• Archives of Plastic Surgery
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• v.42 no.1
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• pp.28-33
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• 2015

Background Topical anesthetics, such as eutectic mixture of local anesthetics (EMLA) cream, can be applied to reduce pain before minor procedure. This trial evaluated EMLA as pretreatment for facial lacerations and compared pain, discomfort and overall satisfaction. Methods This trial included consecutive emergency department patients ${\geq}16years$ of age who presented with simple facial lacerations. At triage, lacerations were allotted to either the routine processing group or EMLA pretreatment group according to date of admission. Initially, the emergency department doctors inspected each laceration, which were dressed with saline-soaked gauze. In the pretreatment group, EMLA cream was applied during wound inspection. The plastic surgeon then completed primary closure following the local injection of an anesthetic. After the procedure, all patients were given a questionnaire assessing pain using the 10-point visual analog scale (VAS) ("no pain" to "worst pain"). All questionnaires were collected by the emergency department nurse before discharge. Results Fifty patients were included in the routine processing group, and fifty patients were included in the EMLA pretreatment group. Median age was 39.9 years, 66% were male, and the average laceration was 2.67 cm in length. The EMLA pretreatment group reported lower pain scores in comparison with the routine processing group (2.4 vs. 4.5 on VAS, P<0.05), and lower discomfort scores during the procedure (2.0 vs. 3.3, P=0.60). Overall satisfaction was significantly higher in the EMLA pretreatment group (7.8 vs. 6.1, P<0.05). Conclusions Pretreating facial lacerations with EMLA topical cream aids patients by reducing pain and further enhancing overall satisfaction during laceration treatment.

• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.4
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• pp.329-336
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• 2021

Background: In the field of dentistry, topical anesthetics play an important role in reducing pain during needle pricks. The anesthetic property of betel leaves remain unexplored, even though they have been widely used for the treatment of various ailments. The purpose of this study was to compare and evaluate pain perception following topical application of lignocaine gel, clove gel, ice, and newly developed betel leaf extract gel during intraoral injection in children. Methods: Sixty children aged 6-10 years who met the inclusion criteria were divided into four groups. Topical anesthetic agents, 2% lignocaine (Lox-2% Jelly, Neon, Mumbai, India), 4.7% clove gel (Pain Out Dental Gel, Colgate Palmolive India Ltd, Solan, India), 10% betel leaf extract gel, and ice were applied to each group for one min, followed by administration of infiltration anesthesia. Pain perception was analyzed during needle insertion. The Wong Bakers FACES pain rating scale (WBFPRS) was used for subjective assessment and the Sound, Eye, Motor (SEM) scale for objective assessment. Recorded values were tabulated and subjected to appropriate statistical analysis using SPSS software with a P value set at 0.05. Results: The clove oil and betel leaf groups demonstrated the highest WBFPRS scores, followed by the ice and lignocaine groups. The clove, betel leaf extract, and ice groups showed equal and highest SEM scores, followed by the lignocaine group. The mean WBFPRS and mean SEM scores were statistically significant. Conclusion: Betel leaf extract gel is effective in reducing pain and can act as an alternative topical anesthetic agent.

• Journal of Dental Anesthesia and Pain Medicine
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• v.24 no.2
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• pp.91-99
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• 2024

Background: Palatal injections are often painful. We aimed to compare topical ice and 20% benzocaine gel for pre-injection anesthesia before greater palatine nerve block (GPNB) injections. Methods: A randomized split-mouth clinical trial was conducted among patients aged 15-60-years needing bilateral GPNB injections. A total of 120 palatal sites from 60 patients were randomly allocated to Group A (topical ice) or Group B (20% benzocaine gel). Pain was evaluated using sound, eye, motor (SEM), and the visual analog scale (VAS) in both groups. Inferential analysis was performed using the Mann-Whitney U test. Results: The mean age of the participants was 20.5 ± 3.9 years. The median VAS score for group A was 11 (Q1 - Q3: 5.25 - 21.75), which was slightly higher than the 10 (Q1 - Q3: 4.0 - 26.75) reported in group B. However, the difference was not statistically significant (P = 0.955). The median SEM score for group A and group B was 3.5 (Q1 - Q3: 3.0 - 4.0) and 4.0 (Q1 - Q3: 3.0 - 4.0), respectively, which was statistically insignificant (P = 0.869). Conclusion: Using ice as a form of topical anesthetic for achieving pre-injection anesthesia before GPNB was as effective as 20% benzocaine gel.

• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.1
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• pp.41-47
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• 2021

Background: This study was designed to compare the efficacy of DentalVibe against 2% lidocaine gel in reducing pain during the administration of local anesthetic injection in the adult population. Methods: This was a split-mouth open-label, randomized, controlled clinical study conducted in the Department of Oral and Maxillofacial Surgery of a dental institute. Fifty patients who were scheduled for bilateral dental extractions requiring an inferior alveolar nerve block were enrolled in the study. Site A (n = 50) was coated with 2% lidocaine gel followed by a local anesthetic injection, and DentalVibe with local anesthetic injection was used for Site B (n = 50). The primary outcome was pain, which was recorded immediately after the administration of anesthetic injection using the Visual Analogue Scale [VAS 0 - 10]. Results: The VAS pain scores ranged from 4 to 10 for site A and 0 to 6 for site B. Comparison between the two sites showed a statistically significant difference [Mann-Whitney U test value = 51.50, P < 0.001] favoring site B. Conclusion: This study showed that DentalVibe reduces pain during injection of local anesthesia compared to topical anesthetic gel.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.20 no.1
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• pp.11-16
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• 2009

OPD based laryngeal procedures offers a new avenue to the modern laryngologist, incorporating new technology in the office setting. With the development of flexible fiberoptic endoscopes, compact video system, and short acting anesthetics and sedatives allow these procedures. The success or failure of procedures are depend on excellent topical anesthesia. An inadequately anesthetized patient is apt to be uncomfortable, anxious and hyperresponsive and therefore unlikely to tolerate the procedure. On the other hand, a patient who is well informed, reassured, and thoroughly anesthetized can complete procedures. Therefore, optimal anesthesia is obligatory for excellent surgical results. The phonosurgeon should choose the anesthetic and sedative agents based on duration of action, time of onset of action, and any medical contraindications that the patient may have. And should be familiar with the properties and interaction of the agents used, as well as the signs of toxicity.

• Journal of the korean academy of Pediatric Dentistry
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• v.38 no.1
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• pp.1-8
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• 2011

The objective of this study was to determine the effectiveness of topical 5% EMLA cream versus 20% Benzocaine gel in reducing pain from intra oral needle insertion alone as well as injection of anesthetic. The 2 topical anesthetics were tested against each other bilaterally using a randomized, controlled, single blinded, split mouth design. Phase I was conducted to find out the rapidity of onset action of the two agents on anterior/posterior vestibules and anterior/posterior palatal mucosa. Phase II was conducted to evaluate the efficacy of the two topical anaesthetic agents in reducing the pain of intraoral injections. The agents were left in anterior/posterior vestibules and anterior/posterior palatal mucosa for the amount of time recorded in phase I. Subjects recorded pain on a 100-mm modified visual analog scale(VAS). A pulse oximeter was used to recorded the preoperative and postoperative pulse rates. In phase I of the study, two topical agents showed the longer onset of action at anterior part and vestibules than posterior part and palatal mucosa. EMLA cream showed the rapidest onset of action compared to benzocaine gel except on anterior palatal mucosa. In phase II of the study, the VAS grading of the pain for anesthetic administration showed EMLA cream was significantly(P<.05) better in elimination or reducing the pain on the anterior/posterior palatal mucosa. In conclusion, EMLA cream showed the rapidest onset of action compared to benzocaine gel except on anterior palatal mucosa. EMLA cream was found to be superior to Benzocaine gel with regards to pain reduction for anesthetic administration especially on anterior and posterior palatal mucosa.

• Journal of the korean academy of Pediatric Dentistry
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• v.37 no.2
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• pp.213-217
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• 2010

The use of chloral hydrate and hydroxyzine for oral sedation is most effective in children aged less than 36 months and weighing less than 15 kg. Children who do not belong to this category may show frequent movements due to shallow sedation level, and it can lead to sedation failures. One of the solutions to such sedation failure is conversion to deeper sedation. But, it is not so much of an option, since inhalation anesthetics and devices are required. In this case, conversion from oral sedation to intravenous sedation was successfully achieved without causing injection pain while searching for an intravenous route, by using EMLA cream (Eutectic Mixture of Local Anesthesia). A patient aged 46 months and weighing 15 kg visited the Pediatric Department of Dankook University Dental Hospital. Treatment under TSD(Tell Show Do) was offered, but due to the parent's request, oral sedative measures were taken. Considering prompt converting from oral sedation to iv sedation in case the oral sedation fails, EMLA cream was apllied preemptively. Adequate sedation level could not be achieved after 90 minutes of oral administration, therefore, under the parent's consent, intravenous route was prepared after conscious sedation by $N_2O-O_2$. During treatment, $ETCO_2$, $SPO_2$ and heart rate was monitored every 5 minutes. The patient showed stable vital signs and did not show any movements. The whole procedure took two and a half hours in total, and the treatment was completed without any adverse effects.

• Journal of Dental Anesthesia and Pain Medicine
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• v.24 no.2
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• pp.109-117
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• 2024

Background: Dental fear and anxiety are significant challenges in managing behavior in children. Oral administration of sucrose or sweet-tasting solutions has shown effectiveness in reducing procedural pain in infants and neonates. This study aimed to investigate whether pre-application of sucrose solution had an effect on minimizing pain perception during injection and to assess the potential impact of the child's age and sweet preference. Methods: A randomized control clinical trial was conducted on 60 children aged 3-9 years requiring buccal infiltration injections. Following parental consent, demographic data of the children were recorded. Sweet preferences was assessed using a modified forced-choice test. Children were equally and randomly allocated into study (sucrose) and control groups using a lottery method. Sucrose solution or distilled water, respectively, was applied to the lateral surface of the tongue for 2 min. Topical anesthetic was applied at the site of injection, followed by local anesthesia administration. The children rinsed their mouths thrice with water immediately after anesthetic injection. A video was recorded during injection which was then scored by three blinded examiners on the Sound Eye Motor (SEM) scale. The children also self-evaluated using Wong-Baker Faces Pain Rating Scale (WBFPS). Results: The mean SEM scores and WBFPS scores were analyzed using the Kruskall-Wallis test. The mean SEM score in the study group was 1.37 ± 0.61, compared to 3.17 ± 0.87 in the control group, showing a statistically significant difference (P < 0.001). Mean pain scores assessed by WBFPS in the study group were 0.60 ± 1.4, while in the control group, they were 6.27 ± 2.33, also showing a statistically significant difference (P < 0.001). Children with a sweet preference demonstrated a subjective reduction in pain perception. Conclusion: Application of sucrose before dental injections in children helps to minimize pain upon injection across all age groups.

• Journal of Trauma and Injury
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• v.20 no.2
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• pp.115-118
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• 2007

Purpose: A eutectic mixture of local anesthetics (EMLA$^{(R)}$) cream has been used as a topical anesthetic to reduce the pain of procedures penetrating the skin. It is generally applied for 40 to 60 minutes before the painful procedure. Because of the long application period, EMLA$^{(R)}$ is not useful in the emergency department (ED). The purpose of this study was to determine whether a 20-minute application of 9.6% lidocaine would be useful in reducing the pain of routine peripheral intravenous cannulation in the ED. Methods: We examined 27 male and 19 female patients ages over 18 years of age who required intravenous cannula insertion. Intravenous insertion was performed on 46 patients: 24 patients in the placebo group (mean age: 40.0 years) and 22 in the 9.6% lidocaine group (mean age: 37.6 years). The 9.6% lidocaine or placebo gel was applied and covered with an occlusive dressing for 20 minutes. Pain was scored by the patients using a 0- to 10-cm visual analogue scale. Results: The patients in the 9.6% lidocaine group (mean pain score: 3.4) experienced less pain than those in the placebo group (mean: 5.3), and the difference was statistically significant (p=0.029). Conclusion: We concluded that a 20-minute application of 9.6% lidocaine is safe and effective for reducing pain associated with venipuncture.

• Tuberculosis and Respiratory Diseases
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• v.46 no.2
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• pp.251-259
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• 1999

Background: Even though the necessity for premedication has been questioned, some combinations of antisialogogues, sedatives and analgesics are usually employed by most bronchoscopists. The goal of this study was to determine whether fiberoptic bronchoscopy(FOB) could be performed safely and effectively without premedication while using a standardized topical anesthetic. Method: Eighty outpatients were randomized in a double-blind manner into group I(n=20) with 1 ml normal saline, group II(n=20) with 0.5mg of atropine, group III(n=20) with 0.5mg of atropine plus 5mg of midazolam, and group IV(n=20) with 0.5mg of atropine plus 50mg of meperidine, given intramuscularly 30 minutes before FOB as premedication Topical anesthetics administered were same in each group. Each patient was given 5ml(200mg) of 4% nebulized lidocaine and additional intratracheobronchial 2% lidocaine. Oxygen saturation, pulse rate and electrocardiogram were monitored and recorded before, during, just after and 2 minutes after FOB. Immediately after FOB, the bronchoscopists answered four questions such as ease of procedure, extent of coughing, extent of secretion, and overall impression. Before leaving bronchoscopy suite, patients completed similar questions on discomfort during procedure, and willingness to return for a repeat procedure. Results: Age, gender, baseline pulmonary function, dose of 2% lidocaine used for topical anesthesia, and duration of FOB were not significantly different. There was no statistical difference among group I to IV with regard to extent of coughing answered by bronchoscopist. But extent of secretion was significantly different between group I without atropine and group II-IV with atropine. And there was also significant difference in ease of procedure and overall impression among groups. There was no statistical difference in patient's willingness and level of discomfort among the groups. Thirteen patients(16%) showed hypoxemia(arterial oxygen saturation: <90%), and 3 patients(4%) showed significant tachyarrhythmia(heart rate: > l60/min), but the rate of complication was not statistically different among the groups. Conclusion: These results suggest that the value of premedication is questionable for outpatient FOB, although it may be necessary in excessively anxious patient.