• Archives of Plastic Surgery
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• 제33권1호
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• pp.120-123
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• 2006

Spontaneous extensor pollicis longus tendon rupture is commonly caused by attrition of the tendon from trauma or inflammatory processes. We experienced a patient with extensor pollicis longus tendon rupture after steroid injection, in which the rupture may have been caused by the effects of steroid itself as well as direct damage from the needle. A 51-year-old woman complained of inability to extend her right thumb at the first metacarpophalangal & interphalangeal joint level. The patient had a history of local steroid injection into the dorsal & radial side of wrist on two occations, and had no history of trauma or rheumatologic disease. After a physical examination of the patient, we decided to explore the wrist. The patient agreed with operation. Intraoperatively, an incision was made into the wrist and the proximal and distal ends of the ruptured extensor pollicis longus tendon were identified. The defect between the proximal and the distal end was measured to approach 8cm, and a palmaris longus tendon graft was performed. After three months of rehabilitation, the first metacarpophalangal & interphalangeal joint recovered the normal range of motion. Steroid injection has been widely used in various musculoskeletal disorders such as rheumatoid arthritis and osteoarthritis. However, inadvertent steroid injection into the extra or intra articular spaces may lead to tendon rupture. Steroids reduce tensile strength by decreasing tenocyte activity and collagen synthesis. Also, the physical effect of direct needle-stick injury into the mesotenon and blood vessels around the tendon may cause damage. In addition, hematoma and edema may increase pressure around the tendon and compromise blood supply, leading to tendon degeneration and subsequent rupture. When injecting steroid into an articular area, all physicians should have a complete understanding of the surrounding anatomy and always keep in mind the hazards of such procedures.

• The Korean Journal of Pain
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• 제9권1호
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• pp.39-45
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• 1996

Tachyphylaxis to local anesthetics has shown to be promote longer interanalgesic intervals between injections. Previous study demonstrated thermal hyperalgesia accelerates development of tachyphylaxis to sciatic nerve blockade in rats, while MK-801 prevents development of tachyphylaxis. Dextromethorphan is one of NMDA receptor antagonist similar to MK-801. A hypothesis that dextromethorphan would prevent the development of tachyphylaxis was tested in this study. A catheter was surgically implanted along the sciatic nerve a in rat. After recovery from surgery, the animal received repeated injections of 3% 2-chloroprocaine followed by motor block testing with or without hot-plate testing at $56^{\circ}C$. In other experiments, dextromethorphan was administrered by intraperiotneal injection prior to an injection of local anesthetic therough the implanted catheter. Sensory and motor testing was then carried out. Rats injected with 2-chloroprocaine and subjected to hot-plate testing, developed tachyphylaxis to motor and sensory blockade. However, animals pretreated with dextromethorphan did not develop tachyphylaxis over series of three injections. Dextromethorphan seems to prevent development of tachyphylaxis to sciatic nerve blockade in this rat model. Dextromethorphan, one of N-Methyl-D-aspartate receptor antagonist, can be applied to prolong the effect of local anesthetic.

• Journal of Dental Anesthesia and Pain Medicine
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• 제20권1호
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• pp.29-37
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• 2020

Background: This study evaluated the efficacy of three intraoral topical anesthetics in reducing the injection needle prick pain from local anesthetic among children aged 7-11 years old. Methods: It is a prospective, Interventional, parallel design, single-blind, randomized clinical trial in which subjects (n=90) aged 7-11 years were included in the study based on an inclusion criteria. Subjects were divided into three groups based on computer-generated randomization with an allocation ratio of 1:1:1. Groups A, B, and C received benzocaine 20% jelly (Mucopain gel, ICPA health products Ltd, Ankleshwar, India), cetacaine anesthetic liquid (Cetylite Industries, Inc, Pennsauken, NJ), and EMLA cream (2% AstraZeneca UK Ltd, Luton, UK), respectively, according to manufacturer's instructions, for 1 minute prior to local anesthetic injection. After application of topical anesthetic agent, for all the groups, baseline pre-operative (prior to topical anesthetic administration) and post-operative scores (after local anesthetic administration) of pulse rate was recorded using Pulse oximeter (Gibson, Fingertip Pulse Oximeter, MD300C29, Beijing Choice Electronic). Peri-operative (i.e., during the administration of local anesthesia) scores were recorded using Face, Legs, Activity, Cry, Consolability (FLACC) Scale, Modified Children hospital of Eastern Ontario Pain Scale (CPS) behavior rating scale, and Faces Pain Scale (FPS-R) - Revised (For self-reported pain). Direct self-reported and physiological measures were ascertained using FPS-R - Revised and Pulse oximeter, respectively, whereas CPS and FLACC scales assessed behavioral measures. To test the mean difference between the three groups, a one way ANOVA with post hoc tests was used. For statistical significance, a two-tailed probability value of P < 0.05 was considered as significant. Results: The Cetacaine group had significantly lower pain scores for self-report (P < 0.001), behavioral, and physiological measures (P < 0.001) than the other two groups. However, there was no significant difference between the Benzocaine group and EMLA group during palatal injection prick. Conclusion: Cetacaine can be considered as an effective topical anesthetic agent compared to benzocaine 20% jelly (Mucopain gel) and EMLA cream.

• Journal of Dental Anesthesia and Pain Medicine
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• 제20권4호
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• pp.233-240
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• 2020

Background: Palatal injection of local anesthetics is the most painful injection. To obviate the need for palatal injections, local anesthetic agents with diffusibility are being investigated. Hence the present study was designed to analyze the anesthetic efficacy of 2% lidocaine hydrochloride (HCl) with 1:100,000 adrenaline and 4% articaine hydrochloride (HCl) with 1:100,000 adrenaline using single buccal infiltration for the extraction of maxillary premolars. Methods: A prospective, double-blind, crossover, randomized clinical study was performed on 60 consecutive systemically healthy patients with an age range of 15-30 years, requiring extraction of asymptomatic bilateral maxillary premolars for orthodontic purposes. They received 1ml buccal infiltration of 4% articaine HCl with 1:100,000 adrenaline on one side and 2% lidocaine HCl with 1:100,000 adrenaline on the other side. The extraction procedure on either side was scheduled 14 days apart. Parameters assessed were the time of onset of anesthesia, intraoperative discomfort, hemodynamic parameters, and the duration of analgesia. Analysis of the data was done using the Mann-Whitney test, the Wilcoxon test, the Kruskal-Wallis ANOVA test, and the chi-square test. Statistical significance was established at P < 0.05. Results: Articaine showed a faster time of onset and longer duration of analgesia than lidocaine. However, the difference in the intraoperative discomfort and hemodynamic parameters was statistically insignificant. Conclusion: Within the limitations of the study, it can be concluded that the extraction of maxillary premolars can be performed with a single buccal infiltration of 2% lidocaine HCl with 1:100,000 adrenaline, which is one of the most commonly used local anesthetic agent.

• Journal of Yeungnam Medical Science
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• 제34권2호
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• pp.161-168
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• 2017

Peripheral nerve blocks are commonly used for surgical anesthesia, postoperative analgesia, and to reduce opioid requirements. Although these blocks have traditionally been carried out using local anesthetics, single-injection techniques can be short-lived and limited by the relatively brief duration of action of currently available local anesthetics. Increasing the dose or concentration of local anesthetics may prolong the duration of analgesia, but may also increase the risk such as unwanted motor weakness or systemic toxicity of local anesthetics. Numerous adjuvant medications have been added to local anesthetics to prolong the durations of anesthesia and analgesia achieved by peripheral nerve blocks, and currently, a number of different adjuvants are used to improve quality of the block. This article will review the several nerve block adjuvants used in combination with local anesthetics to provide blockade of peripheral nerves in clinical practice, describing the rationale for their use in peripheral nerve blocks, and the evidence for their effectiveness.

• 대한소아치과학회지
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• 제28권4호
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• pp.633-637
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• 2001

소아치과에서 국소마취는 공포의 대상이며, 특히 행동조절이 힘든 소아의 경우 더욱 그러하다. 국소마취에 대한 공포는 주사침의 자입시나 주사액의 주입시 느끼는 동통 만큼이나 주사침 자체의 공포도 크게 차지한다. 주사침 자입시의 동통을 완화하기 위하여, 도포마취제 등이 개발되었으나 이들은 국소마취의 동통을 완화시키는 면은 있으나 주사침 자체에 대한 공포를 없애지는 못하였다. Syrijet Mark II$^{(R)}$(Mizzy Inc, USA)는 주사침이 없는 치과용 분사식 주사기 (jet injection device)로서 소아에서 주사침에 대한 공포를 성공적으로 감소시킬 수 있다고 알려져 있다. 저자들은 여러 행동등급의 소아를 대상으로 Syrijet을 사용하여 국소마취를 시행한 후 동통평가의 척도로서 VAS(visual analogue scale)를 소아에게 적합하게 색상화한 CAS(color analogue scale)를 이용하여 국소마취시의 동통수준을 측정한 결과, 기존 주사침에 의한 국소마취시 보다 국소마취의 동통이 감소된 것을 알 수 있었다. Syrijet의 장점으로는 주사침이 없다는 점, 기존의 술식에서 일회용이었던 마취용 카트리지를 재사용할 수 있다는 점, 신경 및 혈관에 안전하다는 점 등이 있었으며, 단점으로 부피가 크며, 가격이 비싸며, 사용시 숙련성을 요구한다는 점 등이 있었다.

• Journal of Dental Anesthesia and Pain Medicine
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• 제19권3호
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• pp.143-149
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• 2019

Background: Uncooperative behavior of children due to dental anxiety may interfere with the effective delivery of dental care and compromise the quality of treatment provided. Injection of local anesthesia is one of the most anxiety-inducing stimuli in pediatric dentistry. This study aimed to compare the efficacy of a child-friendly device, having a combined effect of vibration and distraction, with the conventional method of injection on pain, anxiety, and behavior of pediatric patients aged 6-11 years. Methods: This randomized, crossover, split-mouth study included 30 children requiring a bilateral inferior alveolar nerve block. The children were equally divided into two groups: group 1, aged 6-8 and group 2, aged 9-11 years. All children were injected with anesthesia using the conventional and device method in two separate sessions. They were assessed for anxiety by measuring the pulse rate before and during the administration of local anesthesia. Behavior was assessed using Faces, Legs, Activity, Cry, Consolability (FLACC) scale, and the child's experience while receiving anesthesia was assessed using the Wong Bakers Pain Rating Scale. Results: Results showed that the children who received local anesthesia using the device method had a lower mean pulse rate, FLACC scores, and pain rating scores than those who received local anesthesia using the conventional method. Conclusion: The device method was more effective than the conventional method in managing pain, anxiety, and behavior of patients aged 6-11 years. The device is a cost effective, simple, and child-friendly product for administrating local anesthesia in pediatric patients.

• 대한기계학회논문집B
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• 제29권1호
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• pp.46-54
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• 2005

Film cooling characteristics has been examined numerically for the height variation of a stepped slot exit. In this study, the upstream wall height of the stepped slot exit varies from -2d (d = slot width) to 3d, blowing ratio ranges from 0.5 to 3, and injection angles are $15^{\circ},\;30^{\circ},\;and\;45^{\circ}$. The results showed that film cooling performance was mainly subjected to the magnitude of recirculation region near the downstream-side slot exit as well as the magnitude and the distribution region of turbulent kinetic energy due to the local velocity and momentum differences between the coolant and the main flow near the slot exit. The up-1d type slot at higher blowing ratios over 2 and the flat type slot at lower blowing ratios below 1 have the best film cooling performances, in case of the injection angles of $30^{\circ},\;and\;45^{\circ}$, respectively. Compared with the other injection angles, in case of the injection angles of $15^{\circ}$, the best film cooling performances was shown in even a higher upstream wall (up-3d) at higher blowing ratio like 3 by the gradual reduction of the coolant velocity which minimizes the local velocity differences between the coolant and the main flow near the slot exit.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제48권6호
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• pp.331-341
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• 2022

This systematic review evaluates current evidence regarding the feasibility of using needleless jet injection instead of a conventional local anesthetic needle. EBSCO, ProQuest, PubMed, and Scopus databases were used to identify relevant literature published in English from 2005 to 2020. Ten studies were selected. Five of them were randomized clinical trials, 3 case-control studies, and 2 equivalence trials. Using the Critical Appraisal Skills Program checklist, 6 studies scored between 67% and 100%, and 4 studies scored between 34% and 66%. According to Jadad's scale, 2 studies were considered strong, and 8 studies were considered moderate in quality. The results of the 10 studies showed differences in patient preference for needleless jet injection. Needleless injection technique has been found to be particularly useful in uncooperative patients with anxiety and needle phobia. Needleless jet injection is not technique sensitive. However, with needleless jet anesthesia, most treatments require additional anesthesia. Conventional needle anesthesia is less costly, has a longer duration of action, and has better pain control during dental extraction. Needleless jet anesthesia has been shown to be moderately accepted by patients with a fear of needles, has a faster onset of action, and is an efficient alternative to conventional infiltration anesthesia technique.

• Archives of Plastic Surgery
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• 제51권4호
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• pp.432-440
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• 2024

Background The risk of flap necrosis in tissue reconstruction surgery is elevated in patients with vascular disorders, such as diabetes mellitus. Chronic hyperglycemia causes endothelial cell dysfunction and increases inflammatory process, causing vascular insufficiency. Platelet-rich plasma (PRP) contains high levels of platelets, growth factors, and fibrinogens. Its regenerative properties spark interest in supporting flap survival in relation to diabetic complications. Methods Thirty Wistar rats were divided into three groups. The first group included diabetic rats without PRP injection, which underwent flap procedure. The second group included diabetes-induced rats receiving PRP subcutaneous injection 1 day prior to flap procedure. The third group included nondiabetic rats receiving PRP injection 1 day prior to flap procedure. Flap tissue samples were taken on the seventh day to measure vascular endothelial growth factor (VEGF) levels using enzyme-linked immunosorbent assay method; angiogenesis and collagen density were measured from histopathology examination, and flap viability was analyzed using digital measurements. Results Analysis showed that flap viability, angiogenesis, and VEGF levels were significantly higher in the PRP-injected diabetic rats compared with diabetic rats that did not receive PRP. The levels of VEGF, angiogenesis, and viability of flaps in diabetic rats given PRP did not differ significantly compared with nondiabetic rats that received PRP. Conclusion Flap preconditioning through local injection of activated PRP enhances flap viability, VEGF levels and angiogenesis, in random skin flaps in diabetic rats, to the level where it does not differ significantly to nondiabetic rats that were given PRP.