[Local anesthesia of the hip and of its region according to A.V. Vishnevskii].
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Anesthesia↗
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Results for “Anesthesia, Local”
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The ice-saline-Xylocaine technique. A simple method for minimizing pain in obtaining local anesthesia.
Prior to skin surgery, localized cryoanesthesia is initially obtained utilizing Cryogel packs before local anesthesia injection, minimizing or abolishing pain from the piercing of the skin by the injection needle. The surgical field is then infiltrated with benzyl alcohol-containing normal saline, a painless solution producing moderate local anesthesia. Subsequently, a stronger anesthetic containing a vasoconstrictor or other desired additives can be infiltrated without significant patient discomfort. This simple three-step method has resulted in excellent patient acceptance, and is potentially useful for a wide range of surgical procedures and medical specialties.
Anesthesia, Local↗
[Local anesthesia without anesthetic and without local application; study of the mechanism of action].
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Anesthesia↗
Local anesthesia for suspension microlaryngoscopy.
Despite the strong trend toward use of general anesthesia for laryngoscopy, local anesthesia retains inherent advantages from the standpoint of patient safety and maintenance of physiologic function of the larynx during endoscopy. Topical anesthesia produces incomplete sensory blockade and is unsatisfactory for suspension laryngoscopy. A method of infiltration anesthesia is described whereby profound anesthesia of the base of the tongue, valleculae, and larynx can be achieved to allow suspension laryngoscopy.
Anesthesia, Local↗
Preemptive analgesia and local anesthesia as a supplement to general anesthesia: a review.
General anesthesia (GA) and local anesthesia (LA) evolved on separate tracks. Procedures that could not be performed under LA were typically conducted under GA. Decoding of afferent linkage of peripheral noxious stimuli has provided important understanding that may change the way we traditionally treat surgical pain. In the 1980s, animal studies suggested that preemptive peripheral blocking of painful (nociceptive) stimuli to the central nervous system with regional anesthesia or LA and nonsteroidal analgesics could be beneficial in attenuating postoperative pain. Clinical studies based on this knowledge suggest combining LA with GA, and perhaps non-steroidal analgesics with or without narcotics, to reduce the severity of postoperative pain. General anesthetics can be given in lower minimal alveolar concentration when combined with LA, and recovery characteristics are superior. Increasing evidence suggests that the combined use of GA and LA may reduce the afferent barrage of surgery, and that preemptive analgesia may reduce postoperative pain and should be used in patient care. This article reviews the evidence supporting the combined use of LA or analgesics with GA or sedation to provide improved pain management after surgery.
Analgesia↗
[Parathyroidectomy under local anesthesia. First two cases in Lebanon and review of the literature].
The routine use of automated techniques to measure serum calcium levels have made disease states of the parathyroid gland a common endocrinologic problem. Because of the low sensitivity and specificity of early radiologic techniques to identify enlarged parathyroid glands, and because skilled endocrine surgeons report success rates of > 95% in identifying abnormal parathyroid glands, historically most parathyroid glands surgery consisted in a large cervicotomy under general anesthesia without preoperative localization. However, the development of sophisticated imaging techniques has now made it possible to identify the abnormal gland in a significant number of patients, leading some surgeons to choose unilateral neck exploration under local anesthesia for primary hyperparathyroidism. The success of the procedure is ascertained by measuring PTH peroperatively. We report the first two Lebanese patients, presenting with a solitary parathyroid adenoma, who underwent this easy, safe and cost-effective surgical technique.
Adenoma↗
New horizons in local anesthesia.
The computer-controlled local anesthesia system and the TEA system present 21st-century alternatives to the traditional syringe. The TEA system is a non-invasive form of anesthesia that blocks pain electronically, using the same cellular mechanism as local chemical anesthesia. Targeted electronic anesthesia provides pain control for restorative dental procedures without the use of needles or postoperative discomfort, numbness, and swelling. The computer-assisted system outperforms syringes for traditional injections. This new system generates a precisely controlled anesthetic flow rate that eliminates the need for the operator to use thumb pressure to administer the injection. The lightweight pen-grasp handle results in greater tactile feedback, precision, operator ease, and patient comfort. The greatest advantage may be in the new techniques that it makes available. With these techniques, a dentist can target the teeth to achieve profound pulpal anesthesia, often without the annoying side effects of facial numbness. With this new advanced system in the maxillary arch, the AMSA injection offers clinical advantages over traditional anesthesia techniques, according to Dr. Mark Friedman, whom I consulted with earlier this year. In the mandibular arch, a safe and predictable PDL injection technique may replace the need for an inferior alveolar block in numerous clinical situations. The use of these modified injection techniques can have a positive influence on patient safety, patient comfort, and office productivity. Both of these systems take the fear and anxiety out of dental injections. They offer exciting advanced technology for local pain control. Significantly, if patient stress and anxiety are reduced, the operator immediately benefits. New horizons in local anesthesia offer improved opportunities for patient comfort using computer-controlled local anesthetic systems and TEA.
Anesthesia, Dental↗
Safety, accuracy, and diagnostic yield of needle localization biopsy of the breast performed using local anesthesia.
BACKGROUND: In changing our technique to performing needle localization breast biopsies (NLBB) using local anesthesia in an outpatient setting, we investigated whether or not our complication rates with local anesthesia were acceptable when compared with complications from a cohort of biopsies of the breast performed for palpable masses. We were also interested in determining whether or not our rate of missed biopsies was within acceptable ranges. STUDY DESIGN: Complications occurring in 283 patients who underwent 301 NLBB using local anesthesia between 1983 and 1991 were compared with complications occurring after excision of 249 palpable masses of the breast excised using local anesthesia during this period. RESULTS: Complications associated with NLBB were missed lesions, six (1.99 percent) of 301; hematoma, 12 (3.99 percent) of 301; abscess, three (0.99 percent) of 301; seroma, one (0.33 percent) of 301, and wound separation, two (0.66 percent) of 301, for a total of 24 complications (7.96 percent). These rates were not statistically different from the rates of complication after biopsies of palpable lesions using local anesthesia (p < 0.49). The 301 NLBB revealed 87 carcinomas (28.9 percent); 50 invasive and 37 in situ. Of the nonpalpable carcinomas, 43 percent were in situ. Only 11 percent carcinomas, 43 percent were in situ. Only 11 percent of the palpable lesions were in situ (p < 0.001). Forty-four patients with nonpalpable invasive carcinoma had a 25 percent rate of positive axillary lymph nodes. CONCLUSIONS: Needle localization breast biopsies can be performed using local anesthesia exclusively with less than a 2 percent chance of missed lesions and complication rates similar to those associated with biopsies of palpable lesions. The biology of these lesions varies. Although there is a high rate of in situ carcinoma, there is a significant rate of node positivity in the patients with nonpalpable invasive carcinoma.
Adolescent↗
High ligation and stripping of the long saphenous vein using the tumescent technique for local anesthesia.
BACKGROUND: Advantages of tumescent local anesthesia (TLA) have been described for use in ambulatory phlebectomy removing large varicose side branches. OBJECTIVE: To evaluate the TLA method for high ligation and stripping of the long saphenous vein with or without administration of intravenous sedatives. METHODS: Forty-nine patients underwent 58 phlebosurgical procedures, including 41 ligations and strippings of the long saphenous vein. They were kept in the hospital for 24 hours after surgery to record potential complications and demand for medical assistance. RESULTS: The surgical procedures were easily performed under TLA without major complications. Minor complications were mild hematoma (n = 2) and temporary inguinal seroma (n = 1). Forty-one percent of the patients required additional i.v. sedation and analgesia perioperatively. Postsurgical guidance by a physician was necessary only in patients on full-dose heparin. CONCLUSION: The tumescent technique for local anesthesia allows high ligation and stripping of the long saphenous vein even in both legs in one session, however, frequently with additional i.v. medication.
Adult↗
The key to profound local anesthesia: neuroanatomy.
BACKGROUND: To achieve profound dental local anesthesia, it is necessary for the dentist to have a thorough knowledge of the details of sensory innervation to the maxilla and mandible. Since the early 1970s, dentistry has experienced a resurgence of interest in the neuroanatomical basis of local anesthesia, resulting in numerous scientific reports on the subject. OVERVIEW: Current studies afford a more detailed knowledge of the branching of various divisions of the trigeminal nerve, the great sensory nerve of the head region. In this article, the authors provide an update of the peripheral distribution of the trigeminal nerve to enhance induction of safe and effective dental local anesthesia. CONCLUSIONS AND PRACTICAL IMPLICATIONS: An understanding of the potential variations in innervation should help the dentist improve his or her ability to induce profound local anesthesia.
Anesthesia, Dental↗
[Prudental block and local anesthesia in second stage of labor].
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Anesthesia↗
[Tumescent local anesthesia in proctologic surgery].
INTRODUCTION: Tumescent local anesthesia (TLA) was introduced to facilitate liposuction and other procedures mainly in plastic surgery. The aim of our study was to evaluate if this new technique can also be safely applied in proctologic surgery. METHODS: The following 50 proctologic procedures were performed using TLA as day surgery cases: perianal vein thrombectomy (n=15), subanodermal fistula resection (n=7), anal polyp resection (n=7), fissurectomy ( n=6), perianal abscess revision (n=6), excision of anal skin tags (n=3), hemorrhoidectomy for thrombosed piles (n=3), intersphincteric fistula extirpation (n=1), pilonidal sinus (n=1), and perianal tumor excision (n=1). The subcutaneously infused solution contained 200 ml of Ringer's solution, 50 ml of 2% Mepivacain, and 2.5 ml of epinephrine diluted 1:10,000. RESULTS: During an average application time of 14.3+/-4.9 min, a mean of 93.1+/-40.7 ml tumescent solution was infused. This dosage resulted in complete pain relief after 18.3+/-5.0 min. Local anesthesia was maintained up to 14 h postoperatively, with a mean duration of 6.7+/-1.9 h. Two patients developed moderate hematomas which required no further treatment. CONCLUSIONS: Our pilot study demonstrates that slow infusion tumescent local anesthesia can be widely and safely applied in proctologic surgery and enables the performance of these procedures on an outpatient basis.
Abscess↗
[Is local anesthesia necessary for venipuncture?].
We evaluated the necessity of local anesthesia for the venipuncture pain in 27 healthy adult volunteers by using a visual analogue scale (VAS) from 0 to 10. The pain scales were measured three times: at the time of percutaneous intravenous cannulation (20 G polyurethane catheter) without local anesthesia as well as the skin infiltration with local anesthetics (0.5% lidocaine 0.5 ml; 25 G needle), and after intravenous cannulation. The measurements were done twice, once by an expert staff and once by a novice staff with an interval of three days. VAS values were significantly higher (2.4 +/- 1.1) for the percutaneous intravenous cannulation without local anesthesia than both for the skin infiltration with local anesthetics (1.4 +/- 0.6) and for the evaluation after intravenous cannulation (0.7 +/- 0.8), independent of who inserted the catheter. VAS values were significantly lower (2.1 +/- 1.0) when the percutaneous intravenous cannulation without local anesthesia was performed by expert staff than when it was performed by novice staff (2.7 +/- 1.1; P < 0.05). We conclude that local anesthesia is necessary when novice staff performs the percutaneous intravenous catheterization.
Adult↗
Laparoscopic tubal sterilization under local anesthesia.
Laparoscopic tubal sterilization has been performed under local anesthesia in the United States since 1971. Pilot studies suggested that local anesthesia was as adequate and as safe as general anesthesia. Since 1980, the senior author has performed more than 3000 outpatient laparoscopic tubal sterilizations with the silastic ring under local anesthesia. A retrospective descriptive study was conducted on 2827 cases. The technical failure rate was 0.14%. There were no unintended laparotomies due to complications. The mean operative time was 10.0 +/- 5.1 minutes. The mean anesthesia time was 23.3 +/- 6.9 minutes. The hospital cost for the patient was reduced by 68-85%. This study demonstrates that laparoscopic tubal sterilization can be performed adequately, safely, and quickly under local anesthesia.
Adult↗
Transurethral ureteroscopy: is local anesthesia with intravenous sedation sufficiently effective and safe?
OBJECTIVE: To evaluate the effectiveness and safety of local anesthesia and sedation in ureteroscopic interventions and to compare the results with other kinds of anesthesia. METHODS: 107 ureteroscopic interventions have been done to 99 renoureteral units involving 77 patients under different kinds of anesthesia. RESULTS: 45 of 107 procedures were performed under general anesthesia, 11 under spinal/epidural anesthesia, and 51 using local anesthesia and intravenous sedation. The overall success rate was 90%. The failure rate was 18% for the procedures undertaken using local anesthesia. CONCLUSION: Local anesthesia in ureteroscopic interventions may be considered as a first choice because of almost similar success rates to other kinds of anesthesia: is has a low morbidity and low cost.
Adult↗
Utilization of local anesthesia by Arkansas dental hygienists, and dentists' delegation/satisfaction relative to this function.
PURPOSE: Given the legalization of administration of local anesthesia as an expanded function for dental hygienists in Arkansas, the purpose of this study was to 1) describe the utilization of local anesthesia in dental hygiene care; 2) compare the utilization of local anesthesia by dental hygienists certified in the administration of local anesthesia and those who were not; 3) determine if there was a difference in attitude toward the use of local anesthesia for dental hygiene procedures between dental hygienists certified in the expanded function versus those not certified; 4) determine if and to what degree employers delegate this procedure to certified employees; and 5) compare employer satisfaction with this expanded function for those who employed a certified dental hygienist and those who did not. METHODS: Surveys were sent to all Arkansas dental hygienists certified, as of June 1998, to administer local anesthesia as well as an equal random sample of Arkansas dental hygienists not certified in the expanded function. The dentist employers of these dental hygienists also were asked to complete a companion survey. These surveys included demographic items as well as questions about the demand for and utilization of local anesthesia by dental hygienists. Additionally, the surveys included an opinionnaire section concerning attitudes toward and perceptions of the administration of local anesthesia by dental hygienists. RESULTS: An overall response rate of 31% (n = 182) was achieved for the survey of the dental hygienist sample (n = 580). Forty-one percent of the surveys (n = 118) were returned by the dental hygienists certified in the administration of local anesthesia, while 22% (n = 64) of the surveys were returned by those not certified in the function. An approximate response rate of 25% (n = 146) was achieved for the surveys of the dentist employers. Findings indicate that the respondents perceived local anesthesia as beneficial for both dental hygiene patients and clinicians. Arkansas dental hygienists and dentists reported that this function had a positive impact on scheduling, production, patient satisfaction and comfort, and quality of care. Furthermore, more than nine out of 10 of the dentist respondents were satisfied with their dental hygienists local anesthesia skills and/or would encourage their uncertified dental hygienists to become certified. Dental hygienists certified in the function reported utilizing this technique moderately to fully for patient care, particularly for those in practices with greater numbers of periodontally involved patients. Certified dental hygienists also viewed local anesthesia as contributing to the quality of patient care and necessary for dental hygiene procedures. CONCLUSIONS: Results of this study provide evidence that local anesthesia benefits dental hygiene patients and clinicians. Both Arkansas dental hygienists and dentists viewed this expanded function as necessary for provision of quality dental hygiene care. The dentist employers of certified dental hygienists reported that the function had a positive impact on scheduling, production, patient satisfaction and comfort, and quality of care.
Anesthesia, Dental↗
[Local anesthesia in surgery of the thorax].
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Anesthesia↗