were excluded from this study. All patients were graded as ASA 1 (according to the American Society of Anesthesiologists). The bowel was evaluated by colonoscopy in 6 patients and by barium enema in 8 patients. Bowel preparation was performed with Colayte and all patients were given prophylactic antibiotics. Closure of the colostomy was extraperitoneal and the time taken to perform the operation ranged from 40 to 120min. Tolerance was regarded as excellent in 9 patients, good in 3, and average in 2. There were 3 anastomotic leaks that resolved without further surgical treatment, 2 wound infections, and 1 bowel obstruction that was successfully treated with medication. Patients were discharged 2-22 days postoperatively, after a mean period of 9 days. Local anesthesia offers a safe and effective alternative to general or regional anesthesia for surgical closure of colostomies.

Adolescent↗

PubMed2001

Oral premedication for operations on the face under local anesthesia: a placebo-controlled double-blind trial.

Modern strategies for preventing or controlling pain and anxiety demand a premedication for operations using local anesthesia and for those using sedation or general anesthesia. For optimal patient care, the premedication should be given orally and, with respect to the outpatient basis of the operations, should have a short recovery period. Midazolam, one of the most favored premedications for general anesthesia, has been recommended as a premedication for operations using local anesthesia as well. However, midazolam has only sedative-anxiolytic effects and does not reduce pain sensation, which should be mandatory for operations using local anesthesia. A further requirement is the maintenance of stable hemodynamics for the prevention of postoperative hematomas, especially in the face. For these reasons, another premedication meeting all requirements (anxiolysis, analgesia, and stable hemodynamics) was researched. A randomized, double-blind prospective study was performed from March of 1997 to June of 1998. Five groups totalling 150 patients were included in the study; each group contained 30 patients who had operations performed solely on the face. In the first four groups, the effect of midazolam (0.15 mg/kg(-1)), morphine (0.3 mg/kg(-1)), and clonidine (1.5 microg/kg(-1)) administered orally was compared with a placebo. The fifth group was the control group and received no premedication. To evaluate the effects of the premedications, a corresponding questionnaire was completed independently by the patient and surgeon. With regard to the anxiolytic or analgesic properties of the premedication, 61 percent of the patients preferred pain reduction to anxiety control, and 24 percent of patients preferred reduction of anxiety. The remainder insisted on a reduction of both properties (8 percent) or had no preference (7 percent). Reduction of anxiety was largest in the midazolam and the clonidine groups, but the difference was not significant. The least pain during the application of local anesthesia was experienced by the morphine group (37 percent) and the clonidine group (33 percent), in contrast to the midazolam group (60 percent) (p = 0.04). Morphine and clonidine met the requirements of pain reduction equally well. Nevertheless, considering the rate and intensity of adverse effects with respect to hemodynamic compromises, nausea, and emesis, clonidine is even better suited as an oral premedication for operations on the face using local anesthesia.

Administration, Oral↗

PubMed1997

Feasibility of outpatient percutaneous bladder neck suspension under local anesthesia.

OBJECTIVES: To demonstrate the feasibility of outpatient percutaneous bladder neck suspension (BNS) under local anesthesia to treat stress urinary incontinence (SUI) in females. METHODS: Since October 1994, 40 women with SUI (mean age 59.6+/-12.0 years) underwent outpatient percutaneous BNS with "Z" suture anchoring of the anterior vaginal wall and pubocervical fascia. The suspension sutures were secured to percutaneously placed bone anchors. The procedure was performed under local anesthesia. Pain during surgery was evaluated with an analogue scale graded from 0 (no pain) to 5 (severe pain). RESULTS: In 98% of the BNS, the procedure was successfully performed with the patient under local anesthesia. Conversion to general anesthesia was necessary for only 1 patient due to knee pain in the lithotomy position. No major complications were observed. Patients rated their perioperative pain as 1.0+/-0.6 (that is, minimal pain). Patients required pain medications for a mean of 2.4+/-1.3 days postoperatively. Mean duration of recovery (defined by a return to normal activities) was 2.2+/-1.0 weeks; 92% of the patients were continent postoperatively, and no recurrence of urethral hypermobility was observed. CONCLUSIONS: Our results demonstrate the feasibility of outpatient percutaneous BNS performed in patients under local anesthesia without significant morbidity. Continued follow-up will be necessary to determine the long-term efficacy of this procedure.

Aged↗

PubMed1992

Knee arthroscopy using local anesthesia.

This study confirms the feasibility of performing arthroscopy and arthroscopic surgery with patients under local anesthesia. Seventy patients underwent arthroscopy under local anesthesia using mepivacaine with adrenaline. In 49 patients, arthroscopic surgery was performed. It is important to wait at least 20 min after the injection of the anesthetic before surgery to anesthetize the medial part of the joint. There were few complications. Diagnostic and surgical arthroscopy can be successfully performed in the majority of patients with local anesthesia.

Adult↗

PubMedDate not supplied

Knee arthroscopy with the use of local anesthesia--an increased risk for repeat arthroscopy? A prospective, randomized study with a six-month follow-up.

Although there have been many reports of good results when local anesthesia is used with knee arthroscopy, it is not used as a standard anesthetic. Concerns about local anesthesia include the fear of prolonged surgery, which could result in inadequate anesthesia, thus causing the patient unnecessary discomfort. The purpose of this study was to evaluate the risk of repeat arthroscopy and the patient satisfaction rate up to 6 months after knee arthroscopy under local anesthesia. In this prospective, randomized study, 400 patients scheduled for elective knee arthroscopy were allocated to one of three groups: local anesthesia (200 patients), spinal anesthesia (100 patients), or general anesthesia (100 patients). All enrolled patients were asked to complete a questionnaire 6 months after surgery and all of their medical records were reviewed. No repeat arthroscopies occurred in the spinal and general anesthesia groups and only three occurred in the local anesthesia group, a nonsignificant difference. In only one of these three cases was the clinical course altered by the repeat arthroscopy. There was no difference in the satisfaction rate between the three anesthesia groups. We conclude that the choice of anesthesia does not influence the frequency of repeat arthroscopy, satisfaction with the procedure, or recovery at 6 months after knee arthroscopy.

Adult↗

PubMed2006

Thoracoscopic pleural biopsy for tuberculous pleurisy under local anesthesia.

OBJECTIVE: We directly examined the thoracic cavity by thoracoscopy under local anesthesia, performed pleural biopsy, and made a definitive pathological diagnosis in tuberculous pleurisy. SUBJECTS AND METHODS: We performed a retrospective study of 32 patients who had been bacteriologically and pathologically diagnosed with tuberculous pleurisy by thoracoscopy under local anesthesia in our hospital between January 1995 and November 2004. RESULTS: Bacteriological examination of pleural fluids obtained by thoracentesis before examination showed that one sample was polymerase chain reaction (PCR)-positive, and 5 samples were culture-positive. Bacteriological examination of pleural fluids obtained by thoracoscopy revealed that 2 samples were PCR-positive, and 5 samples culture-positive, including 2 preoperatively positive samples. The adenosine deaminase (ADA) levels ranged from 18.3 to 279.0 U/L, with a mean of 72.9 U/L, including 50 U/L or less in 5 patients and 35 U/L or less in 3 patients. Thirty patients (93.8%) were successfully diagnosed by pleural biopsy with pathological examination, and 21 (65.6%) of them by pathological examination alone. CONCLUSION: In patients with suspected tuberculous pleurisy, thoracoscopic pleural biopsy under local anesthesia should be actively performed, because the technique has a high diagnostic rate, and can be easily and safely performed.

Adenosine Deaminase↗

PubMed2004

Local anesthesia use for laparoscopic cholecystectomy.

This study aimed to investigate the effects and timing of local anesthesia during laparoscopic surgery in terms of postoperative pain, nausea, and the need for opioids and antiemetics. This prospective study was carried out on 142 patients who underwent laparoscopic cholecystectomy. Peroperative local anesthesia was not administered to 53 patients (group A). The skin, subcutis, fascia, and parietal peritoneum were infiltrated with 0.5% bupivacaine HCl at trocar sites before trocar insertion in 46 patients (group B). Local anesthesia was given to 43 patients in equal doses at the same sites and the same manner at the end of surgery (group C). The higher requirement for analgesics in group A patients was statistically significant when compared with that in group B and C patients. The mean doses of analgesics postoperatively were significantly higher in group B than in group C. The time delay to the first antiemetics was significantly shorter in group A than in group C. Applying local anesthesia to the skin, subcutis, fascia, and parietal peritoneum through trocar sites reduces the postoperative analgesic requirement and pain intensity. This approach is more effective when applied at the end of an operation than at the start.

Adult↗

PubMed1991

[A case of delirium which occurred during otorhinolaryngological treatment under local anesthesia--the importance of close communication between practitioners and local general hospitals].

We experienced a case of delirium which occurred during treatment of chronic sinusitis under local anesthesia in a ENT practitioner, which took an unique course. We were able to treat the patient immediately after occurrence of the complication because we have emergency hot-line between anesthesiologists in our hospital and the practitioners in our area. Fortunately the patient recovered without severe sequelae due to immediate therapy. We consider that in emergency cases, a close communication between practitioners and local general hospitals is important for exact diagnosis and suitable treatments as well as for life-saving procedures.

Anesthesia, Local↗

PubMed1994

Comparison of iontophoresis of lidocaine with a eutectic mixture of lidocaine and prilocaine (EMLA) for topically administered local anesthesia.

BACKGROUND: Almost all dermatologic surgery is accomplished using local anesthesia. To make our patients more comfortable, there is a constant search for less painful methods of administering anesthetic agents. Topical EMLA as well as iontophoresis are both useful in this regard. OBJECTIVE: In this study we compared topical EMLA with lidocaine delivered by iontophoresis in a double-blind placebo-controlled trial. Our goal was to assess the degree of anesthesia obtained as well as the relative rapidity of onset. METHODS: A double-blind controlled study was performed on 10 healthy volunteers between 26 and 37 years of age. Three test sites were placed on each forearm. EMLA or a moisturizer control was placed on two of the three test sites on each arm. Each site was wiped free of cream and tested for sensitivity to pinprick 30 and 60 minutes after cream placement. One iontophoretic unit was placed on each forearm. Both units were saturated with anesthesia with the control unit being turned off. Sensitivity to pinprick was evaluated at the iontophoretic sites and one of the EMLA sites 30 minutes after site placement on the subject. The additional EMLA-treated site was tested in the same manner 60 minutes after placement. RESULTS: Both EMLA cream and the iontophoretic unit delivered topical anesthesia greater than the control. Significantly more anesthesia was acquired 1 hour after application of EMLA than was seen 30 minutes earlier. The iontophoretic patch-treated area provided greater anesthesia than the EMLA-treated sites evaluated 30 and 60 minutes after placement. Both modalities provided significant anesthesia when left in place for 60 minutes. CONCLUSION: Both iontophoresis of lidocaine and topical EMLA delivered significant, and sometimes complete, local anesthesia. A greater degree of anesthesia is delivered via iontophoresis after 30 minutes as compared with EMLA left on the skin for 30 or 60 minutes. Both modalities have important and unique advantages and disadvantages. Topical EMLA and iontophoretically delivered lidocaine are both valuable tools for the dermatologic surgeon.

Administration, Cutaneous↗

PubMed1983

Electrical skin resistance changes in meridians during ophthalmic surgery with local anesthesia.

Electrical skin resistance on Accumulation points in twelve meridians was measured during operation of cataract under local anesthesia. Electrical skin resistance increased an average of 15 percent in bladder, kidney, liver, stomach, gall bladder meridians, and decreased an average of 18 percent in lung, small intestine, heart, spleen-pancreas, heart constrictor, triple heater, large intestine meridians. When comparing the skin resistance values with those under acupuncture anesthesia during ophthalmic surgery, the skin resistance value under acupuncture anesthesia exhibited a marked decrease in all meridians (average 23 percent decrease) except the kidney meridian. On the other hand, the skin resistance under local anesthesia was only a 7.4 percent decrease in all meridians except the kidney meridian. It was speculated as one of the reasons for less changes of skin resistance under local anesthesia that sympathetic nervous activity did not occur so much because of pain relief due to local anesthesia.

Acupuncture Therapy↗

PubMedDate not supplied

Stroke prevention during carotid surgery in high risk patients (value of transcranial Doppler and local anesthesia).

In a series of 114 cases, carotid surgery was performed under local anesthesia by cervical block in order to assess cerebral status. Preoperative transcranial Doppler was used to select high risk patients for shunting. Intraoperatively brain function was checked by carotid arterial blood pressure monitoring and transcranial Doppler. No stroke occurred during the procedure. Postoperatively two deaths (1.8%) occurred, one due to intracerebral hemorrhage and one to a late myocardial infarct. The predictive value of both transcranial Doppler and stump pressure monitoring for shunting was 97% respectively. In combination, the two methods provided 100% protection. During the same period, 1406 patients underwent carotid surgery under general anesthesia. Carotid surgery stroke can be prevented either by using transcranial Doppler together with carotid stump pressure monitoring when the procedure is performed under general anesthesia or by operating under local anesthesia.

Aged↗

PubMed1976

Patient acceptance of local anesthesia for breast biopsy.

Three out of every four patients undergoing breast biopsy found the outpatient local-anesthesia method acceptable in this study. Patient acceptance was greater among those who experienced less pain and anxiety. This suggests that acceptance could be increased by more complete preoperative explanation to the patient, adequate premedication, properly administered local anesthesia and gentle technique. Acceptance would also probably be far greater in a private practice setting than in the instititutional and sometimes impersonal setting of a large federal hospital. Breast biopsy under local anesthesia has not compromised survival rates or increased local recurrence. When it is done on an outpatient basis, hospital costs have been reduced at least threefold. It is apparent, then, that patient objection is not a deterrent to the use of breast biopsy under local anesthesia on an outpatient basis. For patients with dominant breast masses, this modality can be added to any plan of management which seeks to reduce patient risk and inconvencience, diminish hospital costs and alleviate bed demand all without impairing diagnostic accuracy or long-term survival.

Adolescent↗