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PubMed2005

Influence of local anaesthesia on pain and distress induced by two bloodless castration methods in young lambs.

To assess short- and long-term effects of bloodless castration methods with and without local anaesthesia, behavioural and cortisol responses of lambs were used as indicators of pain and distress. Seventy lambs, aged 2-7 days, were control-handled or castrated by Burdizzo or rubber ring methods with and without local anaesthesia. Either 5 mL of diluted lidocaine (4 mg/kg) or physiological sodium chloride solution was distributed in both spermatic cords and the scrotal neck. The serum cortisol response was monitored for 48 h, and behavioural and clinical traits were followed for three months. Local anaesthesia tended to reduce behavioural and cortisol responses after Burdizzo castration and provided a significant reduction after rubber ring castration. Prolonged pain after rubber ring castration with anaesthesia was not evident. If combined with local anaesthesia, both the rubber ring and the Burdizzo methods are acceptable methods for castration of lambs up to one week of age.

Anesthesia, Local↗

PubMed1996

Knee arthroscopy under local anaesthesia: results and evaluation of patients' satisfaction.

A study of 55 consecutive knee arthroscopies under local anaesthesia was undertaken, in order to evaluate the effectiveness, patient satisfaction and acceptability of the procedure. Knee arthroscopy was performed without a thigh tourniquet under low volume (20 ml) local anaesthesia using half the recommended safe dose of anaesthetic agents, as a single intra-articular injection together with skin infiltration of the arthroscopic portals. The diagnostic accuracy and effectiveness of the procedure was similar to that of surgery under general anaesthesia. Sixty-two lesions were diagnosed and 48 surgical procedures were successfully carried out in 53 patients. All but one of the questioned patients (97 per cent) were satisfied with the procedure which caused little or no discomfort in 94 per cent of cases. It is concluded that knee arthroscopy under local anaesthesia may be considered as a reliable, well tolerated and safe alternative to conventional procedures.

Adolescent↗

PubMed2005

Surgical abortion using manual vacuum aspiration under local anaesthesia: a pilot study of feasibility and women's acceptability.

OBJECTIVE: Studies from the USA have reported the efficacy and high acceptability of surgical abortion using manual vacuum aspiration (MVA) under local anaesthesia. The aim of this study was to assess the feasibility, acceptability and efficacy of surgical abortion using MVA under local anaesthesia for termination of pregnancy up to 63 days' gestation, within a UK National Health Service setting. METHODS: Surgical abortion was carried out using MVA under local anaesthesia. Women's satisfaction with the procedure, and pain and anxiety levels, were assessed. The main outcome measures were: (1) feasibility assessed through successful completion of the procedure without the need for general anaesthetic or conversion to suction vacuum aspiration, (2) efficacy assessed through complete uterine evacuation without the need for further medical or surgical intervention and (3) women's acceptability of the procedure. RESULTS: The mean (SD) gestation was 50 (9.4) days. A total of 55/56 (98%) women had a successful procedure and did not require any further surgical or medical treatment. Fifty-five (98%) women were satisfied with the procedure, 48 (86%) said they would recommend it to a friend and 45 (80%) said they would have the same method again in the future. Anxiety levels, as reflected by the visual analogue scales, showed a significant fall in anxiety scores following the procedure (p<0.01). CONCLUSIONS: Surgical abortion using MVA under local anaesthesia is effective and acceptable to women. These findings now need to be assessed in the context of a randomised trial.

Abortion, Induced↗

PubMed1997

Uterine thermal balloon therapy under local anaesthesia for the treatment of menorrhagia: a pilot study.

This study evaluates the use of local anaesthesia in a subset of patients undergoing uterine thermal balloon endometrial ablation for the treatment of menorrhagia. Out of 51 patients with dysfunctional uterine bleeding, 18 were included for uterine balloon therapy under local anaesthesia. Inclusion criteria were dysfunctional bleeding with absence of organic lesions in the uterine cavity, adequate relaxation and pain control during physical examination and diagnostic hysteroscopy, and patient desire to avoid a general anaesthetic. Paracervical block was performed with 20 ml of dilute 1% lignocaine HCl with epinephrine 1:200,000. Success of the procedure was defined as amenorrhoea, hypomenorrhoea, or eumenorrhoea. The median follow-up period was 13.9 +/- 5 months and 11 patients (61%) had follow-up of >1 year. Treatment led to a significant decrease in menstrual flow, duration, and pad count in all patients (P < 0.0001). No intra-operative complications occurred. A pain scale (level 1-10) was used to evaluate the patients' tolerance of the procedure (mean 3.8 +/- 1.3). In light of these successful and well tolerated procedures, thermal balloon endometrial ablation, utilizing local anaesthesia, appears practical as an office-based therapy.

Adult↗

PubMed1996

Bone marrow harvesting using local anaesthesia and PCA-alfentanil: a feasible alternative to general or regional anaesthesia.

We examined the feasibility of combined use of local anaesthesia (LA) and patient-controlled analgesia with alfentanil (PCA-alfentanil) for bone marrow harvesting (BMH) in 16 consecutive in-patient donors (nine allogeneic and seven autologous). A loading dose of alfentanil 15 micrograms/kg was delivered at the time of skin preparation followed by a background infusion of alfentanil 0.05 microgram/kg/min. On -demand bolus doses of alfentanil were 4 micrograms/kg with lockout intervals of 3 min. Local anaesthesia was achieved using 1% lignocaine (up to 7 mg/kg) with 1:200,000 adrenaline. All donors were mildly sedated during BMH, tolerated the procedure well, and experienced no cardiovascular or respiratory complications. Post-operative nausea and vomiting were the only side-effects. All donors indicated that the combined use of LA with PCA-alfentanil was acceptable for BMH. Our preliminary results suggest that although optimal PCA settings have yet to be determined, this technique may be a feasible and effective alternative for BMH in situations where general or regional anaesthesia is undesirable.

Adult↗

PubMed1996

Removal of femoral Kuntscher nails in selected cases under local anaesthesia.

A preliminary study of fifteen patients undergoing extraction of Kuntscher nails after fracture surgery under local anaesthesia indicated varying behavioural responses and tolerance of the procedure. In the main study cohort, of 59 patients within the age range of 16-65 years, made up of 41 males and 18 females, 38 patients (64.4%) tolerated the procedure without discomfort, 14 patients (23.7%) experienced mild to moderate pain, while the remaining seven patients (11.9%), pain and discomfort was severe enough to require the additional use of intravenous anaesthesia (ketamine hydrochloride). There were no significant complications post-operatively. Financial considerations are assuming a greater importance, since planned procedures for osteosynthetic metal implants removal contribute considerably to the waiting lists for elective surgery. We conclude that there are clear advantages in removal of Kuntscher nails under local anaesthesia and it is also noteworthy that the compliance rate amongst our patients has been on the increase, as this method offers shorter waiting period, immediate ambulation, is a day procedure with early return to work and lower monetary costs. We are unaware of existing prospective work on the extraction of Kuntscher nails under local anaesthesia.

Adolescent↗

PubMed1994

Late follow-up results of operative ankle arthroscopy in patients under local anaesthesia.

The purpose of this study was to evaluate our long-term results of operative ankle arthroscopy in local anaesthesia, without tourniquet and antibiotic prophylaxis, and to see whether we could produce the same results other investigators had published using general anaesthesia. Between 1987 and 1992, 51 operative ankle arthroscopies were performed--all as out-patient procedures. Thirty-six patients had local anaesthesia, 7 had general anaesthesia, one had spinal anaesthesia and one had epidural anaesthesia. No prophylactic antibiotics were given. Indications for surgery were the same for patients who had local anaesthesia as for those who had the other types of anaesthesia. Nineteen patients had partial synovectomies, 8 had removals of osteophytes, 7 had debridements of osteochondral fractures, 6 had debridements of mild degenerative osteoarthritis, 3 had loose bodies and 2 had septic arthritis. After a mean of 3 years (range 1-8) the patients were sent a questionnaire. They were asked to rate activity level, pain, swelling, and limb stiffness on a four-grade scale pre- and postoperatively and to rate their total subjective improvement. They were also asked if they would undergo the same procedure again knowing the outcome of the procedure. Forty-five patients (88%) were available for follow-up. Thirty-four patients (76%) were improved, 10 remained unchanged, and one became worse after surgery. No correlation existed between preoperative symptom duration, sex, trauma, type of anaesthesia, postoperative diagnosis or type of surgical procedure. Minor complications occurred in 11% of patients. Eighty-four percent of the patients said they would undergo the same procedure again. The type of anaesthesia used did not influence this decision.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1991

Closed lateral subcutaneous sphincterotomy under local anaesthesia in the treatment of chronic anal fissure.

We studied 65 consecutive ambulatory patients with chronic anal fissure that were treated by sphincterotomy under local anaesthesia. The patients were allowed to leave the clinic immediately after the operation. Healing rate was determined three to four months postoperatively by clinical examination and proctoscopy. Fifty-seven patients (88%) were free of symptoms and the fissure was healed. Eight unhealed patients were subjected to a repeated procedure under local anaesthesia, leaving two unhealed patients, that were operated with open sphincterotomy under general anaesthesia. We conclude that local anaesthesia can be recommended for the closed lateral subcutaneous sphincterotomy in ambulatory treatment of chronic anal fissure.

Adolescent↗

PubMed2000

Superficial parotidectomy under local anaesthesia.

We report a case of superficial parotidectomy performed under local anaesthesia. The patient presented with a parotid lump in which aspiration cytology showed cells consistent with mucoepidermoid carcinoma or adenocarcinoma ex pleomorphic adenoma. Despite counselling the patient refused general anaesthesia but accepted the need for removal of the pathology. We have been unable to find a single case report in the English literature since 1966 outlying this procedure being undertaken solely under local anaesthesia.

Adenoma, Pleomorphic↗

PubMed2006

Feasibility of percutaneous nephrolithotomy under assisted local anaesthesia: a prospective study on selected patients with upper urinary tract obstruction.

OBJECTIVE: To evaluate the feasibility of performing percutaneous nephrolithotomy (PCNL) under local anaesthesia in selected patients. METHODS: Twenty-four patients with unilateral renal obstruction due to pelvic stones > or =2.0 cm were enrolled in our study. First a percutaneous nephrostomy to decompress the obstructed kidney was performed using local anaesthesia (lignocaine). A 16-Fr nephrostomy tube was left in place for 1 wk, and then the second stage was carried out. After having infiltrated the tract and the renal parenchyma with lignocaine, dilatation of the nephrostomy tract was performed. Subsequently, PCNL was done using a 24-Fr rigid nephroscope and a ballistic lithotripter. All patients were premedicated with pethidine HCl intramuscularly 30 min before the beginning of both stages. Diazepam was given (0.1mg/kg orally) to patients before the second stage. Pain scores were collected using 10-cm linear visual analogue scale (VAS) after the completion of both procedures. RESULTS: The procedure was well tolerated. One patient needed further treatment with midazolam during PCNL. The mean VAS score was 38 mm (range: 17-60 mm) for the first stage and 36 mm (13-69 mm) for the second stage. The mean operative time, including both stages, was 127 min (85-155 min). No anaesthesia-related complications occurred. CONCLUSION: Our study indicates that PCNL under assisted local anaesthesia is safe and effective in selected patients.

Adult↗

PubMed1998

Current practice of local anaesthesia for routine ocular surgery.

We surveyed the current practice of local anaesthesia for routine ocular surgery by consultant anaesthetists in the Wessex region using a postal questionnaire. Most consultants were in agreement concerning the type and technique of block, and monitoring to be used during local anaesthesia for ocular surgery. The issue of teaching for trainee anaesthetists produced a varied response. We found that a different level of perioperative preparation and monitoring was used from that recommended by the Joint Working Party on the subject in 1993.

Anesthesia, Local↗

PubMed2001

The effects of handholding on anxiety in cataract surgery patients under local anaesthesia.

AIM OF THE STUDY: To assess the effectiveness of handholding on the anxiety of patients undergoing planned cataract surgery under local anaesthesia. BACKGROUND: Anxiety concerning anaesthesia, pain, physical injuries, isolation, prognosis, possibilities of deformity, or loss of self-control may be stressful to patients undergoing surgery. Anxiety activates the sympathetic nervous system, characterized by an increase in catecholamine concentration, heart rate and blood pressure and increased glucocorticoid levels; it also affects immune responses. Therefore, there is a need for nursing interventions to reduce the anxiety of patients under local anaesthesia who are conscious. METHODS: An untreated control group design with pre and post-test was used. Among 62 patients, 30 were randomly assigned to the handholding group and 32 to the control group. Handholding was provided to subjects of the handholding group during surgery. Visual analogue scales and interviews were used to measure anxiety, and pulse rate and systolic and diastolic blood pressure were used as physiological measures of stress. Blood was taken for analysis of levels of epinephrine, norepinephrine, cortisol, neutrophils, lymphocytes and natural killer cells. RESULTS: The number of subjects who reported decreased anxiety during operation was significantly higher in the handholding group compared with the control group and most of the subjects reported that handholding during operation was very helpful in reducing anxiety. Epinephrine levels in the handholding group were significantly lower than in the control group. CONCLUSIONS: Results suggest that this noninvasive intervention has potential for reducing anxiety in patients having cataract surgery under local anaesthesia.

Adult↗

PubMed1999

Appendicectomy under local anaesthesia.

OBJECTIVE: To analyse our results of appendicetomy under local anaesthesia. DESIGN: Prospective study. SETTING: University hospital, India. SUBJECTS: 165 patients who presented with appendicitis between January 1996 and December 1997. INTERVENTION AND MAIN OUTCOME MEASURES: Appendicectomy after infiltration of local anaesthetic. No patient required general or spinal anaesthesia. RESULT: Five patients (3%) developed postoperative wound infections. Mean operating time was 20 minutes (range 15-30) and median hospital stay 2 days (range 1-3). CONCLUSION: Appendicectomy under local anaesthesia is quick, cost-effective and carries little morbidity. It can be safely used for all age groups.

Adolescent↗

PubMed2002

Daycase arthroscopic knee surgery performed under local anaesthesia with hyaluronidase: technical note.

Whilst local anaesthesia for daycase arthroscopic knee surgery has been well reported, there are few centres in the United Kingdom performing such a technique. Hyaluronidase has been widely used as an adjunct to local anaesthetic infiltration in the fields of ophthalmic and plastic surgery, but it is rarely used in orthopaedic surgery. We report our technique, which the senior author has successfully used in 121 patients having arthroscopic knee surgery over the past year, and discuss the role of added hyaluronidase to the local anaesthetic portal infiltrate.

Adjuvants, Anesthesia↗

PubMed1997

Extraction of Kuntscher (femoral) implant under local anaesthesia: an appraisal of patients tolerance and merits.

A preliminary study of 15 patients undergoing extraction of Kuntscher nails after fracture surgery under local anaesthesia indicated varying behavioural responses and tolerance of the procedure. In the main study cohort, of 59 (fifty-nine) patients within the age range of 16-65 years, made up of 41 males and 18 females, 38 patients (64.4%) tolerated the procedure without discomfort, 14 patients (23.7%) experienced mild to moderate pain, while the remaining 7 patients (11.9%), pain and discomfort was severe enough to require the additional use of intravenous anaesthesia (Ketamine Hydrochloride). There were no significant complications post-operatively. Financial considerations are assuming a greater importance, since planned procedures for osteosynthetic metal implants removal contribute considerably to the waiting lists for elective surgery. We conclude that there are clear advantages in removal of Kuntscher nails under local anaesthesia and it is also noteworthy that the compliance rate amongst our patients has been on the increase, as this method offers shorter waiting period, immediate ambulation, is a day procedure, early return to work and lower monetary costs. We are unaware of existing prospective work on the extraction of Kuntscher nails under local anaesthesia.

Adolescent↗

PubMed1978

Comparison of diazepam and flunitrazepam for sedation during local anaesthesia for bronchoscopy.

Diazepam and flunitrazepam were compared as amnesic and sedative adjuncts to local anaesthesia for diagnostic bronchoscopy in 92 patients. After local anaesthesia of the pharynx, larynx and trachea with lignocaine, atropine plus diazepam of flunitrazepam was injected i.v. The co-operation of the patients and the technical circumstances under which the bronchoscopy was performed were good in each group. None of the treatments significantly modified arterial pressure or heart rate. Two hours after the injection, flunitrazepam 0.01 mg kg-1 more frequently caused amnesia for pictures shown to the patients during the first 15 min after injection (failure to recall 42--75%, and for bronchoscopy 67%), than did diazepam 0.125 mg kg-1 (failure to recall 21--67%; bronchoscopy 38%). Double doses of the drugs caused amnesic actions similar to those of flunitrazepam 0.01 mg kg-1. When failure to recall was assessed on the following day, 29% and 5% of the patients remembered bronchoscopy after flunitrazepam 0.01 and 0.02 mg kg-1 respectively; after diazepam 0.125 and 0.25 mg kg-1 the corresponding percentages was 59% and 30% (P less than 0.05% v. fluintrazepam). The ability to stand and walk on a stright line was similar after the smaller doses of both drugs, but after the larger doses recovery was slower after flunitrazepam. Psychomotor performance was still distinctly impaired 2 h after the injection of the larger doses.

Adult↗

PubMed2001

Rectus muscle trauma complicating sub-Tenon's local anaesthesia.

PURPOSE: To describe three cases of rectus muscle trauma in patients undergoing phacoemulsification cataract extraction and intraocular lens implantation under sub-Tenon's local anaesthesia via the inferonasal quadrant. METHODS: Retrospective review was carried out of 3 cases from 1080 patients who underwent phacoemulsification cataract extraction and intraocular lens implantation under sub-Tenon's local anaesthesia in our unit over a 3 year period up to April 2000. RESULTS: Two patients complained postoperatively of vertical diplopia and were shown to have restriction of elevation of the eye, which was found at surgical exploration to be due to inferior rectus muscle restriction. One patient had post-operative horizontal diplopia due restriction of abduction and exploration of the medial rectus muscle was planned. CONCLUSION: Rectus muscle trauma is proposed as a complication of sub-Tenon's local anaesthesia and caution is advised to operators to clearly identify the sub-Tenon's space for injection of local anaesthetic.

Aged↗

PubMed2005

How I do it? Excision of neck lumps under local anaesthesia.

Excisions of neck lesions under local anaesthesia are made technically more difficult by the injection of anaesthetic agent, causing the lesion to become less palpable. Pen marking the lesion can circumvent the problem; however, this marking often disappears after skin preparation. We describe a technique which abolishes this problem.

Anesthesia, Local↗