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Background: Dermatosurgery is one of the fastest expanding subspecialty of dermatology. Local anesthetic agents play an important role in these procedures. Materials and Methods: This was a prospective, interventional study that included eighty patients with forty patients in each group (groups A and B). Group A: Topical 2.5% lignocaine and 2.5% prilocaine cream. Group B: Infiltration of 2% lignocaine Injection. Patients satisfying the inclusion criteria were recruited for the study. The patients were asked to rate pain perception at the time of drug administration and, then, during and after the surgical procedure using a visual, analogue scale separately. Results: In our study, the most common age group at presentation was 21-40 years. Males constituted 57.8%, whereas females constituted 42.2%. The common procedures performed in our study were electrocautery 33.3%, intralesional steroid 18.9%, and intralesional PRP 15.7%. In the topical EMLA cream group, the VAS score during drug administration was 0. In the lignocaine infiltration group, 70% were found to have VAS a score of 4-6, and 30% had a VAS score of 1-3, preprocedurally. The mean VAS score during the procedure was 3.36 for the topical EMLA cream group and 1.33 for the lignocaine infiltration group. The post-procedural VAS score showed similar results as the procedural VAS score. Conclusion: The results of our study showed that topical EMLA cream is a better choice of anesthesia in superficial aesthetic and dermatosurgical procedures in providing adequate analgesia. [ABSTRACT FROM AUTHOR]

The laryngeal adductor reflex (LAR) is a brainstem reflex that closes the vocal fold and constitutes a new method for continuously monitoring the vagus and laryngeal nerves during different surgeries. Previous reports concluded that topical lidocaine in spray inhibited LAR responses. However, topical anesthesia in the upper airway may be necessary in awake intubation. We present six patients who underwent neck endocrine surgery due to an intrathoracic goiter that compromised the airway. Before awake intubation, a nebulization of lidocaine 5% was applied for at least 10 min. The intubation procedure was well tolerated, and bilateral LAR with suitable amplitudes for monitoring was obtained in all cases. In our series, the nebulization of lidocaine 5% did not affect the laryngeal adductor reflex. Laryngoscope, 134:4161–4164, 2024 [ABSTRACT FROM AUTHOR]

Cataract is the main cause of visual impairment and blindness worldwide while the only effective cure for cataract is still surgery. Consecutive phacoemulsification under topical anesthesia has been the routine procedure for cataract surgery. However, patients often grumbled that they felt more painful during the second-eye surgery compared to the first-eye surgery. The intraoperative pain experience has negative influence on satisfaction and willingness for second-eye cataract surgery of patients with bilateral cataracts. Intraoperative ocular pain is a complicated process induced by the nociceptors activation in the peripheral nervous system. Immunological, neuropsychological, and pharmacological factors work together in the enhancement of intraoperative pain. Accumulating published literatures have focused on the pain enhancement during the second-eye phacoemulsification surgeries. In this review, we searched PubMed database for articles associated with pain perception differences between consecutive cataract surgeries published up to Feb. 1, 2024. We summarized the recent research progress in mechanisms and interventions for pain perception enhancement in consecutive second-eye phacoemulsification cataract surgeries. This review aimed to provide novel insights into strategies for improving patients' intraoperative experience in second-eye cataract surgeries.

Abstract Background One of the main goals for pediatric dentists is to offer a painless anesthesia experience. Laser photobiomodulation is among the suggested strategies to decrease injection pain. So, this study aimed to assess the impact of laser photobiomodulation on local anesthesia (LA) injection pain in children and its effect on the efficacy of LA during pulpotomy and SSC procedures. Methods The research was carried out as a randomized controlled clinical trial with two parallel group design. It involved 64 cooperative healthy children, age range from 5 to 7 years, each having at least one maxillary molar indicated for pulpotomy. Children were randomly allocated to one of the two groups based on the pre-anesthetic tissue management technique used: test group received laser photobiomodulation, while control group received topical anesthetic gel. Pain during injection, pulpotomy, and SSC procedures was assessed using physiological measures (Heart Rate (HR)), subjective evaluation (modified Face-Pain‐Scale (FPS), and objective analysis (Sound‐Eye‐Motor scale (SEM)). Results A total of 64 children with mean age 6.23 ± 0.78 participated in this research. The mean HR scores were significantly lower in the laser PBM group during buccal and palatal infiltration injections. The SEM mean scores were significantly lower in the laser PBM group during both injections. For the FPS scale, the number of children who recorded satisfaction during injection was significantly higher in laser PBM group. There was no statistically significant difference in mean HR as well as in SEM and FPS scores between the two groups during pulpotomy and SSC procedures. Comparisons between the two study groups were performed using independent samples t- and Mann-Whitney U tests. Significance was set at p value

Background: One of the main goals for pediatric dentists is to offer a painless anesthesia experience. Laser photobiomodulation is among the suggested strategies to decrease injection pain. So, this study aimed to assess the impact of laser photobiomodulation on local anesthesia (LA) injection pain in children and its effect on the efficacy of LA during pulpotomy and SSC procedures. Methods: The research was carried out as a randomized controlled clinical trial with two parallel group design. It involved 64 cooperative healthy children, age range from 5 to 7 years, each having at least one maxillary molar indicated for pulpotomy. Children were randomly allocated to one of the two groups based on the pre-anesthetic tissue management technique used: test group received laser photobiomodulation, while control group received topical anesthetic gel. Pain during injection, pulpotomy, and SSC procedures was assessed using physiological measures (Heart Rate (HR)), subjective evaluation (modified Face-Pain‐Scale (FPS), and objective analysis (Sound‐Eye‐Motor scale (SEM)). Results: A total of 64 children with mean age 6.23 ± 0.78 participated in this research. The mean HR scores were significantly lower in the laser PBM group during buccal and palatal infiltration injections. The SEM mean scores were significantly lower in the laser PBM group during both injections. For the FPS scale, the number of children who recorded satisfaction during injection was significantly higher in laser PBM group. There was no statistically significant difference in mean HR as well as in SEM and FPS scores between the two groups during pulpotomy and SSC procedures. Comparisons between the two study groups were performed using independent samples t- and Mann-Whitney U tests. Significance was set at p value < 0.05. Conclusion: Laser photobiomodulation is a promising non-pharmacological pre-anesthetic tissue management technique in children that offered less painful injection compared to topical anesthetic gel without compromising the effectiveness of LA. Trial Registration: ClinicalTrials.gov Identifier: NCT05861154. Registered on 16/5/2023. [ABSTRACT FROM AUTHOR]

Background: Platelet-rich plasma injection (PRP) for hair loss is a widely accepted treatment modality at present. The most common problem with PRP is the pain that is associated with the procedure. The type of anesthesia is decided mostly based on preference rather than protocol. Aims and Objectives: The current study was undertaken to establish a standardized anesthetic protocol for PRP based on the response of the patients undergoing the treatment plan. Materials and Methods: The study included 60 patients who underwent four sittings of PRP at 1-month intervals for hair loss treatment. The modality of anesthesia was different during each of the sessions - topical anesthesia, vibration anesthesia, nerve block, and ring block. The order of anesthetic modality was different in each patient, to avoid bias. Responses by the patients for the following questions related to anesthetic pain during the procedure was recorded and analyzed based on the type of anesthetic procedure adopted. Results: Vibration anesthesia had the highest mean intra procedure numerical pain scale value. Nerve block was the least acceptable modality with maximal problems including the pain of the local anesthetic injection and the unsightly visible bulge in the supra orbital region. Post procedural pain was highest for vibration anesthesia and least for ring block. Highest acceptance was seen with the ring block technique. Conclusion: This is a preliminary study aimed at standardizing the anesthetic protocol for PRP. This modality of treatment involves multiple sittings with long total duration. Improving patient comfort with adequate anesthesia will improve compliance to a great extent.

Lidocaine is the most commonly used local anesthetic worldwide, known for its rapid onset and moderate duration of anesthesia. However, it is short-lived and does not effectively promote effective topical anesthesia in the oral cavity when used alone. Our aim was to investigate whether an approximate 50% encapsulation of lidocaine in poly(ε-caprolactone) nanocapsules (LDC-Nano) would be able to increase its permeation and analgesic efficacy and reduce cytotoxicity. In this study, we characterized LDC-Nano and conducted MTT tests with HaCaT cells to assess their in vitro cytotoxicity. Additionally, in vitro permeation assays across the pig esophageal epithelium and the anesthetic efficacy of the hind paw incision model in rats were performed. Plain lidocaine (LDC) was compared with LDC-Nano and lidocaine hydrochloride plus epinephrine (LDC-Epi). The physicochemical characteristics of LDC-Nano were satisfactory (pH: 8.1 ± 0.21; polydispersity index: 0.08 ± 0.01; mean diameter (nm): 557.8 ± 22.7; and encapsulation efficiency (%): 51.8 ± 1.87) and remained stable for up to 4 months. LDC-Nano presented similar in vitro cytotoxicity to LDC but was higher than LDC-Epi (LD50: LDC = 0.48%; LDC-Nano = 0.47%; and LDC-Epi = 0.58%; p < 0.0001). Encapsulation increased the permeability coefficient about 6.6 times and about 7.5 the steady-state flux of lidocaine across the mucosal epithelium. Both encapsulation and epinephrine improved anesthesia duration, with epinephrine demonstrating superior efficacy (100% of animals were anesthetized up to 100, 30, and 20 min when LDC-Epi, LDC-nano, and LDC were used, respectively). Although LDC-Epi demonstrated superior in vivo anesthetic efficacy, the in vitro permeation and cytotoxicity of LDC-Nano indicate promising avenues for future research, particularly in exploring its potential application as a topical anesthetic in the oral cavity. [ABSTRACT FROM AUTHOR]

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Background: Platelet-rich plasma injection (PRP) for hair loss is a widely accepted treatment modality at present. The most common problem with PRP is the pain that is associated with the procedure. The type of anesthesia is decided mostly based on preference rather than protocol. Aims and Objectives: The current study was undertaken to establish a standardized anesthetic protocol for PRP based on the response of the patients undergoing the treatment plan. Materials and Methods: The study included 60 patients who underwent four sittings of PRP at 1-month intervals for hair loss treatment. The modality of anesthesia was different during each of the sessions - topical anesthesia, vibration anesthesia, nerve block, and ring block. The order of anesthetic modality was different in each patient, to avoid bias. Responses by the patients for the following questions related to anesthetic pain during the procedure was recorded and analyzed based on the type of anesthetic procedure adopted. Results: Vibration anesthesia had the highest mean intra procedure numerical pain scale value. Nerve block was the least acceptable modality with maximal problems including the pain of the local anesthetic injection and the unsightly visible bulge in the supra orbital region. Post procedural pain was highest for vibration anesthesia and least for ring block. Highest acceptance was seen with the ring block technique. Conclusion: This is a preliminary study aimed at standardizing the anesthetic protocol for PRP. This modality of treatment involves multiple sittings with long total duration. Improving patient comfort with adequate anesthesia will improve compliance to a great extent. [ABSTRACT FROM AUTHOR]

Introduction: Nervous patients often postpone dental visits until they are in severe pain, exacerbating anxiety. Buccal patches provide a noninvasive method of delivering drugs between the upper gum and cheek, offering local and systemic effects. Prior research has demonstrated the effectiveness, safety, and reliability of topical lidocaine or articaine patches for oral anesthesia. Consequently, this study aimed to develop a three-layered buccal drug delivery system for topical anesthetics. Methods: The first step was preparing and optimizing lidocaine-loaded three-layer patches using Design-expert software. The effects of ethylcellulose, Eudragit, and carbopol concentrations were investigated on patch characteristics, including mucoadhesion, Young's modulus, and Elongation-at-break. Subsequently, patches were fabricated according to the optimized formulation determined by the software, and their efficacy was studied in a randomized, double-blind clinical trial. Participants received either lidocaine or articaine-loaded compared with placebo in a split-mouth study. They evaluated their pain levels using the Visual Analogue Scale (VAS), and the onset and duration of action were recorded for each treatment. Results: According to the results, increasing ethyl cellulose and Eudragit concentrations improved mucoadhesion force (p

Objective: To evaluate corneal sensitivity and acute side effects following application of ropivacaine hydrochloride 0.5% and lidocaine hydrochloride 2% on the healthy equine cornea. Animals Studied: Eight healthy adult horses. Procedure: A randomized, masked, crossover study design was utilized. Baseline Semiquantitative Preclinical Ocular Toxicology (SPOT) scores and corneal touch thresholds (CTT) using a Cochet‐Bonnet esthesiometer were recorded and measured, respectively, for eight healthy adult horses before medication application. Commercially available eyewash was used as a negative control. Ropivacaine hydrochloride 0.5% or lidocaine hydrochloride 2% solution was sprayed on a randomly selected eye, and the contralateral eye received eyewash. CTT was measured in both eyes at 1, 5, 15, 25, 35, 45, 55, 65, and 75 min post‐application. Post‐application SPOT scores were recorded immediately following the trial. Linear mixed model statistical analyses (mean ± standard error) were performed (p <.05). Results: Mean eyewash CTT (3.41 cm ± 0.464) was significantly different from ropivacaine‐treated (1.44 cm ± 0.562) (p =.008) and lidocaine‐treated eyes (1.75 cm ± 0.562) (p =.024); CTT was not significantly different between drug groups (p =.88). Time to maximum anesthesia was not significantly different between ropivacaine (13.25 min ± 3.353) and lidocaine (16.25 min ± 3.353) (p =.40). No side effects were appreciated as confirmed by SPOT. Conclusions: Ropivacaine and lidocaine similarly decreased corneal sensitivity when applied topically without clinically evident short‐term ocular side effects. Lidocaine may be preferable in clinical settings due to its large, multi‐use vials and similar effects to ropivacaine. [ABSTRACT FROM AUTHOR]

Lidocaine is the most commonly used local anesthetic worldwide, known for its rapid onset and moderate duration of anesthesia. However, it is short-lived and does not effectively promote effective topical anesthesia in the oral cavity when used alone. Our aim was to investigate whether an approximate 50% encapsulation of lidocaine in poly(ε-caprolactone) nanocapsules (LDC-Nano) would be able to increase its permeation and analgesic efficacy and reduce cytotoxicity. In this study, we characterized LDC-Nano and conducted MTT tests with HaCaT cells to assess their in vitro cytotoxicity. Additionally, in vitro permeation assays across the pig esophageal epithelium and the anesthetic efficacy of the hind paw incision model in rats were performed. Plain lidocaine (LDC) was compared with LDC-Nano and lidocaine hydrochloride plus epinephrine (LDC-Epi). The physicochemical characteristics of LDC-Nano were satisfactory (pH: 8.1 ± 0.21; polydispersity index: 0.08 ± 0.01; mean diameter (nm): 557.8 ± 22.7; and encapsulation efficiency (%): 51.8 ± 1.87) and remained stable for up to 4 months. LDC-Nano presented similar in vitro cytotoxicity to LDC but was higher than LDC-Epi (LD50: LDC = 0.48%; LDC-Nano = 0.47%; and LDC-Epi = 0.58%; p < 0.0001). Encapsulation increased the permeability coefficient about 6.6 times and about 7.5 the steady-state flux of lidocaine across the mucosal epithelium. Both encapsulation and epinephrine improved anesthesia duration, with epinephrine demonstrating superior efficacy (100% of animals were anesthetized up to 100, 30, and 20 min when LDC-Epi, LDC-nano, and LDC were used, respectively). Although LDC-Epi demonstrated superior in vivo anesthetic efficacy, the in vitro permeation and cytotoxicity of LDC-Nano indicate promising avenues for future research, particularly in exploring its potential application as a topical anesthetic in the oral cavity.

Background: Needle fear is one of the most common fears in dental treatment, thus, patients’ demand for topical anesthetics has been increasing significantly. Topical anesthetic has always been generally supported as a technique for decreasing anxiety and discomfort related to needle insertion and its important part in the atraumatic injection of local anesthesia. Objective: This study aims to investigate patients’ psychological and physiological aspects of topical anesthetics in reducing dental needle pain. Materials and Methods: The data were collected from patients attending the Dental University Hospital at King Saud University in Riyadh, Saudi Arabia. The targeted subjects were patients with no previous or current history of psychological impairment or prior history of pain disorder. Results: The most commonly perceived benefits of topical anesthesia were local numbness (50.1%) and relaxation (33.0%). Most of the participants had ever requested a topical anesthetic before injection. The most common reasons were anxiety and tension due to needle pain (53.2%) and previous experiences with injection-related pain (42.9%). Conclusion: This study showed that the topical anesthetic has a significant psychological impact on patient’s attitudes toward dental treatment with most patients demanding topical anesthetic before dental injections to reduce their level of anxiety and fear before dental injections. [ABSTRACT FROM AUTHOR]

Aim The purpose of this study was to describe and evaluate a novel one-person intravitreal injection (IVI) technique for the treatment of retinopathy of prematurity (ROP) under topical anesthesia. Patients and methods This is a retrospective study that was conducted on 44 babies who had IVI for the treatment of severe ROP under topical anesthesia. The swaddled baby’s head and body were fixed to the operating table with strips of adhesive tape, obviating the need for an assistant to hold the baby still. The calibers were used both to fix the globe and to determine the site of the injection by measuring the distance of 1.5 mm from the limbus. Results The mean gestational age of the patients was 29.6±1.5 weeks, with a mean birth weight of 1085.2±239.4 g. The mean procedure duration (between the insertion of the lid speculum at the beginning of the procedure and its removal at the end) for the right eye (64.9±15.6 s) was less than for the left eye (66.4±15.1 s), but the difference was not statistically significant (P=0.29). Inadvertent head movements occurred in 2 (4.5%) cases, with a large postmenstrual age of 37 and 38 weeks at treatment. None of the cases had inadvertent eye movements. Conclusion The technique seems safe and effective, especially in patients with a smaller postmenstrual age at the time of the injection. Additional care should be taken during taping of the head and the body in larger babies. Alternatively, giving sedation or general anesthesia may be a safer option.

Background: Ophthalmic surgery is a common procedure in pediatric populations, and anesthesia is used to ensure patient comfort and safety during the surgery. The aim of this study was to compare the efficacy and safety of topical anesthesia and peribulbar block as an adjuvant to general anesthesia in children undergoing ophthalmic surgery. Objectives: The study aimed to evaluate the differences in hemodynamic changes during surgery, pain relief during and after surgery, and the duration of postoperative pain relief between the two anesthesia techniques. It also aimed to examine the occurrence of ocular-cardiac reflex and changes in intraocular pressure. Methodology: A randomized control study was conducted with two groups, Group GA-PB, consisting of general anesthesia with peribulbar block, and Group GA-TA, consisting of general anesthesia with topical anesthesia. The study population consisted of 50 children aged 2 to 12 years. The primary outcome measures included differences in intraoperative hemodynamic changes, the need for pain relief during and after surgery, and the duration of postoperative pain relief. The secondary outcome measures included the occurrence of ocular-cardiac reflex, incidence of postoperative nausea and vomiting, and changes in intraocular pressure. Results: There was no significant difference in age and weight between the two groups. The mean preoperative and intraoperative intraocular pressure did not differ significantly between the two groups. The GA-PB group showed significantly lower heart rate during surgery and required less pain relief during and after surgery. The duration of postoperative pain relief was also longer in the GA-PB group. There were no significant differences in oxygen saturation, blood pressure, incidence of ocular-cardiac reflex, or changes in intraocular pressure between the two groups. Conclusion: The study concluded that peribulbar block as an adjuvant to general anesthesia was more effective in reducing pain during and after ophthalmic surgery in children. It also showed that peribulbar block did not have any adverse effects on hemodynamic changes, oxygen saturation, or intraocular pressure. Therefore, peribulbar block can be considered as a safe and effective option for anesthesia in pediatric ophthalmic surgeries. [ABSTRACT FROM AUTHOR]

This study investigated the effect of oral melatonin as a premedication before cataract surgery on pain score, anxiety, surgical conditions, and intraocular pressure (IOP) during cataract surgery with phacoemulsification under topical anesthesia. This randomized, double-blind prospective study was conducted among 120 patients aged 50 to 80. Patients were randomly assigned to receive either sublingual melatonin 3 mg or placebo 60 min before surgery. Verbal anxiety and pain scores, heart rate, systolic and diastolic blood pressure, intraocular pressure, and quality of surgical conditions were recorded. The results were analyzed using SPSS 23 software, and statistical analysis consisted of χ2 test and t-test, and a P value less than.05 was considered significant. There was a significant difference between the two groups regarding pain after the surgery before being discharged from the recovery room. The mean pain score in the melatonin group was lower than the placebo group in T4 (in the postoperative ward) (P <.05). The anxiety score of patients was lower in the melatonin group in T3 and T4 (during surgery and in the postoperative ward, respectively) (P <.05). IOP was significantly lower in the case group at the end of the surgery after receiving premedication (P =.021). This study showed that 3 mg Sublingual melatonin premedication for patients undergoing cataract surgery under topical anesthesia reduced patients' anxiety scores, pain score, and IOP. [ABSTRACT FROM AUTHOR]

Objective: Photodynamic therapy (PDT) is a minimally invasive method with strong tissue selectivity and nonthermal effects. We aim to investigate the efficacy of an in‐office method utilizing PDT with local application of 5‐aminolevulinic acid (ALA) and 635 nm diode laser for treating laryngeal leukoplakia. Study Design: Retrospective cohort study. Setting: Outpatient clinic‐tertiary medical center. Methods: This study reviewed 32 patients with laryngeal leukoplakia, including 11 recurrent cases after surgery. All the procedures were performed in an office setting under topical anesthesia. Fifteen percent ALA solution was locally applied to the lesion through a flexible laryngoscope. Light illumination was performed using a 635 nm diode laser through a 400 μm optic fiber. The power density was 165 mW/cm2 to reach 100 J/cm2. Results of laryngostroboscopy and voice evaluation during follow‐up were collected. Results: The mean follow‐up was 7.91 ± 4.83 (3‐18) months. Thirty‐nine procedures were performed, including 1 session for 27 patients, 2 sessions for 3 patients, and 3 sessions for 2 patients. The total response rate was 96.875% (31/32), including complete responses in 26 (81.25%) patients, partial responses in 5 patients (15.625%), and no response in 1 patient (3.125%). It appeared that PDT selectively eliminated the leukoplakia without affecting lamina propria and the surrounding normal mucosa remained unharmed. Scores of Voice Handicap Index‐10, jitter, shimmer, and harmonic‐to‐noise ratio were significantly improved after PDT. Conclusion: Office‐based PDT is an effective, repeatable, and practical method for treating laryngeal leukoplakia. Local application of ALA is sufficient to achieve photodynamic reactions. PDT could eliminate laryngeal leukoplakia selectively while protecting the normal laryngeal structure. [ABSTRACT FROM AUTHOR]

Background: Using split-thickness skin grafting to treat diabetic foot and leg ulcers is common. Diabetic patients usually exhibit multiple comorbidities and high risks of adverse responses to general and spinal anesthesia. Topical anesthesia can be an alternative to avoid these risks. In this study, the clinical experience of split-thickness skin grafting under topical anesthesia was demonstrated, to evaluate its effectiveness and benefits in diabetic patients. Methods: From 2018 to 2020, diabetic patients with foot or leg wounds undergoing split-thickness skin grafting were reviewed and categorized into two groups according to the anesthesia methods: topical anesthesia and general/spinal anesthesia. Patient demographics, wound characteristics and healing status, postoperative complications, and perioperative blood glucose levels were recorded and analyzed. Results: During the study period, 28 patients underwent split-thickness skin grafting under topical anesthesia and 46 under general/spinal anesthesia. The rate of complete wound healing in 4 weeks was similar in both the groups. The topical anesthesia group suffered fewer postoperative infections (3.6% vs 21.7%, p = 0.044), required shorter postoperative hospitalization (8.3 ± 6.2 vs 11.1 ± 7.2 days, p = 0.048), and exhibited lower mean blood glucose levels and less glucose variability than the general/spinal anesthesia group. Conclusion: Conducting split-thickness skin grafting under topical anesthesia was shown to be a safe and effective means of treating leg and foot wounds in diabetic patients. [ABSTRACT FROM AUTHOR]

Background: Even after the invention of the modern injection techniques, palatal injection still remains a painful experience for patients, and this pain is attributed to the presence of rich nerve complement and displacement of tightly adherent palatal mucosa during anesthesia. Aim: To check the clinical efficacy of EMLA as a topical anesthetic agent instead of palatal injection during maxillary dental extractions. Methodology: The trial includes a total of 102 participants, in whom maxillary molar extractions were indicated, were randomly divided into the experimental group (eutectic mixture of local anesthesia (EMLA) topical application was used along with buccal injection) and control group (palatal injection along with buccal injection). Pain perception during extraction was recorded using the visual analog scale (VAS). Results: Mean VAS score for 'injection' in control group patients was 5.2 ± 2.08 in contrast to no pain in experimental group. In experimental group, mean VAS score on 'probing' was 0.92 ± 1.50. VAS score on 'extraction' in EMLA group was little higher though the difference was not statistically significant. The overall experience using Liekert's scale was higher in experimental group (4.0 ± 0.76) as compared to (3.3 ± 0.82) in control group leading to higher overall satisfaction among patients who underwent extraction in the experimental group. Conclusion: EMLA application produced a satisfactory level of anesthesia in the palatal tissue when compared with the palatal injection. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to investigate the effect of liposomal and emulsion forms of topical anesthesia on pain reduction during dental anesthesia. Methods: The study was a randomized clinical trial with a split-mouth design conducted on 15 patients who were referred to a private dental clinic and needed injectable anesthesia for flap surgery in the posterior maxillary area. First, one of the four concentrations (2%, 5%, 7.5%, and 10%) of the emulsion form of Lidocaine-Prilocaine topical anesthesia was applied on one side of the maxilla, and two weeks later, four concentrations of the liposomal form were applied on the other side. These areas were randomly selected for topical anesthesia before injecting anesthesia into the vestibular area. The amount of pain caused by needle insertion was measured by the Visual Analogue Scale. Results: The comparison of the emulsion and liposomal forms of Lidocaine-Prilocaine topical anesthesia indicated that 5% of the emulsion form and 7.5% of the liposomal form demonstrated the lowest VAS scores; however, the comparison of different concentrations of the emulsion (P=0.46) and liposomal forms (P=0.64) did not indicate any significant difference. There was not any statistically significant difference between liposomal and emulsion forms regarding the same concentrations (P=0.75). Conclusion: Despite the longer substantivity of the liposomal form of Lidocaine-Prilocaine topical anesthesia on the oral mucosa, compared to that of the emulsion form, the findings of the present study revealed that different concentrations of topical anesthesia did not significantly differ in terms of pain reduction efficacy.

Abstract Objective To evaluate the effects of cryotherapy on pain scores and satisfaction levels of patients during cataract surgery under topical anesthesia. Eighty patients aged between 55 and 75 years scheduled for cataract surgery were randomly allocated to two study groups to receive topical anesthesia with cryotherapy (TC) or topical anesthesia alone (T) groups. Visual analog pain scores, patient satisfaction level, hemodynamic parameters, and quality of operating conditions were recorded. Results Cryotherapy significantly reduced VAS pain scores during surgery (P = 0.014). Although no significant difference in postoperative pain scores, opioid consumption, heart rate, and mean arterial blood pressure was seen in the postoperative period. The surgeon reported better quality of operating conditions in the TC group (P = 0.018). Cryotherapy as a complementary method with topical anesthesia reduced pain scores of patients during surgery. It also produced a better quality of operating conditions for surgeons. There was no significant difference in either postoperative pain scores or opioid consumption. Trial registration This trial was registered at Iranian clinical trial registering: IRCT registration number: IRCT2017052734091N2

This study aims to investigate the efficacy of office-based potassium-titanyl-phosphate (KTP) 532-nm laser in the management of recurrent laryngeal papillomatosis (RLP) following other treatments. A retrospective assessment was performed on 55 patients in 259 cases of RLP between 2012 and 2019. Derkay scores were obtained for all patients who underwent 532-nm KTP laser procedure (6 W of power with a continuous output mode) prior to treatment and after treatment. Analysis of parameters is based on the distribution characteristics of data. An ordinal logistic regression was also performed. Patients received a median of 3 (range 1–24) office-based KTP laser treatments. Among them, 96.36% (53 patients) were previously on cold steel equipment, CO2 laser, or microdebrider treatment under general anesthesia, and all previous treatments on them had failed. One patient progressed to invasive cancer, so he was excluded from the following analyses. After final KTP treatment, 36 patients (66.67%) received complete resolution with follow-up time ranging from 12.9 to 80.53 months (median 55.54 months). Results of subjective voice-quality indicators such as VHI-30 and GRBAS all improved greatly at the last follow-up. The initial Derkay scores and treatment intervals were found to be predictive of complete lesion remission. Arytenoid involvement may also correlate with lesion resolution. Serial office–based KTP treatment is an effective option for RLP patients, with ideal disease control and voice quality preservation. KTP laser therapy should be repeated with an interval of 1 month from the beginning of treatment until the lesion has been evaluated and subsided. Non-bulk or scattered laryngeal papilloma is an appropriate indication for KTP laser treatment. [ABSTRACT FROM AUTHOR]

Background and Aim: Venipuncture for blood collection elicits fear and pain in children. We investigated factors that affect satisfaction with health checkups that included blood collection in healthy 7–8‐year‐old children who underwent blood collection with topical anesthesia. Method: Two studies, one questionnaire survey, and the other structured interviews were conducted to gather insights and understand the emotions of 492 and 20 children, respectively. Results: We found that the following six points can be applied to encourage children to assess their experience of blood collection positively: (1) prior information using a pamphlet; (2) telling the children that the volume of blood drawn will be small; (3) carefully explaining the risk and benefit of topical anesthesia; (4) conducting the blood collection process swiftly; (5) praising and thanking the children's effort and cooperation; and (6) explaining the results of the research to the children if their blood is going to be used for research. Conclusion: The findings indicate that with appropriate measures to reduce pain and fear, children's initial negative feelings toward blood collection can be replaced by positive feelings after the procedure. [ABSTRACT FROM AUTHOR]

Abstract Background Cataract surgery is one of the most frequent surgeries in the world. It is a very safe procedure mostly performed under topical anesthesia in outpatients centers. Due to the growing lack of anesthesiologists, cataract surgeries are more frequently performed without an anesthesiologist present in the operating room. Although extremely rare, life-threatening complications may occur. Cases presentation We report two cases of cataract surgery complicated by severe hypotension that required emergency resuscitation in the immediate postoperative period and hospitalization in intensive care unit. Anaphylactic shock was confirmed in the first case and suspected in the second. Conclusions and importance Even though cataract surgery is a very safe procedure, it is essential to ensure the presence of an anesthesiologist to manage potential, though extremely rare, life-threatening complications such as anaphylactic reactions.

Purpose: This study aimed to evaluate the effect of using the lubricated eyelid speculum on the overall pain perception by the subject patients who underwent cataract surgery by phacoemulsification technique under topical anesthesia. Methods: A prospective interventional randomized comparative study was conducted at the tertiary eye care center, wherein adult patients scheduled for bilateral cataract surgery with phacoemulsification techniques under topical anesthesia were randomized to undergo surgery with two different modes of eyelid speculum insertion, either with or without lubrication of the eyelid speculum. Fifty percent of the patients underwent surgery with eyelid speculum without lubrication, and 50% with lubrication of the eyelid speculum. The primary outcome was to compare the level of overall pain perception among the subject patients of the two groups by using the Visual Analogue Scale (VAS) in the immediate postoperative period. Results: The study included 130 patients who underwent bilateral cataract surgery (n = 260 eyes) under topical anesthesia, wherein n = 130 eyes underwent surgery using lubricated eyelid speculum and n = 130 eyes underwent surgery with dry eyelid speculum. Pain perception score assessed on the VAS (0–10 cm) ranged from 0.5 to 6, with a mean ± standard deviation of 2.06 ± 1.12. A significant correlation was found with two different methods of eyelid speculum insertion with reduced overall pain perception in patients with the use of lubricated eyelid speculum compared to the dry eyelid speculum (P = 0.0001). Conclusion: The overall pain perception associated with cataract surgery performed by phacoemulsification technique under topical anesthesia can be further minimized by lubricating the eyelid speculum prior to insertion for exposing the globe.

Purpose: To compare the efficacy and safety of cold saline solution (0.9% NaCl) with topical ophthalmic proparacaine for maintaining topical anesthesia of patients undergoing phacoemulsification surgery. Methods: The prospective, double-blinded, and randomized clinical study was randomly assigned to two groups that underwent phacoemulsification surgery due to cataracts. The cold saline group included 86 eyes of 86 patients with topical anesthesia of cold saline solution alone. The proparacaine group included 84 eyes of 84 patients with topical ophthalmic proparacaine (room temperature) anesthesia alone. The patients were scored according to a pain survey questionnaire of Visual Analog Scale (VAS) ranked between 0 and 10. The surgeon scored surgical experience by a Surgeon Questionnaire Scale (SQS) in three parameters, each of which was ranked from 1 to 3 based on questions regarding ease and comfort during the surgery. Results: The mean VAS scores were 1.29 ± 0.65 and 1.22 ± 0.66 for the cold saline and proparacaine groups, respectively (P = 0.182). The mean scores of SQS (lower values represented favorable results) were 4.11 ± 0.76 and 3.97 ± 0.74 in the cold saline and proparacaine groups, respectively (P = 0.163). Ten patients in the proparacaine group experienced corneal epitheliopathy in the postoperative period. Conclusion: As an easily accessible and cost-effective method, cold saline solution alone might be an alternative to topical ophthalmic proparacaine alone with comparable safe and effective results. The absence of allergic or toxic effects also provided a significant advantage in the cold saline application.

A new topical delivery system based on bio polysaccharides-based hydrogels for the local anesthetics drug benzocaine, was primed to circumvent its limited efficacy and short duration of action. The new system based on encapsulating the drug within nano-mesoporous silica then incorporating into different types of natural bio polysaccharides-based hydrogels including pullulan, dextran, acacia, and amino cellulose. Polysaccharides based hydrogels were prepared by grafting of polyacrylic acid onto the nature polysaccharides and then confirmed. Mesoporous silica nanoparticles (MSNs) were prepared and the drug benzocaine was encapsulating within it. The size, and morphology of prepared nanoparticles and the loaded nanoparticles were visualized using TEM and SEM analysis. Drug loaded nanoparticles were then incorporated into the prepared bio polysaccharides-based hydrogels and these composites were used to treat cotton gauze to use it as anesthetics topical bandage. The resistance to microbial growth of the prepared hydrogels were investigated using culture count method and the mechanical properties of the treated cotton gauze was tested. Drug loaded silica rented in polysaccharide-based hydrogel were conducted in invitro-release and ex vivo drug permeation study through isolated rat skin. In comparison to free drug aqueous suspension the hydrogel patches revealed enhanced amplified skin permeation sustained all over 24 h.

Abstract Background and Aim Venipuncture for blood collection elicits fear and pain in children. We investigated factors that affect satisfaction with health checkups that included blood collection in healthy 7–8‐year‐old children who underwent blood collection with topical anesthesia. Method Two studies, one questionnaire survey, and the other structured interviews were conducted to gather insights and understand the emotions of 492 and 20 children, respectively. Results We found that the following six points can be applied to encourage children to assess their experience of blood collection positively: (1) prior information using a pamphlet; (2) telling the children that the volume of blood drawn will be small; (3) carefully explaining the risk and benefit of topical anesthesia; (4) conducting the blood collection process swiftly; (5) praising and thanking the children's effort and cooperation; and (6) explaining the results of the research to the children if their blood is going to be used for research. Conclusion The findings indicate that with appropriate measures to reduce pain and fear, children's initial negative feelings toward blood collection can be replaced by positive feelings after the procedure.

Objective: To compare the efficacy of total laryngeal anesthesia and simple local anesthesia during awake fiberoptic bronchoscopy. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Pulmonology, Combined Military Hospital Lahore, from Jan to Jul 2020. Methodology: A total of 70 patients, who were undergoing fiberoptic bronchoscopy were divided into two groups. Group-I patients were given topical anesthesia with 2% Lignocaine while group-II patients, in addition to topical Lignocaine, had 2% Lignocaine injected into bilateral internal laryngeal nerves for total laryngeal anesthesia. Assessment of efficacy of anesthesia was evaluated by Reasoner scale. Results: In group-I, 26 (74.28%) patients showed mild or moderate cough and gagging during stage-1. Fifteen (42.85%) patients showed moderate cough and gagging that interfered with the procedure during stage-2 and 19 (54.28%) patients showed mild cough or gagging that did not interfere with the procedure in stage-3. In group-II, 17 (48.57%) patients exhibited mild cough or gagging during stage-1. Sixteen (45.71%) exhibited mild cough or gagging that did not interfere with the procedure during stage-2 with all the patients showing either no cough or mild cough and gagging that did not interfere with the procedure during stage-3. More patients of group-II 32 (91.42%) agreed to a repeat test if required medically as compared to group-I 28 (80%). Conclusion: Patients undergoing fiberoptic bronchoscopy who underwent total laryngeal anesthesia and sedation, in addition to topical anesthesia experienced less cough and gagging than those receiving only local anesthesia.

Objective: The purpose of this article is to investigate whether the percutaneous delivery of compound lidocaine cream by roller microneedles can shorten the minimal effective onset time of anesthesia, enhance the intensity of anesthesia and prolong the analgesic time, so as to provide a theoretical basis for exploring a comfortable, safe and effective anesthesia method for photoelectric cosmetic surgery. Methods: A total of 90 healthy volunteers, including 18 male and 72 female, met the criteria and were enrolled in the study from December 2020 to September 2021 in Department of Plastic and Burn Surgery of the First Affiliated Hospital of Chongqing Medical University. This study adopted a two‐factor randomized block design of 3 (anesthesia time on the test side: 30, 45, 60 min) × 2 (the test side: the left and right side), and the subjects were divided into group A (n = 30), group B (n = 30), and group C (n = 30). On the test side, the compound lidocaine cream was used for topic anesthesia for 10 min, then the roller microneedle was used to roll on the treatment area, compound lidocaine cream was appropriately supplemented, and the topic anesthesia was kept continued for 20 min (group A), 35 min (group B), and 50 min (group C), respectively. The mirrorsymmetrical area of the test side of the three groups was the control side, and the compound lidocaine cream was used for topic anesthesia for 60 min. Photoelectric therapy was performed after anesthesia was completed. The analgesic effect of the subjects on both sides was comprehensively compared; the scores were obtained using the Kuttner Facial Expression Scale, the Frankl Treatment Compliance Scale, the Houpt Behavior Scale, and the Visual Analog Scale (VAS); the satisfaction with anesthesia was investigated. Before and after treatment the skin temperature, color and adverse reactions of the subjects were recorded. Results: Comparing both sides of the same group, there was no significant difference in terms of the comprehensive evaluation, intraoperative comfort, tolerance, cooperation, pain or satisfaction between the 30‐min test side and the routine anesthesia side in group A; the comprehensive evaluation, intraoperative tolerance, cooperation degree, pain degree and satisfaction evaluation of the subjects on the 45‐min test side in group B were significantly better than those on the control side; the comprehensive evaluation, intraoperative comfort, tolerance, cooperation, pain and satisfaction of the subjects on the 60‐min test side in group C were significantly better than those on the control side. Comparing groups on the control side, there was no significant difference in the comprehensive evaluation, intraoperative comfort, tolerance, cooperation, pain or satisfaction between the three groups of subjects on the control side. Comparing the three groups on the test side, with the prolongation of compound lidocaine cream indwelling time, the subjects' comprehensive evaluation, comfort and pain degree were significantly improved. There was no significant difference in postoperative bruising, swelling, pain, discoloration, redness, or tenderness between the test side and the control side. Conclusion: The percutaneous delivery of compound lidocaine cream by roller microneedles can not only shorten the effective time of anesthesia, but also has a good analgesic effect without obvious adverse reactions. [ABSTRACT FROM AUTHOR]

Background and Aims: Premature neonates require regular ophthalmological examination, generally indirect ophthalmoscopy, to screen for retinopathy of prematurity (ROP). Conventional analgesia is provided with topical anesthetic eyedrops and oral sugar solution, but neonates still experience significant pain. Here, the literature base was examined to evaluate the usefulness of other pharmacological analgesics. Materials and Methods: A systematic review was undertaken, adhering to a PROSPERO preregistered protocol in accordance with PRISMA guidelines (identifier CRD42022302459). Electronic databases were searched for primary research articles on pharmacological pain interventions used for ROP screening in neonates. The primary outcome measure was pain scores recorded using validated pain scoring tools, with and without pharmacological interventions in neonates during eye examination. For analysis, studies were separated into two categories: topical anesthesia and alternative pharmacological treatments. Results: Eleven studies met the inclusion criteria. Topical analgesia, oral paracetamol, and intranasal fentanyl were found to be effective in reducing the pain of eye examination. Oral morphine and inhaled nitrous oxide had no significant effect on premature infant pain profile (PIPP) scores during indirect ophthalmoscopy. Discussion: In addition to topical anesthesia, premedication with oral paracetamol is recommended during screening examination for ROP. The routine use of fentanyl is not recommended due to the risk of potential side effects. Non‐pharmacological measures, such as sweet oral solutions and comfort techniques should also be employed. Further research is required to determine whether the use of nitrous oxide has a role, and to develop a safe and effective analgesic strategy to fully ameliorate the pain of ROP screening. [ABSTRACT FROM AUTHOR]

Purpose: To provide evidence of efficacy and postoperative benefit of topical anesthesia (TA) for harvesting split-thickness skin graft (STSG) in an Asian population.Materials and Methods: Patients with well-granulating wounds with skin grafting were randomized into TA or general anesthesia (GA) groups. In the TA group, an eutectic mixture of lidocaine and prilocaine (EMLA) was applied. Perioperative heart rate, postoperative donor site pain, adverse effects, patients' satisfaction, duration of surgery, and operation room (OR) stay duration were recorded.Results: Thirty-nine patients (19 males, 20 females; mean age 54.9 ± 17.8) were included. Twenty underwent TA and 19 underwent GA for STSG. The TA group patients had tolerable pain during skin graft harvesting (VAS, 0.85 ± 1.5). Average EMLA exposure duration was 180.3 ± 65.8 min, and the amount applied was 1.72 ± 0.43 g/10 cm2. The TA group had lower donor site pain score at one hour postoperatively (1.34 ± 1.49 vs 3.08 ± 1.90, p = 0.005), lower OR stay duration (36.5 ± 6.5 min vs 65.1 ± 17.2 min, p < 0.001) and less adverse effects than the GA group.Conclusion: Harvesting STSG under TA with EMLA is an effective and efficient approach for most Asian patients with less early postoperative donor site pain and fewer adverse effects. [ABSTRACT FROM AUTHOR]

AIM: To explore the efficacy and safety of sutureless autologous conjunctival transplantation under topical anesthesia in the treatment of pterygium. METHODS: Retrospective study. A total of 126 patients(126 eyes)with primary pterygium treated in the ophthalmology department of our hospital during 2018-01/2019-09 were selected as subjects. According to the mode of operation, the patients were divided into observation group(64 eyes, 64 cases in seamless autologous conjunctival transplantation group)and control group(62 eyes, 62 cases in suture group). The operation time, postoperative wound healing time, ocular irritation symptoms, tear film rupture time and postoperative recurrence were compared between the two groups. RESULTS: The operation time of the patients in the observation group was significantly shorter than that in the control group(t=6.19, P0.05), the comparison at different time points and the comparison between the two groups after operation were statistically significant(all P0.05). CONCLUSION: Pterygium excision combined with seamless autologous conjunctival transplantation has a definite effect on pterygium, reduces the incidence of postoperative irritation symptoms, shortens the operation time and helps to promote postoperative conjunctival healing.

Objectives: Tumescent anesthesia frequently causes the intraoperative and postoperative pain during radiofrequency ablation (RFA) of varicose veins. We have to find a way to reduce pain caused by these injections. This randomized controlled trial investigated the effectiveness of topical anesthesia pretreatment (TAP) on relieving needle puncture pain during administration of tumescent anesthesia among patients undergoing RFA of varicose veins. Methods: Eligible patients treated with RFA were recruited and randomized to either application of TAP with lidocaine-prilocaine cream (EMLA) or water-based cream (placebo). The primary outcome was patient described pain scores on the visual analogue scale (VAS) at different time points during the procedure. Secondary outcomes were technical success rate, complications, satisfaction level, expense, and extra analgesia use. Results: Sixty-two patients were randomized: 32 to EMLA and 30 to placebo. Both groups had comparable baseline demographics, CEAP classification, and Venous Clinical Severity Score (VCSS). Less tumescent anesthetic needle puncture pain was found in the EMLA group (22 ± 7 vs 42 ± 8, p <.01). Pain scores of other time points were equivalent. There was less pain in EMLA pretreated area compared to non-pretreated area in the same patient during needle puncture (22 ± 7 vs 45 ± 7, p <.01), and similar phenomena did not appear in the placebo group. There was no statistical difference in complications, satisfaction level, expense, and technical success between the two groups. And no extra analgesia was used in all patients. Conclusion: We recommend the routine use of TAP to reduce the needle puncture pain during tumescent anesthesia in RFA of lower extremity varicose veins. [ABSTRACT FROM AUTHOR]

The periapical local anesthetic injection may be associated with fear of needles and pain administration. Dental topical anesthetic agents can help to reduce pain perception; however, adverse events can occur. To investigate the efficacy of 1064-nm photobiomodualtion (PBM) in inducing mucosal anesthesia delivered with a flat-top hand-piece compared to 20% Benzocaine topical anesthetic gel, sixty healthy patients were randomly allocated (1:1) to either 20% benzocaine topical gel + placebo laser (T group) or PBM + placebo gel (L group). The 1064-nm Nd:YAG laser was employed and is associated with a novel flat-top hand piece. The applied operational parameters were 0.5 W, 10 Hz, 100 µs pulse width, and 30 J/cm2 for one-minute single application time. The enrolled subjects were asked to assess pain intensity at the time of anesthetic injection with a Visual Analog Scale. Taking into consideration taste, undesirable numbness, and overall satisfaction, the patients were asked to rate their experiences according to a verbal rating scale. Statistical analysis showed no statistically significant difference between the T and L Groups for pain ratings (p = 0.0596). The L Group displayed significantly higher ratings than T Group for taste, undesirable numbness, and overall satisfaction (p < 0.001). The 1064-nm PBM delivered by flat-top hand piece is effective in inducing mucosal anesthesia, eliminating the adverse side-effects of the conventional topical anesthetic gel. [ABSTRACT FROM AUTHOR]

Simple Summary: Intramuscular injection for vaccination and venipuncture for blood sampling are necessary for routine preventative health care for horses. A considerable proportion of horses react to these procedures, particularly as a needle pierces the skin. Many progress to become "needle shy." Avoidance behaviors often quickly escalate to dangerous levels. Our clinical experience suggests that topical numbing solutions shown to reduce needle discomfort in other species also help horses better tolerate needles. To critically evaluate this clinical impression, 78 ponies were divided into three groups, each with either 5% or 10% lidocaine solution (commercially available preparations) or 0% control (sterile water) applied two minutes before each of two intramuscular vaccinations. Personnel handling the ponies, performing injections, scoring behavior reactions and analyzing data were unaware of treatment assignments. For both lidocaine treatments, behavioral reactions were lower than control treatment and not significantly different from one another. Fewer than 15% of lidocaine-treated ponies (7 of 51) had greater than a slight flinch reaction, compared to more than half (55%) of control group ponies (15 of 27). This clearly demonstrates that topical anesthetic can effectively reduce the behavior reaction of horses to intramuscular injection, providing convincing support for its routine use to improve animal welfare and care staff safety. Vaccinations via intramuscular injection are a key component of preventative health care in horses. Development of problematic behavioral aversion to injections is quite common. Our clinical impression has been that topical anesthetic applied to injection sites can reduce the behavioral reaction; however, this has not been critically tested. To blindly evaluate efficacy, either 5% or 10% topical lidocaine solution or 0% control was applied to injection sites for 78 ponies two minutes before intramuscular vaccination. Mean reaction scores on a scale of 0–3 were 0.84 (se 0.18) for 5% lidocaine solution, 0.62 (se 0.14) for 10% lidocaine solution, compared to 1.30 (se 0.19) for 0% control solution. Reaction scores for both the 5% and 10% lidocaine were significantly lower than for the control group. Additionally, the proportion of subjects with a reaction greater than a slight flinch was 2 of 25 for the 5% lidocaine, 5 of 26 for the 10% lidocaine and 15 of 27 for the 0% lidocaine control. For both the 5% and 10% lidocaine groups, the proportion differed significantly from the control. The difference between the 5% and 10% lidocaine groups was not statistically significant. These findings confirm our clinical impression that application of topical anesthetic just two minutes in advance of intramuscular injection can effectively reduce the behavior reaction of horses. [ABSTRACT FROM AUTHOR]