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At least 523 records · Page 29Linked to original sources
PubMed2003

Transient impaired vision, external ophthalmoplegia, and internal ophthalmoplegia after blepharoplasty under local anesthesia.

PURPOSE: To report a case of transient bilateral vision impairment with external ophthalmoplegia and internal ophthalmoplegia after blepharoplasty under local anesthesia. DESIGN: Interventional case report. METHODS: A 70-year-old man underwent bilateral upper blepharoplasty under local anesthesia. During orbital fat removal additional anesthetic was injected into both medial fat pads for pain control. RESULTS: Immediate postoperative examination revealed bilateral decreased visual acuity and internal ophthalmoplegia in the right eye. An exotropia was present with marked limitation of right eye adduction. These findings resolved completely 3 hours postoperatively. CONCLUSIONS: Local anesthesia during blepharoplasty can enervate the optic nerve, ciliary ganglion, and extraocular muscle nerves. Local anesthesia should be injected judiciously during orbital fat removal to avoid this reversible but alarming event.

Aged↗
PubMed2000

Does local anesthesia at mid-trimester amniocentesis decrease pain experience? A randomized trial in 220 patients.

OBJECTIVES: To evaluate whether local anesthesia decreases patients' pain experience during mid-trimester amniocentesis. METHODS: In a randomized trial, one group did not receive local anesthesia while, in another group, lignocaine 1% was injected subcutaneously prior to amniocentesis. Five different scoring systems were used to evaluate patients' pain experience. RESULTS: Two hundred and twenty women entered the study: 114 received local anesthesia, while 106 did not. The mean (SD) Visual Analog Scale was 1.4 (1.5) on a 0-10 scale (range 0-7.6). Some 97% of patients described the procedure as not painful or bearable, 79% had expected the procedure to be more painful and 59% reported the amniocentesis to have a comparable discomfort as venous blood sampling; 98% of women declared they would undergo an amniocentesis again if indicated. There were no statistical differences between both randomization groups. CONCLUSIONS: Mid-trimester amniocentesis is not a painful procedure. Local anesthesia does not affect pain experience during amniocentesis.

Adult↗
PubMed1999

Iontophoresis: a needle-free, electrical system of local anesthesia delivery for pediatric surgical office procedures.

BACKGROUND/PURPOSE: Delivery of local anesthesia for surgical office procedures for pediatric patients can be difficult. Injections are painful and often lead to patient anxiety, and topical anesthetics frequently provide incomplete anesthesia. The authors prospectively studied the efficacy of iontophoresis, a needle-free technique in which positively charged lidocaine and epinephrine molecules are drawn into the tissue by an electrical current as an anesthetic for pediatric surgical office procedures. METHODS: Children undergoing an office procedure were offered local anesthesia via iontophoresis. Prospectively collected data included patient characteristics, procedure, iontophoresis dose and time, need for additional injected anesthetic, pain during the procedure as determined by a 0 to 5 faces scale, and complications. A satisfaction questionnaire was completed at the follow-up visit or by telephone. RESULTS: Over an 8-month period, 34 patients with a mean age of 6.8 years (range, 3 months to 15 years) underwent 38 office procedures with anesthesia supplied through iontophoresis. Skin lesion excision (n = 14) and abscess drainage (n = 12) were the most common procedures. Seven patients required unplanned injected anesthetic. A small, superficial burn was the only complication. Sixty percent of patients and 84% of parents rated pain as 0 to 2 (zero to mild). Overall, 88% were satisfied with the anesthetic. CONCLUSION: Iontophoresis appears to be an effective and safe alternative method of local anesthesia delivery for pediatric surgical office procedures.

Ambulatory Surgical Procedures↗
PubMed1994

Local anesthesia for inguinal hernia repair step-by-step procedure.

OBJECTIVE: The authors introduce a simple six-step infiltration technique that results in satisfactory local anesthesia and prolonged postoperative analgesia, requiring a maximum of 30 to 40 mL of local anesthetic solution. SUMMARY BACKGROUND DATA: For the last 20 years, more than 12,000 groin hernia repairs have been performed under local anesthesia at the Lichtenstein Hernia Institute. Initially, field block was the mean of achieving local anesthesia. During the last 5 years, a simple infiltration technique has been used because the field block was more time consuming and required larger volume of the local anesthetic solution. Furthermore, because of the blind nature of the procedure, it did not always result in satisfactory anesthesia and, at times, accidental needle puncture of the ilioinguinal nerve resulted in prolonged postoperative pain, burning, or electric shock sensation within the field of the ilioinguinal nerve innervation. METHODS: More than 12,000 patients underwent operations in a private practice setting in general hospitals. RESULTS: For 2 decades, more than 12,000 adult patients with reducible groin hernias satisfactorily underwent operations under local anesthesia without complications. CONCLUSIONS: The preferred choice of anesthesia for all reducible adult inguinal hernia repair is local. It is safe, simple, effective, and economical, without postanesthesia side effects. Furthermore, local anesthesia administered before the incision produces longer postoperative analgesia because local infiltration, theoretically, inhibits build-up of local nociceptive molecules and, therefore, there is better pain control in the postoperative period.

Anesthesia, Local↗
PubMed1996

Local anesthesia in carotid angioplasty.

PURPOSE: To determine the safety and efficacy of local anesthesia for percutaneous carotid angioplasty and stenting performed via a direct common carotid access. METHODS: Deep cervical plexus blockade was used for anesthesia in 22 of 32 patients (26 males; mean age 66 years) undergoing percutaneous carotid balloon angioplasty and/or stenting via direct carotid puncture. Local anesthesia was selected according to patient preference (n = 9); advanced age (n = 4); ischemic heart disease (n = 4); intended extracorporeal circulation for unstable angina (n = 3); and an incompetent circle of Willis (n = 2). The technique involved injection of bupivacaine hydrochloride along the C2, C3, and C4 transverse processes. No superficial cervical plexus blockade was used. RESULTS: No complications of anesthesia were observed, though there were cases in which surgery became necessary under local anesthesia for angioplasty-related complications. These conversions were accomplished without difficulty. CONCLUSIONS: Cervical nerve blockade appears to be a safe and effective anesthetic method for endovascular carotid interventions performed percutaneously through direct carotid puncture.

Age Factors↗
PubMed1998

Transurethral resection of the prostate and laser prostatectomy under local anesthesia.

OBJECTIVE: To perform transurethal resection of the prostate (TURP) and transurethral laser ablation prostatectomy (TULAP) under appropriate local anesthesia. PATIENTS AND METHODS: A total of 54 patients were examined in this study. We carried out TURP in 42 and TULAP in 12 of them under local anesthesia with lignocaine chloride. Patient's discomfort was recorded by means of a four-point descriptive pain scale. RESULTS: We had perfect pain control in the majority of the patients. Patient's acceptance was very high. No patient required conversion to general anesthesia. Complications due to local anesthesia were not observed. CONCLUSION: We believe that ours is a simple, safe and effective procedure.

Aged↗
PubMed1976

Clinical evalation of the the of local anesthesia for repair of inguinal hernia.

Three hundred sixty-six patients undergoing elective inguinal hernioplasty were randomized to receive either local anesthesia or traditional spinal or general anesthesia. Overall operative complication rates were nearly the same, but wound complication predominated in the local anesthesia group while problems related to anesthesia were more common with spinal or general technique. Patients who had local anesthesia had significantly fewer postoperative symptoms than did the others.

Adult↗
PubMed2000

Periprostatic local anesthesia before ultrasound guided prostate biopsy.

PURPOSE: We assessed the morbidity and benefit of periprostatic local anesthesia administered before ultrasound guided prostate biopsy. MATERIALS AND METHODS: After placing the transrectal ultrasound probe and visualizing the prostate 50 consecutive patients received local anesthesia before prostate biopsies. RESULTS: There was no morbidity associated with the infiltration of local anesthesia into the periprostatic neurovascular plexus. Only 1 patient had discomfort during prostate biopsies, and 10 patients who previously underwent biopsies without anesthesia commented favorably on the dramatic difference. CONCLUSIONS: Many patients have pain during transrectal ultrasound guided biopsies of the prostate and few clinicians provide a periprostatic nerve block before this procedure. A periprostatic nerve block administered before the biopsies dramatically decreases discomfort. We urge all urologists to attempt this procedure, and we are confident that they will adopt it as part of their practice.

Anesthesia, Local↗
PubMed1997

[Extraperitoneal, "tension free" inguinal hernia repair with local anesthesia--a contribution to effectiveness and economy].

In this present randomized controlled study, two groups, each consisting of 45 patients, underwent tension-free inguinal hernia repair under general versus local anesthesia. Patients in the local anesthesia group described their pain during mobilisation by using the VAS and were found to have a significant pain level decrease from the first to the fifth postoperative day. In conclusion, it could be shown that tension-free hernia repair under local anesthesia is superior to tension-free hernia repair during general anesthesia concerning perception of pain and pain management.

Adolescent↗
PubMed1996

[Local anesthesia in operations of the head-neck area].

BACKGROUND: Many operations in the head and neck area can be performed under local anesthesia. However, the use of local anesthesia does not automatically reduce the risk for the patient undergoing surgery. RESULTS: In the present paper, the authors discuss local anesthetics used in surgical procedures in the head and neck region. Aminoesters are currently the most commonly used local anesthetics. Local anesthetics vary with respect to the onset and duration of the local anesthetic effect. The choice of local anesthetic depends on the estimated duration of the surgical procedure. Possible side effects of these substances may affect the central nervous as well as the cardiovascular system. Certain changes in serum electrolytes (i.e., hyperkalemia) as well as hypoxia and hypercapnia significantly increase the cardiotoxic potential of local anesthetics. Different vasoconstrictor agents are used in addition to local anesthetics to prolong the duration of the local anesthetic effect and to provide the surgeon with a nearly bloodless field. The two groups of vasoconstrictors used in these days are catecholamines (epinephrine) and vasopressin analogs. Systemic side effects of catecholamines include cardiovascular reaction, mainly in patients with typical risk factors (i.e., coronary heart disease, high blood pressure, or chronic heart failure). Vasopressin analogs produce fewer side effects than epinephrine. Even so, an overdose of these vasoconstrictors might still result in severe cardiac complications. The recommended maximum doses of these drugs should be strictly observed. CONCLUSIONS: For several reasons, local anesthesia has become popular for a variety of surgical procedures in the head and neck in recent years. Even though the use of local anesthetics and vasoconstrictors in head and neck procedures has its advantages for both the patient and the surgeon, the limitations for the use of these drugs must always be taken into consideration.

Anesthesia, Local↗
PubMed1993

[Modified radical mastectomy in local anesthesia].

The authors report their experience on the use of local anesthesia for modified radical mastectomy. They have used this modality in five patients who could not undergo general anesthesia because of underlying severe medical illness and in a sixth one who adamantly refused general anesthesia. They describe in detail the technique used, stressing the importance of a thorough knowledge of regional neuroanatomy. There were no complications in their small series. The authors conclude by stating that the use of local anesthesia may expand the indications for "toilet mastectomy" to include patients in poor medical condition, unsuitable for general anesthesia.

Aged↗
PubMed2006

Digital versus local anesthesia for finger lacerations: a randomized controlled trial.

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 > or = 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.

Adolescent↗
PubMed1993

[Hypercapnea during facial surgery under local anesthesia].

We examined the ventilation of patients whose faces were draped during facial surgery under local anesthesia. Ten patients who underwent eye surgery received hydroxyzine 25 mg and pentazocine 15 mg i.m. before local anesthesia. Arterial blood samples and end-tidal respiratory gases from nasal cannulae were collected at the following selected times: before draping their faces, 10 min, 30 min, 60 min after draping, and after the drapes were removed. Both arterial carbon dioxide tension (42 +/- 1 mmHg before draping and 46 +/- 1 mmHg at 10 min) and end-tidal carbon dioxide tension (33 +/- 2 mmHg before draping and 36 +/- 1 mmHg at 10 min) were elevated significantly after their faces were draped. Hypercapnea was completely eliminated by suctioning the expired gases. It is concluded that hypercapnea is inevitable during face or neck surgery under local anesthesia, and that the expired gases should be monitored and removed.

Adult↗
PubMed2002

Optimizing local anesthesia during 10-core biopsy of the prostate.

OBJECTIVES: To examine, in a prospective, randomized study, the effect of different anesthetic techniques versus no anesthesia in a 10-core prostate biopsy. Reports thus far have shown a high variability in assessing the pain intensity of prostate biopsies and the effectiveness of anesthesia. METHODS: Ultrasound-guided 10-core prostate biopsy was performed. Patients were prospectively randomized into four groups: no local anesthesia (group 1); anesthetic block of the prostatic plexus (group 2); local anesthesia onto the capsula of the apex (group 3); and a combination of the anesthesia used for groups 2 and 3 (group 4). The degree of pain was recorded using the visual analog scale/numeric analog scale (VAS/NAS) score. RESULTS: The study included 187 patients. Results were assessed in 170 patients: 44 in group 1, 44 in group 2, 40 in group 3, and 42 in group 4. In group 1 (no anesthesia), 2 (4.5%) of 44 patients had no pain during biopsy (VAS/NAS = 0); the pain was mild (VAS/NAS of 1 to 4) in 38 (86.4%), moderate (VAS/NAS of 4 to 7) in 3 (6.8%), and severe (VAS/NAS of greater than 7) in 1 (2.3%) of 44 patients. The mean pain scores were 2.33 in group 1, 1.68 in group 2 (P = 0.05), 1.07 in group 3 (P <0.001), and 1.23 in group 4 (P <0.001). Pain caused by the local anesthesia itself was 0 in group 1, 1.52 in group 2 (P = 0.001), 1.05 in group 3 (P = 0.001), and 1.79 in group 4 (P = 0.001). CONCLUSIONS: Local anesthesia significantly reduces pain. An injection onto the capsule at the apex was the most effective technique. It is technically easier to perform than an anesthetic block of the prostatic plexus and can be recommended.

Aged↗