• Child Health Nursing Research
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• v.12 no.2
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• pp.253-259
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• 2006

Purposes: Venipuncture is one of the most painful and frequently performed invasive procedure for children by nurses. The purpose of this study was to investigate the effect of EMLA cream(eutectic mixture of local anesthetics: 2.5% lidocaine and 2.5% prilocaine) to decrease venipuncture related pain and anxiety in children. Methods: A randomized, double blinded, placebo-controlled study was conducted. Sixty children scheduled venipuncture were recruited, and randomly allocated to receive either EMLA or a placebo cream 1 hour before venipuncture. Venipuncture was carried out by one nurse investigator. Pain and anxiety was measured by parent, nurse investigator, and nurse observer. Results: Pain in the EMLA group was significantly lower than that of placebo group. However, there was no significant difference in anxiety score between the EMLA and placebo groups. Local side effect of EMLA cream were negligible. Conclusions: EMLA cream was found to be an effective local anesthetic for pediatric venipuncture pain. Further studies should continue to evaluate the facilitators and barriers of EMLA cream application in pediatric nursing practice.

• Journal of Dental Anesthesia and Pain Medicine
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• v.19 no.3
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• pp.135-141
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• 2019

Background: The fear of needle insertion and pain during anesthesia is a source of patient dissatisfaction in dentistry. Inferior alveolar nerve block (IANB) remains the most common type of block and is in itself painful. Computer-controlled local anesthetic delivery (CCLAD) has been proven to reduce the pain associated with injection of anesthetics in various blocks. However, the efficacy of CCLAD for IANB in adults remains unknown. Methods: Sixty-four adult patients requiring bilateral IANB were selected and divided into two groups: group A (50 patients receiving IANB via CCLAD) and group B (50 patients receiving IANB using a conventional cartridge syringe). Pain perception and patient comfort were assessed using the visual analog scale and the 5-point semantic scale, respectively. Results: The pain perception was compared between the two groups using the Mann-Whitney U-test, and the P value was 0.003. The patient comfort was also compared using the same test, and the P value was 0.484. Conclusion: A significant difference was observed in the pain perception of the patients during CCLAD. The patient comfort was grossly equal for both techniques.

• Biomolecules & Therapeutics
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• v.19 no.3
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• pp.357-363
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• 2011

In relieving local pains, ropivacaine has been widely used. In case of their application such as ointments and creams, it is difficult to expect their effects for a significant period of time, because they are easily removed by wetting, movement and contacting. Therefore, the new formulations that have suitable bioadhesion were needed to enhance local anesthetic effects. The effect of drug concentration and temperature on drug release was studied from the prepared 1.5% Carboxymethyl cellulose (CMC) (150MC) gels using synthetic cellulose membrane at $37{\pm}0.5^{\circ}C$. As the drug concentration and temperature increased, the drug release increased. A linear relationship was observed between the logarithm of the permeability coefficient and the reciprocal temperature. The activation energy of drug permeation was 3.16 kcal/mol for a 1.5% loading dose. To increase the skin permeation of ropivacaine from CMC gel, enhancers such as saturated and unsaturated fatty acids, pyrrolidones, propylene glycol derivatives, glycerides, and non-ionic surfactants were incorporated into the ropivacaine-CMC gels. Among the enhancers used, polyoxyethylene 2-oleyl ether showed the highest enhancing effects. For the efficacy study, the anesthetic action of the formulated ropivacaine gel containing an enhancer and vasoconstrictor was evaluated with the tail-flick analgesimeter. According to the rat tail-flick test, 1.5% drug gels containing polyoxyethylene 2-oleyl ether and tetrahydrozoline showed the best prolonged local analgesic effects. In conclusion, the enhanced local anesthetic gels containing penetration enhancer and vasoconstrictor could be developed using the bioadhesive polymer.

• Archives of Plastic Surgery
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• v.37 no.6
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• pp.795-800
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• 2010

Purpose: According to various medical publications, it is believed that epinephrine should not be injected in fingers. However numerous articles show the successful use of local anesthetic with epinephrine in the digits. Epinephrine-mixed lidocaine solution enables to maintain a bloodless field for operation and provides long duration of local anesthesia when patient was wide awake. Methods: From May 2009 to December 2009, ten patients underwent flexor tendon reconstruction with local anesthesia using epinephrine. No tourniquet was necessary. Before operation, all patients were injected with local anesthetics using 1% lidocaine 20 mL and 0.1% epinephrine 0.1 mL. Results: There was no case of digital necrosis nor gangrene in the epinephrine injection. All 10 patients actively could move the finger through a full range of motion. All procedures were performed without sedation nor tourniquet and we could obtain a good vision of operative field and patients were comfortable. The patient make his or her fingers move through a full range of active motion before the skin is closed. Phentolamine was not required to reverse the vasoconstriction in any patients. Conclusion: The assertation that epinephrine should not be injected into the fingers is clearly no longer valid. The epinephrine injection allowed the authors to adjust flexor tendon surgery without risks associated with general anesthesia. It also enables to ensure longer anesthetic duration and bloodless operative field, and prevent post operative complications. In case of flexor tendon surgery, the use of epinephrine injection is recommended because of the advantages of local anesthesia.

• The Korean Journal of Physiology and Pharmacology
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• v.4 no.3
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• pp.243-251
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• 2000

In order to provide a basis for studying the molecular mechanism of pharmacological action of local anesthetics and to develop a fluorescence spectroscopic method which can detect the microviscosity of native and model membranes using intramolecular excimerization of 1,3-di(l-pyrenyl)propane (Py-3-Py), we examined the effect of lidocaine HCl on the microviscosity of model membranes of phosphatidylcholine fraction extracted from synaptosomal plasma membrane vesicles (SPMVPC). The excimer to monomer fluorescence intensity ratio (I'/I) of Py-3-Py in liquid paraffin was a simple linear function of $T/{\eta}.$ Based on this calibration curve, the microviscosity values of the direct probe environment in SPMVPC model membranes ranged from $234.97{\pm}48.85$ cP at $4^{\circ}C$ to %19.21{\pm}1.11$ cP at $45^{\circ}C.$ At $37^{\circ}C,$ a value of $27.25{\pm}0.44$ cP was obtained. The lidocaine HCl decreased the microviscosity of SPMVPC model membranes in a concentration-dependent manner, with a significant decrease in microviscosity value by injecting the local anesthetic even at the concentration of 0.5 mM. These results indicate that the direct environment of Py-3-Py in the SPMVPC model membranes is significantly fluidized by the lidocaine HCl. Also, the present study explicitly shows that an interaction between local anesthetics and membrane lipids is of importance in the molecular mechanism of pharmacological action of lidocaine HCl.

• Journal of Korean Neurosurgical Society
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• v.48 no.5
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• pp.429-433
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• 2010

Objective : This prospective study evaluated the use of continuous sedation using propofol and remifentanil when carpal tunnel release (CTR) was performed under local anesthesia. Methods : We sedated 60 patients undergoing CTR using local anesthesia with remifentanil at loading and continuous doses of $0.5\;{\mu}g\;kg^{-1}$ and $0.05\;{\mu}g\;kg^{-1}min^{-1}$, respectively, and propofol, using a target controlled infusion (TCI) pump set to a target of $2\;{\mu}g\;mL^{-1}$ (group A), or with the same drug doses except that the continuous remifentanil dose was $0.07\;{\mu}g\;kg^{-1}min^{-1}$ (group B) or $0.1\;{\mu}g\;kg^{-1}min^{-1}$ (group C). Results : In group B, the levels of pain when local anesthetics were administered (p = 0.001), intraoperative pain (p < 0.001) and anxiety (p = 0.001) were significantly lower than those of group A. Furthermore, the incidence of adverse events, including desaturation (p < 0.001) and vomiting (p = 0.043), was significantly lower in group B than in group C. Conclusion : Continuous sedation using an appropriate dose of remifentanil and propofol can be used as safe, efficacious ambulatory anesthesia in cases of CTR under local anesthesia, performed using only 2 mL of local anesthetic, with a high degree of patient satisfaction.

• The Korean Journal of Pain
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• v.32 no.4
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• pp.301-306
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• 2019

Background: Ganglion impar blockade is a reliable and effective treatment option used in patients with coccydynia. Our primary objective was to specify the role of corticosteroids in impar blockade. We compared applications of local anesthetic with the local anesthetic + corticosteroid combination in terms of treatment efficiency in patients with chronic coccydynia. Methods: Our study was a prospective randomize double-blind study. The patients were divided into 2 groups after randomization. The first group (group SL) was made up of patients where a corticosteroid + local anesthetic were used during ganglion impar blockade. In the second group (group L) we used only local anesthetic. We evaluated numeric rating scale (NRS) and Beck depression scale, which were employed before the procedure and in 1st and 3rd months after the procedure. Results: Seventy-three patients were included in the final analysis. We detected a significantly greater decrease in NRS values in the 1st month in group SL than in group L (P = 0.001). In the same way, NRS values in the 3rd month were significantly lower in the group with steroids (P = 0.0001). During the evaluation of the Beck test, we detected significantly greater decreases in the 1st month (P = 0.017) and 3rd month (P = 0.021) in the SL group than in the L group. Conclusions: Ganglion impar blockade decreases pain in the treatment of chronic coccydynia and improve depression. Addition of steroids in a ganglion impar blockade is required for treatment response that should accumulate over a long period of time.

• The Korean Journal of Pain
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• v.35 no.2
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• pp.183-190
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• 2022

Background: To compare ultrasound-guided pulsed radiofrequency (PRF) of the genicular nerve with the genicular nerve block using local anesthetic and steroid for management of osteoarthritis (OA) knee pain. Methods: Thirty patients with OA knee were randomly allocated to receive either ultrasound-guided PRF of the genicular nerve (PRF group) or nerve block with bupivacaine and methylprednisolone acetate (local anesthetic steroid [LAS] group). Verbal numeric rating scale (VNRS) and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) scores were measured at pre-procedure and 1-, 4-, and 12-weeks post-procedure. Results: VNRS scores decreased significantly (P < 0.001) in both the groups at 12 weeks and other follow up times compared to baseline. Seventy-three percent of patients in the PRF group and 66% in the LAS group achieved effective pain relief (≥ 50% pain reduction) at 12 weeks (P > 0.999). There was also a statistically significant (P < 0.001) improvement in WOMAC scores in both groups at all follow up times. However, there was no intergroup difference in VNRS (P = 0.893) and WOMAC scores (P = 0.983). No complications were reported. Conclusions: Both ultrasound-guided PRF of the genicular nerve and blocks of genicular nerve with local anesthetic and a steroid provided comparable pain relief without any complications. However, PRF of the genicular nerve is a procedure that takes much more time and equipment than the genicular nerve block.

• Journal of Korean Neurosurgical Society
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• v.52 no.3
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• pp.228-233
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• 2012

Objective : Chronic neck or back pain can be managed with various procedures. Although these procedures are usually well-tolerated, a variety of side effects have been reported. In this study we reviewed cases of unexpected temporary adverse events after blocks and suggest possible causes. Methods : We reviewed the records of patients treated with spinal pain blocks between December 2009 and January 2011. The types of blocks performed were medial branch blocks, interlaminar epidural blocks and transforaminal epidural blocks. During the first eight months of the study period (Group A), 2% mepivacaine HCL and triamcinolone was used, and during the last six months of the study period (Group B), mepivacaine was diluted to 1% with normal saline. Results : There were 704 procedures in 613 patients. Ten patients had 12 transient neurologic events. Nine patients were in Group A and one was in Group B. Transient complications occurred in four patients after cervical block and in eight patients after lumbar block. Side effects of lumbar spine blocks were associated with the concentration of mepivacaine (p<0.05). The likely causes were a high concentration of mepivacaine in five patients, inadvertent vascular injection in three patients, intrathecal leak of local anesthetics in one, and underlying conversion disorder in one. Conclusion : Spinal pain blocks are a good option for relieving pain, but clinicians should always keep in mind the potential for development of inevitable complications. Careful history-taking, appropriate selection of the anesthetics, and using real-time fluoroscopy could help reduce the occurrence of adverse events.

• The Korean Journal of Pain
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• v.10 no.2
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• pp.220-224
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• 1997

Background: The incidence of pain on injection of propofol varies between 30 and 100%. A variety of pretreatments have been tried to alleviate this problem such as a local anesthetics, cooling and opioids. However, none of these pharmacological maneuvers were satisfactory yet. In a recent study, subhypnotic doses of both thiopental sodium and propofol decrease the acute pain. We report a comparison of thiopental sodium, lidocaine and placebo on the incidence and severity of pain on injection of propofol. Method: A controlled, double-blind study was performed to compare the prior administration of intravenous saline 2 ml(n=30, group S), lidocaine 20 mg(n=30, group L) and thiopental sodium 50 mg(n=30, group T) in alleviating the pain by propofol. Injection pain was assessed with the four-point verbal categorical scoring system. Result: The incidence of injection pain during induction was lower in group L(30%) and T(17%) than group S(77%). The incidence of injection pain was lower in group T(17%) than group L(30%), but not significant statistically. The pain scores for recall of pain in the recovery room was simlar to those pain during propofol induction. Conclusion: The pretreatment of thiopental sodium can be effective in reducing both incidence and severity of propofol injection pain and has similar effect to lidocaine to prevent propofol injection pain.