Is local anesthesia necessary for venipuncture?

We evaluated the necessity of local anesthesia for the venipuncture pain in 27 healthy adult volunteers by using a visual analogue scale (VAS) from 0 to 10. The pain scales were measured three times: at the time of percutaneous intravenous cannulation (20 G polyurethane catheter) without local anesthesia as well as the skin infiltration with local anesthetics (0.5% lidocaine 0.5 ml; 25 G needle), and after intravenous cannulation. The measurements were done twice, once by an expert staff and once by a novice staff with an interval of three days. VAS values were significantly higher (2.4 +/- 1.1) for the percutaneous intravenous cannulation without local anesthesia than both for the skin infiltration with local anesthetics (1.4 +/- 0.6) and for the evaluation after intravenous cannulation (0.7 +/- 0.8), independent of who inserted the catheter. VAS values were significantly lower (2.1 +/- 1.0) when the percutaneous intravenous cannulation without local anesthesia was performed by expert staff than when it was performed by novice staff (2.7 +/- 1.1; P < 0.05). We conclude that local anesthesia is necessary when novice staff performs the percutaneous intravenous catheterization.     

Periprostatic local anesthesia before ultrasound guided prostate biopsy

PURPOSE: We assessed the morbidity and benefit of periprostatic local anesthesia administered before ultrasound guided prostate biopsy. MATERIALS AND METHODS: After placing the transrectal ultrasound probe and visualizing the prostate 50 consecutive patients received local anesthesia before prostate biopsies. RESULTS: There was no morbidity associated with the infiltration of local anesthesia into the periprostatic neurovascular plexus. Only 1 patient had discomfort during prostate biopsies, and 10 patients who previously underwent biopsies without anesthesia commented favorably on the dramatic difference. CONCLUSIONS: Many patients have pain during transrectal ultrasound guided biopsies of the prostate and few clinicians provide a periprostatic nerve block before this procedure. A periprostatic nerve block administered before the biopsies dramatically decreases discomfort. We urge all urologists to attempt this procedure, and we are confident that they will adopt it as part of their practice.     

Transurethral prostatic resections under local anesthesia.

Standard transurethral prostatic resections were done on 18 patients with benign prostatic hyperplasia. Local anesthesia was used with standard 1 per cent lidocaine local infiltration of the prostate and topical instillation into the urethra. This anesthesia was supplemented in a few instances by modest doses of intravenous tranquilizers, which has proved to be a safe, simple and effective procedure.     

Periprostatic local anesthesia eliminates pain of office-based transrectal prostate biopsy

Up to 96% of patient who undergo prostate biopsy report pain. We performed periprostatic local anesthesia injection in an effort to improve patient acceptance of prostate biopsy. Sixty patients were randomized to receive either local injection of lidocaine in the periprostatic nerves or no anesthetic. Lidocaine was injected through a 7-inch spinal needle placed through a transrectal ultrasound biopsy guide. Ten-core biopsies were immediately performed. Following biopsy, all patients gave a Visual Analog Scale (VAS) assessment of their pain experienced during biopsy.A majority of patients reported Visual Analog Scale (VAS) scores in the moderate (28.6%) or severe (28.6%) ranges unless local anesthesia was given. Only one of 27 patients (3.7%) receiving local anesthetic reported moderate pain, and none reported severe pain. Mean VAS pain scores were 1.4 in the anesthetic group and 4.5 in the control group (P<0.0001). No difficulty was encountered from scarring in the five patients who underwent nerve spring radical retropubic prostatectomy following local anesthetic injection. Periprostatic injection of local anesthetic essentially eliminates pain from prostate biopsy. Nerve-sparing radical retropubic prostatectomy is not more difficult as a result.     

Local anesthesia for ultrasound guided prostate biopsy: a prospective randomized trial comparing 2 methods

PURPOSE: Since the introduction of prostate specific antigen (PSA) screening, asymptomatic men often undergo transrectal ultrasound guided prostate biopsy. This procedure may cause significant discomfort, which may limit the number of biopsies. We performed a randomized prospective study to compare periprostatic infiltration with 1% lidocaine with intrarectal instillation of 2% lidocaine gel before prostate biopsy. MATERIALS AND METHODS: From October 1999 to July 2000, 150 men underwent prostate biopsy at the Miami Veterans Administration and Jackson Memorial Hospital. Experienced senior residents performed all biopsies. Patients were randomized into 2 groups depending on the method of anesthetic delivery. A visual analog scale was used to assess the pain score. Statistical analysis of pain scores was performed using the Student t test. RESULTS: Ultrasound guided prostate biopsy was done in 150 cases. There was a statistical difference in the mean pain score after periprostatic infiltration and intrarectal instillation (2.4 versus 3.7, p = 0.00002) with patients receiving periprostatic infiltration reporting significantly less pain. CONCLUSIONS: Men should have the opportunity to receive local anesthesia before ultrasound guided prostate biopsy with the goal of decreasing the discomfort associated with this procedure. Our prospective randomized study indicates that ultrasound guided periprostatic nerve block with 1% lidocaine provides anesthesia superior to the intrarectal placement of lidocaine gel.     

Local anesthesia for extracorporeal shock wave lithotripsy: a double-blind, prospective, randomized study

OBJECTIVE: The efficacy of local anesthesia in decreasing intravenous analgesic requirements during extracorporeal shock wave lithotripsy with a second-generation lithotriptor was studied. METHODS: Subcutaneous infiltration was performed before the procedure. Sixty-nine patients (ASA I-II) were randomly allocated into four groups. Lidocaine 1% plus epinephrine (5 microg/ml) were infiltrated subcutaneously in a group of patients with ureteral stones (group UL), and a group with renal stones (group RL). The same amount of saline was administered to a group of patients with ureteral stones (group UC), and a group with renal stones (group RC). RESULTS: Patients with ureteral stones needed higher doses of intravenous analgesic. Neither patients with renal stones nor patients with ureteral stones administered local anesthetic required less intravenous analgesic than patients given placebo. CONCLUSION: Local anesthesia did not decrease the requirement of intravenous doses of analgesics in patients treated with a second-generation lithotriptor (Dornier MPL 9000).     

The effectiveness of benzodiazepines and narcotics in outpatient surgery

In a prospective study of 211 outpatients undergoing cosmetic surgical procedures under local anesthesia supplemented with intravenous diazepam and morphine, patient pain response to the local anesthetic infiltration was graded and the recall of the operative experience was assessed. One hundred and fifty-five patients (73%) had either no pain response or a mild response, 41 (19%) had a moderate response, and 15 (7%) had a severe response. One hundred and eighty-seven patients (88%) had total amnesia for the local anesthetic infiltration and the operative procedure, and 183 (87%) could not recall pain, but had recall of events during surgery. There were no untoward drug reactions nor episodes of cardiorespiratory depression. We conclude that intravenous diazepam with or without intravenous morphine following triazolam, morphine, and premethazine premedication is a safe and effective regimen, for outpatient surgery.     

Saturation prostate biopsy with periprostatic block can be performed in office

PURPOSE: Recent reports of saturation prostate biopsy performed in the operating room with the patient under anesthesia have shown increased cancer detection rates over repeat office based prostate biopsy. We report equivalent success and tolerability of saturation biopsy in the office using local anesthesia. MATERIALS AND METHODS: We performed 24 core saturation prostate biopsies in 15 patients using periprostatic local anesthesia. Before biopsy 20 cc 2% lidocaine (10 cc per side) were injected under ultrasound guidance into the periprostatic nerve entry into the prostate bilaterally. After measurements were made a random 24 core prostate biopsy was performed using a spring loaded biopsy gun. Pain was determined using a visual analog scale to assess tolerability. RESULTS: Complete 24 core biopsies were successful and well tolerated in all 15 patients. Cancer detected in 5 patients (33%) was clinical stage T1C. Mean prostate specific antigen before biopsy was 11.2 ng./dl. (range 5 to 24.1). The indication for biopsy was elevated prostate specific antigen after a previous normal biopsy in 12 patients. In 2 patients prostatic intraepithelial neoplasia was noted on a previous biopsy and in 1 previous atypia was identified on biopsy. The mean visual analog scale pain score was 0.7 (range 0 to 3). Prolonged minor hematuria greater than 5 days in duration occurred in 3 cases requiring no intervention. No other complications occurred. Nerve sparing was not more difficult in the single patient who underwent radical prostatectomy. CONCLUSIONS: Saturation prostate biopsy is well tolerated in the office setting with the patient under local anesthesia. The additional risk, time and cost of performing these procedures in the operating room using anesthesia may be safely avoided.     

A case of a foreign body (sheath dilator) in the urethra and bladder

An 84-year-old man presented with the chief complaints of fever and disturbance of consciousness at another hospital. A sheath dilator had been inserted into the urethra instead of an indwelling catheter at the hospital. Since he had previously been treated for myelodysplastic syndrome in our Department of Internal Medicine, he was transferred to our hospital. He presented at our Department with the chief complaints of urinary difficulty and lower abdominal fullness. Kidney-ureter-bladder x-ray and computed tomography revealed the sheath dilator in the uretha and bladder. First, we performed a percutaneous cystostomy under local anesthesia. Second, we utilized optical forceps and successfully removed the sheath dilator transurethrally under intravenous anesthesia.     

局部浸润麻醉应用于拇外翻术后镇痛的可行性研究

目的：探讨罗哌卡因联合复方倍他米松局部浸润麻醉在拇外翻术后镇痛中的临床疗效及不良反应。方法：自2019年9月至2020年12月手术治疗拇外翻患者48例,根据术后不同镇痛方式分为联合局部浸润组和静脉镇痛泵组。联合局部浸润组24例,男2例,女22例;年龄21~78（58.3±7.7）岁;行软组织松解加Chevron截骨15例,行跖趾关节融合9例;术后即刻应用罗哌卡因联合复方倍他米松混合稀释液20 ml局部浸润麻醉1次。镇痛静脉镇痛泵组24例,男3例,女21例;年龄23~81（56.8±8.3）岁;行软组织松解加Chevron截骨17例,跖趾关节融合7例;术后即刻静脉镇痛泵进行镇痛,设置基础流量为2 ml/h,自控剂量为0.5 ml,锁定时间15 min。记录患者术后12、24、48、72 h疼痛视觉模拟评分（visual analogue scale,VAS）,同时记录术后24 h换药时VAS,记录术后0~12 h、12~24 h、24~48 h药品不良反应发生情况,并记录拆线后刀口愈合情况。结果：所有患者获得随访,时间14~17（14.60±0.92） d。术后联合局部浸润组与静脉镇痛泵组12、24、48 h VAS比较差异有统计学意义（P<0.05）。术后两组72 h VAS比较差异无统计学意义（P>0.05）。两组术后0~12 h发生药品不良反应例数比较差异无统计学意义（P>0.05）;术后12~24 h发生药品不良反应例数比较差异有统计学意义（P<0.05）;术后24~48 h两组均未发生麻醉药品不良反应。拆线后两组刀口愈合等级比较差异无统计学意义（P>0.05）。结论：与静脉镇痛泵镇痛相比,罗哌卡因联合复方倍他米松的局部浸润麻醉在不增加麻醉药品不良反应的情况下,可显著降低患者拇外翻术后伤口疼痛,且不增加刀口感染风险。     

Knee arthroscopy using local anesthesia.

This study confirms the feasibility of performing arthroscopy and arthroscopic surgery with patients under local anesthesia. Seventy patients underwent arthroscopy under local anesthesia using mepivacaine with adrenaline. In 49 patients, arthroscopic surgery was performed. It is important to wait at least 20 min after the injection of the anesthetic before surgery to anesthetize the medial part of the joint. There were few complications. Diagnostic and surgical arthroscopy can be successfully performed in the majority of patients with local anesthesia.     

局部浸润麻醉与黏膜表面麻醉在经直肠超声引导前列腺穿刺活检中的应用比较

目的比较前列腺局部浸润麻醉与直肠黏膜表面麻醉在经直肠超声引导前列腺穿刺活检中应用的安全性和有效性。方法将2018年3月至8月中山大学附属第三医院拟行前列腺穿刺活检的疑似前列腺癌患者纳入本研究,前瞻性随机分成两组。实验组采用超声引导下利多卡因于前列腺基底部和精囊腺间交角周围的血管神经束进行局部浸润麻醉;对照组采用利多卡因凝胶直肠黏膜表面麻醉。收集患者穿刺前后基线特征及穿刺后VAS评分、穿刺前后膀胱残余尿、穿刺阳性率、Gleason评分及血尿等相关并发症进行比较。结果共66例患者纳入本研究。穿刺过程中实验组疼痛评分低于对照组。两组间穿刺阳性率、Gleason评分、残余尿、尿潴留、肉眼血尿、发热等没有组间差异。结论局部浸润麻醉比直肠黏膜表面麻醉更能明显缓解经直肠超声引导前列腺穿刺的疼痛,对穿刺阳性率无明显影响,是更安全有效的麻醉方法,但需要一定经验的超声医师引导。     

Peripheral intravenous catheter infiltration: anesthesia providers do not adhere to their own ideas of best practice

Study ObjectiveTo survey anesthesia providers for their opinion on “best practice” in perioperative peripheral intravenous catheter (PIV) management, and to determine if they follow those opinions.DesignSurvey instrument.SettingAcademic medical center.Subjects266 United States (U.S.) anesthesia provider respondents (attending anesthesiologists, anesthesiology residents, anesthesia assistants, certified registered nurse-anesthetists and student registered nurse-anesthetists).MeasurementsBetween May 2009 and October 2010 a national survey was distributed to individuals who provide intraoperative anesthesia care to patients. Results were gathered via the SurveyMonkey database.Main Results266 anesthesia providers from across the U.S. took part in the survey. The majority (70%) had less than 5 years’ experience. Nearly 90% of respondents cared for a patient with an intravenous catheter infiltration at some point during their training; 7% of these patients required medical intervention. Intravenous assessment and documentation practices showed great variability. Management and documentation of PIVs was more aggressive and vigilant when respondents were asked about “best practice" than about actual management.ConclusionThere is no commonly accepted standard for management and documentation of PIVs in the operating room. From our survey, what providers think is “best practice" in the management and documentation of PIVs is not what is being done.     

Ethanol injection therapy of the prostate for benign prostatic hyperplasia: preliminary report on application of a new technique.

PURPOSE: We evaluate the efficacy of a new technique of minimally invasive treatment for benign prostatic hyperplasia involving direct injection of dehydrated ethanol. MATERIALS AND METHODS: Dehydrated ethanol was injected transurethrally with lumbar or sacral and urethral anesthesia in 10 patients with prostatic hyperplasia. Endoscopic injection was performed at 4 to 8 sites in the prostate and 3.5 to 12.0 ml. ethanol were used. RESULTS: There were no intraoperative complications but postoperative urinary retention occurred transiently in all patients which required catheterization for a mean of 8.8 days. Mean symptom score plus or minus standard deviation was 12.2+/-5.8 at 3 months postoperatively, which was significantly improved from 23.1+/-7.0 preoperatively (p<0.01). Mean quality of life score also improved significantly from 5.1+/-0.6 preoperatively to 3.2+/-1.5 at 3 months postoperatively (p<0.01), mean peak urinary flow rate increased from 8.0+/-2.2 (9 patients) to 13.1+/-3.6 ml. per second (p<0.05) and mean residual urine volume decreased from 129.1+/-55.3 (9 patients) to 49.3+/-34.7 ml. (p<0.05). There was no significant change in prostate volume. Acute epididymitis and chronic prostatitis occurred in 1 patient each. CONCLUSIONS: This technique can be performed as an outpatient procedure and appears to be safe and cost-effective. Retrograde ejaculation can be avoided.     

Tumescent local anesthesia for the surgical treatment of burns and postburn sequelae in pediatric patients

BACKGROUND: Tumescent local anesthesia is a technique for regional anesthesia of the skin and the subcutaneous tissue, using infiltration of large volumes of local anesthetic. The advantages of this technique are (1) simplicity, (2) prolonged postoperative analgesia, (3) low incidence of bleeding, and (4) anesthetization of a large area of the body. There are no reports on the use of tumescent local anesthesia in pediatric patients. METHODS: In 30 consecutive pediatric burn patients with American Society of Anesthesiologists physical status class I or II who were 1-120 months old (34 +/- 31.6 months), after induction of anesthesia with nitrous oxide-oxygen-sevoflurane, infiltration with 0.05% (14 ml/kg) or 0.1% (7 ml/kg) lidocaine solution was performed. Anesthesia was maintained with patients spontaneously breathing with 1.5% sevoflurane in nitrous oxide-oxygen (50%). The maximum dose of lidocaine used was 7 mg/kg. Postoperative pain was assessed by using the Children's Hospital of Eastern Ontario Pain Scale (for patients aged up to 5 yr) and by using a visual analog scale (for patients older than 5 yr). A comparison with a historic control group not treated with the tumescent local anesthesia technique was performed. RESULTS: No patients were excluded from the study, and no significant variations in the monitored intraoperative parameters were observed. Five patients had an increase in heart rate and respiratory rate at the beginning of surgery, and of these, two needed a temporary increase in sevoflurane concentration. After the initial incision, no response to painful stimulus was observed. No complications occurred. Six patients required postoperative acetaminophen administration, and 24 patients did not require analgesic treatment. CONCLUSIONS: Tumescent local anesthesia with maximum dose of 7 mg/kg lidocaine seems to be safe and the sole possible effective locoregional anesthesia technique for the surgical treatment of noncontiguous pediatric burns.     

Tumescent Local Anesthesia for the Surgical Treatment of Burns and Postburn Sequelae in Pediatric Patients

Background: Tumescent local anesthesia is a technique for regional anesthesia of the skin and the subcutaneous tissue, using infiltration of large volumes of local anesthetic. The advantages of this technique are (1) simplicity, (2) prolonged postoperative analgesia, (3) low incidence of bleeding, and (4) anesthetization of a large area of the body. There are no reports on the use of tumescent local anesthesia in pediatric patients.

Methods: In 30 consecutive pediatric burn patients with American Society of Anesthesiologists physical status class I or II who were 1-120 months old (34 +/- 31.6 months), after induction of anesthesia with nitrous oxide-oxygen-sevoflurane, infiltration with 0.05% (14 ml/kg) or 0.1% (7 ml/kg) lidocaine solution was performed. Anesthesia was maintained with patients spontaneously breathing with 1.5% sevoflurane in nitrous oxide-oxygen (50%). The maximum dose of lidocaine used was 7 mg/kg. Postoperative pain was assessed by using the Children's Hospital of Eastern Ontario Pain Scale (for patients aged up to 5 yr) and by using a visual analog scale (for patients older than 5 yr). A comparison with a historic control group not treated with the tumescent local anesthesia technique was performed.

Results: No patients were excluded from the study, and no significant variations in the monitored intraoperative parameters were observed. Five patients had an increase in heart rate and respiratory rate at the beginning of surgery, and of these, two needed a temporary increase in sevoflurane concentration. After the initial incision, no response to painful stimulus was observed. No complications occurred. Six patients required postoperative acetaminophen administration, and 24 patients did not require analgesic treatment.     

Carpal tunnel release under intravenous regional or local infiltration anaesthesia

Fifteen patients with bilateral carpal tunnel syndrome underwent surgery using intravenous regional anaesthesia (IVRA) on one hand and local infiltration anaesthesia (LA) on the other. All 30 carpal tunnel releases were performed without complication. Patient tolerance for IVRA and LA was similar. Six patients preferred the LA, eight preferred IVRA and one had no preference. Tourniquet time averaged 16 minutes when LA was used and 24 minutes with IVRA (P<0.05). Use of local anaesthesia allows more expeditious surgery and limits costs, but intravenous regional anaesthesia is recommended if epineurotomy, internal neurolysis or flexor tenosynovectomy are planned.     

高龄前列腺增生患者经尿道电切汽化术的麻醉

目的：探讨高龄高危前列腺增生患者经尿道前列腺电切汽化切割术麻醉的方法及其安全性。方法：将80例75～94岁的患者随机分为腰-硬联合麻醉（combined spinal-epidural anesthesia,CSEA）组和硬膜外麻醉（epidural anesthesia,EA）组,各40例,观察各组麻醉起效时间,阻滞平面,镇痛和肌松效果,局麻药和静脉辅助药的用量及术中SAP,DAP,HR,RR,SpO2的变化,术后随访有无头痛、恶心、呕吐等副作用。结果：CSEA组比EA组麻醉起效快,镇痛及肌松效果好。局麻药和辅助药用量少（P〈0.01）,术中血流动力学变化及术后随访两组无显著差异。结论：CSEA用于高龄高危前列腺增生患者经尿道电切汽化术的麻醉安全有效,围手术期个体化处理及麻醉操作和用药是关键。     

前列腺尖部活检疼痛机制及预防的临床研究

目的 研究前列腺尖部活检疼痛的发生机理及预防方法. 方法 观察尖部活检时穿刺针的进针位置,设计2种方法来降低疼痛程度.设立3个研究组,应用视觉模拟评分(VAS)尺评估应用不同镇痛方法进行前列腺尖部活检时患者的疼痛程度.对照组:10例,直接进行活检.肛管局麻组:10例,插入直肠探头前行肛管局部麻醉,1%利多卡因10 ml从肛门口向肛管方向环绕腹侧半圈局部浸润麻醉肛管,然后再插入直肠超声探头进行活检.针刺痛觉测试组:15例,穿刺针轻轻接触直肠,以患者有无疼痛的自主感觉判断齿状线的位置(齿状线上方无痛觉,下方有痛觉),然后从齿状线的上方进针活检.3组患者均先行尖部活检,VAS评分结束后再行前列腺其他部位的活检.结果观察尖部活检引起患者剧痛时的进针点,发现其位于齿状线以下的肛管.尖部活检3组的疼痛评分分别为:对照组4.46±1.24,肛管局麻组1.84±0.78,针刺痛觉测试组1.98±0.67(P<0.05);肛管局麻组麻醉时的疼痛评分为5.24±0.83,与对照组比较差异无统计学意义(P>0.05).对照组与肛管局麻组各有1例术后肛周疼痛,针刺痛觉测试组1例术后发热38.4℃. 结论 前列腺尖部穿刺活检引起的疼痛主要由活检针刺穿齿状线以下的肛管皮肤引起.通过针刺痛觉测试从齿状线上方进针能显著减轻疼痛.肛管局部麻醉虽然能减轻活检时的疼痛,但由于麻醉本身即能引起患者明显疼痛,无益于改善患者整个穿刺过程的疼痛体验.     

Percutaneous computerized tomography guided renal cryoablation using local anesthesia: pain assessment

PURPOSE: The administration of intravenous sedation during prone computerized tomography guided, percutaneous procedures has the potential for complications. We assessed the pain associated with computerized tomography guided, percutaneous renal cryoablation using straight local anesthesia. MATERIALS AND METHODS: Patients were treated with cryoablation probes inserted into the renal tumor under computerized tomography guidance with local anesthesia. Patients were asked to rate the pain experienced during needle placement and cryoablation using a visual 10-degree pain score scale. Sedation was given when pain was greater than 7 or when requested by the patient. Parameters assessed were cardiopulmonary complications, the need for intravenous supplementation, the pain score during the procedure and the postoperative score. RESULTS: A total of 25 patients (30 tumors) underwent a total of 26 cryoablation sessions with only local anesthesia. Mean patient age +/- SD was 67 +/- 13 years (range 33 to 88). Average tumor and ice ball size was 2.1 +/- 0.7 (range 1.1 to 4.3) and 4.1 +/- 1.0 cm (range 2.6 to 5.9), respectively. The mean dose of 1% lidocaine was 43.89 +/- 24.97 ml (range 10 to 110). All procedures were completed in an average of 68.78 +/- 20.7 minutes (range 40 to 120). Vital signs were not significantly changed during the procedure. Successful completion of percutaneous computerized tomography guided cryoablation using local anesthesia was accomplished in 22 of the 26 sessions (84.62%) without sedation. Four patients required intravenous supplementation. CONCLUSIONS: Percutaneous computerized tomography guided cryoablation for renal tumors can be performed using local anesthesia with minimal discomfort in most patients.