• Restorative Dentistry and Endodontics
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• v.47 no.3
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• pp.25.1-25.11
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• 2022

Objectives: This study aimed to evaluate the effects of 5% lidocaine and 2.5% lidocaine/2.5% prilocaine topical anesthetic on pain during needle insertion and infiltration injection in the labial mucosa of anterior maxillary teeth, and to assess the relationship between patients' anxiety and pain scores. Materials and Methods: The Modified Dental Anxiety Scale questionnaire was applied and recorded. Patients were randomly divided into 4 groups (n = 30), as follows: G1 group: 5% lidocaine and placebo for 1 minute, G2 group: 2.5% lidocaine/2.5% prilocaine and placebo for 1 minute, G3 group: 5% lidocaine and placebo for 3 minutes, and G4 group: 2.5% lidocaine/2.5% prilocaine and placebo for 3 minutes. Before the application of topical anesthesia, one side was randomly selected as the topical anesthesia and the contralateral side as the placebo. The pain levels were measured with Visual Analog Scale (VAS) immediately after needle insertion and injection and were compared. The correlation between anxiety and pain scores was analyzed. Results: Administration of 5% lidocaine for 1 minute had significantly higher pain scores for both insertion and infiltration injection than the other groups (p < 0.05). There was a significant moderate positive correlation between dental anxiety and the injection-induced VAS pain score in the placebo side in all groups (p < 0.05). Conclusions: Topical anesthetics significantly reduced the pain caused by both needle insertion and injection pain in comparison to the placebo side. The pain scores of patients with dental anxiety were lower on the topical anesthesia compared to the placebo side.

• Journal of Oral Medicine and Pain
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• v.42 no.3
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• pp.53-61
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• 2017

Myogenous temporomandibular disorder is a collective term for pathologic conditions of the masticatory muscles, mainly characterized by pain and dysfunction associated with various pathophysiological processes. Among the subtypes of myogenous temporomandibular disorder, myofascial pain is one of the most common muscle disorders, characterized by the presence of trigger points (TrPs). Various modalities, such as ultrasound, manipulative therapy, spray-and-stretch technique, transcutaneous electrical nerve stimulation, injection/dry needling, and low-level laser therapy are used to inactivate TrPs. Needling/injection on the TrPs is one of the most common treatments for myofascial pain. Despite the evidence, there is continued controversy over defining the biological and clinical characteristics of TrPs and the efficacy of injection/dry needling. This review discusses the current concept of injection/needling to relieve TrPs.

• The Korean Journal of Pain
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• v.26 no.3
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• pp.265-269
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• 2013

Background: Transforaminal epidural steroid injections are known to reduce inflammation by inhibiting synthesis of various proinflammatory mediators and have been used increasingly. The anti-inflammatory properties of opioids are not as fully understood but apparently involve antagonism sensory neuron excitability and pro-inflammatory neuropeptide release. To date, no studies have addressed the efficacy of transforaminal epidural morphine in patients with radicular pain, and none have directly compared morphine with a tramadol for this indication. The aim of this study was to compare morphine and tramadol analgesia when administered via epidural injection to patients with lumbar radicular pain. Methods: A total of 59 patients were randomly allocated to 1 of 2 treatment groups and followed for 3 months after procedure. Each patient was subjected to C-arm guided transforaminal epidural injection (TFEI) of an affected nerve root. As assigned, patients received either morphine sulfate (2.5 mg/2.5 ml) or tramadol (25 mg/0.5 ml) in combination with 0.2% ropivacaine (1 ml). Using numeric rating scale was subsequently rates at 2 weeks and 3 months following injection for comparison with baseline. Results: Both groups had significantly lower mean pain scores at 2 weeks and at 3 months after treatment, but outcomes did not differ significantly between groups. Conclusions: TFEI of an opioid plus local anesthetic proved effective in treating radicular pain. Although morphine surpassed tramadol in pain relief scores, the difference was not statistically significant.

• The Korean Journal of Pain
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• v.14 no.2
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• pp.276-279
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• 2001

Epidural steroid injection is one method of releiving chronic back pain. However, problems with the loss of resistance to air technique include the possible subarachnoid or subdural injection of air resulting in headache, venous air embolism, and the introduction of air bubbles into the epidural space. Pneumocephalus is a rare complication of epidural block for epidural steroid injection. We report a case of a 58-year-old woman who developed a severe headache and posterior nuchal pain with incomplete oculomotor palsy due to pneumocephalus occuring after an epidural steroid injection.

• Journal of mucopolysaccharidosis and rare diseases
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• v.1 no.1
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• pp.15-18
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• 2015

Biopharmaceuticals, with their ability to treat many unmet needs, are seen as promising medications in diabetes mellitus, growth hormone deficiency, chronic renal failure, cancer, and rheumatoid arthritis. However, almost all biopharmaceuticals should be administrated by injection; IV, IM, and SC. In addition, these treatments are long term, and patients should receive frequent injections for many years. Patient compliance is therefore of critical importance to ensure treatment benefits. Therefore, the goal of drug product development should be focused on improving patient compliance by reducing injection-associated pain as well as stable formulation development. This review will suggest the kinds of factors that should be considered to minimize injection pain with regard to formulation, device, and injection procedures focused on SC injections.

• Journal of The Korean Dental Society of Anesthesiology
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• v.13 no.3
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• pp.89-94
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• 2013

Background: Various strategies have been studied to reduce the propofol injection pain. This study was designed to find out effect-site target concentration (Ce) of remifentanil at which there was a 50% probability of preventing the propofol injection pain (EC50). Methods: Anesthesia was induced with a remifentanil TCI (Minto model). The Ce of remifentanil for the first patient started from 2.0 ng/ml. The Ce of remifentanil for each subsequent patient was determined by the response of the previous patient by Dixon up-and-down method with the interval of 0.5 ng/ml. After the remifentanil reached target concentrations, propofol was administered via a target-controlled infusion system based on a Marsh pharmacokinetic model using a TCI device (Orchestra$^{(R)}$; Fresenius-Vial, Brezins, France). The dose of propofol was effect site target-controlled infusion (TCI) of $3{\mu}g/ml$. Results: The EC50 of remifentanil to prevent the propofol injection pain was $1.80{\pm}0.35ng/ml$ by Dixon's up and down method. Conclusions: The EC50 of remifentanil to blunt the pain responses to propofol injection was $1.80{\pm}0.35ng/ml$ for propofol TCI anesthesia.

• The Korean Journal of Pain
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• v.20 no.1
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• pp.46-49
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• 2007

Background: Cervical epidural injection, performed via the interlaminar approach, represents a useful interventional pain management procedure indicated in patients with a cervical herniated disk. Due to thedecreased epidural space in the cervical region, cervical epidural injections may result in potentially serious complications, especially during a large volume injection. Methods: Thirty-four patients with neck pain due to a cervical herniated disk that were referred to the pain clinic for cervical epidural steroid injection were randomized into two groups. One group received a cervical epidural injection of 4 ml drug and the other group received 2 ml drug. The injected mixture included triamcinolon, ropivacaine and omnipaque. Spread levels of the drug after injection were estimated with the use of C-arm fluoroscopy. Results: Spread levels to the cephalad for patients in the two groups were $4.88{\pm}0.78segments$ and $4.53{\pm}0.49segments$, respectively. Spread levels to the caudad for patients in the two groups were $4.59{\pm}0.93segments$ and $4.47{\pm}0.51segments$, respectively. The results showed no significant difference in the spread level between the two groups. Conclusions: Use of a small volume of drug (2 ml) can provide a sufficient spread level of the injected drug that is desirable for patients with a cervical herniated disk.

• Journal of Chest Surgery
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• v.26 no.7
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• pp.538-542
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• 1993

An approach to the treatment of post-operative pain by the injection of bupivacaine into the pleural space through an intrapleural cathter has been studied. Among 24 thoracotomy patients, bupivacaine was injected only to experimental group[ 12 patients ] when the patient was able to head up for oneself during recovery from anesthesia. The pain and ROM[ range of motion ] scores, respiration rate, PaCO2 level of both experimental and control group were measured at the time of head-up and 30 and 120 minutes thereafter.The scores of pain and ROM of experimental group were significantly[ P value < 0.05 ] decreased in 30 minutes and 120 minutes after bupivacaine injection compared with those of control group but respiration rate and PaCO2 level were not changed significantly. With this result, we can suggest that intrapleural injection of bupivacaine is useful for pain relief following thoracotomy.

• The Korean Journal of Pain
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• v.20 no.1
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• pp.74-77
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• 2007

The trigger point injection technique is widely used in pain clinics for the treatment of acute and chronic pain. Yet it has a variety of complications such asvasovagal syncope, total spinal anesthesia, paralysis, root block, pneumothorax, needle breakage, skin infection, and hematoma formation. Among them, the simultaneous occurrence of psoas and epidural abscesses is extremely rare. We report here on a patient who was diagnosed with epidural and psoas abscesses after paravertebral trigger point injection.

• Journal of The Korean Dental Society of Anesthesiology
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• v.6 no.2 s.11
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• pp.98-102
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• 2006

The purpose of this study was to evaluate the difference on pain intensity and discomfort between pressure-controlled injection system and conventional syringe injection technique from the patients undergoing oral and maxillofacial surgery. In a prospective, randomized, case-controlled study, 60 patients were divided into two groups (n=30 in each). In experimental group, pressure-controlled injection system was applied. In control group, conventional syringe injection system was applied. Pain rating score (PRS) and visual analogue scale (VAS) were assessed. The average of VAS in experimental group ($16.67{\pm}15.07$) was smaller than that of control group ($25.63{\pm}22.21$), though there were no significant differences (P=0.072). In PRS, fifteen patients (50.0%) of experimental group answered that they experienced mild pain. However sixteen patients (53.3%) of control group answered that they experienced intermediate pain. From the results, pressure-controlled injection system may be an effective method to reduce pain during the dental local anesthetic procedure.