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Results for “Local anaesthesia”

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At least 127 records · Page 7Linked to original sources

PubMed1998

Cochlear implantation under local anaesthesia, the Belfast experience.

The profoundly deaf, who gain little or no benefit from conventional hearing aids and meet various criteria are potential candidates for cochlear implantation. The last two decades have witnessed remarkable progress in this field, and it is now a routine clinical procedure. A few adult patients who are potential candidates for cochlear implantation have an unacceptably high risk for hypotensive general anaesthesia due to other systemic conditions. This group has been successfully implanted under local anaesthesia in our centre. The post-implantation progress of these patients was comparable to those carried out under hypotensive general anaesthesia. Data regarding patient selection criteria, examination, anaesthesia, surgery and the outcome are discussed. It was concluded that cochlear implantation under local anaesthesia is a safe and effective procedure for those patients who otherwise may be denied an implant.

Adult↗

PubMed2005

Combined nebulization and spray-as-you-go topical local anaesthesia of the airway.

BACKGROUND: Twenty-five anaesthetists underwent awake fibreoptic intubation using a combination of nebulization and topical local anaesthesia. Plasma lidocaine concentrations were measured and the quality of the local anaesthesia was assessed. METHODS: After i.v. glycopyrrolate 3 microg kg(-1) and intranasal xylometolazone 0.1%, lidocaine 4% 200 mg was administered by nebulizer. Supplementary lidocaine to a maximum total of 9 mg kg(-1) was applied directly and via a fibreoptic endoscope. Nasotracheal intubation was performed once the vocal cords became unreactive. Heart rate, non-invasive blood pressure and oxygen saturation were recorded at 5-min intervals. Blood sampling commenced with a baseline sample and continued at 10 min intervals until 60 min after final administration of local anaesthetic. Subjects graded levels of anxiety, pain and coughing using written and visual analogue scales. RESULTS: Conditions for fibreoptic endoscopy and intubation were good. Seventeen received the maximum lidocaine dose of 9 mg kg(-1). The average dose used was 8.8 mg kg(-1). All plasma lidocaine concentrations assayed were below 5 mg litre(-1). Four volunteers reported feeling lightheaded after the procedure, despite normal blood pressure. Of these, two had the highest plasma lidocaine concentrations recorded: 3.5 and 4.5 mg litre(-1). Twenty-two of the 25 subjects found endoscopy and intubation acceptable, three found it enjoyable and no subject rated it as distressing. CONCLUSIONS: This method of airway anaesthesia was acceptable to this small group of unsedated subjects. It produced good conditions for fibreoptic intubation. A maximum calculated lidocaine dose of 9 mg kg(-1) did not produce toxic plasma concentrations of lidocaine.

Administration, Topical↗

PubMed1987

The effect of local anaesthesia of the nasal vestibule on nasal sensation of airflow and nasal resistance.

The effect of local anaesthesia of the nasal vestibule on nasal sensation of airflow and nasal resistance was assessed in 15 subjects. A single blind parallel group trial was undertaken in 30 subjects, with lignocaine as the active drug, and normal saline as the placebo. Fifteen subjects were included in each group. Both agents were infiltrated bilaterally into the floor of the nasal vestibule on each side via the sublabial route. Local anaesthesia of the nasal vestibule by infiltrating lignocaine produced a sensation of nasal obstruction in 9 out of 15 subjects (P less than 0.02). The infiltration of normal saline had no such effect. The difference between the effect of the 2 agents on nasal airflow sensation was significant (P less than 0.05). Neither injection had any significant effect on nasal resistance to airflow as assessed by active anterior rhinomanometry.

Adult↗

PubMed1993

Haemostasis during carpal tunnel release under local anaesthesia: a controlled comparison of a tourniquet and adrenaline infiltration.

A randomized controlled comparison of tourniquet and local adrenaline infiltration for control of bleeding was performed in patients undergoing bilateral carpal tunnel release under local anaesthesia. Visual analogue scores for intra-operative pain were substantially greater for tourniquet (mean score 4.7) than for adrenaline (2.2). Incomplete control of bleeding was responsible for longer operating time and for the surgeons' perception of slightly greater operative difficulty with the use of adrenaline. There were no complications attributable to the use of adrenaline. The use of adrenaline-containing local anaesthesia for carpal tunnel release avoids tourniquet pain and is preferred by patients.

Anesthesia, Local↗

PubMed2005

Percutaneous regional compared with local anaesthesia for facial lacerations: a randomised controlled trial.

OBJECTIVE: Facial lacerations are usually repaired after local infiltration of an anaesthetic agent. Regional nerve blocks of the face offer several theoretical advantages over local infiltration. This study compared the pain of injection and anaesthetic efficacy of percutaneous regional and local anaesthesia for facial lacerations. STUDY DESIGN: Randomised clinical trial. PARTICIPANTS: Convenience sample of emergency department patients with facial lacerations requiring suturing in anatomical areas innervated by a regional nerve (supraorbital, infraorbital, or mental). INTERVENTIONS: Facial lacerations treated using standard wound care. Lacerations were randomised to local or regional infiltration of lidocaine (lignocaine) 1% with adrenaline (epinephrine) 1:100 000 using a number 27 needle. OUTCOMES: Pain of injection on 100 mm visual analogue scale (VAS) and need for rescue anaesthetic infiltration before suturing. DATA ANALYSIS: Group comparisons were with Student's t test and chi(2) test. This study had 80% power to detect a 20 mm difference in pain of injection (two tailed, alpha = 0.05). RESULTS: 36 patients were randomised to local (18) and regional (18) anaesthesia. Mean (SD) age was 20 (14); 19% were female. Groups were similar in baseline characteristics. Patients in the regional anaesthesia group experienced more pain during infiltration than patients in the local anaesthesia group (42.4 mm v 24.8 mm, mean difference 17.6 mm (95% CI 0.3 to 35.6 mm) and were more likely to require additional infiltration of a local anaesthetic (28% v 0%, (95% CI 6% to 50%)) than patients in the local anaesthetic group. CONCLUSIONS: Local infiltration of anaesthetics for facial lacerations is less painful and results in more effective anaesthesia than percutaneous regional infiltration.

Adolescent↗

PubMed2000

Lidocaine inhalation for local anaesthesia and attenuation of bronchial hyper-reactivity with least airway irritation. Effect of three different dose regimens.

The inhalation of lidocaine attenuates bronchial hyper-reactivity but also causes airway irritation. However, how lidocaine dose and plasma concentration influence relationships are unknown. Accordingly, we evaluated the effects of three concentrations of lidocaine (1, 4, and 10%, total dose of 0.5, 2.0, and 5.0 mg kg-1, respectively) vs. placebo in 15 mild asthmatic patients, selected by their response to a histamine challenge (decrease in FEV1 > 20% to less than 18 mg mL-1 of histamine [PC20]). Baseline lung function, histamine-induced bronchoconstriction, topical anaesthesia, and lidocaine plasma concentrations were obtained. FEV1 following lidocaine inhalation showed the greatest decrease for the highest dose (from 3.79 +/- 0.15-3.60 +/- 0.15; P = 0.0012). Lidocaine inhalation increased baseline PC20 (6.1 +/- 1.3 mg mL-1) significantly (to 11.8 +/- 3.1, 16.1 +/- 3.3, and 18.3 +/- 4.5 mg mL-1, respectively) with no difference between the two highest doses. The duration of local anaesthesia was not significantly different between lidocaine concentrations of 4% and 10%. Thus, lidocaine inhalation, with increasing concentrations of the aerosolized solution, increases initial bronchoconstriction while significant attenuation of bronchial hyper-reactivity is not further enhanced with increasing concentrations from 4 to 10%. Plasma concentrations of lidocaine were always far below the toxic threshold. In conclusion, when local anaesthesia of the airways is required a lidocaine dose of 2.0 mg kg-1 as a 4% solution can be recommended for local anaesthesia and attenuation of bronchial hyper-reactivity with the least airway irritation.

Adult↗

PubMed2003

Ropivacaine compared to lidocaine for tonsillectomy under local anaesthesia.

The aim of the present study was to investigate the safety and efficacy of ropivacaine compared to lidocaine for tonsillectomy under local anaesthesia. During the last 2 years, 77 patients undergoing tonsillectomy under local anaesthesia in the seated position were randomised to receive ropivacaine or lidocaine. The following parameters were recorded: time to surgical anaesthesia, the duration of the procedure, postoperative pain, the need for analgesics during the first 10 h after surgery, cardiac arrhythmias, the occurrence of allergic reaction and larynx spasm. It took significantly longer to reach surgical anaesthesia in the ropivacaine patients (8.3+/-1.3 min versus 2.7+/-0.8 min.), but the pain immediately following the procedure was significantly lower (1.0+/-0.4 versus 2.6+/-1.0). Adjuvant analgetics were administered later and in significantly lower doses in the ropivacaine patients. There were no adverse reactions. In conclusion, ropivacaine in local tonsillectomy is safe, has a longer onset-time, but is more efficient concerning postoperative pain than lidocaine.

Adolescent↗

PubMed1992

Fractured-nose reduction under local anaesthesia. Is it acceptable to the patient?

This article examines patients' acceptance of fractured-nose reduction under local anaesthesia, both objectively and subjectively. At each stage of the reduction the level of the discomfort, the patients' experiences were recorded. The success rate of complete reduction of the nasal fracture was found to be 71% and this was similar to that obtained in other studies that have used general anaesthesia. An overall level of discomfort for the procedure in terms a layman can understand was obtained by comparing the manipulation with that of having a tooth filled at the dentist. Sixty-three percent of the patients said that the nasal fracture reduction was no worse or the same as a dental filling. Our study showed that 96% of patients would be willing to undergo the same local anaesthetic procedure if they fractured their nose a second time. We conclude that it is possible to reduce the majority of fractured noses adequately with little inconvenience to the patient under local anaesthesia, and so we recommend that this procedure should be considered in the first-line treatment of the displaced fractured nose.

Adolescent↗

PubMed2006

Local anaesthesia for carpal tunnel decompression: a comparison of two techniques.

Carpal tunnel decompression is mostly performed as a day case procedure using local anaesthesia. The local anaesthetic is commonly administered by subcutaneous infiltration alone (the Gale technique) or by infiltration of the local anaesthetic into the carpal tunnel in addition to the subcutaneous infiltration (the Altissimi and Mancini technique). The intention of this study was to compare the efficacy of anaesthesia using these two techniques. Twenty patients with bilateral carpal tunnel syndrome were recruited. One side underwent surgery at a time. Patients were randomised to receive anaesthesia by one technique on the first side and the other on the second. Pain was evaluated using the numerical rating pain scale (0-10). Six patients experienced intraoperative pain with the Gale technique, while none had pain with the Altissimi and Mancini technique (P = 0.02). The postoperative pain was not significantly different between the two groups, although the patients anaesthetised by the Altissimi and Mancini technique required significantly lower numbers of analgesic tablets.

Adult↗

PubMed1990

Transurethral ureterorenoscopic lithotripsy and retrieval of ureteric calculi under local anaesthesia and sedation.

Under strict indications, ureterorenoscopic (URS) lithotripsy was used to treat ureteric calculi in 61 patients under local anaesthesia and sedation in a 2-year period ending November 1988. Assessments of success and discomfort of the procedure were made. Stone retrieval was accomplished in 48 patients (78% success rate) and a mean pain score of 6 was recorded in a scale from 0 to 10. It was concluded that performing URS under local anaesthesia is an acceptable alternative.

Adult↗

PubMed1981

Ruptured achilles tendons treated surgically under local anaesthesia.

Twenty-two patients with rupture of the Achilles tendon were successfully treated by simple end-to-end suture under local anaesthesia. The results are discussed in the light of previous literature on surgical versus conservative treatment and the advantages of surgery under local anaesthesia are pointed out.

Achilles Tendon↗

PubMed1986

Local anaesthesia in inguinal herniorrhaphy: influence of dextran and saline solutions on duration of action of bupivacaine.

Because recent clinical trials have shown that dextran solutions can prolong the local anaesthetic action of 0.25% bupivacaine, a prospective double blind trial was performed in patients (n = 50) undergoing uncomplicated elective inguinal herniorrhaphy under local anaesthesia alone. Patients were randomised prior to infiltration of local anaesthesia into 2 groups: 0.5% bupivacaine (30 ml) diluted with an equal volume of either 0.9% saline or an equal volume of dextran 110. There was no significant difference in duration nor degree of postoperative anaesthesia between the two groups. Dextran solutions were found to be significantly more acidic than saline solutions and the possible effects of this on bupivacaine kinetics are discussed.

Adult↗

PubMed1996

An adverse reaction to local anaesthesia: report of a case.

The safety of local anaesthetic agents is high but adverse reactions do occur. A common mistake among practitioners is misdiagnosing an adverse reaction to local anaesthesia as a hypersensitivity reaction. Some prospective dental patients are unable to undergo routine dental treatment because they have been mislabelled as allergic to local anaesthetics. This case report illustrates the need for practitioners to be sure of the signs and symptoms of potential adverse reactions and their appropriate management.

Adult↗

PubMed1995

Warming lignocaine reduces the pain of injection during peribulbar local anaesthesia for cataract surgery.

AIMS: To test if the simple technique of warming lignocaine reduces the pain of injection during local anaesthetic cataract surgery. METHODS: Sixty patients undergoing peribulbar local anaesthesia for cataract surgery were allocated randomly to receive either warm (37 degrees C) or cold (room temperature) plain 2% lignocaine for the injection. Pain was assessed subjectively by asking the patients to score their pain from 0 (no pain) to 10 (most severe pain imaginable). RESULTS: The mean pain score for the warm group was 2.3 (SD 1.3) in comparison with a mean score of 5.5 (1.0) for the cold group (p < 0.01). CONCLUSIONS: The process of warming lignocaine to 37 degrees C has been found to reduce significantly the pain of injection during peribulbar local anaesthesia. It is recommended that this technique be more widely adopted in order to minimise patient's discomfort.

Aged↗

PubMed1983

Complications in 8509 laparoscopic Falope ring sterilizations performed under local anaesthesia.

During the 3-year period 1 January 1980-31 December 1982, 8509 laparoscopic Falope ring sterilizations were performed under local anaesthesia in rural areas of the Cape Province by the Sterilization Service of Tygerberg Hospital. Despite the fact that 476 of the patients had undergone previous lower abdominal surgery, major complications (anaphylactic shock after injection of lignocaine and inadvertent perforation of the bladder by the trocar) occurred in only 2 cases. It was not possible to complete the sterilization under local anaesthesia in 98 cases, resulting in a technical failure rate of 1.15%. A prospective study of the minor complications encountered among the 193 patients sterilized during November 1982 showed that torn tubes occurred in 3.1% and uterine perforation in 2.1%. This can be partially explained by the fact that evidence of previous pelvic infection was seen during laparoscopy in 9.3% of cases. The pregnancy rate after sterilization was 0.28% for the group as a whole.

Anesthesia, Local↗

PubMed1998

The efficacy of local anaesthesia for percutaneous epididymal sperm aspiration and testicular sperm aspiration.

A total of 37 percutaneous epididymal sperm aspiration (PESA) and/or testicular sperm aspiration (TESA) procedures were performed under local anaesthesia (LA) on 34 men between June and November 1996. Local anaesthesia was achieved by injecting 10 ml of 1% lignocaine solution along the sides of the vas deferens near the external inguinal ring (spermatic cord block). Sperm retrieval was successful in 92% of the procedures. Of the 37 procedures, in 29 the patients felt either no pain or mild discomfort while in six they experienced moderate but tolerable pain. Analgesia was incomplete in two procedures and was supplemented with i.v. sedation. Vasovagal reflex in two procedures was reversed by i.v. atropine. In 24 procedures patients felt relaxed, whilst in 13 they felt anxious. In 32 procedures the patients expressed overall satisfaction. If the procedure was to be repeated, after 29 procedures the patients requested LA again, while after four procedures they preferred i.v. sedation and after four were undecided. LA is adequate for PESA and TESA in a large proportion of patients. Prior discussion of LA technique with the patient is necessary. Back-up facilities for i.v. sedation and atropine should be available.

Adult↗

PubMed1996

Randomised trial of topical versus sub-Tenon's local anaesthesia for small-incision cataract surgery.

Fifty unselected patients undergoing routine cataract surgery were randomised to receive either topical or sub-Tenon's local anaesthesia with 2% prilocaine administered by a blunt cannula. Visual analogue scales were used to assess pain during administration of sub-Tenon's anaesthetic and pain during surgery, and any complications were noted. Sub-Tenon's anaesthesia proved to be entirely comfortable to administer, and allowed for a statistically significantly more pain-free operation, at the expense of some residual eye movement and an inevitable subconjunctival haemorrhage. Both techniques compared well with other studies assessing periorbital or retro-orbital injections, and both have significant safety advantages which are discussed in the context of the joint Royal Colleges report on ophthalmic anaesthesia. It is suggested that a combination of one or other technique could safely cover all requirements for intraocular surgery under local anaesthesia.

Administration, Topical↗

PubMed1999

The National Survey of Local Anaesthesia for Ocular Surgery. I. Survey methodology and current practice.

PURPOSE: To describe the current usage of the various techniques of local anaesthesia (LA) in the United Kingdom, and safety precautions taken. METHODS: An observational study of practice of LA in the whole of the United Kingdom was carried out over 3 months in late 1996. Staff in all ophthalmology theatres in the National Health Service were invited to report every LA given for the purpose of intraocular surgery during the first week, and thereafter to report adverse events only. RESULTS: Participation during the first week was calculated to be 72.8% overall. Anaesthesia techniques for intraocular surgery were: 70% LA alone, 5.8% LA with sedation and 24.2% general anaesthesia. LA techniques were: 65.6% peribulbar, 16.9% retrobulbar, 6.7% sub-Tenon's, 4.4% subconjunctival, 2.9% topical and 2.3% combinations. Of patients who were given LA, 96% were monitored, 84% had an anaesthetist available in theatres in case of a problem and intravenous access was established in 60%. CONCLUSION: Local anaesthesia is frequently used for intraocular surgery in the United Kingdom. A variety of techniques are used, and safety precautions are taken in most cases.

Anesthesia, Local↗