• Journal of the Korean Orthopaedic Association
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• v.56 no.4
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• pp.310-316
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• 2021

Purpose: Septic arthritis of the knee is an orthopedic emergency that requires early diagnosis and surgical treatment. This study examined the effectiveness of drain insertion and irrigation in the treatment of septic arthritis of the knee under local anesthesia. Materials and Methods: A retrospective study was conducted on nine cases (eight patients) diagnosed with septic arthritis of the knee from September 2017 to February 2020 and treated with drain insertion and irrigation under local anesthesia. After penetrating through the superolateral portal to the superomedial portal and inserting the drain, daily irrigation of approximately 3 L of normal saline was done. The following were investigated: age, sex, underlying disease, cause, degree of osteoarthritis, time from diagnosis to surgery, duration of hospitalization, duration of normalization of C-reactive protein, and smear and culture. Results: The initial white blood cell count of joint fluid was 71,472±51,667/mm³ (32,400-203,904/mm³), and polymorphic leukocytes were 91.1%±2.6% (86%-95%). The average time from diagnosis to surgery was 8.3±1.3 hours (6-10 hours), and the irrigation period was 8.2±3.2 days (4-15 days). The average length of hospitalization was 20.8±8.7 days (9-37 days). There was no reoperation or recurrence. Smear and culture tests were not identified. Conclusion: In the treatment of septic arthritis of the knee, the insertion of a drain tube and irrigation under local anesthesia is a relatively fast and simple method to reduce pain by repetitive draining of purulent joint fluid and can be used as an alternative treatment for patients with a risk of general or spinal anesthesia.

• Journal of Oral Medicine and Pain
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• v.31 no.1
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• pp.59-67
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• 2006

There exist patients complaining speech problem due to dysesthesia or anesthesia following dental surgical procedure accompanied by local anesthesia in clinical setting. However, it is not clear whether sensory problems in orofacial region may have an influence on motor speech abilities. The purpose of this study was to investigate whether transitory sensory impairment of mandibular nerve by local anesthesia may influence on the motor speech abilities and thus to evaluate possibility of distorted motor speech abilities due to dysesthesia of mandibular nerve. The subjects in this study consisted of 7 men and 3 women, whose right inferior alveolar nerve, lingual nerve and long buccal nerve was anesthetized by 1.8 mL lidocaine containing 1:100,000 epinephrine. All the subjects were instructed to self estimate degree of anesthesia on the affected region and speech discomfort with VAS before anesthesia, 30 seconds, 30, 60, 90, 120 and 150 minutes after anesthesia. In order to evaluate speech problems objectively, the words and sentences suggested to be read for testing speech speed, diadochokinetic rate, intonation, tremor and articulation were recorded according to the time and evaluated using a Computerized Speech $Lab^{(R)}$. Articulation was evaluated by a speech language clinician. The results of this study indicated that subjective discomfort of speech and depth of anesthesia was increased with time until 60 minutes after anesthesia and then decreased. Degree of subjective speech discomfort was correlated with depth of anesthesia self estimated by each subject. On the while, there was no significant difference in objective assessment item including speech speed, diadochokinetic rate, intonation and tremor. There was no change in articulation related with anesthesia. Based on the results of this study, it is not thought that sensory impairment of unilateral mandibular nerve deteriorates motor speech abilities in spite of individual's complaint of speech discomfort.

• Journal of the korean academy of Pediatric Dentistry
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• v.44 no.3
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• pp.365-369
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• 2017

Local anesthetics are widely used in clinical dentistry. However, while rare, there have been some reports of true hypersensitivity to local anesthetics. A case of hypersensitivity in a 26-month-old boy is reported. After administering local anesthesia with lidocaine, treatment was performed while the patient was under oral sedation. After treatment, the patient presented with lower lip edema. Treatment with anti-histamines and a steroid successfully reversed his symptoms.

• The Korean Journal of Pain
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• v.18 no.1
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• pp.39-42
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• 2005

Background: Besides its general anesthetic effect, ketamine interacts with sodium channels in a local anesthetic-like fashion, including the sharing of binding sites with those commonly used by clinical local anesthetics. This study evaluated the dose related effects of ketamine during epidural anesthesia with 0.5% ropivacaine. Methods: Sixty ASA physical status I II patients, scheduled for minor elective surgery under epidural anesthesia using 0.5% ropivacaine, were randomly divided into three groups (n = 20 each). The patients initially received either 0.5% ropivacaine (group 1), ketamine (0.1 mg/kg) in addition to the epidural 0.5% ropivacaine (group 2) or ketamine (0.2 mg/kg) in addition to the epidural 0.5% ropivacaine (group 3). The regression of sensory block was assessed by transcutaneous electric stimulation (TES), equivalent to a surgical incision. Motor block was assessed using the Modified Bromage's scale. Episodes of bradycardia, hypotension and sedation were also recorded. Results: There were no significant differences among the three groups in the maximal levels of sensory block or the times taken for these levels to be reached. The mean times for the block to regress to two and four segments below the maximal level were significantly prolonged by epidural ketamine. Conclusions: Epidural ketamine prolongs the duration of ropivacaine epidural anesthesia. These results suggest that ketamine has local anesthetic-like actions.

• Journal of Neurocritical Care
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• v.11 no.2
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• pp.93-101
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• 2018

Background: At most centers, general anesthesia (GA) has been preferred for endovascular treatment (EVT) of ruptured intracranial aneurysms (RIAs). In this study, we analyzed procedural results, clinical outcomes, and follow-up angiographic findings for patients undergoing EVT for RIA under local anesthesia (LA) with conscious sedation (CS). Methods: We retrospectively evaluated 308 consecutive patients who underwent EVT for RIAs at a single institution between June 2009 and February 2017. EVT under LA with CS was considered for all patients with aneurysmal subarachnoid hemorrhage, regardless of Hunt and Hess (HH) scale score. Results: EVT was performed for 320 aneurysms in 308 patients with subarachnoid hemorrhages. The mean patient age was $55.5{\pm}12.6$ years. Moderate (III) and poor (IV, V) HH grades were observed in 75 (24.4%) and 77 patients (25%), respectively. Complete occlusion immediately after EVT was achieved for 270 (84.4%) of 320 aneurysms. Thromboembolic complications and intraprocedural ruptures occurred in 25 (7.8%) and 14 cases (4.3%), respectively. The morbidity rate at discharge (as defined by a modified Rankin scale score of 3 or greater) was 27.3% (84/308), while the mortality rate was 11.7% (36/308). Follow-up angiographic results were available for 210 (68.1%) of 308 patients. Recanalization was observed in 64 (29.3%) of 218 aneurysms in 210 patients. Conclusion: Based on our experience, EVT for RIAs under LA with CS was feasible, regardless of the clinical grade of the subarachnoid hemorrhage. Complication rates and follow-up angiographic results were also comparable to those observed when GA was used to perform the procedure.

• The Korean Journal of Pain
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• v.26 no.4
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• pp.336-346
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• 2013

Intrathecal drug delivery is an effective and safe option for the treatment of chronic pathology refractory to conventional pain therapies. Typical intrathecal administered drugs are opioids, baclofen, local anesthetics and adjuvant medications. Although knowledge about mechanisms of action of intrathecal drugs are every day more clear many doubt remain respect the correct location of intrathecal catheter in order to achieve the best therapeutic result. We analyze the factors that can affect drug distribution within the cerebrospinal fluid. Three categories of variables were identified: drug features, cerebrospinal fluid (CSF) dynamics and patients features. First category includes physicochemical properties and pharmacological features of intrathecal administered drugs with special attention to drug lipophilicity. In the second category, the variables in CSF flow, are considered that can modify the drug distribution within the CSF with special attention to the new theories of liquoral circulation. Last category try to explain inter-individual difference in baclofen response with difference that are specific for each patients such as the anatomical area to treat, patient posture or reaction to inflammatory stimulus. We conclude that a comprehensive evaluation of the patients, including imaging techniques to study the anatomy and physiology of intrathecal environment and CSF dynamics, could become essential in the future to the purpose of optimize the clinical outcome of intrathecal therapy.

• Journal of the Korean Academy of Clinical Electrophysiology
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• v.4 no.1
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• pp.63-83
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• 2006

This study conducted the following experiment to examine anesthetic effects of 500 kHz ultrasound with lidocaine. Clinical experiment was conducted to compare local anesthetic effects by ultrasound frequencies and drugs with 40 normal adults and it divided subjects into experimental group (I) applying only ultrasound, ointment group (II) applying only lidocaine, phonophoresis group of 1 MHz (III), phonophoresis group of 500 kHz lidocaine (IV) for pain threshold and nerve conduct experiments. Mechanical threshold was measured with von Frey monofilament, thermal pain threshold with halogen lamp and digital thermometer, action potential in median nerve with diagnostic electromyography before and after treatment, and at 30 min., 60 min., 90 min., and 120 min. after treatment. Results of this study can be summarized as follows. Topical anesthesia experiment showed that pain threshold of phonophoresis groups was significantly increased, but there were little differences in ultrasound frequency and drugs among phonophoresis groups. Conduction anesthesia experiment showed that phonophoresis group of 500 kHz using lidocaine had significant difference in pain threshold and sensory nerve conduction compared to ointment group and ultrasound group, but there was no great difference from other phonophresis groups and light nerve block effect was found. It was considered that application of 500 kHz ultrasound using lidocaine will be more effective in deep anesthesia or nerve block than 1 MHz ultrasound. However, researches considering various frequencies, intensities and application hours in low frequency areas including kHz ultrasound are needed to increase deep permeation of drugs.

• Journal of Dental Anesthesia and Pain Medicine
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• v.15 no.4
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• pp.201-205
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• 2015

Background: This prospective, randomized, double-blind, clinical study was conducted to compare the effects of 4% articaine with 1:100,000 epinephrine (A100) and 4% articaine with 1:200,000 epinephrine (A200) on the vital signs and onset and duration of anesthesia in an inferior alveolar nerve block (IANB). Methods: In the first appointment, an IANB was performed by injecting A100 or A200 in 1 side of the mouth (right or left) randomly in patients referred for extraction of both their first mandibular molars. In the second appointment, the protocol was repeated and the other anesthetic solution was injected in the side that had not received the block in the previous session. Systolic and diastolic blood pressures (SBP and DBP) and pulse rate were measured during and 5 min after the injection. The onset and duration of anesthesia were also evaluated. Data were analyzed using t-test and Mann-Whitney U-test, and p-value was set at 0.05. Results: SBP and pulse rate changes were slightly more with A100; however, DBP changes were more with A200, although the differences were not significant (P > 0.05). There were no statistically significant differences in the parameters evaluated in this study. The onset and duration of anesthesia, and the changes in SBP, DBP, and pulse rate during and 5 min after the injection were the same in both the groups. Conclusions: For an IANB, A200 and A100 were equally efficient and successful in producing the block. Epinephrine concentration did not influence the effects of 4% articaine.

• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.5
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• pp.441-449
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• 2021

Background: The efficacy of local anesthesia decreases in patients with symptomatic irreversible pulpitis. Therefore, it was proposed that the use of premedication with an anti-inflammatory drug might increase the success rate of pulpal anesthesia in mandibular posterior teeth with vital inflamed pulp. Methods: One hundred thirty-four patients who were actively experiencing pain willingly participated in this study. The Heft Parker (HP) visual analog scale (VAS) was used to record the initial pain intensity. Patients were randomly allocated to receive a placebo, 10 mg of ketorolac, and 650 mg of paracetamol. The standard inferior alveolar nerve block (IANB) was administered to all patients using 2% lidocaine with 1:200,000 adrenaline after one hour of medication. After 15 min, the patient was instructed to rate the discomfort during each step of the treatment procedure, such as access to remaining dentin, access to the pulp chamber, and during canal instrumentation on the HP VAS. IANB was considered successful if the patient reported no or mild pain during access preparation and instrumentation. Moderate or severe pain was classified as a failure of IANB and another method of anesthesia was used before continuing the treatment. Results: The rate of successful anesthesia in the placebo, paracetamol, and ketorolac groups was 29%, 33%, and 43%, respectively, and no statistically significant difference was found between the groups. Conclusion: Preoperative administration of paracetamol or ketorolac did not significantly affect the success rate of IANB in patients with irreversible pulpitis. No significant difference was observed between the paracetamol and ketorolac groups.

• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.1
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• pp.1-10
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• 2022

Background: Inferior alveolar nerve block (IANB) is known to have a lower success rate for anesthesia in patients with irreversible pulpitis. This calls for supplementary techniques to effectively anesthetize such patients. This systematic review aimed to evaluate the published literature for determining the success rate of anesthesia induction using post-IANB intraligamentary (IL) injection in the mandibular teeth of patients with symptomatic irreversible pulpitis. The review question was, "What is the success rate of IL injection in the mandibular teeth of patients with irreversible pulpitis as a supplementary technique for endodontic treatment?" Methods: A thorough search of electronic databases and manual searches were performed. The protocol of the review was framed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and was registered in the International Prospective Register of Ongoing Systematic Reviews (PROSPERO) with a proper criterion for inclusion and exclusion of studies. The included studies were analyzed using the Cochrane Collaboration "Risk of Bias" tool. A meta-analysis that included a comparison of primary nerve block and supplemental IL injection was performed. The success rate was evaluated using the combined risk ratio (RR) with a random risk model. A funnel plot was created to measure publication bias. Results: After all analyses, four studies were included. In the forest plot representation, RRs were 3.56 (95% CI: 2.86, 4.44), which were in favor of the supplemental IL injections. Statistical heterogeneity was found to be 0%. These values suggest that supplemental IL injections provide better success rates for anesthesia. Conclusion: According to the pooled qualitative and quantitative analyses, supplemental IL injections increased anesthetic efficacy.