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PubMed1962

Local anesthesia in ophthalmology.

With local anesthesia for intraocular operations, postoperative agitation, nausea and vomiting are less frequent, which tends to reduce the number of intraocular complications. Bleeding is less troublesome, and secretions are better controlled. Fewer cardiac and pulmonary complications occur with local anesthesia. Meperidine hydrochloride (Demerol(R)) and pentobarbital sodium (nembutal) remain drugs of choice in preoperative medication. Lidocaine (Xylocaine(R)), 1 or 2 per cent, is a most satisfactory local anesthetic for intraocular operations. Complete akinesia of the eyelids has been achieved in every instance by a modified combination of the O'Brien and Van Lint techniques, using lidocaine 1 per cent. Nasolacrimal procedures can be performed satisfactorily by injecting the nasociliary and infraorbital nerves with lidocaine 2 per cent.

Analgesia↗
PubMed2000

Sub-Tenon's injection for local anesthesia in posterior segment surgery.

OBJECTIVE: To determine whether the sub-Tenon's parabulbar approach for local anesthesia is a safe and effective choice for posterior segment surgery. DESIGN: Prospective, noncomparative case series. PARTICIPANTS: Two hundred seventy-six consecutive patients underwent posterior segment surgery at the University of Texas Medical Branch. INTERVENTION: Two hundred patients received sub-Tenon's parabulbar anesthesia containing an 11 -ml mixture of 5-ml 2% lidocaine (Xylocaine), 5-ml 0.5% bupivacaine (Marcaine), and 1 ml of 150 hyaluronidase (Wydase) units as primary anesthesia. The method did not involve a separate transcutaneous lid nerve or subconjunctival injection. MAIN OUTCOME MEASURES: The proportion of cases receiving supplementation (significant intravenous anesthesia, intraoperative local anesthesia, or both) was estimated. Its relationship to duration of surgery and surgical procedures deemed painful was assessed. Surgery lasting 3 hours or more was considered a long duration. Both scleral buckle and cryotherapy were considered painful procedures. The proportion of cases receiving additional local anesthesia preoperatively was also evaluated. Complications associated with sub-Tenon's parabulbar injection were monitored. RESULTS: There were 101 instances of patients receiving additional anesthesia. Nineteen received additional preoperative sub-Tenon's anesthesia, 12 received intraoperative local anesthesia supplementation, and 70 received intravenous medication. Of these 70, 19 required what the authors defined as a significant amount of intravenous medication, three of whom also received intraoperative local anesthesia supplementation. Consequently, 28 of 200 patients (14%; 95% confidence interval: 9.5, 19.6) received supplementation (significant intravenous anesthesia, intraoperative local anesthesia, or both). The proportion of cases receiving supplementation was directly related to duration of surgery. Patients involved in longer cases (51.7% vs. 7.6%; P < 0.001) and those involved in more painful procedures (48.2% vs. 8.7%; P < 0.001) were more likely to receive supplementation. Adjusting for surgery duration, a greater proportion of patients undergoing painful procedures required supplementation (31.3% vs. 0.5% for surgery < 3 hours, P = 0.003; 72.7% vs. 38.9% for surgery > or = 3 hours, P = 0.13). No associated ocular or systemic complications were observed. CONCLUSIONS: The results of this large study demonstrate that a single injection of sub-Tenon's anesthesia is relatively safe and effective for achieving local anesthesia during vitrectomies, with or without other intraocular procedures, lasting less than 3 hours. Other types of posterior segment surgery may require supplementation if they are more painful procedures, such as scleral buckle or cryotherapy, or last longer than 3 hours.

Adult↗
PubMed1984

Repair of the groin hernia. Outpatient approach with local anesthesia.

The outpatient and local anesthesia approach to the repair of groin hernias has proved to be safe, effective, and less expensive, and is favored by patients. This approach reduces the surgeon's workload. In this era of increasing social pressures to reduce medical care costs--seemingly regardless of the effect on quality of care--the outpatient, local anesthesia approach should become the surgeons's preferred approach to the repair of groin hernias.

Adolescent↗
PubMed1988

Tips for local anesthesia in blepharoplasty.

Successful local anesthesia depends on many factors, but the most important is patient confidence in the surgeon and surgical team. In addition, the proper sequencing of the delivery of the local anesthesia will allow adequate time for anesthesia and vasoconstriction. This requires that the local infiltrative anesthetic injection with Wydase and epinephrine be given prior to preparing, draping, and marking the patient.

Anesthesia, Local↗
PubMed2004

Percutaneous release for trigger thumb in children under general and local anesthesia.

A retrospective trial of percutaneous release for 40 trigger thumbs in 33 children under different types of anesthesia (general versus local) at a mean age of 2.5 years was conducted between February 1989 and March 2003. Based on the tolerance of the child and parents, 20 children were processed using local anesthesia at our office and 13 children were given general anesthesia. We recommend special manipulation to ensure complete release of the A1 pulley when general anesthesia is necessary. Of the 26 trigger thumbs in the local anesthesia group, 23 were successfully released. Only one patient in the general anesthesia group had an unsatisfactory outcome. Percutaneous surgery achieved a 90% successful release rate for trigger thumb in children, without recurrence. There was no statistical difference in the release of trigger thumbs with these two anesthetic procedures (p = 0.66). Overall, 37 trigger thumbs achieved full extension and flexion without any residual deformity following percutaneous release. Our results suggest that percutaneous release for trigger thumb is satisfactory, no matter which method of anesthesia is used.

Ambulatory Surgical Procedures↗
PubMed1985

Ultra-long-duration local anesthesia produced by injection of lecithin-coated methoxyflurane microdroplets.

This study was designed to evaluate a new drug delivery system. The authors undertook to determine if microdroplets prepared by encapsulating volatile anesthetics with a membrane of lecithin could be used for local anesthesia. Local anesthesia was determined by monitoring the response of the rat to tail clamping and electrical stimulation of the skin following the intradermal injection of the microdroplets. Microdroplets were prepared from isoflurane, enflurane, halothane, methoxyflurane, diethyl ether, chloroform, and heptane. Although all microdroplet preparations produced local anesthesia, only methoxyflurane microdroplets produced an ultra-long duration of local anesthesia (approximately 24 h). Further characterization of the methoxyflurane microdroplets revealed two important differences from conventional local anesthetics. First, the local anesthetic effect of methoxyflurane reached a plateau that did not change significantly for 20 h while the injection of lidocaine and bupivacaine resulted in a peak effect that returned to baseline within 1 and 3 h, respectively. Second, the anesthetic effect of methoxyflurane remained essentially localized to the site of injection, while the anesthetic effect of lidocaine and bupivacaine migrated 15 cm in less than 1 h. The toxicity and safety of methoxyflurane were evaluated. When administered over the dosage range 1-16% (v/v) intradermally, or by injections into muscle, or by repeat injections every 4 days for 16 days, all animals regained their pretreatment response to painful stimulations, and there was no evidence of gross injury to tissue. Deliberate intravenous injection of 0.8 ml of 6.7% (v/v) methoxyflurane microdroplets had no apparent anesthetic or toxic effect. The present study demonstrates that methoxyflurane microdroplets produce an anesthetic effect that is highly localized, stable in intensity, ultra-long in duration, and reversible.

Anesthesia, Local↗
PubMed1992

Local anesthesia: a review.

Local anesthetics are the most widely administered drugs in dentistry. Significant advances have been made in past decades that have greatly increased both the safety and the efficacy of these important drugs. This paper reviews the history of local anesthesia, pharmacokinetics and clinical implications, techniques, complications, and future directions in the quest for more effective pain control in dentistry.

Anaphylaxis↗
PubMed1991

An alternative technique of local anesthesia for vitreoretinal surgery.

Retrobulbar anesthesia produces effective local anesthesia for ocular surgery, but significant complications have been reported with its use. To maintain its efficacy and to minimize the risks associated with the passage of a needle behind the eye, we have placed local anesthesia into sub-Tenon's space posteriorly using a blunt irrigating cannula in 100 patients undergoing vitreous or retinal procedures. Posterior Tenon's capsule is opened by blunt dissection, allowing the irrigating cannula to be passed into the posterior sub-Tenon's space for anesthetic injection. The technique was effective in 98 of 100 patients, and no morbidity was associated with its use.

Anesthesia, Local↗
PubMed1993

Local anesthesia during surgery: when is the best time to give it?

Patients undergoing third molar extractions while under general anesthesia were given local anesthesia either before (group 1) or after (group 2) surgery. The medication intake and pain scores were studied for 7 days but showed no difference between the two groups. It is suggested that timing of local anesthesia alone may not prevent or reduce the postoperative pain experience.

Adult↗
PubMed1976

[Local anesthesia after percutaneous administration. I].

Local anesthesia of the intact skin is difficult because of the skin barrier to epicutaneous penetration. Using solutions of local anesthetics in organic agents, which have the ability of penetrating the skin without causing irreversible damage and enhancing the percutaneous absorption of all materials dissolved therein, topical anesthesia seems to be attainable. A satisfactory method for determining pain threshold in uninjured skin of animals has been set up. Measurments of the pricking pain threshold have been made by exposing the skin of guinea-pigs to defined mechanical and electrical stimuli. A nociceptive muscle reflex (twitch) has been taken as the index of pain sensation. The suppression of this twitch has been used as an indicator of anesthetic potency. Two methods have been applied with varying parameters: stimulation at a fixed intensity until the pain threshold was reached (duration of anesthetic effect) and stimulation with increasing stimulus strenght until the cutaneous reflex was elicited (intensity or "depth" of anesthesia). The local anesthetic effects of lidocaine, fomocaine and procaine bases were studied, after dissolving them in dimethyl sulfoxide (DMSO), a wellknown carrier for transmembranal application. The duration of local anesthesia measured by electrical stimuli was longer than that obtained with mechanical ones. Differences are discussed. All results indicate that fomocaine (5%) has a greater local anesthetic potency than procaine (5%) but both are less active than lidocaine (5%). No effect could be seen after application of DMSO alone.

Administration, Topical↗
PubMed1988

Parathyroid gland exploration with local anesthesia in elderly and high-risk patients.

The management of symptomatic hyperparathyroidism in elderly and medically compromised patients, who are at risk under general anesthesia, may be safely and effectively accomplished using local anesthesia. Positive localization with ultrasound, thallium 201-technetium Tc 99m subtraction, and computed tomography permit surgical exploration with local anesthesia in one or two stages, or bilaterally in one stage, in selected cases, by employing the surgical lateral approach to parathyroid surgery. Our study of 29 patients selected for this technique affirms the value and the safety of this method, especially as surgical experience has grown and localization studies have improved. During the latter 24 months of our study, 11 (30%) of 36 operations were performed using local anesthesia by one of us. A success rate in ten of 11 cases was achieved, with one patient requiring a second exploration for adenomatous hyperplasia while under local anesthesia.

Aged↗
PubMed1979

[Minor eye operations on infants under local anesthesia].

A procedure with local anesthesia is possible after premedication with Thalamonal and atropine in some special cases. The child is sufficiently sedated and remains co-operative. Four cases are reported in order to illustrate how such a procedure leads to satisfactory results.

Anesthesia, Local↗
PubMed1993

Preoperative needle localization in the breast: utility of local anesthesia.

Eighty-nine consecutive patients undergoing needle localization at two facilities were alternately assigned to "local-anesthesia" (n = 46) and "no-local-anesthesia" (n = 43) groups. Those in the local-anesthesia group received 1-2 mL lidocaine hydrochloride 1% subcutaneously at the expected site of insertion of the localizing needle. All patients were asked to rate the level of pain they experienced from the procedure as a whole by using a 10-cm horizontal visual analog pain scale. Data about patient age, menopausal and menstrual status, average daily caffeine intake, and whether the patients considered mammography to be a painful procedure were collected. Patients who did not receive local anesthesia had a lower mean pain score (2.52) than those who did (3.27, P = .18). Premenopausal patients in the second half of their menstrual cycle at the time of the procedure had a significantly higher pain score than those in the first half (3.54 vs. 1.70, P = .05). Patients who considered mammography a painful procedure reported a higher level of pain than those who did not (3.79 vs 2.38, P = .012). There was no relationship between age, caffeine intake, or menopausal status and pain experienced.

Adult↗
PubMed2000

Less adrenergic activation during cataract surgery with total intravenous than with local anesthesia.

BACKGROUND: Previous studies reported that, contrary to local anesthesia, cataract surgery under inhalational anesthesia is associated with substantial adrenergic activation. We tested the hypothesis that total intravenous anesthesia (TIVA) with propofol and alfentanil produces less or comparable adrenergic activation during cataract surgery than local anesthesia. METHODS: Patients were randomly assigned to peribulbar local block (n=10) or TIVA (n=10). The heart rate, blood pressure, plasma concentrations of catecholamines, cortisol, and glucose were assessed at seven pre-, intra-, and post-operative time points. RESULTS: In the patients given local anesthesia, plasma concentrations of epinephrine, norepinephrine and cortisol did not change significantly. In contrast, plasma epinephrine decreased by roughly 66% during TIVA: from 45+/-16 to 15+/-8 pg/ml. Plasma norepinephrine concentration decreased by roughly 50%, from 462+/-265 to a minimum value of 219+/-6 pg/ml and plasma cortisol concentrations decreased by roughly 61%, from 16.4 ng/ml to 6.4 ng/ml. Blood pressure and heart rates remained near baseline values during local anesthesia. In contrast, systolic blood pressure decreased by 30% and heart rate by 12 beats/min during TIVA. CONCLUSION: The presented study and available data clearly suggest that local anesthesia produces the best adrenergic and hemodynamic stability during cataract surgery. Contrary to previously reported results on inhalational anesthesia (thiopentone/enflurane), the TIVA regimen used effectively prevents the adrenergic and metabolic response during cataract surgery.

Adult↗