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Background: One of the drugs that is most frequently used in dentistry is local anesthetics. They are decisive while performing any dental procedure. The average length of a dental procedure is 47 min, but the local anesthetics used in standard dental procedures last between 1 and 3 h, with the most common inadequacy being the persistence of soft-tissue anesthesia (the numbness of the lips, cheeks, and tongue), which can persist for at least 3–5 h. This extended soft-tissue anesthetic in children can result in self-inflicted wounds like biting of the lips, tongue, or cheek. Aim: The study’s aim was to evaluate dental practitioners’ knowledge, awareness, and usage of phentolamine mesylate, a soft-tissue local anesthetic reversal agent. Materials and Methods: Two hundred and two dentists and graduate students participated in the study by filling out a validated questionnaire. The data obtained were entered into an Excel sheet and statistically analyzed using SPSS software version 22.0. It was observed that 66.50% of the participants had knowledge scores that were lower than the mean, 81.07% had awareness scores that were lower than the mean, and 91.26% had practice scores that were lower than the mean. With a very statistically significant P = 0.0001 (P = 0.05), Karl Pearson’s correlation coefficient revealed a positive correlation between knowledge, awareness, and practice. Conclusion: There was a general lack of knowledge about the drug phentolamine mesylate leading to lesser attitude, thereby leading to lesser use of the drug.

Abstract Background This meta-analysis aimed to perform a head-to-head comparison of the role of general anesthesia (GA) and local anesthesia (LA) in the management of patients with nasal bone fractures (NBFs). Methods PubMed, Embase, and Web of Science were comprehensively searched. Studies investigating the clinical outcomes of GA and LA in the management of NBFs were included. Pooled odds ratios (OR) with the respective 95% confidence intervals (CIs) were calculated. Heterogeneity between the included studies was evaluated. The risk of bias in the included studies was assessed. Results Eight studies were included in this meta-analysis. The pooled ORs for cosmetic results, residual septal deformity, the need for further surgery, patients’ satisfaction with the anesthesia procedure, and patients’ satisfaction with the surgery results were 0.70 (95% CI 0.18, 2.64; z = − 0.53, p = 0.5957), 1.11 (95% CI 0.37, 3.30; z = 0.18, p = 0.8558), 1.19 (95% CI 0.65, 2.20; z = 0.56, p = 0.5760), 1.57 (95% CI 0.92, 2.69; z = 1.65, p = 0.0982), and 1.00 (95% CI 0.55, 1.80; z = − 0.00, p = 0.9974). Conclusions Insignificant difference on clinical outcomes was observed between GA and LA in the manipulation of patients with NBFs, and the choice of anesthetic approach should be based on the tolerability of the methods and the severity of nasal fractures.

Introduction Optimal surgical treatment for chronic subdural hematoma (CSDH) in the elderly has been controversial. Whenever possible, a less invasive technique should be used to avoid complications.

Background: Lumbar surgery is known to cause severe pain in the post-operative period. Modalities to reduce pain in the perioperative period include opioids, non-steroidal anti-inflammatory drugs, neuraxial blocks, and erector spinae block (ESB). Aims and Objectives: In this study, we aimed to evaluate whether ESB could reduce perioperative pain, opioid consumption, and muscle relaxant consumption. Materials and Methods: Fifty patients scheduled for lumbar decompression spine surgery were randomly allocated to two groups, the erector spinae plane (ESP) group (n=25) and the control group multimodal analgesia group (n=25). Intraoperative hemodynamics, muscle relaxant requirement, opioid consumption post-operative visual analog score, and rescue analgesia were evaluated. Results: Compared with the control group, heart rate (91.24±14.86 and 90.20±14.26) (77.12±11.96 and 77.44±11.96) arterial blood pressures (87.12±8.45 mmHg) (85.25±7.25) (78.73±5.56 and 79.64±5.95) were higher during surgical incision and 1st-time interval than in ESP group, respectively. The visual analog scale scores were higher in the control group than in the ESP group during all measurements of time. The requirement for rescue analgesia was more in the control group compared to the ESP group. Post-operative analgesia lasted for 15–18 h. Conclusion: Ultrasound-guided ESP block is a simple and safe technique which provides effective intraoperative, and post-operative analgesia and patient satisfaction with reduced opioid and muscle relaxant consumption.

Key Clinical Message The ectopic supernumerary teeth (ST) commonly occur in the oral cavity. Ectopic ST in the maxilla can be extracted not only through an intraoral approach but also through a nasal approach. Abstract The ectopic supernumerary teeth (ST) commonly occur in the oral cavity. We are reporting a case of a 23‐year‐old female patient with one ectopic ST in the anterior midmaxillary region. We extracted the ectopic ST under local tissue anesthesia through the nasal cavity using piezosurgery and minimally invasive extraction tools. During the operation, the adjacent structures remained intact, and the patient discomfort. This case indicates that ectopic ST in the maxilla can be extracted not only through an intraoral approach but also through a nasal approach.

Background: This study was conducted to evaluate the feasibility of local anesthesia (LA) instead of general anesthesia (GA) in upper gastrointestinal abdominal procedures including open gastrostomy, gastrojejunostomy, gastroduodenal disjunction, jejunostomy and traction esophageal stenting. Materials and Methods: This study was conducted at Thoracic surgery department, Nishtar Hospital Multan, Pakistan from September,1st-December,31st,2020. Out of 147 patients 80 and 67 patients were operated under LA and GA respectively. Age, BMI, gender, procedure performed, etiology, mean time, stay in recovery, PONV, postoperative pain at 4, 8, 12 hours, postoperative sedation and discomfort, within 3-and 7-days postoperative mortality were documented and compared between the two groups. Results: Mean age of the patients in group LA was significantly higher as compared to group GA(p

Overactive bladder (OAB) has a significant impact on the quality of life; thus, it requires treatment that can be adhered to over a long period without undue side effects. The current treatment which uses an anticholinergic or β-3 agonist may fail to improve symptoms and has side effects, leading to high discontinuation rates. OnabotulinumtoxinA (OnabotA) detrusor injection has been approved for idiopathic OAB as a second-line treatment with good effectiveness and tolerability. This study used a visual analog scale (VAS) to assess the impact of the type of needle used for OnabotA detrusor injections under local anesthesia on the pain levels after each injection. This study included 68 female patients. We used three different needles with thicknesses ranging from 22 to 27 gauge, lengths between 4 and 5 mm, and different cuts. The sensation of pain was rated at each standardized injection location. Regardless of the needle used, the patients’ perceptions of pain at the beginning of the procedure were rated as being less than the subsequent injections. Most pain sensations were rated as low to moderate. The mean pain sensation on the VAS was 2.5 ± 0.3 overall, i.e., for all patients and needles used. Statistically significant differences in pain sensation were rated only at some locations of the bladder (on the back wall and the right side of the bladder). The single needles averaged the following pain scores: 2.8 ± 0.3 for needle A (20 G, 4 mm), 2.1 ± 0.3 for needle B (27 G, 5 mm), and 2.6 ± 0.4 for needle C (20 G, 4 mm, sharp cut 15°). The 27-gauge needle caused significantly less pain, and it had no negative impact due to its length, which was 1 mm longer than the other needles. Thus, the needle thickness was a decisive factor in the patients’ perceptions of pain.

Background: Simplified easily reproducible pudendal nerve block technique for anorectal surgery (SEPTA) is a novel technique of local anesthesia for anorectal surgeries. Aims and Objectives: The present study was undertaken to assess the feasibility of SEPTA technique in terms of perioperative anesthesia and patients satisfaction. Materials and Methods: A prospective, randomized, comparative single-blinded study was done with 30 patients in each of two groups. Patients in Group A received Saddle Block and in group B received pudendal nerve block by SEPTA technique. Patients were evaluated with respect to onset of anesthesia, first rescue analgesia, ambulation, and patient satisfaction scores. Statistical Analysis: Student’s independent t-test or Mann–Whitney U-test was employed for comparing continuous variables. The chi-square test or Fisher’s exact test, whichever appropriate, was applied for comparing categorical variables. Results: Onset of anesthesia was earlier (3.72±2.78 min) in Group B as compared to Group A (7.15±4.19 min). Time to first rescue analgesia was earlier in Group A (132.1±23.75 min) as compared to Group B (223.2±92.51 min). Group B patients had early ambulation (32 min) postoperatively as compared to Group A patients (297.1 min), which was statistically significant. Conclusion: SEPTA is a good alternative to Saddle Block for providing anesthesia for anorectal surgeries with added advantages of rapid onset, no risk of nausea, vomiting, back pain, urinary retention and early ambulation, and discharge of the patient.

Abstract Background To determine the safety and feasibility of sutureless pars-plana vitrectomy (ppV) in sub-Tenon anesthesia. Methods In this prospective study. Pain and anxiety at various times after ppV using a visual analogue scale (VAS) and Wong-Baker-FACES scale as well as visual sensations during surgery were investigated. The surgeon evaluated motility, chemosis, overall feasibility. Results ppV was performed on 67 eyes (33 sub-Tenon anesthesia, 34 general anesthesia). Pain during surgery in sub-Tenon anesthesia was 1.8 ± 2.2 (0.0–8.0), anxiety was 2.3 ± 2.2 (0.0–8.5). There was a moderate correlation between pain and anxiety (R 2 = 0.58). Comparing sub-Tenon and general anesthesia no difference in pain perception was found the day after surgery. 27.3% of patients saw details, 21.2% saw colors, 90.1% saw light/motion perception, 3.0% had no light perception. Median chemosis after surgery was 1.0 (IQR = 1.0). Median motility of the eye during surgery was 1.0 (IQR = 1.0), median grade was 1.0 (IQR = 1.0). 24.2% of patients showed subconjunctival hemorrhage during or after surgery. Conclusions Sutureless pars-plana vitrectomy in sub-Tenon anesthesia was performed safely, with pain and anxiety levels tolerable for the patients and without the necessity for presence of an anesthesiologist. With 88.9% of patients willing to undergo vitreoretinal surgery in sub-Tenon anesthesia again, we recommend it as a standard option. Trial registration This study was approved by the Institutional Ethical Review Board of the RWTH Aachen University (EK 111/19). This study is listed on clinicaltrials.gov (ClinicalTrials.gov identifier: NCT04257188, February 5th 2020).

Background: Intraperitoneal instillation (IPI) of local anesthetic agents into peritoneal cavity has proved to be an effective method of post-operative analgesia in laparoscopic cholecystectomy (LC). The addition of adjuvants such as narcotics or α2-agonists has been proposed to prolong the duration of post-operative analgesia. Aims and Objectives: This study aimed to compare post-operative analgesia of IPI and periportal infiltration of ropivacaine plus dexmedetomidine with ropivacaine plus nalbuphine in patients undergoing LC. Materials and Methods: This was a comparative, prospective, randomized controlled double-blind study conducted on total of 100 patients (American Society of Anesthesiologists class I and II) planned for LC who were randomly divided into two groups of 50 patients: Group Ropivacaine+Dexmedetomidine (RD) received IPI and periportal infiltration of 150 mg of ropivacaine (0.375%) and dexmedetomidine (1 μg/kg) diluted with normal saline to 40 mL and Group Ropivacaine+Nalbuphine (RN) received 150 mg of ropivacaine (0.375%) and 10 mg nalbuphine diluted with normal saline to 40 mL. Post-operative pain was assessed by Visual Analogue Score, time to first request of analgesia, and total amount of rescue analgesics given in 24 h and side effects were noted. Data were analyzed by Student’s independent t-test and Chi-square test using SPSS version 20.0. Results: Overall Visual Analog Scale scores (1.38±0.78 vs. 2.59±1.15), time to first request of analgesia (7.3±3.74 vs. 4.2±2.71), and total analgesic consumption (82.4±15.34 vs. 158.5±16.19) were significantly lower in the RD group compared to the RN group. Among post-operative adverse events, the incidence of post-operative nausea and vomiting was significantly higher in the RN group. Conclusion: The addition of dexmedetomidine appears to be superior to nalbuphine in terms of prolonged post-operative analgesia, lesser requirement of rescue analgesia, and less complications.

Background and purpose: Pain management is one of the important issues in dental treatments. Fear of pain can make the process of anesthesia injection before dental treatment difficult for both the dentist and the patient. The aim of this study was to compare the effect of Najo-Caine P® with topical Benzocaine in reducing the pain of needle insertion in palatal anesthesia in 9-12 year old children. Materials and methods: In a double-blind clinical trial, 23 children aged 9-12 years were selected via convenience sampling, who needed palatal anesthesia injection on both sides of the jaw, at the Dental Clinic affiliated with Mazandaran University of Medical Sciences, in 2022. The desired areas were air-dried for 5 seconds. Benzocaine was applied with a cotton swab on one side of the jaw, and in the next session with the same preparation on the other side of the jaw, Najo-Caine P® anesthesia (2.5% lidocaine cream and 2.5% prilocaine similar to EMLA) was applied by the injector for 2 minutes. Results: The Visual Analogue Scale (VAS) scores for Benzocaine and Najo-Caine P® were compared. The VAS score for Najo-Caine P® (3.52) was lower than that of Benzocaine (3.78), but, the difference was not statistically significant (P= 0.488). Conclusion: Current study suggests that Najo-Caine P®, as a form of EMLA cream, can be used as an alternative to Benzocaine before palatal infiltrate injection to reduce palatal pain in children. (Clinical Trials Registry Number: IRCT20220412054516N1)

This study aimed to assess the effect of inferior alveolar nerve (IAN) block of the mandible and infiltration anesthesia of the maxilla using lidocaine plus epinephrine or prilocaine with felypressin anesthetic agents on systolic and diastolic blood pressures, heart rate (HR) and peripheral oxygen saturation rate of patients. This randomized double-blind clinical trial evaluated 112 patients in four groups (n=28) based on the jaw (maxilla or mandible) and type of anesthetic agent (lidocaine with epinephrine or prilocaine with felypressin). Groups 1 and 2 received IAN block of the mandible or infiltration anesthesia of the maxilla, respectively, with 2% lidocaine plus 1:80.000 epinephrine. Groups 3 and 4 received IAN block of the mandible or infiltration anesthesia of the maxilla, respectively, using prilocaine with felypressin. Systolic and diastolic blood pressures and HR were measured by an automatic upper arm blood pressure monitor and the percentage of peripheral oxygen saturation rate was measured by a finger pulse oximeter 10 minutes before the injection, immediately after injection, 10 minutes after injection and 20 minutes after injection.

Background: Hemorrhoids are one of the most common afflictions of human beings from times immemorial. It is said that 40% of population have symptoms due to hemorrhoids at some time in their lives. Stapled hemorrhoidopexy under local anesthesia has been emerging as the procedure of choice for symptomatic hemorrhoids. Aims and Objectives: The objectives of the study are as follows: (1) To assess the advantage of performing stapled hemorrhoidopexy under local pudendal block. (2) To study the post-operative complications after stapled hemorrhoidopexy. (3) To assess the feasibility of stapled hemorrhoidopexy in grade IV hemorrhoids. (4) To assess the advantages of stapled hemorrhoidopexy in anal skin regression after surgery. Materials and Methods: 50 patients of grade 4 hemorrhoids were operated by hemorrhoid stapler under local anesthesia. Results: Stapled hemorrhoidopexy under local anesthesia can be safely performed as a day care procedure in grade IV hemorrhoids. Patients following stapled hemorrhoidopexy under local anesthesia have reduced post-operative pain, hospital stay, analgesic requirements, and earlier return to work, early mobility out of bed, less operative time, short learning curve, less operative complications, cost effectiveness, and good patient satisfaction. Conclusion: Stapled hemorrhoidopexy under local anesthesia is feasible to be used in those patients who are unwilling and unfit for other modes of anesthesia with better results with lesser complication rate and as a day care procedure.

Background Uncertainty exists regarding the pain scores and the success rate of intraligamentary anesthesia compared to other infiltration anesthesia. Based on the conditions of clinical anesthesia techniques, we conducted a systematic review and meta-analysis to compare the efficacy of intraligamentary anesthesia with other infiltration anesthesia. Methods The search was carried out in PubMed Central, Cochrane Central Register of Controlled Trials, MEDLINE (via OVID), Embase (via OVID), and Scopus from the inception to March 26, 2023. Results Seven eligible randomized controlled trials were included in the meta-analysis. The results indicated no significant difference in the success rate (RR = 0.96; 95% CI [0.81–1.14]; p = 0.65; I2= 73%) and visual analog scale (VAS) during dental procedures (MD = 3.81; 95% CI [−0.54–8.16]; p = 0.09; I2= 97%) between intraligamentary anesthesia and other infiltration anesthesia. However, intraligamentary anesthesia exhibited a higher VAS score during injection than other infiltration anesthesia (MD = 8.83; 95% CI [4.86–12.79]; p

Background Safe and effective local anesthesia is a prerequisite for emergency oral surgeries and most dental treatments. Pregnancy is characterized by complex physiological changes, and increased sensitivity to pain. Pregnant women are particularly vulnerable to oral diseases, such as caries, gingivitis, pyogenic granuloma and third molar pericoronitis. Maternally administered drugs can affect the fetus through the placenta. Therefore, many physicians and patients are reluctant to provide or accept necessary local anesthesia, which leads to delays in the condition and adverse consequences. This review is intended to comprehensively discuss the instructions for local anesthesia in the oral treatment of pregnant patients. Methodology An in-depth search on Medline, Embase, and the Cochrane Library was performed to review articles concerned with maternal and fetal physiology, local anesthetic pharmacology, and their applications for oral treatment. Results Standard oral local anesthesia is safe throughout the pregnancy. At present, 2% lidocaine with 1:200,000 epinephrine is considered to be the anesthetic agent that best balances safety and efficacy for pregnant women. Maternal and fetal considerations must be taken into account to accommodate the physiological and pharmacological changes in the gestation period. Semi-supine position, blood pressure monitoring, and reassurance are suggested for high-risk mothers to reduce the risk of transient changes in blood pressure, hypoxemia, and hypoglycemia. For patients with underlying diseases, such as eclampsia, hypertension, hypotension, and gestational diabetes, the physicians should use epinephrine cautiously and control the dose of anesthetic. New local anesthesia formulations and equipment, which contribute to minimizing injection pain and relieving the anxiety, have and are being developed but remain understudied. Conclusions Understanding the physiological and pharmacological changes during pregnancy is essential to ensure the safety and efficiency of local anesthesia. Optimal outcomes for the mother and fetus hinge on a robust understanding of the physiologic alterations and the appropriate selection of anesthetic drugs and approaches.

Objective: This study aimed to compare the clinical and economic outcomes between excisional debridement with a local xylocaine block (LAD) and excisional debridement under general anesthesia (GAD). Material and Methods: This retrospective medical record review was designed to review records of excisional debridement in necrotizing fasciitis (NF) at Sisaket Hospital from January 1, 2017, to December 31, 2019. Outcome measures were clinical outcomes at the preoperative time (baseline data, door-to-operating room), peri-operative time (operating time, blood loss, number of reoperations), postoperative time (mortality rate, length of stay, pain score, opioid drug use), types of NF, and direct costs of treatment by the provider’s perspective. Descriptive statistics, chi-square and Mann-Whitney U test were used. Results: The results of 245 patients showed that LAD was superior to GAD in terms of door-to-operating room time, lower operating time and blood loss, shorter length of hospital stay and lower cost of treatment. Moreover, the LAD showed a lower postoperative pain score, and less opioid drug use when compared to GAD. There were no significant differences in mortality rate, sites of infection and types of NF. Conclusion: LAD showed better clinical outcomes and lower cost of treatment when compared to GAD in the treatment of NF. Nevertheless, excisional debridement under a LAD could be a choice for small wounds at the lower extremities in hospitals with limited resources, and insufficient numbers of anesthesiologists.

Reducing the drug administration times and prolonging the postoperative analgesia duration are important requirements of clinical local anesthesia. However, both local anesthetics currently used in the clinic and potentially new anesthetic drugs such as biological toxins have limited pharmaceutical effect. Biomaterials such as liposomes and polymeric microspheres can be designed to load local anesthetics to achieve a prolonged duration and on-demand drug release, accordingly satisfying clinical needs. In this review, we briefly summarized the recent developments in the design of drug delivery systems for controlled release of local anesthetics, and introduced the design principle, the function of several representative drug controlled release systems, and their applications in local anesthesia. We also discussed the challenges and future perspectives in this field.

Introduction:Currently, local or general anesthesia is commonly applied in patients undergoing percutaneous kyphoplasty (PKP) procedures; however, the best anesthesia method for PKP remains elusive. This study examined the efficacy of erector spinae plane block (ESPB) in comparison with local anesthesia in terms of postoperative analgesia requirement and pain scores, in patients undergoing kyphoplasty.Methods:The files of 42 patients who underwent kyphoplasty were retrospectively reviewed. PKP procedure was either under local anesthesia (controls, n=20) or using ultrasound-guided ESPB (ESPB group, n=22). Postoperative analgesia requirement and pain scores assessed by visual analog scale (VAS) were recorded and compared.Result:All control patients (100.0%) required postoperative analgesia, whereas only five patients (22.7%) in the ESPB group required postoperative analgesia (p

Statement of the Problem: Methemoglobinemia is a potentially life-threatening rare medical condition, which refers to an increase in the level of oxidized form of hemoglobin (methemoglobin). Excessive replacement of hemoglobin with methemoglobin leads to functional hypoxia and even fatal conditions. Purpose: The aim of this study was to evaluate the effect of two common local anesthetic agents namely lidocaine and articaine administered for hemostasis during surgery on methemoglobin level. Materials and Method: This prospective cohort study was conducted from January 2017 to December 2019. Demographic data including age, gender, and weight of patients were collected. Sixty patients were randomly divided into three groups (n=20) regarding the local anesthetic agent administered for hemostasis during surgery as lidocaine group (group 1), articaine group (group 2), and control group (no local anesthetic; group 3). The patients were candidates for orthognathic surgery, reconstruction of the maxillary and mandibular atrophic ridges with autogenous grafts, and reconstruction of maxillofacial fractures. The methemoglobin level was measured before surgery and six hours after the initiation of surgery. Results: The mean age and weight of patients were not significantly different among the three groups (p= 0.891 and p= 0.416, respectively). No significant differences were observed among the three groups regarding the gender distribution (p= 0.343) or type of surgery (p= 0.990). Statistical analysis did not show any significant difference in the mean baseline methemoglobin level among the three groups (p= 0.109). Although the mean methemoglobin values increased in the three groups, paired sample t-test did not show any significant change in the values at six hours after the initiation of surgery compared with baseline in any of the three groups (p= 0.083 for group 1, p= 0.096 for group 2, and p= 0.104 for group 3). Conclusion: The results demonstrated that administration of lidocaine and articaine plus epinephrine for hemostasis during general anesthesia are equally safe.

Background A supraclavicular brachial plexus nerve block provides analgesia for the shoulder, arm, and hand; however, the maximum safe duration for a continuous infusion remains controversial. A novel continuous peripheral nerve block (CPNB) technique combining the Lateral, Intermediate, and Medial femoral cutaneous nerves (termed the ‘LIM’ block) to provide analgesia to the lateral, anterior, and medial cutaneous areas of the thigh while preserving quadriceps strength will also be described in detail here. Case We present a complex case in which simultaneous utilization of an unilateral supraclavicular CPNB (5 weeks) and bilateral LIM CPNB (5 days) are successfully performed to provide analgesia for a traumatic degloving injury resulting in multiple surgeries. Conclusions The analgesic plan in this case study eliminated previous episodes of opioid-induced delirium, facilitated participation in recovery, and removed concerns for respiratory depression and chronic opioid use in a patient at particular risk for both issues.

Background The clavipectoral fascial plane block was introduced by Dr. Luis Valdes in a symposium at the 2017 European Society of Regional Anesthesia and Pain Therapy Congress. Case Clavipectoral plane block (CPB) with intravenous sedation provided surgical anesthesia and analgesia in a 39-year-old male patient with a right midshaft clavicle fracture. This in-plane technique was used to deposit 30 ml of a local anesthesia mixture between the clavipectoral fascia and periosteum on both the medial and lateral sides of the fracture line. Conclusions Excellent anesthesia and analgesia for up to 16 h post-block were provided by CPB during the clavicle surgery.

Smoking is harmful to all organs of the human body and can affect nerve response to local anesthesia.This study aimed to determine the effect of cigarette smoking on the amount and onset of local anesthesia, as well as the chief complaint (symptomatic and asymptomatic), number of cigarettes, and duration of smoking. Materials and methods: A selective clinical case-control study carried out at the Oral Surgery Clinic of the Teaching Hospital at the College of Dentistry. One hundred and three male patients participated in the study, and they were divided into two groups (55 smokers and 48 nonsmokers). The patients received a local anesthetic agent (2% Lidocaine) in a 1.8 ml dental cartridge. The number of cartridges and the onset time of local anesthesia were detailed for each patient in a special case sheet prepared for this study. Results: There was a statistically significant difference between the smoker and nonsmoker groups regarding the amount of local anesthetic solution (p = .041) with a higher amount needed in the smoker group; however, the onset of action showed no significant difference between the two groups (p = 0.983). The symptomatic cases in smokers needed a higher amount of local anesthesia than the asymptomatic cases with a statistically significant difference (p = 0.002). There was no relationship between daily cigarette consumption and the amount of local anesthetic solution (p = .054) and also the onset of local anesthesia (p = .938). The duration of smoking has no significant relationship with onset time (p = .480) and the amount of local anesthesia (p = .418). Conclusion: The amount of local anesthesia used in smoker patients was higher than that in nonsmoker patients, especially if there were symptoms like pain. The duration of smoking and daily cigarette consumption had no effect on the amount and the onset of local anesthesia.

Background The efficacy of 2% lignocaine is reduced in a hot tooth. Local aesthetic agents can be preheated and buffered to increase their effectiveness. The present investigation was carried out due to limited information concerning adult patients with symptomatic irreversible pulpitis in mandibular teeth. Methods A total of 252 individuals were included in the clinical trial in accordance with the selection criteria only after clinical study was registered with the Clinical Trial Registry of India (CTRI/2020/09/027796). Scores on the visual analog scale (VAS) and electric pulp test (EPT) on a 1–10 scale were recorded prior to the commencement of therapy. In this double-blinded study, patients were randomly divided by a co-investigator using computer randomisation (www.randomizer.org) into three groups, group A: inferior alveolar nerve blocks (IANB) with 2% lignocaine preheated at 42 °C (injected at 37 °C) (N = 84), group B: IANB of 2% lignocaine buffered with 0.18 ml of 8.4% sodium bicarbonate (N = 80) and group C: 2% lignocaine (N = 88). Excluding the dropouts of individuals (n = 11), wherein the anaesthesia failed, a total of 241 people were finally assessed 15 minutes after profound anaesthesia, endodontic access, and intraoperative pain were quantified using VAS. Pain on injection for all three groups was recorded immediately after IANB with VAS. The analysis was performed using one way ANOVA with Tukey’s post hoc test and Paired T-Test using SPSS version 21. Results Preheated, Buffered, and conventional 2% lignocaine showed statistically significant reduction in intraoperative pain (P

Pain is a common symptom reported by patients during procedures of aesthetic medicine and cosmetic dermatology. Effective analgesia affects not only patient’s satisfaction and comfort, but also effectiveness of the treatment. The variety of available methods of anesthesia enables individualized analgesia depending on the type of surgery and patient’s preferences. The purpose of this article is to present the current and available methods of anesthesia in aesthetic medicine and cosmetic dermatology as a response to the intensive development of this field of medicine. The article below is based on our own observations and the literature found in the pubmed database.

The problem of anesthesia includes mainly the treatment of pre-existing pain or surgical manipulations with the use of anesthesia. However, the problems of pain prevention during traumatic (invasive) procedures are also actively solved, methods of prevention are improved and expanded, taking into account the impact of pain on the quality of life. Pain is not a simple physiological process of conducting stimulation from the receptor apparatus to the CNS structures, but a complex phenomenon that includes biological, emotional, psychological and social components. Pain is one of the earliest formed psychophysical functions; by the 30 th week of fetal development all pathways of pain conduction and perception are already formed, so both fetus and child are already capable of perceiving pain, and the intensity is often even higher than in adults. Many believe that: young children do not feel pain because their central nervous system is immature; children remember themselves from the age of 4–5 years, so they do not remember the pain they suffered, so all surgical problems that cause pain should be addressed as early as possible; if the child is sleeping or playing, he or she has no pain, etc. Current research has demonstrated significant short-term adverse reactions and long-term negative effects in children in response to pain-related manipulations. Anesthesia of intact skin was previously impossible without prior painful anesthetic injection. Today, other ways of administering anesthetics are used as alternatives: oral, in enemas or suppositories, locally as sprays, ointments, or by application. To address the pain associated with invasive procedures, the effectiveness of a 5% local anesthetic cream based on a water-oil emulsion of lidocaine and prilocaine (1:1), which has good absorption properties, has been studied. Using local anesthesia can prevent and/or reduce the risk of pain-induced stress. Considering the results of these studies, the use of a local combined anesthetic containing 2.5% lidocaine and 2.5% prilocaine may be suggested.

ABSTRACT Objective: Evaluate the experience of private and public health services with the WALANT procedure in the COVID-19 pandemic. Methods: This is a retrospective, multicenter longitudinal study gathering cases of hand surgery subjected to the WALANT technique in the Hospitals Dr. Radamés Nardini and IFOR during the COVID-19 pandemic (August 2020). As a parameter, the verbal numerical rating scale for twenty patients referring to the preoperative, intraoperative and postoperative periods was applied. Results: The patients did not feel any pain during surgery, which showed the efficiency of the anesthetic technique in its purpose. Conclusion: The results indicate the WALANT technique as beneficial when facing the COVID-19 pandemic, as the main differential of the technique is that it is applied by a well-trained orthopedic hand surgeon. Level of Evidence IV, Case Series.

Objective: To compare the mean Sound, Eye and Motor (SEM) score of pre cooling and topical application at injection site in pediatric patients. Study Design: A quasi experimental study. Place and Duration of Study: Fatima Jinnah Dental College and Hospital, Karachi, from Sep to Dec 2017. Methodology: Sixty four paediatric patients aged between 8-12 who needed dental anaesthesia were randomly divided into two groups A and B. Subjects in group A were applied topical anaesthesia at the injection site for one minute before needle penetration and in group B ice pack was applied for the same duration at the injection site. A designed questionnaire based on SEM scale was used to measure the patients‟ reaction. Independent-samples t-test was applied to compare the mean SEM score of both groups by taking p-value ≤0.05 as significant. Results: The mean sound, eye and motor (SEM) score was 5.22 ± 1.718 for group A and 3.28 ± 1.373 for group B; with statistically significant differences between both the groups (p≤0.05). Conclusion: Injection of local anaesthesia at a precooled site results in lesser pain and thus decreased child anxiety levels, more effective analgesia and increased patient comfort.

Objective: To access whether there was a difference of attitude between general dentists and specialist Paediatric dentists regarding management of pain. Study Design: Questionnaire based survey. Place and Duration of Study: This survey was performed among general and Peadiatric dentists working in various setups in Pakistan, from Jun 2019 to Nov 2019. Methodology: This survey was performed among actively partaking general dentists and specialist Paediatric dentists (n=345) working in various hospital setups in Pakistan over a period of 6 months. They were asked to fill questionnaire about pain management with various clinical scenarios, the type of pharmaceutical agent used and the timing of pre-operative analgesics, as well as the use of topical anesthesia and use of local anesthetic. The questionnaire also contained socio-demographic profiles of the dentists participating in the survey. Those who were retired and above 70 years of age were excluded from the study. Results: Out of 345 participants only 287 responded with a relatively higher response rate among specialist Paediatric dentists as compared to general dentists. Forty were dropouts. However, the response rates between gender did not show any significant difference. The mean age of general dentists was 39.49 (SD: 11.68) whereas, mean age for specialist Paediatric dentists was 41.19 (SD: 10.8). About 161 (59.4%) of the general dentists and 16 (100%) specialist Paediatric dentists recommended pre/post op analgesics (p=0.000). Ibuprofen was the most commonly recommended pre-op analgesic in Pakistan (p=0.005) recommended by about 108 (39.85%) general dentists and 11 (68.75%) Paediatric dentists. About 58 (21.4%) general dentists recommended pre-op analgesics more than an hour before treatment (p=0.008) and 5 (31.25%) specialist Paediatric dentists recommended it about an hour before treatment. Conclusion: Specialist Paediatric dentists were found using all kinds of pain reducing strategies, topical and local anesthesia more frequently while treating primary teeth as compared to general dentists.

Introduction: Dentists earnestly try to practice painless treatment. Conventional inferior alveolar nerve block technique is preferred by most of the dentists despite its various modifications.However its failure rate as per literature is quite high. Inexperienced dentists face difficulty in obtaining effective anesthesia. This may be due to limited access to inferior alveolar nerve,greater density of alveolar bone,bulky soft tissues,damage to nerve or due to risk of intravascular injection. Aim: The aim of this study is to review and clinically assess the factors causing difficulty or failure of inferior alveolar nerve block in predoctoral students and to review the mandibular nervve blocks. Material and methods: Dental interns of riyadh elm university were monitored during administration of inferior alveolar nerve block for difficulty factors influencing inferior alveolar nerve block. Onset of anesthesia, efficacy anesthesia of inferior alveolar nerve, lingual nerve and long buccal nerve were ascertained. Difficulty index was used to assess the “item difficulty” with a score of 0.0 which indicates that none of the dental interns anesthetised correctly to 1.0 suggesting all the dental interns anesthetised correctly. Results: Complete failure of inferior alveolar nerve block was noticed in 2.4% of predoctoral students. The most common cause for inferior alveolar nerve block failure was attributed to the difficulty in palpating the landmarks (77%), 22% of the patients refused multiple needle penetrations,and 19% of inferior alveolar nerve block failure was due to the fear of potential complications by the predoctoral students. Conclusion: Clinical skill of predoctoral students need adequate training in nerve blocks. Revising the current literature on alternative inferior alveolar nerve block techniques or use of evidence based dentistry to update and practice alternative nerve block techniques would aid in improving the clinical skills and treatment outcome which would therefore enable to remove the stumbling blocks in successful anesthesia.

Objective: To compare the difference in pain perceived by patients undergoing intra-oral local anesthesia with different gauge needles. Study Design: Qausi experimental study. Place and Duration of Study: Oral and Maxillofacial surgery department of Institute of Dentistry, Combined Military Hospital, Lahore Medical College, Lahore, from July 2019 to August 2019. Methodology: One hundred patients were selected by consecutive sampling from the oral surgery OPD clinic. They were divided into two groups A and B randomly. Twenty three gauge needle on a 3cc disposable syringe was used for inferior alveolar nerve block and buccal nerve block for group A and 27 gauge needle on a metal dental syringe was used for the same in group B. Patients gave a verbal pain score, from 0-10 for each injection. Results: One Hundred participants were included in study, 37 (37%) males and 63 (63%) females. Mean pain score for group A for the inferior alveolar nerve block was 4.50 ± 2.1 and group B was 3.86 ± 2. The mean pain score for the buccal nerve block in group A was 4.02 ± 1.7, while that of group B was 3.94 ± 1.8. There was no significant difference (p=0.167 & 0.855) in pain perceived by patients undergoing intra oral local anesthesia using needles of different gauges. Conclusion: There is no difference in pain perceived by patients undergoing intra oral local anesthesia using needles of different gauges.

Objective: The objective of current study was to evaluate variations in systolic and diastolic blood pressure and the pulse rate of normotensive and hypertensive patients going through extraction after giving two cartridges of local anesthesia with 1:100000 epinephrine. Study type, settings & duration: This prospective study was carried out at Department of Oral Surgery, Riphah International University, Islamic International Dental College (IIDH), Islamabad from January to April 2020. Methodology: Sixty patients between 20-60 years of age who presented at Oral and Maxillofacial Surgery clinic for tooth extraction were included in research. Group A was hypertensive patients and Group B was normotensive patients. Their systolic and diastolic BP and pulse rates were documented at five different time intervals during the extraction. Independent t-test was used to check the statistical variance between mean BP and pulse rates of Group A and Group B at five different time intervals. Results: There was a significant difference in diastolic BP at T2 and T3 which means during the extraction, the diastolic blood pressure of hypertensive patients got significantly higher than normotensive patients. There was significant difference between diastolic blood pressure at T4 as well which signifies that diastolic BP of hypertensive patients took longer to come back to pre-anesthetic state. Difference in pulse rate remained insignificant at all time intervals. Conclusion: Local anesthesia with epinephrine does not significantly increase the systolic blood pressure of hypertensive patients during the extraction and but it does increase diastolic blood pressure significantly during extraction in hypertensive patients...........

Background: One of the most important aspects of dental surgery is the injection of local anesthetics, which control pain. Local anesthetics are administered close to certain nerves or fibers to block nerve transmission. Intraoral administration of local anesthetics, on the other hand, can affect other nerves, resulting in complications in the outside of the oral cavity. Ophthalmic problems are uncommon, accounting for about 0.04 to 0.1% of all complications Purpose: The purpose of this case is to discuss the unusual case of contralateral ocular complication following dental local anaesthesia. Case: We reported a 41 years old Malay male came to Kuching Armed Forces Dental Clinic for his appointment on surgical removal of impacted left lower wisdom tooth. After the minor oral surgery procedure under local anaesthesia has been done, the patient had a twitching right eye. Case Management: The patient's vital signs were checked to rule out the possibility of a stroke or anaphylactic shock. The patient was a sure to be calmed, laid down, and put cold compresses on both eyes with dim lighting. After 45 minutes of review, the patient was allowed to leave, followed by a two-week post-minor surgery check-up. Conclusion: Risk of complications from local anaesthesia can be reduced with the effective patient evaluation and anxiety management, correct injection technique, and sufficient knowledge of dental local anaesthesia. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the risks of propofol-based total intravenous anesthesia (TIVA) compared to local anesthesia (LA) in patients undergoing percutaneous transluminal angioplasty (PTA) in a lower extremity. Material and Methods: A retrospective cohort study was conducted in 231 patients who underwent PTA in the lower extremity using either propofol-based TIVA or LA between January 2016 and September 2018. The outcomes of interest included perioperative major adverse cardiac events (MACE) and minor perioperative complications. Risk factors analysis was performed using a univariate logistic regression and backward stepwise multivariate logistic regression. Results: Although the rate of perioperative MACE was two times higher in the propofol-based TIVA group (7.8%) than the LA group (3.9%), no significant difference was found (p-value=0.221). The propofol-based TIVA group had a significantly higher incidence of all minor perioperative complications than the LA group (77.6% vs 13.6%, p value

Background and Aims: Various methods to induce anesthesia have been investigated in situations where the primary inferior alveolar nerve block (IANB) injections fail. The aim of this study was to compare the effect of synergic effects of anesthetic injection of prilocaine supplemental with that of lidocaine anesthesia in teeth with irreversible pulpitis. Materials and Methods: This study was a parallel-controlled clinical trial on 58 patients with one mandibular molar tooth having irreversible pulpitis. The first anesthesia was injected with an inferior alveolar block with 2% lidocaine anesthesia. Patients who failed pulpal anesthesia were randomly divided into two groups; case and control groups. In the case group, IANB was injected with 3% prilocaine, and in the control group with 2% lidocaine anesthesia. Anesthesia after the second injection was evaluated by three methods of numerical evaluation of the patient's response to Electric Pulp Tester (EPT), the severity of the patient's response to the cold test, and the extent of pain during the onset of access cavity latency on the Visual Analog Scale (VAS). Statistical analysis was performed using T-test and Mann-Whitney tests. Results: There was no significant difference between the two groups in terms of depth of anesthesia (P>0.05). Conclusion: The results of this study showed that there was no difference between 2% lidocaine and 3% prilocaine in the depth of supplemental IANB anesthesia after failure of first IANB in mandibular molar teeth with irreversible pulpitis.

INTRODUCTION: Chronic venous insufficiency (CVI) is a common disease in the community. Endovascular procedures have been widely used in the treatment of this disease in recent years. In this study, we aimed to reveal the results of radiofrequency ablation (RFA) treatment and compare the local / spinal anesthesia in the treatment of great saphenous vein insufficiency. METHODS: One hundred and fifty-three(153) patients who underwent RFA treatment due to great saphenous vein insufficiency between January 2016- 2018 were included in the study retrospectively. Operations were performed under spinal anesthesia or local anesthesia. Group 1 was used for local anesthesia while Group 2 was used spinal anesthesia. RESULTS: Local anesthesia was used in 105(68.6%) patients(Group 1) and spinal anesthesia was used in 48 (31.4%) patients(Group 2). The mean age of the patients was 36.1 +- 9.2 years in Group 1 and 36.5 +- 7.7 in Group 2 (p = 0.794). Female gender ratios were 60% in Group 1 and 54.2% in Group 2 (p = 0.497). Postoperatively, 9 patients had ecchymoses, 9 patients had hematoma, 4 patients had thrombophlebitis, 3 patients had cellulitis, 11 patients had paresthesia and 1 patient developed deep vein thrombosis. There was no statistically significant difference between the groups in terms of complications. The total stay of hospitalization was 11.9 +- 8.5 hours. DISCUSSION AND CONCLUSION: The RFA method can be used safely to treat great saphenous vein insufficiency. Use of local anesthesia in this treatment may shorten hospitalizations.

Basal cell carcinoma occupies a leading place among cutaneous neoplasms, exposure to solar radiation being the main incriminating factor în the occurrence of this type of cancer. The present paper presents a complex case of facial reconstruction using local anesthesia, performed în order to cover the defect remaining after the excision of a basal cell carcinoma located at the level of the infraorbital region. The tumor excision, the dissection of the cheek flap and its rotation to cover the defect were performed after the infiltration of the anesthetic solution at the level of the right hemiface, so that during the entire operation the patient was aware, constantly communicating with the surgical team. Without a doubt the early identification of this condition and the rapid establishment of the surgical treatment can be associated with a favorable prognosis. The photographs taken 12 months after the surgical intervention show that this type of intervention is associated with favorable aesthetic results under the conditions of eliminating the risks associated with general anesthesia.

Amaç: Kronik subdural hematom insan ömrünün artmasıyla birlikte sıklığı daha da artan önemli morbiditelere neden olan ve oldukça sık görülen ekstraserebral kanamalardandır. Literatürde hafif kafa travmaları ile birlikteliğinin %60-80 oranında olduğu bildirilmektedir. Bu çalışmanın amacı kronik subdural hematom hastalarının ameliyatında uygulanan lokal ve genel anestezinin ameliyat süresi, ameliyat maliyeti ve toplam ameliyathane odasını kullanım süreleri açısından bir farklılığa sebep olup olmadığını araştırmaktır.Gereç ve Yöntemler: Düzce Üniversitesi Tıp Fakültesi Sağlık Araştırma ve Uygulama Hastanesi Nöroşirürji Anabilim Dalında 2016 ve 2018 yılları arasında tek taraflı kronik subdural hematom tanısı ile opere edilmiş olan toplam 27 hastanın kayıtları geriye dönük olarak incelenmiştir. Yaş, cinsiyet, ASA skoru, ameliyat süresi, ameliyat odasına giriş ve çıkış zamanları arasındaki süre, hastanede kalış süresinin uzunluğu ve ameliyat maliyetleri kaydedildi.Bulgular: Lokal anestezi uygulanan hastalarda ameliyat maliyetinin ve ameliyathane odasına giriş ve çıkış arasındaki toplam sürelerinin daha kısa olduğu ve genel anestezi uygulanan hastalar ile arasındaki farklılığın istatistiksel olarak anlamlı olduğu saptanmıştır (her iki p değeri de

Objectives: We sought to review the management of scorpion stings in tertiary and secondary care emergency departments in Oman and determine physician’s knowledge of management protocols. Methods: We conducted a retrospective study of all scorpion stings cases seen in Sultan Qaboos University Hospital (SQUH) emergency department (ED) from March 2016 to July 2017. Additionally, we conducted a survey of ED physicians regarding their management of scorpion stings in three different EDs including SQUH. Results: The total number of scorpion stings seen at SQUH during the study period was 128. Localized pain was seen in 97.7% (n = 125), swelling in 14.8% (n = 19), and local redness in 7.0% (n = 9) of patients. Around 13.0% (n = 17) of patients were found to have systemic symptoms with tachycardia being the most common. Bedside clotting test was done for 11.7% (n = 15) of patients. The most commonly used treatment was local anesthesia (54.7%, n = 70). No patient received scorpion antivenom. In the 89 surveyed physicians the main management method used was analgesia (88.8%, n = 71) followed by local anesthesia (81.1%, n = 65). Most physicians (80.0%, n = 64) believed that local anesthesia was the most effective management. However, 32.5% (n = 26) ordered a whole blood bedside clotting test, 69.2% (n = 18) of which were junior doctors. Conclusions: Most scorpion sting cases managed in SQUH had local symptoms. Tachycardia was the most common systemic manifestation. Bedside clotting test was not commonly ordered and mainly requested by junior doctors. Local anesthesia infiltration is the recommended management for scorpion sting. Analgesia was the main management followed by local anesthesia.

Introduction: The aim of the present study was to determine if the use of local anesthesia by different ways would reduce postoperative pain after laparoscopic total extraperitoneal inguinal hernia repair.Methods: Thirty patients were randomly divided into three groups. Upon completion of the prolene mesh repair, Group 1 (mean age: 45.8±8.6 years) received 5 cc levobupivacaine installed into the preperitoneal space every 6 h for 24 h via a catheter placed to the preperitoneal space. In Group 2 (mean age: 44.9±11.5 years), levobupivacaine-soaked spongostan was placed into the preperitoneal space after the placement of the prolene mesh. Group 3 (mean age: 45.4±10.7 years) was determined as the control group and received 75 mg diclofenac sodium after inguinal hernia repair. Pain was assessed by using a Visual Analog Scale of 1 (minimal pain) to 10 (worst pain) at fixed time intervals of 0, 6, 12, 18, and 24 h after surgery.Results: The trend of postoperative pain in 0, 6, and 18 h of Group 1 was significantly lower than that of Group 3 (p

Abstract Background Local anesthesia is an important skill and a prerequisite for most dental treatments. However, the step from theory to application on the patient is huge for the novice. Hence, a mannequin training model course was developed and implemented into the existing local anesthesia curriculum in undergraduate dental students. It was the aim of this study to evaluate the relation between training-model and real-life anesthesia performance and to measure whether a gain in skill on the model translates to the actual patient situation. Methods Thirty-six third-year students (14 males, 22 females, age 24 years±2.98) attended the four-day course comprising each 4 h of lectures and practical training. The student cohort gave subjective ratings about the didactical components of the course after attendance by using the TRIL questionnaire (TRIL-mod; University of Trier). At the end of the course the performance of each student in administering an inferior alveolar nerve (IAN) block on the training model as well as on a fellow dental student was investigated using a standardized checklist. To evaluate the successful performance, the in vivo IAN-block was assessed using subjective patient-feeling, the sharp-blunt test and an objective pain- and thermal sensitivity tester (PATH). Results The course was rated with an average score of 5.25 ± 0.44 (range 1–6; 6 = best). On the training model, 69.4% of the students successfully performed an IAN-block. The in vivo assessment, objectified by the PATH test, showed a successful anesthesia in 36.9% of the cases. The assessment of local anesthesia by using the sharp blunt test and the subjective patient feeling significantly correlated with these findings (k = 0.453–0.751, p

MB,ChB, FICMS, CABS (ENT), Consultant ENT Surgeon, Al-Sadr Teaching Hospital, Basrah, IRAQ. Abstract The nose is the most prominent structure in human face, making it more susceptible to trauma which may reach more than one third of all facial injuries. Although fracture nose is a common surgical problem, very few studies are conducted in Iraq on it. The aim of this study is to evaluate the efficiency of local anesthesia in fracture nose manipulation and to assess the degree of patient’s satisfaction from the functional and esthetic point of view. The majority of patients attended ENT department were males (68.5%) lying in the age group between 21–30 years and the reason for their injuries was personal assault. Waiting for complete resolution of edema results in some complications such as bleeding and pain. Fracture nose manipulation under local anesthesia gives high degree of satisfaction both for the functional (83.3%) and esthetic (88.9%) point of view, so this procedure can be recommended in ENT clinical practice in the view of these results as it is more safe, time saving and cost effective.

Introduction: Surgical removal of third molars has been well- known for causing stressful situation for the majority of the patients. Increasing serum glucose level is expected following acute rise in epinephrine level or probably local anesthetic injection. This study was designed to compare blood glucose levels before and after third molar surgery. Materials and Methods: In this prospective clinical trial study, candidates for third molar removal surgery were enrolled. Blood glucose level was measured by glucometer before and 10 minutes after surgery in each patient and the result were compared. Results: The mean blood glucose in 92 patients before the procedure were 110.82±15.38 mg/dl and after surgery, it increased significantly to 123.95±16.87 mg/dl (P

Background. At the present, Lidocaine is the leading and the safest local anesthetic for flexible bronchoscopy. However, there are possible systemic complications that necessitate the search for a more rational application scheme. Materials and methods. The efficacy and safety of the author's method of local anesthesia were studied based on the results of 22273 flexible bronchoscopies (100.00 %). The method involves the use of a 5 % lidocaine solution applied to irrigate the vocal folds, carina bifurcation of the trachea and the upper lobes spurs. Results. In all cases, reliable anesthesia of the vocal folds was achieved rather quickly: a bronchoscope was carried out through the glottis with virtually no cough. No medical complications due to the use of lidocaine in the declared dosage were noted. Conclusions. The proposed approach to local anesthesia provides reliable suppression of the cough reflex when passing through tussogenic zones with a bronchoscope and, at the same time, does not cause any systemic complications.

Introduction Local anesthesia with sedation has been employed for an increasingly number of otolaryngology procedures, and might be associated with lower surgical morbidity and costs. Facial nerve monitoring is often advisable in otology to minimize the risks of injuries to this cranial nerve, but the principles, techniques and parameters involved have only been studied for procedures under general anesthesia. Objective To report the preliminary outcomes of intraoperative facial nerve monitoring during otologic procedures under sedation and local anesthesia. Methods A total of five procedures and their respective intraoperative electrophysiological main findings were described. Facial neuromonitoring was performed using the same device by an electrophysiologist. The monitor sensitivity was set at 100 mV, and a stimulating probe was used whenever needed. Results Progressively decreasing low-amplitude baseline values were usually obtained as the level of anesthesia increased, with isolated oscillations possibly related to some degree of voluntary muscular activity. These oscillations could be easily distinguished from those of the surgical manipulation or electrical stimulation of the nerve, which tended to be of much greater amplitude and shorter latency, occurring during specific surgical steps. Conclusion With a surgical team with proper procedural knowledge and broad expertise regarding the technique, intraoperative facial nerve monitoring under local anesthesia with sedation seemed both feasible and reliable. Thus, the need for intraoperative neuromonitoring should not be an obstacle for otologic procedures under less aggressive anesthetic management.

Objective: To determine the analgesic efficacy of ultrasound guided transversus abdominis plane block in comparison to conventional local anesthetic wound infiltration technique in patients undergoing laproscopic cholecystectomy. Study Design: Randomized controlled trial. Place and Duration of Study: Combined Military Hospital Rawalpindi, from Jan 2016 to Jun 2016. Material and Methods: This study was conducted after approval from the ethical committee. Total of 132 patients, American Society of Anesthesiologists physical status I or II, were randomized to group A and group B (n=66), received ultrasound guided transversus abdominis plane block on each side and local anesthetic wound infiltration with 0.5% bupivacaine (1mg/kg). Injection nalbuphine was used as a rescue analgesic if needed. Mean pain score and total rescue analgesia required were recorded on emergence, then 2 hourly for next 12 hours postoperatively, in numerical rating scale and in milligram (mg). Results: Mean pain score at 12 hours postoperatively in group A and group B were 4.01 ± 2.55 and 6.04 ± 2.74 respectively (p-value

Objectives. To confirm the efficiency of using local anesthesia with lidocaine and epinephrine in hand surgery. Materials and methods. 75 patients in whom we used local anesthesia with 1% lidocaine and epinephrine in solution 1: 100 000. We evaluated the amount of used anesthetic, the time to onset of anesthesia, intraoperative bleeding, the duration of intervention and hospitalization, immediate postoperative complications. Results. It has been no case of digital necrosis or other vascular complications and no intraoperative bleeding. The amount of the used anesthetic varied. In no case it was necessary to use of phentolamine as an antidote to the effects of adrenaline. Conclusions. Wide awake local anesthesia no tourniquet technique is safe, having many advantages: it is not necessary to use the tourniquet with or without intravenous sedation, the surgeon and patient comfort is maximum, there is no risk of digital necrosis, hospitalization time is short and the costs are minimal.

The mandibular foramen (MF) is the place for the inferior alveolar nerve anaesthesia. Knowledge of the anatomical landmarks for its location and of the variations regarding its topography is important for the successful treatments of the mandibular teeth. An analysis of 57 summaries of scientific papers and 41 in extenso articles, using ISI Thomson Web of Knowledge, PubMed and MedLine databases, and additionally, a search in 5 anatomy books were performed. The results showed similarities among most of the accessed studies, but also differences. The most frequent variations concerning the MF position were in relation to the vertical plane. According to most authors, the MF is located in the posterior middle third of the anterior-posterior plane of the mandibular ramus. A precise location of the MF provides therapeutic safety and lack of complications.