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At least 55 records · Page 3Linked to original sources
PubMed2004

Sentinel node biopsy in melanoma of the trunk and the extremities in tumescent local anesthesia.

BACKGROUND: The sentinel node biopsy (SNB) of axilla and groin is a common staging procedure and can be done in both general anesthesia and local anesthesia. OBJECTIVE: To investigate the efficacy of tumescent local anesthesia (TLA) as a widely used type of local anesthesia in dermatologic surgery for the SNB of axilla and groin. METHOD: From 1999 to 2002, 195 patients underwent a SNB of axilla or groin. A 0.1% tumescent solution with prilocaine was used. In cases in which local anesthesia did not produce complete analgesia, there was additional medication using Midazolam and Tramadol. RESULTS: In 74.9% of the patients, TLA was sufficient as the sole method. In 25.1%, sedation became necessary. Additional medication was required for 31.9% of the patients with SNB in the axilla and for 17.3% with SNB in the groin; 26.6% of the patients with SNB of both axillas and 25% with SNB of the axilla and the groin received additional medication using Midazolam. Two patients with a SNB of the axilla received a combination of Midazolam and Tramadol. CONCLUSION: SNB of the axilla and the groin in TLA is a good alternative to other anesthetic techniques, for example, general anesthesia or infiltration anesthesia.

Abdomen↗
PubMed2005

Repetitive low-energy shock wave application without local anesthesia is more efficient than repetitive low-energy shock wave application with local anesthesia in the treatment of chronic plantar fasciitis.

BACKGROUND: It remains unclear whether application of local anesthesia (LA) interferes with clinical efficacy of extracorporeal shock wave therapy (ESWT) for chronic plantar fasciitis. AIMS: To evaluate the effect of local anesthesia on the clinical outcome after repetitive low-energy ESWT for chronic plantar fasciitis. METHODS: Eighty-six patients with chronic plantar fasciitis were randomly assigned to receive either low-energy ESWT without LA, given weekly for three weeks (Group I, n=45; 3 x 2000 pulses, total energy flux density per shock 0.09 mJ/mm2) or identical ESWT with LA (Group II, n=41). Primary outcome measure was: Reduction of pain from baseline to month 3 post-treatment in a pain numeric rating scale [0-10 points] during first steps in the morning, evaluated by an independent blinded observer. Calculations were based on intention-to-treat. RESULTS: No difference was found between the groups at baseline. At 3 months, the average pain score was 2.2+/-2.0 points for patients of Group I, and 4.1+/-1.5 points for patients of Group II. The mean between-group difference was 1.9 points (95% CI: [1.1-2.7 points]; P<.001). Significantly more patients of Group I achieved 50% reduction of pain compared to Group II (67% vs 29%, P<.001). CONCLUSION: ESWT as applied should be done without LA in patients suffering from chronic heel pain. LA applied prior treatment reduced the efficiency of low-energy ESWT.

Adult↗
PubMed2006

Use of a tubular retractor system as a minimally invasive technique for epidural plate electrode placement under local anesthesia for spinal cord stimulation: technical note.

OBJECTIVE: To improve the technique of placement of large plate electrodes for spinal cord stimulation with a minimally invasive approach using the METRx tubular retractor system (Medtronic Sofamor Danek, Minneapolis, MN). This dilating system splits the paravertebral musculature, avoiding the need to strip these muscles from the spine. The technique described makes it possible to perform the procedure (currently, it is most frequently performed using general anesthesia) with local anesthesia and sedation, allowing test stimulation, and with little intraoperative or postoperative discomfort for the patient. METHODS: The tubular retractor system was used to approach the spine at the desired level using local anesthesia. A small laminectomy was performed through the working tube, and the plate electrodes were introduced by the same approach. Test stimulation could be performed to determine the correct electrode position because only local anesthesia was used. RESULTS: Seven patients were scheduled for placement of large plate electrodes for spinal cord stimulation. In six patients, with different indications for the placement of spinal cord stimulation, the electrode could be placed using the minimally invasive tubular retractor system approach with local anesthesia and slight sedation. A good test stimulation was obtained in all of the patients, resulting in good pain relief after definitive implantation. We were not able to perform the procedure in one patient because we could not reach the spinal canal at the level operated on previously. All patients experienced only acceptable postoperative back pain. CONCLUSION: Using a tubular retractor system, implantation of plate electrodes for spinal cord stimulation can be performed under local anesthesia with acceptable discomfort for the patient, making the approach of the spinal canal minimally invasive. This method allows test stimulation to assess the correct electrode position and results in less local postoperative discomfort because of the small-muscle splitting approach.

Anesthesia, Local↗
PubMed2000

New advances in local anesthesia.

In dentistry, local pain management is a critical component of patient care. When efforts to achieve local anesthesia are unsuccessful, the resulting stress for both the patient and practitioner can be significant. This Forum has reviewed new technologies that are reported to increase the probability of a favorable outcome with local anesthesia. Like all new techniques, devices, and drugs, there is a learning curve that must be mastered. However, the potential benefits of the new devices and techniques available in local anesthesia broaden the practitioners' choices. There may not yet be a "magic bullet" in local anesthesia, but the advances reviewed here hold great promise. Our participants seem to agree that predictable local anesthesia will always require a thorough understanding of the broad range of devices, techniques, and drugs available and a commitment by the dentists to use them wisely.

Anesthesia, Dental↗
PubMed2000

Can local anesthesia be recommended for routine use in elective knee arthroscopy? A comparison between local, spinal, and general anesthesia.

Local anesthesia (LA) for outpatient knee arthroscopy is not a standard procedure at most hospitals. To evaluate the LA technique for knee arthroscopy on medically healthy patients, this study compared 3 anesthesia techniques. Four hundred patients were randomized to either local (n = 200), general (n = 100), or spinal (n = 100) anesthesia. Evaluated outcomes included the patient's subjective view of the procedure, and nausea and pain at rest and during active movement. All variables were recorded perioperatively and postoperatively. In addition, the performing surgeon's opinion of the degree of patient pain and the technical difficulty of the procedure were noted. Three hundred forty-two patients completed the study. In the group receiving local anesthesia (n = 180) the median visual analog scale pain score during surgery was 6 mm (mean, 17.5; SD, 23.2; range, 0 to 100 mm). Twenty-one LA patients would have preferred another form of anesthesia. In 29 patients, LA was not considered as the optimal anesthesia by the performing surgeon. Eight LA patients agreed with the surgeon that the anesthesia method used was not optimal, of these patients, 5 had synovitis (3%). In 5% of the LA patients there were technical problems. Thus, this study shows that elective knee arthroscopy can be performed under local anesthesia in 92% of the patients from a technical point of view. Excluding patients who do not choose local anesthesia and those who have hypertrophic synovitis preoperatively, knee arthroscopies can be performed as safely and effectively under local anesthesia as under any other form of anesthesia. For most patients, local anesthesia can be recommended as the standard procedure for outpatient knee arthroscopy.

Adult↗
PubMed2005

A survey of pain, pressure, and discomfort induced by commonly used oral local anesthesia injections.

Intraoral local anesthesia is essential for delivering dental care. However, it is often perceived by some patients as the most painful and in some instances as the only painful part of the treatment, leading in extreme cases to avoidance of dental care. The present study measured the variables of pain, pressure, and discomfort caused by 4 commonly used local anesthesia injections: local infiltration, mental nerve block, inferior alveolar nerve block, and periodontal ligament injections. Patients were asked to grade pain, discomfort, and pressure on a visual analog scale as associated with needle insertion, operator finger position in the mouth, and pressure at injection. The inferior alveolar injection was graded to be the most painful followed by periodontal ligament and then mental nerve block injections. The periodontal ligament injections yielded the highest pressure scores. The inferior alveolar block injection yielded significantly more discomfort than local infiltration and mental nerve block injections when comparing finger and needle position. Local infiltration in the anterior maxillary region yielded the highest needle insertion and finger position discomfort scores. The present study suggests that the dental operator should be aware of local anesthesia injection pain, pressure, and discomfort together with efficacy of technique.

Adolescent↗
PubMed1999

Local anesthesia. Topical application, local infiltration, and field block.

Local anesthetics are warranted whenever a clinical procedure causes pain that could be eliminated by their use. Their effectiveness is influenced by many factors, particularly the choice of agent and the technique of administration. The authors discuss the clinical uses and advantages of common local anesthetics and describe three techniques used in the primary care setting: topical application, local infiltration, and field block.

Anesthesia, Local↗
PubMed2002

Jet anesthesia and jet local anesthesia for the 21st century.

The introduction of the hollow needle and glass syringe in the middle of the 19th century was one gigantic step in the progress of medicine to the current state of art. However, the needle with the pain it causes, become the source of fear for many patients. Indeed, immunization of millions of people who feared the needle, against the deadly contagious diseases, would not have been possible without the introduction of a jet-injector, the Med-E-Jet (Peace Gun), a pain-free way of delivering immunizing medication.

Anesthesia, Local↗
PubMedDate not supplied

Nursing approaches in local anesthesia for ophthalmic surgery.

1. Traditionally, local anesthesia has only been used in patients with coexisting diseases that jeopardize the safety of general anesthesia. Local anesthesia, however, provides a number of advantages which make it suitable for ophthalmic surgery of both the anterior and posterior segment. 2. Preoperative emotional and physical assessment and patient counseling is essential to the successful use of local anesthesia. 3. Anxiety that exists intraoperatively can be relieved by sedentary social diversions such as listening to music, handholding, and other holistic approaches. 4. Discomfort caused by draping can be eliminated by using a drapeholder which lifts the drapes away, providing the patient with a high flow of air.

Anesthesia, Local↗
PubMed1998

[Tubal sterilization by minilaparotomy under local anesthesia].

Minilaparotomy under local anesthesia (ML/LA) is the most widely used technique of tubal sterilization in the world. Since 1993, the University Hospital Center of Dakar, Senegal has been the reference center performing 20 ML/LA a month. Most procedures (72%) are carried out for non-medical personal reasons. The remaining cases (28%) involve physical conditions incompatible with completion of normal pregnancy. In all cases, voluntary, informed consent is obtained from the couple and is documented in writing. Preoperative evaluation is performed to detect contraindications. The procedure consists of five steps: the vaginal phase, local anesthesia, abdomen incision, tubal ligation, and closure. Morbidity is less than 1%. The most common complications involve damage to visceral organs (intestine, bladder). These injuries are accessible to immediate repair and thus have a good prognosis. Failure rate due to technical error is low (average: 5.8/10,000). Current experience shows that ML/AL is a safe, effective, low-cost technique well suited to use in developing countries.

Adult↗
PubMed1991

[Negligence of the physician's duty to care during "therapeutic local anesthesia"].

Therapeutic local anaesthesia, although a seemingly simple procedure, requires informed consent by the patient as well as proper indication and careful execution. Four cases selected from a medico-legal experience illustrate some severe complications. Nausea, dyspnoea and respiratory arrest (anaphylactic shock) occurred in a 34-year-old woman shortly after injection of 0.5% Bupivacaine into the paravertebral musculature for the treatment of acute neck pain. She had to be hospitalized for 18 days, at times requiring mechanical ventilation. Three other patients (women aged 40, 43 and 52 years, respectively) developed a pneumothorax after supposedly intramuscular injection of a local anaesthetic. They were hospitalized for 7 to 12 days for treatment by drainage. Anatomical variations were excluded by ultrasound in the 40- and 43-year-old patients. These case reports demonstrate that doctors performing such procedures do not always possess the necessary anatomical knowledge, and the possible occurrence of complications is underestimated.

Adult↗