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This study aims to evaluate the safety and patient satisfaction of a fast-track procedure for cataract surgery under topical anaesthesia without perioperative anaesthesia care. This is a prospective single-centre study including all cataract procedures in the Centre Ambulatoire de la Chirurgie de la Cataracte at the Hospital of Bourges between May and August 2018. Procedures were performed under topical anaesthesia without the presence of a nurse anaesthesiologist or anaesthesiologist, the patient had not fasted, and no peripheral venous line was placed. Only heart rate and oxygen saturation were monitored intraoperatively with pulse oximetry. Incidence and nature of intraoperative adverse events and surgical complications were recorded. Patient satisfaction was assessed using the Iowa Satisfaction with Anaesthesia Scale (ISAS). In total, 651 cataract surgeries were performed among which 614 (94.3%) were uneventful. Thirty (4.6%) intraoperative adverse events and 8 (1.2%) surgical complications were recorded. All surgeries were successfully completed. No medical emergency team intervention or hospital admittance was encountered. The mean ISAS score was 5.7/6, indicating high patient satisfaction. Cataract surgery in an ambulatory cataract surgery centre without perioperative anaesthesia care is a safe procedure with high patient satisfaction for screened patients. Anaesthesia ressources are scarce and may be more beneficial to more complex ophthalmic or non-ophthalmic surgeries.

Effective dental local anesthetic administration forms the basis of pain-free dentistry; therefore, the application of theoretical knowledge and the ability to deliver injections safely and competently are vital aspects of student learning. Student- to-student administration of the first local anesthetic injection has been a traditional method for preclinical training. The aim of this study was to evaluate oral health students' perceived value of such practice and the impact on their level of anxiety and confidence in giving their first injections to patients. A sequential mixed-methods cohort study design was used. After their local anesthesia training, all 42 second-year students in the oral health program at the Sydney Dental School, University of Sydney, Australia, in 2016-17 were asked to complete five short questionnaires. All 42 students completed each questionnaire, after which seven of them participated in a voluntary focus group. The students reported that they valued the one-on-one feedback from the educators during student-to-student preclinical training. The students' primary concern was the possible pain and discomfort that may arise when they perform the first infiltration or inferior alveolar nerve block injections on patients. Most students reported they felt "a little nervous" and experienced a similar level of confidence in administering the two types of injections. The oral health students valued the experiential learning of student-to-student preclinical dental local anaesthetic training. Students' level of anxiety and confidence was affected by the age of patients and type of local anesthetic injections. The level of anxiety students experienced was negatively correlated with their confidence in giving first local anesthetic injections to patients. Further investigation is needed to determine if this level changes with more clinical experience.

Purpose: To describe patients' experiences undergoing a carotid endarterectomy (CEA) under local anesthesia., Design: Explorative qualitative design., Methods: Semistructured interviews with 15 participants who had undergone CEA under local anesthesia, analyzed by content analysis., Findings: Undergoing CEA under local anesthesia entails enduring stress with no possibility of withdrawal. Patients' lack of understanding of local anesthesia and experiencing pain and discomfort caused feelings of stress. The surgery resulted in a loss of control; patients had to surrender their autonomy to someone else. The nurse anesthetist was the link to the world outside the operating room (OR), and that nurse conveyed feelings of safety and security during the surgery., Conclusions: Patients' experiences ranged from being pleased with the surgical procedure and local anesthesia to vowing never to undergo such a procedure again. It is important to focus on the patients' experiences and feelings when choosing a method of anesthesia., (Copyright © 2017 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

Background/objectives: A few studies have documented the effect of local anesthesia for minor dermatologic surgical procedures on children and their parents. Our objective was to evaluate the psychological effect and global satisfaction of a patient-centered approach to dermatologic surgery under local anesthesia., Methods: Two self-administered questionnaires were used to evaluate the distress and global satisfaction of 388 children who underwent dermatologic surgery under local anesthesia, accompanied by oral and written therapeutic education measures (structured information and a cartoon brochure illustrating the procedure) addressed to children and parents. Distraction techniques were also used during the procedures., Results: Although 54.5% of patients manifested some degree of fear, all other parameters analyzed (pain, surgery-related distress, surgical team-patient and -family relationship, global satisfaction) indicated that the procedures resulted in limited distress and that the large majority of children and parents tolerated them well., Conclusion: Specific measures for therapeutic pediatric patient education may be helpful in limiting discomfort, anxiety, and pain perception linked to procedures performed under local anesthesia. Further controlled studies are required to more precisely assess the benefits of specific therapeutic education measures., (© 2017 Wiley Periodicals, Inc.)

Background: Awake craniotomy for tumor resection and epilepsy surgery is a well-tolerated procedure. Qualitative data on patients' experience of awake deep-brain stimulation (DBS) are, however, lacking. We collected qualitative data on patients' experience of awake DBS with a view to identifying areas for improvement., Methods: Forty-one patients undergoing DBS for Parkinson disease between 2009 and 2015 were surveyed with a structured questionnaire designed to receive patient feedback regarding perioperative management of the awake stage of the procedure., Results: More than 90% of patients felt well-informed. Most remembered the procedure, and almost all were happy that they did. One half of the patients experienced pain, often significant, during the procedure. This mainly occurred during burr-hole drilling and stereotactic frame placement., Conclusions: Although awake DBS is well-tolerated, pain and off-period symptoms are an issue for a significant number of patients. Efforts should be made to minimize these unpleasant aspects of awake DBS., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objectives: Cochlear implantation (CI) under local anaesthetic (LA) has previously been shown to be a successful and safe option for a specific group of patients (e.g. elderly and significant co-morbidity). We aim to discuss our practice and obtain qualitative information about patient experience from our cohort of patients at the Yorkshire Auditory Implant Service (YAIS)., Methods: Retrospective chart review to include demographics, co-morbidities and physiological parameters were recorded and used to calculate P-POSSUM (Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity) scores. The Iowa Satisfaction with Anaesthesia Scale (ISAS) questionnaire was distributed to all patients who received CI under LA and subsequently analysed., Results: Seven patients received CI under LA at YAIS. This included five males and two females. The mean age was 79 years (range 26 -93). The mean P-POSSUM mortality and morbidity for this cohort was 2.4 and 34.9%, respectively. The average ISAS score was +1.72 (where range of -3 is completely dissatisfied and +3 is completely satisfied)., Discussion: We discuss our cohort and show that patients receiving CI have a favourable experience when LA is used. CI under LA is a viable and safe option for more elderly patients and those who are deemed at high risk of morbidity or mortality associated with a general anaesthetic., Conclusions: The data regarding validated patient experience obtained from this study can be used to help counsel patients that may be offered CI under LA.

Aim of the Study: To evaluate the effects of spinal or locoregional anaesthesia versus local tumescent anesthesia during traditional surgical treatment of saphenous reflux, in terms of pain and postoperative functional recovery., Materials and Methods: From January to December 2014, 195 consecutive interventions of stripping of the greater saphenous vein for valvular incompetence were performed. In 114 cases spinal or locoregional anaesthesia was performed (group 1), in the remaining 81 cases local anaesthesia with the tumescence technique was carried out (group 2). All patients underwent an assessment of perceived pain by means of verbal rating scale before and at the end of surgery, at discharge and after a month. The times of recovery of ambulation during hospital stay and at the discharge were recorded and use of analgesic drugs during hospitalization and at home. At the end of the study, patients were asked to express their approval rating on the type of anaesthesia., Results: Patients in group 2 experienced mild to moderate intraoperative pain more frequently than patients in group 1 (p<0.001), while patients in group 1 had more mild adverse anaesthesia-related events than patients in group 2. Patients in group 2 had faster recovery of ambulation and earlier discharge than patients in group 1.Thirty-day results were similar in the two groups; however, patients in group 2 had a higher degree of satisfaction than patients in group 1 with regard to the type of anaesthesia (p<0.001) CONCLUSIONS: Both locoregional and local tumescent anaesthesia are effective and well accepted by the patients, with similar intra-hospital and 30-day results., Key Words: Great Saphenous Vein, Local tumescent anaesthesia, Pain, Stripping.

Objectives: The aims of this study were to determine: 1) the relationship between children's psychological functioning, dental anxiety and cooperative behavior before and during local anesthesia, 2) the relationship of parental dental anxiety with all the above child characteristics., Study Design: There was a convenient sample of 100 children (4-12 years). Child dental anxiety and psychological functioning were measured using the "Children's Fear Survey Schedule" (CFSS-DS) and the "Strengths and Difficulties Questionnaire" (SDQ) respectively. Parental dental anxiety was measured using the "Modified Dental Anxiety Scale" (MDAS). All questionnaires were completed by parents. Before and during local anesthesia, the child behavior was scored by one experienced examiner, using the Venham scale. Non-parametric tests and correlations (Mann-Whitney, Spearman's rho) were used for the analysis., Results: The mean SDQ score was 10±5.6 for boys (n=60) and 8.3±4.8 for girls (n=40) (p=0.038), but there was no correlation with children's age. The mean CFSS-DS score was 33.1±11.86 and there was no correlation with age or gender. Children with higher levels in the pro-social subscale of the SDQ had significantly less anxiety and better behavior before local anesthesia. Higher mean CFSS-DS scores were significantly associated with uncooperative behavior during local anesthesia (p=0.04). There was no correlation between parents' and their children's dental anxiety, psychological functioning and behavior. 46% of the children had previous dental experience in the last 6 months. As time since the last dental treatment increased, an improvement was found in children's behavior during local anesthesia., Conclusions: Child psychological functioning was related to dental anxiety and behavior during dental appointment involving local anesthesia.

Purpose: Patients might refuse the offer of local anaesthesia (LA) administration prior to dental treatment. This study investigates subjective discomfort perception during non-surgical mechanical periodontal therapy delivered with or without LA., Materials and Methods: Sixty patients with mild to moderate chronic periodontitis and prior periodontal debridement experience were randomly enrolled in nonsurgical therapy of a quadrant with or without LA administration. Patients were free to comply or not with the allocated LA arrangement. Visual analogue scales (VAS) of discomfort perception at various stages of the treatment as well as overall satisfaction were recorded. Demographic, psychosocial and periodontal parameters were recorded., Results: Thirty-one patients undergoing nonsurgical periodontal therapy not receiving (LA-) and 29 participants receiving LA (LA+) were studied. Compared to LA- patients, LA+ individuals perceived less discomfort during treatment and reported less dental anxiety (p<0.05). Lower overall treatment satisfaction was associated with prior unpleasant periodontal experience (p=0.047). Overall, debridement discomfort was associated with not receiving LA, noncompliance with the pain control regimen allocated, longer treatment duration, greater gingival inflammation and a higher percentage sites with probing pocket depths≥5 mm (p<0.05)., Conclusion: Clinicians should be aware that patients who refuse LA can experience higher dental anxiety and therefore may require various pain control strategies for comfort during nonsurgical periodontal therapy, which, if not employed, can lead to less periodontal treatment satisfaction.

Objective: To assess self-reported stress during the performance of different procedures in pediatric dentistry, according to the professional experience of the dentists., Study Design: During the years 2010 to 2011, an anonymous survey was administered by means of an internet link, and by distribution at professional meetings of dentists ., Results: No statistically significant differences in stress were reported for maxilla and mandibular procedures. Placement of a rubber dam was rated as the most stressful procedure among dental students. For general practitioners and specialists, injection of local anesthesia to an anxious child was the most stressful procedure, regardless of age, sex, or years of professional experience. A negative correlation was found between years of experience and level of stress for all the procedures surveyed, but not for the use of nitrous oxide. No differences were found between male and female dentists in stress scores for any of the procedures., Conclusion: Higher rates of stress during operative procedures were reported among dental students than among experienced dentists. Anxiety of the pediatric patients, but not the location of the procedure: maxillary or mandibular, affected the dentists' reported level of stress.

Aim: This was to explore factors associated with dentists' difficulties doing restorative treatment in children, in particular (1) stress, (2) clinical experience, (3) use of conscious sedation, and (4) use of local analgesia., Methods: A precoded questionnaire (QuestBack) was sent electronically to all dentists working in the Public Dental Service (PDS) in eight counties in Norway. Chi-square statistics, McNemar's test and bivariate logistic regression analyses were used., Results: A total of 611 dentists received the questionnaire and 391 (65 %) returned the completed form. Self-reported stress was most frequent among dentists when treating patients aged 3-5 years and was statistically significantly associated with the dentists' self-reported difficulties doing restorative treatment. Among dentists with ≤ 10 years experience about 60 % reported stress treating the youngest patients compared with 44 % among the more experienced dentists. Self-perceived stress and working experience was not associated with use of local analgesia and sedation., Conclusions: The frequency of self-perceived stress among dentists when undertaking restorative treatment decreased with increasing patient age from 3 to 18 years. When treating preschool children, a small group of dentists frequently or always experienced this as stressful work. The use of local analgesia or conscious sedation was not related to dentists' stress. Dentists reported less frequently use of local analgesia and conscious sedation in children younger than 10 years. Undergraduate and continuous education and support in the use of local analgesia and conscious sedation is essential to provide optimal dental care for this patient group.

Background/aims: The aim was to assess the efficacy of adding benzydamine (B) spray to standard treatment with a lidocaine (L) spray before upper gastrointestinal endoscopy (UGE) as a topical anaesthetic regimen., Materials and Methods: A total of 118 adult patients undergoing outpatient UGE were randomly assigned to receive L (n=44), LB (n=38) or B (n=36) before the procedure. The primary outcome was the patient tolerance score, which represents a summative evaluation of the taste of the anesthetic agent, the intensity of pharyngeal numbness, the amount of coughing or gagging and the degree of discomfort during oesophageal intubation., Results: The median (min-max) patient tolerance scores were comparable between groups LB (10.5; range 5-12) and L (10; range 4-13) (p=0.235) and significantly lower in group B (7.5; range 3-12) (p<0.01). LB improved several secondary outcomes. Oesophageal intubation was less difficult (5 [range 2-10] vs 3 [range 0-8], p<0.001), and a lower proportion of patients developed postprocedural sore throat (4 [10.5%] vs 15 [34.1%], p=0.011) in LB compared to L., Conclusion: LB is not superior to L in terms of overall patient tolerance, but LB may be preferred over L in cases with difficult oesophageal intubation or a previous history of postprocedural sore throat.

Needle phobia is a common problem encountered by dental practitioners and it can pose a challenge, especially in the paediatric patient. Needle desensitization can be used for patients who have needle fear or phobia and help them overcome this by repeated, non-threatening and controlled contacts. This paper will describe an accepted technique of needle desensitization and work through the steps required to achieve a successful outcome of local anaesthesia being delivered in a calm, safe and controlled manner. Clinical Relevance: Needle desensitization is an effective technique which can be used to enable a needle phobic patient to receive a dental injection.

Background: To evaluate the psychometric properties of the faces version of the Modified Child Dental Anxiety Scale (MCDASf) Malay version in 5-6 and 9-12 year-old children., Methods: The MCDASf was cross culturally adapted from English into Malay. The Malay version was tested for reliability and validity in 3 studies. In the Study 1, to determine test-retest reliability of MCDASf scale, 166 preschool children aged 5-6 years were asked to rank orders five cartoons faces depicting emotions from 'very happy' to 'very sad' faces on two separate occasions 3 weeks apart. A total of 87 other 5-6 year-old children completed the Malay-MCDASf on two separate occasions 3 weeks apart to determine test-retest reliability for Study 2. In study 3, 239 schoolchildren aged 9-12 years completed the Malay-MCDASf and the Malay-Dental Subscale of the Children Fear Survey Schedule (CFSS-DS) at the same sitting to determine the criterion and construct validity., Results: In study 1, Kendall W test showed a high degree of concordance in ranking the cartoon faces picture cards on each of the 2 occasions (time 1, W = 0.955 and time 2, W = 0.954). The Malay-MCDASf demonstrated moderate test-retest reliability (Intraclass correlation coefficient = 0.63, p <0.001) and acceptable internal consistency for all the 6 items (Cronbach's alpha = 0.77) and 8 items (Cronbach's alpha = 0.73). The highest MCDASf scores were observed for the items 'injection in the gum' and 'tooth taken out' for both age groups. The MCDASf significantly correlated with the CFSS-DS (Pearson r = 0.67, p < 0.001)., Conclusions: These psychometric findings support for the inclusion of a cartoon faces rating scale to assess child dental anxiety and the Malay-MCDASf is a reliable and valid measure of dental anxiety in 5-12 year-old children.

Objective: To evaluate the advantage of the usage of local anesthesia for vaginal surgery in gerontological patients., Design: Prospective study., Setting: Charles University in Prague, 1st Medical Faculty and Hospital Bulovka, Department of Obstetrics and Gynaecology, Prague., Methods: 43 patients over 60, 4 were younger, with diagnosed descent of anterior vaginal wall G II-III according to International Continence Society classification, were included into the study. They underwent anterior vaginal wall repair in the sole local anesthesia. For the assessment of the procedure, we used anamnestic data and quality of life questionnaires Visual analogue scale, International Consultation on Incontinence Questionnaire - Short Form, Pelvic Floor Distress Inventory - 20., Results: The results of used questionnaires confirmed positive results of the local anesthesia. We demonstrated statistically significant improvement of the urinary incontinence too, as well as subjective perception of the descent., Conclusion: Excellent subjective assessment of usage of local anesthesia showed us new operative possibility in treatment applicable in high-risk patients.

Aim: To determine and correlate dental anxiety in children, using psychometric and physiological measures., Methods: On hundred children (51 boys and 49 girls) were selected and anxiety was assessed using psychometric (Modified Child Dental Anxiety Scale) and physiological measures (pulse rate and oxygen saturation levels), for local anesthetic administration. Statistical analysis was carried out with SPSS software version 11.0. Metric continuous data are presented as mean ± standard deviation. Analysis between groups was carried out by using one way anova. Categorical variables were analyzed with "Fisher's exact test". For statistical significance, the probability value of < 0.05 was considered. The correlation among psychometric and physiological measures was assessed using the Spearman rank correlation., Results: A very weak negative correlation between pulse rate and MCDAS(f) values was observed. The oxygen saturation level did not show significant variations and was not a reliable indicator of anxiety., Conclusion: Both psychometric and physiological measures have their own merits and are important clinically. Even behavioral measures, although having observer bias, can be used as an adjuvant along with these measures. It is essential to take two or more measures into consideration rather than just one to assess dental anxiety., (© 2013 Wiley Publishing Asia Pty Ltd.)

Objectives: Child dental fear causes a significant management problem. The Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) is the most widely used measure of dental fear in children. This study was undertaken to develop and test reliability and validity for the Arabic version of the CFSS-DS., Study Design: the English CFSS-DS was translated to Arabic language and its reliability and validity were evaluated by distributing it to 6-12 year old Arabic pediatric dental patients (n=220). Of whom 144 children were assigned for test- retest reliability. To test criterion validity; 44 children were subjected to behavior rating during treatment and compared with their CFSS-DS. Fear of returning to the dentist was evaluated for all the children to test construct validity., Results: the Arabic version of the CFSS-DS showed good internal consistency (alpha = 0.86) and test-retest reliability (0.86, P<0.001). Treatment with or without local anesthesia did not affect the children's behavior or fear scores. Significant correlations were found between total fear scores and both Frankl rating scale (r=-0.54, p<0.001) and willingness to return to the dentist (r=0.50, p<0.001)., Conclusion: the Arabic version of the CFSS-DS appears to be a reliable and valid method for evaluating child's dental fear in Arabic cultures.

Our aim was to analyse the amount of anxiety and fear felt before, immediately after, and one week after, dental extraction. We studied 70 patients (35 men and 35 women (mean (SD) age 43 (±10) years), who were listed for dental extraction under local anaesthesia in a private clinic that specialised in oral surgery. Patients were evaluated on 3 consecutive occasions: immediately preoperatively, immediately postoperatively, and 7 days later. Each patient's anxiety was measured using Spielberger's State-Trait Anxiety Inventory (Spanish version), the Modified Corah Dental Anxiety Scale (MDAS) and the Dental Fear Survey. There were significant differences in the STAI-Trait scale between before and 7 days after extraction (p=0.04), and in the MDAS between before and immediately after extraction (p=0.02), and between immediately after and 7 days after extraction (p=<0.001). The DFS also differed between before and immediately after extraction (p=0.002), and between immediately and 7 days after extraction (p<0.001). Dental anxiety immediately after tooth extraction may be influenced by operative techniques (type of anaesthesia, duration of operation, or position of tooth extracted), but anxiety at 7 days after extraction is not., (Copyright © 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

The aim of this study was to investigate the correlation between dental anxiety, salivary cortisol, and salivary alpha amylase (sAA) levels. Furthermore, the aim was to look into individual differences such as age, race, gender, any existing pain, or traumatic dental experience and their effect on dental anxiety. This study followed a cross-sectional design and included a convenience sample of 46. Every patient was asked to complete the Dental Anxiety Scale (DAS) and a basic demographic/dental history questionnaire. A saliva sample, utilizing the method of passive drooling, was then collected in 2-mL cryovials. Samples were analyzed for salivary cortisol and sAA levels by Salimetrics. Significant associations were observed between DAS scores and presence of pain and history of traumatic dental experience. However, no significant correlations were observed between DAS, cortisol, and sAA levels. Our study reconfirms that dental anxiety is associated with presence of pain and a history of traumatic dental experience. On the other hand, our study was the first to our knowledge to test the correlation between the DAS and sAA; nevertheless, our results failed to show any significant correlation between dental anxiety, cortisol, and sAA levels.

Dental surgery generally causes stress and fear, which may affect patient physiology and increase perioperative anxiety. Dental anxiety is considered to be an important factor in determining the need for intravenous sedation. One of the gold standards for measuring preoperative anxiety is Spielberger's State-Trait Anxiety Inventory (STAI). The authors have previously assessed preoperative anxiety using STAI and recommended that intravenous sedation be performed for patients whose anxiety level is high. The intravenous cannulation necessary for sedation and sedation itself may increase anxiety. The authors carried out this study to examine whether planning intravenous sedation before surgery increases preoperative anxiety. The subjects were patients who planned to undergo wisdom teeth extraction under local anaesthesia in the authors' hospital. They were divided into two groups on the basis of the planned intravenous sedation. STAI scores were compared between the initial visit and just before surgery. There were no significant differences in the state and trait anxiety scores between the initial visit and the day of the surgery in the two groups. Planned intravenous sedation based on the evaluation of anxiety levels using STAI is effective for promoting a safe operation without aggravating preoperative anxiety., (Copyright © 2012 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Purpose: Psychosomatic indicators, such as heart rate (HR), salivary alpha amylase (sAA) activity, and behavior, can be used to determine stress. This study's aim was to assess the pattern of changes of salivary alpha amylase, heart rate, and cooperative behavior in previously naïve children receiving dental treatment under local anesthesia., Methods: Included were 30 children with no prior dental experience who needed 4 or more sessions of dental treatment involving local anesthesia. In each session, sAA, HR, and behavior were assessed before and during the application of local anesthesia and at the end of the treatment., Results: The highest sAA value was always observed at the end of each session; overall, the value was lower in the fourth session. HR always increased during the local anesthesia, and did not vary across sessions. No significant relationship was found between child cooperation and either sAA or HR., Conclusion: In this sample, child cooperation may not be an accurate indicator of stress. Based on salivary alpha amylase activity changes, dental treatment involving local anesthesia in naïve children appeared to be less stressful after 3 sessions.

Background: There are limited data on pain perception after periodontal or implant surgery or how pain perception is affected by presurgical anxiety., Methods: Presurgical anxiety and surgical pain perceptions were measured by visual analog scale (VAS) scores and by interview of patients (N = 102) undergoing periodontal or implant therapy in a private periodontal specialty practice in Norway., Results: Patients reported that bad taste, receiving the local anesthetic, and excessive fluid in the mouth were the most uncomfortable experiences associated with periodontal or implant surgery. Analysis of identical responses to these questions showed that there was low intrapatient agreement for uncomfortable experiences (κ = 0.18), but there was reasonably good agreement for comfortable experiences (κ = 0.76). There were no significant differences between repeated VAS scores for pain perception (P = 0.91) or anxiety (P = 0.75) from two consecutive surgeries. There were no significant differences of VAS scores for perception of discomfort for periodontal surgery (9.9 ± 17.0) compared to implant surgery (16.7 ± 24.2; P >0.2). Presurgical anxiety scores were higher for implant surgery (45.5 ± 33.4) than for periodontal surgery (19.5 ± 28.1; P <0.01). Patients with high pretreatment anxiety scores reported that periodontal and implant surgery were more uncomfortable than patients with low anxiety scores (20.5 ± 25.6 versus 0.45 ± 1; P <0.001). VAS perception and anxiety scores did not change on first-time through fourth-time surgeries, but retreatment surgery patients recorded higher perception and anxiety VAS scores than patients undergoing surgery for the third or fourth time (P <0.01). Females recorded significantly higher anxiety scores than males (P = 0.04)., Conclusion: For periodontal surgery and implant treatments pain perception is affected by the level of presurgical anxiety.

Aim:   To investigate the possible influence of gender and anaesthesia type on anxiety prior to day surgery., Background:   Elective surgery undertaken on a day, short stay or 'day of surgery' basis is growing and much emphasis also placed on 'enhanced recovery' for in-patient surgery. During such brief episodes preoperative apprehension can be considerable but the opportunity to help reduce anxiety is minimal and formal plans uncommon., Method:   As part of a larger study, a questionnaire was distributed to 1606 patients undergoing day surgery, with anaesthesia (2005-2007). Participants were requested to return the questionnaire by mail 24-48 hours following surgery, with 674 returned. Data were analysed using descriptive statistics and multivariate analysis of variance., Results:   Of the total patients 82·4% experienced anxiety on the day of surgery with the wait, anaesthesia and possible pain being common anxiety-provoking aspects. The majority preferred to receive information between 1-4 weeks in advance and participants experiencing general anaesthesia required information at a statistically significantly earlier stage. General anaesthesia patients were statistically significantly more anxious than local anaesthesia patients and desired more information. Female patients were statistically significantly more anxious, anxiety commenced earlier and they preferred to wait with a relative/friend or talk with other patients., Conclusions:   Anxiety was experienced by the majority of participants but was more prevalent amongst general anaesthesia and female patients. For general anaesthesia patients, a comprehensive level of information may be required a number of weeks prior to surgery and gender differences associated with the preoperative wait may require greater consideration., (© 2011 Blackwell Publishing Ltd.)

Introduction: With local or regional anaesthesia being employed for more as well as more complex surgical procedures, an increasing number of patients remain fully conscious during their operation. This is generally perceived as being advantageous to the patient as less time is spent in hospital and the side effects of general anaesthesia are avoided. However, there is no direct measure of the patient experience during 'awake surgery', in particular of which aspects of the process may be distressing., Methods: Seventy patients undergoing day case plastic surgery under local anaesthesia were asked to complete a short questionnaire immediately following their operation. This was designed to identify specific factors likely to either increase or reduce anxiety during surgery. The questionnaire was initially validated on a pilot group of ten patients., Results: Unsurprisingly, painful stimuli such as injections were identified as potential stressors. More interestingly, the data highlighted that some commonly used surgical terms such as 'knife' and 'scalpel' provoke considerable anxiety in the conscious patient. This varied according to age and sex with younger and female patients being most vulnerable. Other events identified as potential stressors, such as casual conversations and movements among theatre staff, were actually shown to be non-stressful and, in some cases, stress relieving., Conclusions: Technical jargon used by surgical staff can elevate anxiety levels among patients who are awake for their operation. Careful consideration of the words we use may reduce this, particularly in female patients.

Aim: This paper is a report of a study that aimed to understand the individual's experience of day surgery for repair of vitreo-retinal pathology., Background: Day surgery evolved as a global phenomenon in response to tensions existing between community demand for health-care services and fiscal limitations. Since then vitreo-retinal surgery has been routinely performed as day surgery. Whilst studies have reported on patients' experience's following inpatient surgery, there has been limited investigation of vitreo-retinal day surgery from the patient's perspective., Methods: In-depth unstructured interviews with 18 people were conducted between July 2006 and December 2007. Data analysis using philosophical hermeneutic techniques enabled a co-constructed understanding, where, the 'conditions of understanding' as described by Gadamer were established., Findings: Guided by a Gadamerian approach to analysis, four constitutive themes were identified: 'the physical Self', 'the psychological Self', 'the historically located Self' and 'the Self located in the community'. Within each theme the participant's positive and negative experiences were understood in the context of human need, and gaps in nursing care became illuminated. These experiences included: pain, nausea, problematic self-care and psychological angst., Conclusion: Insights into the experience of vitreo-retinal day surgery, gained from this study can be used to inform nurses planning care for people with vitreo-retinal pathology. Nursing care must address broader patient needs that span multiple human domains, particularly when vision has been threatened by complex pathology., (© 2011 Blackwell Publishing Ltd.)

Fears of dental injections remain a clinical problem often requiring cognitive behavioural psychology counselling and sedation in order to carry out needed dental treatment. This study, based on a national survey in Australia, compared patient concerns about numbness caused by local anaesthesia and fears of the injection itself. It also examined associations between dental fearfulness and avoidance associated with patient self-reported negative experiences and treatment need. Clinical advice on how to approach such patients is offered. Relatively high levels of dental anxiety and fear have been reported in several industrialised Western societies (McGrath & Bedi, 2004; Armfield, Spencer & Stewart, 2006; Lahti et al., 2007; Enkling, Marwinski Jöhren, 2006). In the U.K., almost one in three adults consider themselves to always be anxious about going to the dentist (Nuttall et al., 2001). Of concern is that this dental fear may be passed on to the children of anxious adults (Nuttall, Gilbert & Morris, 2008), leading to an inter-generational perpetuation of the problem. There is considerable evidence that dental fear is related to poorer oral health, reduced dental attendance and increased treatment stress for the attending dentist. There are many aspects of going to a dentist that might elicit feelings of apprehension, concern or anxiety in prospective patients (Liddell & Gosse, 1998; Oosterink, de Jongh & Aartman, 2008). One of the most commonly reported concerns relates to receiving injections. Indeed, fear of needles and the treatment of injection fear has been an important focus of a research in the U.K. (Boyle, Newton & Milgrom, 2010). Needle fear, in particular, is a major issue given that the delivery of local anaesthesia via injection is the central plank of pain relief techniques in dentistry (Malamed, 2009) and dentists as well as patients often avoid difficult injections as a consequence, resulting in poor pain control. A less well described anxiety of receiving dental treatment is fear of numbness associated with the dental injection (Morse & Cohen, 1983). Certainly, many dentists believe that their patients avoid local anaesthesia because of a wish to avoid the disturbing effects of numbness (Moore et al., 1998). Milgrom et al. (1997) found that fears about the numbness associated with receiving local anaesthesia significantly differentiated avoiders and non-avoiders of dental treatment. However, these concerns appeared to be much less common than those concerning the perceived pain of injections and fear of bodily injury resulting from the injection (Milgrom et al., 1997; Kaako et al., 1998). Consistent with these findings, whereas 43% of English patients asked to imagine undergoing future third molar surgery expressed concerns primarily about pain, only 6% of patients indicated concern about numbness as their worst fear (Earl, 1994). More recently, a study of Dutch people found that the feeling of numbness from the anaesthesia was rated as the 41st most feared dental stimulus out of a list of 67 possible stimuli, and that only 1.5% of the general population regarded numbness as extremely anxiety provoking (Oosterink, de Jongh & Aartman, 2008). However, it is important for a clinician to differentiate between those who dislike the sensation of temporary numbness versus those who may worry that it may never wear off. Such problem thinking can be an issue irrespective of whether a patient overcomes the fear of needles with sedation or not. A large number of patients dislike the sensation of numbness enough for manufacturers to respond with a partial antidote in alpha adrenergic receptor antagonist phentolamine mesylate (OraVerse Sanofi-Aventis, Hersh & Lindemeyer, 2010). Approval of this agent, which shortens the length of soft tissue anaesthesia after inferior alveolar block, is pending in the UK and other European countries. In other cases, dentists resort to using local anaesthetics without vasoconstrictors to shorten the period of anaesthesia (Fiset, Getz, Milgrom & Weinstein, 1989). While the association between dental fear and fear of injections has received considerable attention, the relationship between dental fear and numbness has received less attention. In particular, the nature of the associations between dental fear and avoidance and anxiety over numbness has not been studied. There has also been no research into whether or not concerns over numbness are independent of injection concerns. Finally, the association between fear of numbness and injections and dental avoidance and treatment needs has not been investigated. This study, based on survey work in Australia, aimed to compare patient concerns about numbness caused by receiving anaesthesia to that of anxiety over the receipt of needles and injections. Associations with dental fear and avoidance as well as negative experiences and treatment needs were also explored.

The management of a child who requires a medical procedure is a challenging issue for the oral and maxillofacial surgeon (OMS) and practitioners in the dental specialties. The office of the OMS is traditionally one in which short outpatient procedures are performed within brief appointment times often using only local anesthesia. For typical children, this brief procedure may be difficult, and for children with behavioral challenges, it may be impossible without the use of behavioral management techniques or pharmacologic modalities. Practitioners must be aware of current trends in pediatric mental health and should develop treatment protocols to avoid complications., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Aim: The research regards information on anesthesia to patients undergoing oral surgery. Every patient evaluated the information received at the end of the preoperative visit and in the postoperative period., Methods: One hundred-fifty dental patients were asked about the most appreciated information received in the preoperative visit on the anxiolytic technique, local anesthesia and treatment of the perioperative pain. Afterwards the patients had to report on their reaction to the content of the preoperative visit and information quality. On a phone interview they had to evaluate their appreciation of the anxiolytic technique, their perception during loco-regional anesthesia and incidence of pain and edema., Results: The most appreciated details were those on the intervention, pharmacologic treatment, postoperative complicances, postoperative pain and operative competence; less appreciated were those on loco-regional anesthesia, duration of the intervention, anxiolytic techniques, hospital reception and permanence in the hospital. Ninety-eight percent of the patients considered to have been adequately informed on a context judged to be extraordinary (99.3%), 96.6% indicated the information as necessary, 98.6% appreciated the treatment of the intraoperative and postoperative (99.3%) pain and 99.3% the anxiolytic treatment. On the telephone interview, 100% of patients expressed satisfaction for the experienced intraoperative tranquillity, 91.3% complained for not having received in the past a similar preoperative visit, 99.3% wished a diffused application of the information. The loco-regional anesthesia was associated to psychological detachment in 84% of the cases and the incidence of postoperative pain was of 36%., Conclusion: The information on the anxiolytic techniques, loco-regional anesthesia, treatment of perioperative pain and postoperative distress was enthusiastically accepted and albeit initially induced feelings of astonishment resulted to be appreciated and preferred in the whole of the patients.

Aim: The purpose of the current study was to assess whether an unsweetened ice-popsicle imparts a positive feeling to children after dental treatment in which local anaesthesia is administered, and whether it reduces the tendency of children to self-mutilate (bite the lip, cheek or tongue) after the administration of local anaesthesia., Design: Crossover study of 31 children aged 4-11 years old who needed similar dental treatments on both sides of the mandible or maxilla under local anaesthesia. At the end of each appointment the child received a toy or an ice-popsicle especially made for this study. Patients and parents answered a questionnaire regarding the children's behaviour and feeling immediately after the treatment, and 10 and 30 min after receiving the ice-popsicle or toy., Results: Children who received ice-popsicles after dental treatment under local anaesthesia felt less discomfort and suffered less soft tissue trauma than they did when they received a toy. Reduction in soft tissue trauma was evident 10 min after receiving the ice-popsicles., Conclusion: Licking of an ice-popsicle after dental treatment with local anaesthesia reduces the feeling of discomfort and the biting of soft tissue and self- mutilation.

Needleless devices have been developed to provide anesthesia without injections. Little controlled research has examined the acceptability of needleless devices in pediatric patients. The aims of the study were to compare children's acceptance and preference for one type of needleless jet injection with classical local infiltration as well as to evaluate the efficacy of the needleless anesthesia. Eighty-seven nonfearful children with no previous experience of dental anesthesia were studied using a split-mouth design. The first dental procedure was performed with the classical infiltration anesthesia. The same amount of anesthetic was administered using the INJEX needleless device in a second session 1 week later, during which a second dental procedure was performed. Patients rated their acceptance and preference for the 2 methods, and the dentist recorded data about the need for additional anesthesia. More negative experiences were reported for the INJEX method. Most (73.6%) of the children preferred the traditional method. Among the 87 treatment procedures attempted following the use of INJEX, 80.5% required additional anesthesia, compared with 2.3% of those attempted following traditional infiltration. Traditional infiltration was more effective, acceptable, and preferred, compared with the needleless INJEX.

We report an observational prospective study to determine which local anaesthetic technique gave the most comfort during phacoemulsification (cataract) surgery. 1835 patients were recruited. 61.8% were female. Peribulbar (18.2%), subtenons (28.6%), and topical (53.2%) anaesthesia was used. The pain score was assessed by the visual analogue pain scale (VAPS) which ranged from 0 (no pain) to 10 (worse possible pain). The lowest mean pain score occurred in the subtenons group, mean VAPS 0.2 (95% CI 0.1-0.3). The mean pain scores for topical and peribulbar anaesthesia were 0.6 (95% CI 0.5-0.7) and 0.59 (95% CI 0.41-0.76) respectively. Subtenons anaesthesia gave the most comfort during phacoemulsification. Patients experienced more discomfort with 2nd eye surgery. Older patients and males had a higher pain threshold in all three anaesthetic groups.

Objective: Defining the place of regional anaesthesia (RA) for facial wounds in an emergency department., Study Design: Prospective observational study conducted in the emergency department of a regional hospital., Patients and Methods: Two hundred and forty-six successive patients with one or more facial wounds were included from 1st august 2004 to 31st december 2004. Data on patient, operator, wound (measured by the number of stitches), anaesthetic method (RA, local anaesthesia [LA], or no anaesthesia), method of repairing skin, duration of intervention, operator comfort (verbal numeric scale [VNS] from 0 to 10) and pain felt by the patient (visual analogic scale [VAS] from 0 to 10) in the different stages of care were collected., Results: Compared to the LA, the RA of the face decreased the number of punctures (1.36 vs 4.38 punctures, p<0.001) and the quantity of local anaesthetic injected (2.8 ml vs 5.3 ml, p<0.01) for wounds requiring more than 10 stitches. It has improved operator comfort (VNS = 10 [8-10] vs 8 [6.75-10] (p<0.01)). Its effectiveness during skin repair was equivalent to that of the LA by infiltration (VAS 0 [0-1] vs 0 [0-1])., Conclusion: When practicable, the RA of the face is a better technique than the LA for facial wounds treatment., (Copyright 2009 Elsevier Masson SAS. All rights reserved.)

Conclusion: Retroauricular tympanoplasty and tympanomastoidectomy under local anesthesia with sedation can be well tolerated by the patient, with minimum discomfort., Objectives: To evaluate patient discomfort from pain, body/neck position, noise, and anxiety during tympanoplasties and mastoidectomies performed under local anesthesia with sedation., Patients and Methods: This was a prospective study of 83 surgeries in 62 patients (28 type I tympanoplasties, 12 tympanoplasties with ossicular reconstruction, 40 canal wall up mastoidectomies, and 3 revision tympanoplasties). Local infiltration used lidocaine 2% with 1:100 000 epinephrine infiltrated in the retroauricular area and from below the pinna in a 'V' pattern. Sedation was achieved with 50 mg of intramuscular promethazine 1 h before surgery and intravenous midazolam (0.03 mg/kg) at the beginning of surgery. Subsequent doses of midazolam were given to maintain adequate sedation, up to 10 mg. The discomfort during surgery was assessed by the patient with a score from 0 to 4 (0 = no discomfort and 4 = extreme discomfort)., Results: Discomfort due to pain had a mean score of 0.83. Noise discomfort (from drilling and manipulation of instruments) had the lowest mean score (0.70), and discomfort from body and neck position had the highest mean score (1.51).

This research considers whether fear of dental treatment among children is linked with a prior (negative) experience with local anaesthesia or with psychological functioning. Furthermore, the study investigated whether these factors play a role in anxious behaviour before and during a local anaesthetic injection. In this study 128 children between the ages of 4 and 11 took part. With the help of video recordings, the anxious behaviour before and during the local anaesthetic injection was scored using the Venham-scale. During the treatment one of the child's parents or guardians was asked if the child had previously been given a local anaesthetic injection (experience). The fear of dental treatment and the child's psychological functioning were measured using the parents' version of the 'Dental Subscale' of the 'Children's Fear Survey Schedule' and the 'Strengths and Difficulties Questionnaire' respectively. Results showed a correlation between on one hand fear of dental treatment and on the other hand anxious behaviour before and during a local anaesthetic injection and psychological functioning. Furthermore, results indicated that children with fear of dental treatment exhibited more fearful behaviour before and during an injection with local anaesthetic. Only in the case of children whose psychological functioning was reduced there was a significant relationship between experience with local anaesthesia and fearful behaviour prior to the injection of a local anaesthetic.

This study aimed to determine the level of dental anxiety before different dental care procedures. A group of 116 adults presenting for the first time at a French dental hospital were included in the study. These patients completed a French-language version of Corah's Dental Anxiety Scale 1 and used a visual analogue scale to score their perception of the level of difficulty generated by 13 different dental treatments. The acts perceived as the most difficult to face were root canal and restorative treatment without local anaesthesia (LA), followed by oral surgery. There was a positive correlation between DAS score and level of difficulty experienced during dental treatment. Healthy subjects declared difficulty in coping with dental care. Dental procedures may be a factor of co morbidity in terms of the psychological status of dental patients. A classification of dental procedures is given according to the level of difficulty generated.

Aims: This paper is a report of a study: (i) to investigate anxiety arising from the experience of the clinical environment during surgery under local/regional anaesthesia and (ii) to uncover the specific aspects patients find anxiety provoking and possibly dissuade them from opting for such anaesthesia., Background: Operating theatre staff have focused historically on conducting safe, efficient surgery with unconscious patients and not primarily on the care of 'awake' patients. However, with the rise in day surgery, the volume of surgery performed under local or regional anaesthesia is increasing., Method: As part of a larger study investigating anxiety in elective day surgery, a questionnaire was given to 523 patients on the day of surgery to adult patients undergoing surgery with local or regional anaesthesia between 2005 and 2007. They were asked to return this by mail 24-48 hours following surgery and 214 completed questionnaires were returned (response rate 41%)., Findings: The experience of being awake, possibly feeling the surgeon's touch, seeing their body cut open or surgery being more painful than expected were anxiety-provoking aspects. Using factor analysis, 'intra-operative apprehension', 'anaesthetic information provision' and 'health control' were identified as central features. Multiple regression showed that apprehension associated with the intra-operative experience and anaesthetic information provision were statistically significantly associated with an increase in overall level of anxiety., Conclusion: Focusing care on managing the intra-operative experience and providing anaesthetic information in advance might help limit anxiety and expel the apparent misapprehensions associated with conscious surgery.

Background: Day-care open haemorrhoidectomy under local anaesthesia (LH) may be the most cost-effective approach to haemorrhoidectomy. This prospective randomized trial compared outcome after LH from patients' and clinical perspectives with that after day-care open haemorrhoidectomy under general anaesthesia (GH)., Methods: Forty-one patients with third-degree haemorrhoids were randomized to LH (19) or GH (22). Patient demographics were comparable. A single haemorrhoid was excised in 15 patients, and two and three haemorrhoids in 13 each. Independent nurse-led assessment and clinical evaluation were carried out for 6 months. Outcome measures were mean and expected pain scores at 30, 60 and 90 min, then daily for 10 days, and satisfaction scores at 10 days, 6 weeks and 6 months. Secondary outcomes were journey time within the day-surgery unit and overall cost., Results: Pain was worse following LH than GH at 90 min after surgery (P = 0.028), but pain scores on reaching home were similar. Maximum pain was experienced on day 3 after LH and on day 6 after GH. From day 1 onwards, daily pain scores were lower in the LH group, and there was a significant difference on day 8 (mean (95 per cent confidence interval) 3.61 (2.74 to 4.48) for LH versus 5.29 (4.12 to 6.45) for GH; P = 0.027). Mean pain over 10 days, expectation and satisfaction scores were similar in the two groups. LH had a shorter journey time and was less expensive than GH., Conclusion: LH has similar tolerance and clinical outcome to GH, and is associated with a shorter journey time and lower cost., Registration Number: NCT00503269 (http://www.clinicaltrials.gov)., (2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.)

Aim: In this study the relationship between the levels of dental anxiety, psychological functioning and earlier experience with dental injections are examined and the possible influence of these factors on children's behaviour before and during a local anaesthesia injection., Methods: A total of 128 children (4-11 years) were included. The level of dental anxiety and the psychological functioning were measured using the 'Children's Fear Survey Schedule' (CFSS-DS) and the 'Strengths and Difficulties Questionnaire' (SDQ). Based on video recordings the anxiety behaviour was scored on the Venham-scale., Results: There was a positive correlation between levels of dental anxiety, psychological functioning and anxiety behaviour before and during the dental injection. In particular children with emotional problems or peer problems tended to show more anxiety behaviour before the injection and children with emotional or hyperactivity problems tend to show more anxiety behaviour during the injection. Furthermore, the younger children (below 6 years of age), with previous dental experience in the past 6 months, tended to display more anxiety behaviour both before and during the injection than children without or with experience from longer ago., Conclusion: The level of dental anxiety and psychological functioning and recent previous dental experience are important factors in determining which child is likely to display more anxiety and uncooperative behaviour during treatment and therefore potentially need more attention to be able to cope well with dental treatment.

Objective: To determine women's preference towards Thermachoice being performed either awake in the outpatient setting or under general anaesthetic (GA) as a day case., Design: Questionnaire. Setting Large teaching hospital., Population: One hundred women., Methods: The questionnaire was developed from prior research on factors associated with preference for procedures performed in the outpatient versus day case setting., Main Outcome Measures: (1) Describe women's preference towards outpatient versus day case Thermachoice and other menorrhagia treatments. (2) Identify variations in preference by demographic characteristics and prior experience of anaesthesia. Results There was an exact split in preference with 50% preferring Thermachoice as an outpatient and 50% as a day case. The mean age of women preferring outpatient Thermachoice was significantly higher (41.5 years) than those preferring day case (33.5 years) (P < 0.005). Women with children and a higher qualification were more likely to opt for outpatient Thermachoice. A previous bad experience of GA was associated with preference for outpatient Thermachoice. Spending less time in hospital, attending for one visit, feeling well straight after treatment and choosing the treatment setting were important factors to the majority of women. Most women (70%) who opted for Thermachoice as a menorrhagia treatment would prefer to have it performed in the outpatient setting., Conclusions: If the Department of Heath is to target services towards women's choice, there is a need to increase the provision of outpatient menorrhagia treatments, such as Thermachoice, to more women in the UK.

This paper will discuss the various techniques used for the instillation of local anaesthetics (LA) during intraocular (10) cataract extraction. It will be limited to a comparison of peribulbar block, sub-Tenons block and topical plus intracameral anaesthesia alone, as these are those most frequently used at the author's place of work. It will focus on both the surgeons' preferences and the patients' perceptions and comfort pre-, peri- and postoperatively. A description of each technique and the drugs available will be followed with a discussion of the patients' perceptions and pain levels. Included will be a summary of the patients' anxiety levels and the benefits of any sedation. Throughout, general and specific complications will be debated. All will be supported by current, relevant literature.

To assess factors influencing perception of pain, anxiety and overall satisfaction during local anaesthetic cataract surgery an audit was carried out at the West of England Eye Unit. Patients receiving sub-Tenons after previous peribulbar anaesthesia had significantly higher pain scores. Patient satisfaction was significantly higher when a handholder was present in theatre. Finally, no difference was found in the three variables whether anaesthesia was administered by an anaesthetic practitioner or an anaesthetist.

Twenty-three children, (6-11 years, 9 boys and 14 girls), admitted to a pediatric day care department for a planned diagnostic procedure were interviewed with the aim of investigating their level of knowledge regarding a current diagnostic procedure, and the level of participation in discussions and decision making relating to their hospitalization. While the children were being interviewed, their attendant parent completed a questionnaire. The children's level of knowledge was documented and graded. The children's statements and their parents' evaluation of the information given to the child were sorted into groups and compared. The children's descriptions of their participation in discussions and decision-making were assessed and summarized. Finally, the children's and their parents' experiences of the children's anxiety and fear before the hospital visit were compared. The children were undergoing different kinds of diagnostic procedures and they had received information from different people. They were prepared for their admission in different ways, and had participated in discussions and decisions to various degrees. Despite this preparation, it would be safe to state that the participants as a group were not very well informed nor did they participate fully. More knowledge is needed regarding how to prepare each child prior to admission, before, during, and after the hospital visit and which additional factors, e.g., trust and a familiar environment, have influence on the child's experience.

Aims and Objectives: The aim of this study was to show what the experience of local anaesthesia and a surgical situation meant to patients., Background: Many patients who receive local anaesthesia will remain awake during surgery. The very fact of staying awake causes psychological and psychosocial needs. These needs must be met and it is therefore important to identify them., Design/method: Seven patients (aged 61-79) experiencing local anaesthesia and hip surgery (hip replacement surgery or repair of fractured hip) were interviewed. An interpretive phenomenological method developed by Benner was used to extract the experience of what it means to be in local anaesthesia and surgery. One paradigm case is used to illustrate the results., Results: Results show that the well-being and comfort of patients is compromised by challenges such as severe pain and long waits, which may be experienced as endless and which leave the patient thinking of nothing else. By contrast, the experience of trust helps the patient to feel control even in situations where the treatment is hard to grasp., Conclusions: The results highlight that local anaesthesia and surgery force patients to overcome and handle experiences of pain, trust and distrust as well as feelings of alienation and unreality., Relevance to Clinical Practice: The results illustrate the patient's needs, as seen from the patient's perspective. A shared experience makes it possible to understand, and thus to recognize, the required qualitative care to facilitate and to help the patient to remain in control and face the psychological challenges presented by anaesthesia care and surgical situations.

The purpose of the study was to assess how children felt after dental treatment when receiving apopsicle or a toy Each patient received either a popsicle or a toy after dental treatment on the first visit, and the other on the second visit. A significant difference (p = 0.0235) was found 10 minutes and thereafter 30 minutes after dental treatment. More children reported feeling better when they received a popsicle than when they received a toy.

The aim was to evaluate the practice of hiding the needle prior to dental anesthesia administration to children. Fourteen 5 and 6 year olds received dental treatment in two sessions. The needle was shown in one session and hidden in the other. Eleven children were cooperative and 3 uncooperative irrespective of approach. The children's behavior correlated with fears expressed by the mothers. Our initial fndintgs do not support the practice of hiding the needle.

The aim of the present study was to evaluate the prevalence of self-reported problems (fear, pain, unpleasantness, fainting) of dental and medical injections, and the extent to which such problems may lead to avoidance of necessary treatment. The study included a representative sample (n = 1385) of 18-yr-old students attending high schools in the county of Hordaland, Norway. Data were collected by use of questionnaires completed in the classrooms. More problems were reported during dental than medical injections. About 17% and 15% of participants reported high fear during their last dental and medical injection, respectively. Fainting had been experienced by 2% during a dental injection and by 7% during a medical injection. Avoidance of treatment when an injection is needed was 6.7% for dental treatment and 5.2% for medical treatment. In multiple regression analyses, fear was the only explanatory factor for the avoidance of dental treatment. It is concluded that self-reported problems of injections are prevalent in this age group, particularly among girls, and that it may lead to the avoidance of necessary treatment in 5-7% of the adolescent population.

This study compared the level of distress in children during the application of local anaesthesia by a computerized tool (Wand) and by a traditional syringe. The influence of children's mild or extreme anxiety regarding the dental procedure was also determined. 125 children between the ages of 4 and 11 years old participated in this study. Their discomfort was recorded on videotape and marked on the Venham scale and the Observational Scale of Behavioral Distress at 15 second intervals. Parents rated their child's level of anxiety on the Dental Subscale of the Children's Fear Survey Schedule. The results indicate that mildly anxious children suffered less distress and showed less muscle tension, verbal protest and body movement during the first 2 intervals when the computerized tool was used. However, the maximum distress score at the moment of injection was similar in both methods. There was no difference found in the level of distress in the highly anxious children.