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PubMedDate not supplied

[Treatments of inguinal hernia under local anesthesia].

Potentiated local anaesthesia has been generally used for repair of inguinal hernia since the Shouldice technique was first introduced in France in the early 80s. The technique requires a correct understanding of inguinal innervation and the properties of the local anaesthetic. The local anaesthetic is injected into the abdomino-genital and genito-crural nerves and at the line of incision allowing smooth surgical repair. Potentiation relieves patient apprehension. This method can be used for all types of inguinal hernia, whether simple or complicated and in all patients. There is no limitation for age or general condition. Contraindications are rare and include allergy or uncontrolled (no pacemaker) arrhythmias.

Anesthesia, Local↗
PubMed1994

Local anesthesia for dermatologic surgery.

Knowledge of local anesthesia is critically important to perform dermatologic surgery. The objective of this article is to provide an updated review of local anesthesia. The principles of local anesthesia as it pertains to dermatologic surgery are reviewed. New methods of delivering local anesthesia are also presented. Local anesthetics are safe, effective drugs that provide transient insensibility to pain in a limited area of skin. There are a variety of methods of inducing local anesthesia which can be tailored to the requirements of the contemplated procedure. Local anesthetics allow dermatologists to perform a range of procedures safely. Recent developments in topical anesthetics and in tumescent local anesthesia have provided the dermatologic surgeon other methods of delivering local anesthesia.

Anesthesia, Local↗
PubMedDate not supplied

Tonsillectomy under local anesthesia: a safe and effective alternative.

Tonsillectomy using local anesthesia (local tonsillectomy) is a safe and effective alternative to general anesthesia in the healthy cooperative teenage or adult patient. This retrospective analysis involved 64 local tonsillectomies performed over the past 7 years in a minor operating room using only local anesthesia with intravenous sedation. Operations were performed by residents in training as well as by experienced head and neck surgeons. Blood loss, morbidity, complications, and patient satisfaction were reviewed and compared with tonsillectomies done under general anesthesia. The average blood loss was 42 mL in the local tonsillectomy group with no cases of postoperative hemorrhage, compared with 198 mL in the general anesthesia group with two cases of postoperative hemorrhage. There was one major complication related to postoperative antibiotic use in the local anesthesia group, and follow-up interviews revealed that patients were satisfied with the procedure and would recommend and choose local anesthesia again. We conclude that local tonsillectomies have high patient acceptance and are associated with minimal morbidity and complications. Furthermore, they are cost-effective.

Adolescent↗
PubMed1999

Office microlaparoscopy under local anesthesia.

Office laparoscopy under local anesthesia is especially suited to meet the current pressures of quality versus cost in an era of managed care. It is likely that this technique will soon become a major part of the practicing gynecologist's diagnostic operative armamentarium. Advantages of office microlaparoscopy under local anesthesia are realized by the practitioner, the patient, and the managed care provider. Office microlaparoscopy under local anesthesia is a safe, effective, and less costly tool for the evaluation of patients with many different indications. To date, the procedure has been primarily used for patients with infertility, chronic pelvic pain, and tubal ligation. The ease of scheduling, reduced costs, and rapid recovery suggest that it may be the preferred initial procedure for these patients.

Ambulatory Surgical Procedures↗
PubMedDate not supplied

Electroanesthesia (EA) studies: current applications to human volunteers to produce general and local anesthesia.

Electrical currents found to be of sufficient intensity to produce EA in animals were applied to human subjects several hundred times, to determine whether, and how, clinical general anesthesia, and local anesthesia in various parts of the body, could be obtained. General anesthesia was not produced in any subject in any test, the obstacle in every instance being pain. Local analgesia of the arm was obtained in one subject, but in all other subjects muscle spasm and vibration pain prevented application of enough current to produce analgesia or anesthesia in the arm. Anesthesia of the hand was produced several times in all subjects, with a total loss of pain sensation.

Analgesia↗
PubMed1999

Feasibility of endovascular repair of abdominal aortic aneurysms with local anesthesia with intravenous sedation.

PURPOSE: Local anesthesia has been shown to reduce cardiopulmonary mortality and morbidity rates in patients who undergo selected peripheral vascular procedures. The efforts to treat abdominal aortic aneurysms (AAAs) with endovascular techniques have largely been driven by the desire to reduce the mortality and morbidity rates as compared with those associated with open aneurysm repair. Early results have indicated a modest degree of success in this goal. The purpose of this study was to investigate the feasibility of endovascular repair of AAAs with local anesthesia. METHODS: During a 14-month period, 47 patients underwent endovascular repair of infrarenal AAAs with local anesthesia that was supplemented with intravenous sedation. Anesthetic monitoring was selective on the basis of comorbidities. The patient ages ranged from 48 to 93 years (average age, 74.4 +/- 9.8 years). Of the 47 patients, 55% had significant coronary artery disease, 30% had significant chronic obstructive pulmonary disease, and 13% had diabetes. The average anesthesia grade was 3.1, with 30% of the patients having an average anesthesia grade of 4. The mean aortic aneurysm diameter was 5.77 cm (range, 4.5 to 12.0 cm). All the implanted grafts were bifurcated in design. RESULTS: Endovascular repair of the infrarenal AAA was successful for all 47 patients. One patient required the conversion to general anesthesia to facilitate the repair of an injured external iliac artery via a retroperitoneal approach. The operative mortality rate was 0. No patient had a myocardial infarction or had other cardiopulmonary complications develop in the perioperative period. The average operative time was 170 minutes, and the average blood loss was 623 mL (range, 100 to 2500 mL). The fluid requirements averaged 2491 mL. Of the 47 patients, 46 (98%) tolerated oral intake and were ambulatory within 24 hours of graft implantation. The patients were discharged from the hospital an average of 2.13 days after the procedure, with 87% of the patients discharged less than 48 hours after the graft implantation. Furthermore, at least 30% of the patients could have been discharged on the first postoperative day except for study protocol requirements for computed tomographic scanning at 48 hours. CONCLUSION: This is the first reported series that describes the use of local anesthesia for the endovascular repair of infrarenal AAAs. Our preliminary results indicate that the endovascular treatment of AAAs with local anesthesia is feasible and can be performed safely in a patient population with significant comorbidities. The significant potential advantages include decreased cardiopulmonary morbidity rates, shorter hospital stays, and lower hospital costs. A definitive evaluation of the benefits of local anesthesia will necessitate a direct comparison with other anesthetic techniques.

Aged↗
PubMed1996

Hook-needle puncture. A new technique of local anesthesia for anorectal surgery.

PURPOSE: Anorectal surgery has been increasingly performed as an ambulatory procedure using general, regional, and local anesthesia. Local anesthesia is classically performed through infiltration of four quadrants around the anal verge, which renders the procedure painful and uncomfortable for most surgeons and patients. We present a new, painless technique of local anesthesia for anorectal surgery. METHODS: Patients with surgical risk Classes I and II (American Society of Anesthesiologists) bearing anorectal pathologies were sedated and placed on the operating table in the prone jackknife position. After local antisepsis, the anal canal was lubricated with 2 percent lidocaine gel, and the mucosa was punctured by a hook-shaped, curved, 22-gauge needle just above the pectinate line. A solution of local anesthetics was slowly infused in all four quadrants to the submucosal level. If needed, more anesthetics were infused during the operation. RESULTS: This technique was easily and painlessly applied in more than 60 patients and permitted execution of several ambulatory anorectal procedures with comfort and safety. CONCLUSIONS: The hook-needle puncture for local anesthesia is an effective and safe procedure and may be routinely used for ambulatory anorectal surgery in selected patients.

Ambulatory Surgical Procedures↗