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PubMed1998

Complications of abortion performed under local anesthesia.

OBJECTIVE: To assess the incidence of complications of abortion performed under local anesthesia. DESIGN: Prospective study. SETTING: A family planning center in the Paris area. POPULATION: Eight hundred and fifty-eight women admitted for abortion under local anesthesia. MAIN OUTCOME MEASURES: Incidence of immediate (the day of vacuum aspiration) and delayed complications (at the follow-up visit 2 weeks after the procedure). RESULTS: Among the 858 women who underwent vacuum aspiration, 683 (80%) attended the follow-up visit 2 weeks after the procedure. Fifty-nine percent of the 858 women had not had a previous abortion, 25% had had one, and 16% had had two or more. The average duration of amenorrhea was 8.6 weeks (19% at 6 or 7 weeks, 67% between 8 and 10 weeks, and 14% after 10 weeks). The overall complication rate was 3.4% (23/683) (95% CI=2.0-4.8%). The incidence of immediate complications was 1.7% (15/858) (0.8-2.6%) and that of delayed complications 1.2% (8/683) (0.4-2.0%). CONCLUSION: This study confirms the safety and efficacy of abortion by vacuum aspiration under local anesthesia.

Abortion, Incomplete↗
PubMed1995

Development of a program teaching laparoscopic sterilization using local anesthesia.

A program teaching laparoscopic sterilization using local anesthesia was developed and implemented in a large residency program in which sterilization using general anesthesia was already being taught in a traditional fashion. Important steps for the development of such a program included the designation of an individual with overall responsibility for the program, identification of potential obstacles along with feasible solutions, and training of residents and staff in the new techniques. The major obstacles to implementation included opposition from anesthesia personnel, the need for additional training in the new techniques for both residents and faculty, nursing staff resistance, and the uncertainty of patient acceptance. Solutions included involving anesthesia personnel in program planning as well as in the ultimate performance of the procedures, practicing local techniques during cases under general anesthesia, limiting initial cases to candidates anticipated to be uncomplicated, and using nondirective counseling of patients. Similar strategies can be useful both to other residency programs and individuals wishing to offer local anesthesia as an option for laparoscopic sterilization at their hospitals.

Anesthesia, Local↗
PubMed2000

[Hemorrhoidectomy with ropivacaine (Naropin) local anesthesia. Preliminary experience].

BACKGROUND: The use of local anesthesia in non-septic anal surgery is now well established. Tolerance to local injection, duration of local effect and the risk of local or systemic complications still represent unsolved issues. Ropivacaine, a new local anesthetic, seems particularly indicated for this kind of surgery because of its pharmacologic properties which reduce patient's discomfort during infiltration and provide good antalgic coverage in the first hours following the operation. METHODS: The first 20 consecutive cases operated with local anesthesia by ropivacaine have been prospectively studied. All patients have been given an 11-point box VAS scale which is used for subjective evaluation of pain. RESULTS: Mean pain score resulted 1.1, 1.6 and 1.4 at 1, 2 and 3 postoperative hours, respectively. Thirty percent of patients subsequently required pain medication up to the first bowel movement. No complications related to the use of ropivacaine has been observed. CONCLUSIONS: This new drug can be safely used in the outpatient or Day-Surgery treatment of hemorrhoids.

Adult↗
PubMedDate not supplied

Deterioration of Kearns-Sayre syndrome following articaine administration for local anesthesia.

Worsening of the neuromuscular manifestations in Kearns-Sayre syndrome after administering local anesthesia with articaine has not been reported. The authors describe a severe adverse reaction to local anesthesia with articaine for tooth extraction in a 28-year-old woman with Kearns-Sayre syndrome due to a 5.9-kb mitochondrial DNA deletion. The patient was subjected to local anesthesia with 1.5 mL (60 mg) articaine in the left submandibular nerve for tooth extraction. Five minutes after the injection the patient developed weakness of the limb muscles, extreme fatigue with increased desire to sleep, a feeling of heat, inappetence, and frequent urination. The adverse reaction resolved spontaneously within 48 hours without sequelae. Administration of articaine may cause severe side effects in patients with Kearns-Sayre syndrome. Articaine should be used with caution in these patients.

Anesthesia, Local↗
PubMed1989

[Spongia somnifera. Medieval milestones on the way to general and local anesthesia].

Medieval medicine was highly innovative compared to ancient and early modern medicine. The achievements then did not merely comprise new models from the viewpoint of the history of science: development of the university, a well-defined curricula and official degrees, obligatory fees and cost reducing measures. They also included therapeutic procedures like nerve suture, antisepsis, chemotherapy (colchicine), cardiac glycosides (scillaren, convallerin), the development of visual aids (binoculars, magnifying glass, microscope, presbyopic glasses) and further improvement of plastic surgery by the application of delayed grafts (lips/nose plastic). Modern medicine at first rejected and forgot these techniques, which were not rediscovered until the 19th and 20th century. This holds true for the extirpation of abdominal tumors as well as for the concept of therapeutic fever. It also pertains to anesthesia, which in the Middle Ages was developed from ancient methods of sedation. Medieval scholars perfected the method into achieving the first total anesthesia (resorption/inhalation anesthesia) and then local anesthesia (application of morphine at the cornea).

Anesthesiology↗
PubMedDate not supplied

Feasibility analysis of loop colostomy closure in patients under local anesthesia.

PURPOSE: To verify prospectively the practicability of performing loop colostomy closure under local anesthesia and sedation. METHODS: In this study, 21 patients underwent this operation. Lidocaine 2% and bupivacaine 0.5% were utilized. Pain was evaluated during the operation, on the first postoperative day and at hospital discharge. Intraoperative events, postoperative complications and the acceptability of this procedure were analyzed. RESULTS: The mean duration of the operation was 133 minutes (range: 85 to 290 minutes). The mean postoperative hospitalization was four days (range: one to twelve days). No patients died. Complications occurred in two patients (9.4%): abdominal wall hematoma and operative wound infection. With regard to pain severity, scores of less than or equal to three were indicated in the intraoperative evaluation by 80% of the patients (17/21) and on the first postoperative day by 85% (18/21). At hospital discharge, 95.2% of the patients (20/21) said they were in favor of the local anesthesia technique. CONCLUSION: Loop colostomy closure under local anesthesia and sedation is feasible, safe and acceptable to patients.

Adult↗
PubMedDate not supplied

[Evaluation of local anesthesia in inguinal hernia operations].

The results of a group of General, Peridural and Epidural Anesthesia (162 operations) and a group of Local Anesthesia (87 operations) were compared. It was concluded that in the local anesthesia group: 1. A minimal dose of medication was needed (inclusive the anesthetics). 2. Postoperative complication rate was very low. 3. Recurrence rate was nihil after 2 years. 4. The hospitalization time was very low. 5. The acceptance rate was high (96.6%). 6. The cost of this type of anesthesia was up to half the cost of general or regional anesthesia.

Adult↗
PubMed1999

Transfemoral endografting of thoracic aortic aneurysm under local anesthesia: a simple, safe and fast track procedure.

BACKGROUND: Endovascular aneurysm grafting of the descending thoracic aorta is a minimally invasive catheter technique, which is performed under general anesthesia. We describe a technique allowing to perform transfemoral endovascular repair of thoracic aortic repair under local anesthesia. PATIENTS AND METHODS: In 9 consecutive patients local anesthesia was performed in order to gain an opened femoral artery access for the delivery system, and a percutaneous access to the left brachial artery. A pigtail catheter was then placed through the left brachial artery for the location of the origin of the left subclavian artery and/or the aneurysm and self-expanding endoprosthesis was released under fluoroscopic guidance. For the deployment of the endograft a short period of controlled hypotension with nitroglycerin bolus application was produced. RESULTS: All the aneurysms could be successfully sealed with the intended endovascular technique. There was no vascular access complication or pulmonary or ischemic (cardiac, cerebral or peripheral) complication. In the follow-up period of 6 +/- 3 months one patient needed a redo endovascular procedure because of the development of a severe and symptomatic distal endoleak 6 weeks postoperative. This procedure was again performed under local anesthesia. CONCLUSIONS: From a technical point of view, transfemoral endovascular repair of thoracic aneurysm can be performed under local anesthesia. This is a very simple and fast track procedure which combines a minimally invasive catheter technique and a less invasive anesthetic management.

Adult↗
PubMed1991

[Minicholecystectomy with local anesthesia].

In suitable patients the gallbladder can be exercised in local anesthesia through a very small incision. The anatomical background of a safe local anesthesia and the operative procedure is described. Candidates for this operation are patients with gallbladder stone disease without severe acute or chronic complications, and with normal and stone free bile ducts. This type of intervention is an enlargement of the surgeon's armentarium, and it can be offered to patients unwilling to have general anesthesia or with severe contraindications to narcosis.

Aged↗
PubMed1992

Comparison of silastic rings and electrocoagulation for laparoscopic tubal ligation under local anesthesia.

OBJECTIVE: To compare objectively the pain associated with tubal occlusion by Silastic rings versus electrocoagulation during laparoscopic tubal ligation under local anesthesia. METHODS: Consecutive patients scheduled for laparoscopic tubal ligation under local anesthesia were randomized to Silastic rings (N = 50) or electrocoagulation (N = 52) as the method of tubal occlusion. Sterilization was performed under local anesthesia in a standard fashion. Bupivacaine 0.5% was used as the local anesthetic agent. Operative pain was measured based on intraoperative anesthesia requirements and a modified McGill pain questionnaire. This questionnaire was used to assess pain at 15 minutes, 1 hour, and 24 hours postoperatively. RESULTS: Demographics were similar for the two groups. Operative time was shorter in the Silastic-ring group (16.7 versus 21.8 minutes; P = .001), and this group also required less intraoperative anesthesia (P = .004). There were no statistical differences between the groups in self-reported pain intraoperatively or postoperatively. No patient in either group required antiemetics or pain medication in the recovery room. CONCLUSION: Silastic rings appear preferable to bipolar electrocoagulation for laparoscopic tubal sterilization under local anesthesia when long-acting local agents are used for tubal anesthesia.

Adult↗
PubMed2001

Diplopia as a complication of local anesthesia: a case report.

Diplopia caused by local anesthesia at the superior posterior alveolar nerve for the removal of the maxillary third molar is a rare complication. The diplopia is due to facial palsy of the oculomotor muscles of the globe. This paper describes the case of a 22-year-old woman, in whom diplopia was observed after an overall uncomplicated removal of the semi-impacted third molar. Possible causes of the anesthetic effects are reported. The most accepted explanation is that the anesthetic diffuses on the abducent nerve in the cavernous sinus. The necessary actions that the dental surgeon must perform are reported.

Abducens Nerve↗
PubMed1979

[Pacemaker implantation under local anesthesia].

102 pacemakers have been implanted under local anesthesia. The electrodes have been introduced through the left vena cephalica and the pacemakers placed in the infraclavicular groove. Exchanged pacemakers have been put in the already existing cavity. The wounds have been closed by sutures consisting solely of polyglycolic acid. One hematoma and one infection have been observed. In 12% of the cases the electrode was introduced through the vena jugularis externa, owing to obstruction or unsuitable size of the vena cephalica. Reoperation was necessary in 3 cases due to dislocation of the electrode, and in one case due to the perforation of the ventricle caused by the electrode.

Aged↗
PubMed1999

Local anesthesia for prostate brachytherapy.

PURPOSE: To demonstrate the technique and feasibility of prostate brachytherapy performed with local anesthesia only. METHODS AND MATERIALS: A 5 by 5 cm patch of perineal skin and subcutaneous tissue is anesthetized by local infiltration of 10 cc of 1% lidocaine with epinephrine, using a 25-gauge 5/8-inch needle. Immediately following injection into the subcutaneous tissues, the deeper tissues, including the pelvic floor and prostate apex, are anesthetized by injecting 15 cc lidocaine solution with approximately 8 passes of a 20-gauge 1.0-inch needle. Following subcutaneous and peri-apical lidocaine injections, the patient is brought to the simulator suite and placed in leg stirrups. The transrectal ultrasound (TRUS) probe is positioned to reproduce the planning images and a 3.5- or 6.0-inch, 22-gauge spinal needle is inserted into the peripheral planned needle tracks, monitored by TRUS. When the tips of the needles reach the prostatic base, about 1 cc of lidocaine solution is injected in the intraprostatic track, as the needle is slowly withdrawn, for a total volume of 15 cc. The implants are done with a Mick Applicator, inserting and loading groups of two to four needles, so that a maximum of only about four needles are in the patient at any one time. During the implant procedure, an additional 1 cc of lidocaine solution is injected into one or more needle tracks if the patient experiences substantial discomfort. The total dose of lidocaine is generally limited to 500 mg (50 ml of 1% solution). RESULTS: To date, we have implanted approximately 50 patients in our simulator suite, using local anesthesia. Patients' heart rate and diastolic blood pressure usually showed moderate changes, consistent with some discomfort. The time from first subcutaneous injection and completion of the source insertion ranged from 35 to 90 minutes. Serum lidocaine levels were below or at the low range of therapeutic. There has been only one instance of acute urinary retention in the patients treated so far, and no unplanned admissions to the hospital or need to reschedule a patient to be implanted under general or spinal anesthesia. CONCLUSIONS: The substitution of local anesthesia has facilitated rapid introduction of a high-volume brachytherapy program at an institution that previously had none, without requiring the allocation of significant operating room time. Although the patients reported here were implanted without conscious sedation, we are starting to try various sedatives and analgesics for patients who we anticipate will have substantial anxiety with the procedure.

Adrenergic Agonists↗
PubMed1987

Knee arthroscopy and arthrotomy under local anesthesia.

We report our experience with knee arthroscopy in local anesthesia in 64 patients with subsequent arthrotomy in 14 of these. The effectiveness of the anesthetic method was evaluated by both the patient and the anesthetic personnel. There was no difference in pain assessment between arthroscopy alone and arthroscopy followed by arthrotomy. Half of the patients had no pain and only one regarded the procedure as very painful. Supplementary analgesia with 0.05 mg fentanyl was given to half of the patients not undergoing arthrotomy and to two thirds of those who had arthrotomy. It was not necessary to abandon any arthroscopic or surgical procedure because of pain. We conclude that local anesthesia is a safe and practical method for diagnostic arthroscopy, arthroscopic surgery, and minor arthrotomy.

Anesthesia, Local↗
PubMed1998

Toxicity and allergy to local anesthesia.

Considering the amount of local anesthetic administered on a daily basis, dental professionals must be familiar with the factors that influence the dose and type of local anesthetic that induces a toxic or allergic reaction. In addition to the route and rate of administration, the patient's physical condition and health may also influence the dose of local anesthetic that could be safely administered. This article reviews the different causes of local anesthesia toxicity and allergy. With prevention and early recognition of the warning signs, poor prognosis can be avoided.

Age Factors↗
PubMed1990

Posterior cervical spine stabilization under local anesthesia.

A technique is described for posterior cervical stabilization with spinous process wiring and fusion performed with the patient under local anesthesia and using corticocancellous demineralized bone matrix allograft. In patients with unstable cervical spines, posterior stabilization and fusion with local anesthesia allowed patient interaction with the surgeon during crucial parts of the operation. The technique was well tolerated and no untoward complications occurred. The technique has not been described for the neurologically intact patient with cervical spine trauma. The purpose of this report is to document the facility and advantages of this technique over traditional general anesthesia with autograft use. Nineteen patients were treated surgically at the author's institution. Local anesthesia was used in 12, and general anesthesia was used in 7. Allograft was used in 12 and autologous iliac crest graft was used in 7 patients. The indications for surgery were instability or neurologic deficit. Blood loss and operative times were favorable when compared with general anesthesia and autograft. The fusion extended by one level in 6 of 19 patients. One patient had preoperative neurologic deficit. All 19 follow-up patients were Frankel grade E. There is no need for endotracheal intubation, the patient serves as his or her own spinal cord monitor, and the surgeon is able to be aware immediately of any threat to neurological function. Demineralized bone matrix allograft has been shown to effectively induce osteogenesis by osteoinduction as well as osteoconduction. Its use eliminates the need for autograft harvesting and permits the use of local anesthesia alone for cervical spine posterior stabilization. The more neurologically intact the patient, the more this technique is indicated.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2002

Microprocessor-controlled local anesthesia versus the conventional syringe technique in hair transplantation.

BACKGROUND: Local anesthesia by the traditional injection technique is central to optimizing patient comfort during hair transplant procedures. However, even when carefully and properly performed, some patients still describe their treatment sessions as painful. OBJECTIVE: To determine if patients undergoing hair transplantation experience less pain and discomfort when their local anesthesia is performed with the Wand (as of spring 2001, the Wand has been renamed "CompuMed- Featuring the Wand Handpiece"), a microprocessor pump that precisely controls the infusion rate and pressure of local anesthetic solution. METHODS: We used combined retrospective studies and a prospective blinded study of men and women who received hair transplantation treatments between January 1999 and March 2001 at our private outpatient clinics in the United States. A total of 101 patients compared their experiences during their hair transplant sessions performed by us before and after we started using the Wand. Thirty-nine patients compared their experiences during treatments done by 32 other medical groups and when we used the Wand. In addition, 88 patients compared the Wand to injection while blinded to technique. The outcomes were measured with patient pain rating questionnaires using the Wong-Baker Faces Pain Rating Scale (0, no pain-5, severe pain). RESULTS: Patients in all three study groups reported that anesthesia with the Wand was less painful. Wand anesthesia was overwhelmingly (68%) described as associated with none (0) or very little (1) pain. Surprisingly, Wand anesthesia was associated with superior comfort not only during the administration of anesthesia (P =.005), but throughout the treatment session and during the first 48 postoperative hours. CONCLUSION: Microprocessor-controlled local anesthesia with the Wand is superior to traditional injection in consistently producing comfortable hair transplant treatments.

Anesthesia, Local↗