• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.3
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• pp.137-146
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• 2020

Background: Mandibular third molar removal is the most common surgical procedure encountered in oral and maxillofacial clinics. It also presents the greatest challenges and controversies for surgeons when surgical removal is considered. Furthermore, diverse anesthesia results and success rates are achieved after using the same concentrations of different solutions or the same amounts of local anesthetics. The purpose of this study was to examine the efficiency of using double-cartridge (3.4 ml) 4% lidocaine (high concentration) and 4% articaine with a 1:100000 epinephrine infiltration in the retromolar region for impacted lower third molar surgery. Methods: This double-blind study included 30 patients with symmetrically impacted lower third molars. The patients were randomly selected to receive 4% articaine on one side and 4% lidocaine on the other, as a local anesthetic for third molar surgery. The onset, duration of soft-tissue numbness, pulpal sensitivity, amount of additional local anesthetic needed, pain score during the surgical procedure, and duration of the operation were recorded. Results: The results of this research indicate that 86.7% of the operations in the 4% articaine group and 83.3% of those in the 4% lidocaine group were successful. Furthermore, the outcomes in both groups were not statistically significant (P > 0.05). Numbness onset occurred faster in the articaine group than it did in the lidocaine group. However, the duration of soft-tissue anesthesia and pain scores recorded immediately postoperatively were similar. Conclusion: It is concluded that 4% lidocaine and 4% articaine had a similar infiltration efficacy in the retromolar region and both local anesthetics are adequate for impacted lower third molar surgery. There were no statistically significant differences between the two local anesthetics regarding pain control and the duration of soft-tissue numbness during the procedure.

• The Korean Journal of Pain
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• v.34 no.3
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• pp.304-314
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• 2021

Background: The study investigated virtual reality (VR) immersion in alleviating procedure-related pain in patients with chronic pain undergoing fluoroscopy-guided minimally-invasive intervention in a prone position at an outpatient clinic. Methods: In this prospective randomized controlled study, 38 patients undergoing lumbar sympathetic ganglion block were randomized into either the VR or the control group. In the VR group, procedure-related pain was controlled via infiltration of local anesthetics while watching a 30-minute VR hypnotic program. In the control group, the skin infiltration alone was used, with the VR device switched off. The primary endpoint was an 11-point score on the numerical rating scale, indicating procedure-related pain. Patients' satisfaction with pain control, anxiety levels, the need for additional local anesthetics during the procedure, hemodynamic stability, and any adverse events were assessed. Results: Procedure-related pain was significantly lower in the VR group (3.7 ± 1.4) than in the control group (5.5 ± 1.7; P = 0.002). Post-procedural anxiety was lower in the VR group than in the control group (P = 0.025), with a significant reduction from pre-procedural anxiety (P < 0.001). Although patients' satisfaction did not differ significantly (P = 0.158) between the groups, a higher number of patients required additional local anesthetics in the control group (n = 13) than in the VR group (n = 4; P = 0.001). No severe adverse events occurred in either group during the study. Conclusions: VR immersion can be safely used as a novel adjunct to reduce procedural pain and anxiety during fluoroscopic pain intervention.

• Journal of Chest Surgery
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• v.55 no.1
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• pp.30-36
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• 2022

Background: No consensus exists regarding whether volatile anesthetics are superior to intravenous anesthetics for reducing postoperative pulmonary complications (PPCs) in patients undergoing general anesthesia for surgery. Studies of this issue focused on anatomic pulmonary resection are lacking. This study compared the effects of total intravenous anesthesia (TIVA) versus volatile anesthesia on PPCs after anatomic pulmonary resection in patients with lung cancer. Methods: This retrospective study examined the medical records of patients with lung cancer who underwent lung resection at our center between January 2018 and October 2020. The primary outcome was the incidence of PPCs, which included prolonged air leak, pneumonia, acute respiratory distress syndrome, empyema, atelectasis requiring bronchofiberscopy (BFS), acute lung injury (ALI), bronchopleural fistula (BPF), pulmonary embolism, and pulmonary edema. Propensity score matching (PSM) was used to balance the 2 groups. In total, 579 anatomic pulmonary resection cases were included in the final analysis. Results: The analysis showed no statistically significant difference between the volatile anesthesia and TIVA groups in terms of PPCs, except for prolonged air leak. Neither of the groups showed atelectasis requiring BFS, ALI, BPF, pulmonary embolism, or pulmonary edema after PSM. However, the length of hospitalization, intensive care unit stay, and duration of chest tube indwelling were shorter in the TIVA group. Conclusion: Volatile anesthetics showed no superiority compared to TIVA in terms of PPCs after anatomical pulmonary resection in patients with lung cancer. Considering the advantages of each anesthetic modality, appropriate anesthetic modalities should be used in patients with different risk factors and situations.

• Journal of Dental Anesthesia and Pain Medicine
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• v.23 no.5
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• pp.245-256
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• 2023

Background: Surgical and non-surgical periodontal procedures often lead to postoperative pain. Clinicians use pharmacological methods such as anesthetics, anti-inflammatory drugs, and analgesics for relief. However, the multitude of options makes it challenging to select the best approach for routine dental care. Objective: This review aimed to describe previous studies regarding the pharmacological management used for pain control during periodontal procedures as well as factors that may interfere with patients' perception of pain. Methods: We included studies (period of 2000-2023, whose approach corresponded to the pharmacological protocols used for preoperative, trans-operative, and postoperative pain control in adult patients undergoing surgical and non-surgical periodontal therapy. Results: A total of 32 studies were included in the analysis, of which 17 (53%) were related to anesthetic methods and 15 (47%) were related to therapeutic protocols (anti-inflammatory/analgesic agents). These studies predominantly involved nonsurgical periodontal procedures. Studies have reported that factors related to age, type of procedure, and anxiety can influence pain perception; however, only seven of these studies evaluated anxiety. Conclusions: Numerous methods for pain control can be applied in periodontal therapy, which are accomplished through anesthetic methods and/or therapeutic protocols. Factors such as anxiety, age, and type of procedure are related to pain perception in patients. Thus, it is the responsibility of dentists to evaluate each clinical situation and define the best protocol to follow based on the literature.

• Journal of Dental Anesthesia and Pain Medicine
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• v.24 no.2
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• pp.119-128
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• 2024

Background: In pediatric dentistry, fear and anxiety are common among children. Local anesthetics (LA) are widely used to control pain and reduce discomfort in children during dental treatment. Topical anesthetics play a vital role in reducing pain and the unpleasant sensation of a needle puncture in children. Peppermint oil has been extensively used for various diseases. However, its anesthetic properties remain unknown. Peppermint oil, used in mouthwashes, toothpastes, and other topical preparations has analgesic, anesthetic, and antiseptic properties. This study aimed to compare and evaluate pain perception following the topical application of peppermint oil versus lignocaine spray before an intraoral injection in children, aged 8-13 years. Method: Fifty-two children, aged between 8-13 years, who required local anesthesia for dental treatment were divided into two groups of 26 each by simple random sampling (Group 1: 0.2% peppermint oil and Group 2: lignocaine spray). In both groups, physiological measurements (e.g., heart rate) were recorded using pulse oximetry before, during, and after the procedure. Objective pain measurement (Sound Eye Motor (SEM) scale) during administration and subjective measuremeant (Wong-Baker Faces Pain Rating Scale (WBFPRS)) after LA administration were recorded. This was followed by the required treatment of the child. Physiological parameters were compared between the two groups using an independent t-test for intergroup assessment and a paired t-test and repeated-measures ANOVA for intragroup comparisons. The Mann-Whitney U test was used to analyze the pain scores. Results: Intragroup mean heart rates, before, during, and after treatment were statistically significantly different (P < 0.05). However, the intergroup mean pulse rates did not differ significantly between the two groups. The mean WBFPS score in the lignocaine spray group was 4.133 ± 2.06 was statistically different from that of the peppermint oil group (0.933 ± 1.03; P < 0.001^*). The mean SEM score was significantly lower in the peppermint oil group than that in the lignocaine spray group (P = 0.006). No negative effects were observed in this study. Conclusion: 0.2% peppermint oil was effective in reducing pain perception.

• The Korean Journal of Pharmacology
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• v.32 no.3
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• pp.381-388
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• 1996

The hemodynamic changes in septic patients produced by inhalational anesthetics are sufficient to threaten the anesthesiologists. The effect of hydroxocobalamin, a vitamin $B_{12a}$, on contractile responses to phenylephrine during administration of inhalational anesthetics were evaluated in aortic ring preparations obtained from LPS-treated rats. The sepsis was developed by intraperitoneal injection of LPS (1.5 mg/kg for l8h) and confirmed by iNOS expression using RT-PCR. Statistical significances (P<0.05) were analyzed by Student's t-test or paired t-test according to data characteristics. The blood pressure, but not heart rate, was decreased in LPS-treated rats as compared to control rats. The contractile response to phenylephrine were dose-dependently increased from the doses of $10^{-8}\;M$ to that of $10^{-5}$ and were attenuated in LPS-treated rings. Both halothane and enflurane, at the doses of 1 MAC, decreased the contractile responses to phenylephrine while isoflurane did not significantly affect the contractile responses. Hydroxocobalamin ($10^{-5}$ M) significantly potentiated the contractile responses in the LPS-treated aortic ring preparations during administration of each inhalational anesthetic or not. From these results, it is suggested that hydroxocobalamin may improve the hemodynamics of septic patients during inhalational anesthesia. Abbreviations: LPS, lipopolysaccharide; RT-PCR, reverse transcription-polymerase chain reaction; MAC, minimum alveolar concentration; iNOS, inducible nitric oxide synthase; GAPDH, glyceraldehyde 3-phosphate dehydrogenase

• Journal of Pharmaceutical Investigation
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• v.25 no.3
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• pp.33-35
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• 1995

Microspheres containing tetracaine or bupivacaine with poly-lactic-glycolic acid were prepared with a range of compositions. Using the rat scicatic nerve model in vivo it was found that prolonged blockade for periods of 2-7 days. depending on composition variables. Polymer-local anesthetics microspheres are feasible delivery vehicle for prolonged regional nerve blockade.

• The Korean Journal of Pain
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• v.18 no.2
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• pp.176-180
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• 2005

Background: Epidural steroid injections benefit certain patients with radicular pain, and often have only a limited duration. We compared the efficacy of hyaluronidase and triamcinolone and triamcinolone alone in patients with lumbar herniated disc disease treated with transforaminal epidural block. Methods: Forty patients who had undergone a transforaminal epidural injection were retrospectively reviewed. The T group received triamcinolone and local anesthetics; whereas, the HT group received hyaluronidase, triamcinolone and local anesthetics. We evaluated the improvement as being good, moderate, mild or no improvement, and in those where the improvement was good or moderate, also evaluated the duration of pain relief. Data were collected from the medical records of patients or via phone calls, which were analyzed using Student t- and chi-squared tests. A value of P < 0.05 was considered significant. Results: There were no significant differences in the degree of pain improvement or duration of pain relief between the two groups. Conclusions: A hyaluronidase and triamcinolone injection during transforaminal epidural block has on benefit with respect to the degree of pain improvement or its duration compared to a triamcinolone only injection.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.5 no.1
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• pp.50-59
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• 2012

In the domain of orthopaedic surgery, application of regional nerve block for surgery or pain control in upper and lower extremities has been increased. By performing regional block of popliteal (sciatic), femoral, proximal saphenous nerve and ankle block under guidance of ultrasound, not only the safety, but also success rate of the procedure has increased, and amount of local anesthetics could be used less, too. Since the perineural single injection or continuous catheterization of diluted local anesthetics was performed more precisely and easily by the guidance of ultrasound, postoperative pain could be controlled without complications of PCA such as nausea, vomiting, etc. We will discuss about this ultrasound guided regional nerve block.

• Journal of Yeungnam Medical Science
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• v.11 no.1
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• pp.30-34
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• 1994

Local anesthetics produce pain during infiltration into skin. The relationship between local anesthetic-induced pain and pH of the local anesthetic solution has not been fully investigated. Commercial preparation of local anesthetics are prepared as acidic solutions of the salts to promote solubility and stability. And the acidity of local anesthetic solition may be related with the pain during infiltration of the solutione. So, we tried to neutralize the lidocaine hydrochloride solution which is one of the most frequently used local anesthetic agent. Sodium bicarbonate was used for neutralization. Sodium bicarbonate was mixed with lidocaine hydrochloride until the resulting pH of the solution become 7.4 which is identical to the acidity of body fluid. To identify the effect of neutralized lidocaine solution, we had a course of double blind test to 6 volunteers. Both forearm of each volunteer were injected with neutralized lidocaine and plain one, and the degree of pain was estimated by each volunteers. According to subjective description by the volinteers, everyone felt neutralized lidocaine injection site was less painful than plain lidocaine. We concluded that we could reduce pain from infiltration of lidocaine hydrochloride by neutralization of the anesthetic solution with sodium bicarbonate.