Effectiveness of lidocaine spray on radial arterial puncture pain: A randomized double-blind placebo controlled trial

ObjectiveRadial arterial puncture is a painful procedure. The aim of this study was to evaluate the effect of lidocaine spray (10%) on pain associated with radial artery blood withdrawal for arterial blood gas analysis.MethodsThis randomized, controlled, double-blind study was performed between December 2018 and September 2019. Before radial arterial puncture, 10% lidocaine or placebo spray was applied to each patient by the attending physician, who was blinded with regard to random assignment. The spray was administered six times on the site from a distance of 5 cm. After waiting for 5 min, a radial arterial puncture was performed routinely. The pain levels of patients during radial arterial puncture and 5 min after puncture were evaluated with the visual analog scale (VAS). The Wilcoxon test was used to compare pain scores during puncture.ResultsThe research was performed with 67 patients (34 patients in the lidocaine group, 33 patients in the placebo group) who were admitted to the emergency department and required ABG analysis. Forty-three patients were men, and 24 were women. The ages of the patients ranged between 19 and 86 years, and the mean (± standard deviation) age was 56.3 ± 16.6 years. Pain levels, as measured by VAS, were significantly lower in the lidocaine group (24.00 mm IQR:[14.75–33.75]) compared with the placebo group (33.00 mm IQR:[22.00–61.50]) during radial arterial puncture (p = 0.011).ConclusionsThe level of pain perceived during radial arterial puncture was significantly lower in those who were administered lidocaine spray. Lidocaine spray application can be used in pain management related to radial arterial puncture.     

Lidocaine Plus Morphine Versus Lidocaine Plus Paracetamol for Bier Block: A Double-Blind Randomized Controlled Trial

PurposeIntravenous regional anesthesia (Bier block) is widely used as an anesthetic technique for operations of short duration of the distal upper or lower extremities. We compared the efficacy of intravenous regional anesthesia with lidocaine plus paracetamol versus lidocaine plus systemic morphine for short-duration hand and forearm surgeries.DesignA double-blind randomized controlled trial with two parallel arms: lidocaine plus morphine (control) and lidocaine plus paracetamol were carried out at a University hospital.MethodsWe included men and women aged 20 to 70 years scheduled for short surgical procedures (30-60 minutes) distal to the elbow. Intravenous regional anesthesia was carried out by injecting 45 cc lidocaine 0.5% plus 300 mg paracetamol for the paracetamol group; or 45 cc lidocaine 0.5% plus 4 mg intravenous morphine for the control group. The primary outcome was postoperative pain-free period in minutes since deflation of proximal tourniquet. The secondary outcome was the highest intensity of postoperative pain on the visual analog scale within 2 hours after deflating the proximal tourniquet.FindingsThere was no significant difference between morphine and paracetamol in the duration of postoperative pain-free period (P = .078) and the mean intensity for maximum pain (P = .106). However, severe pain was significantly more frequent in the morphine group (P = .001). Paracetamol seemed to be safer than morphine as an adjuvant to lidocaine.ConclusionsWe recommend using 2 cc paracetamol (300 mg Apotel) as the adjuvant to lidocaine for intravenous regional anesthesia.     

Thirst Relief Effect of 0.75% Citric Acid Spray During the Anesthesia Recovery Period: A Randomized Controlled Trial

PurposePostoperative thirst is a common clinical issue. The discomfort caused by thirst during the perioperative period is strong and significant. Postoperative thirst is associated with emotional changes, giving rise to a series of adverse psychological and physical problems to patients. This study aimed to explore the effect of 0.75% citric acid spray on thirst relief during the anesthesia recovery period in China.DesignA randomized controlled trial was conducted on subjects immediately after the removal of the endotracheal tube in a postanesthesia care unit.MethodsA total of 112 patients with TI scores ≥3 on 0–10 numeric rating scale were randomized to the intervention group (0.75% citric acid spray group; n = 56) or control group (cool water spray; n = 56) by computerized randomization. Thirst assessment was performed before and 5 minutes after the intervention. Five minutes after the intervention, if the TI score was still ≥3 points, the spray would be added and the thirst assessment would be performed again until the TI score was <3 points. The onset time, duration time, and the number of additional sprays within 20 minutes was recorded.FindingsFive minutes after the intervention, the thirst intensity score of the 0.75% citric acid spray group decreased from 5.57 ± 1.35 to 3.09 ± 1.20. The onset and duration times were 0.77 ± 0.47 min and 4.41 ± 2.59 min, respectively, and the number of spray additions in 20 min was 1.09 ± 0.92. The thirst intensity score of the cool water spray group decreased from 5.29 ± 1.52 to 3.73 ± 1.54. The onset and duration time were 0.84 ± 0.42 min and 2.77 ± 1.80 min, respectively, and the number of spray additions was 1.91 ± 1.24. No incidence of adverse events, including choking, aspiration, and allergies occurred.ConclusionFor thirsty patients during the anesthesia recovery period, the spray method is safe and has fewer side effects, including choking, aspiration, and allergies. Thus, 0.75% citric acid spray and cool water spray are both safe and effective; however, the 0.75% citric acid spray has a better thirst relief effect that lasts longer than the cool water spray.     

10% Lidocaine spray as a local anesthetic in blood gas sampling: A randomized,double-blind,placebo-controlled study

AimRadial artery blood gas sampling is a very common procedure undertaken in the emergency department to evaluate respiratory and metabolic parameters. This intervention causes both anxiety and pain for the patient. Therefore, the current study aimed to examine the analgesic efficacy of lidocaine spray compared to a placebo during radial artery blood gas sampling.MethodsThis study was conducted in the emergency department of a tertiary hospital with a randomized, double-blind, placebo-controlled design. A total of 144 patients were randomly divided into two groups: One group (n = 72) received 10% lidocaine spray and the other (n = 72) was the placebo group. The analgesic efficacy of the 10% lidocaine spray was compared with the placebo group using the Visual Analog Scale (VAS).ResultsIn the evaluation of the analgesic efficacy of the 10% lidocaine spray, the VAS score was 1.5 [interquartile range (IQR): 2.0] for the lidocaine group and 5 (IQR: 2.0) for the placebo group. The role of lidocaine spray in reducing pain was statistically significant compared to the placebo (p = 0.000).ConclusionIn blood gas sampling, 10% lidocaine spray has analgesic efficacy. Therefore, we recommend the use of lidocaine spray while performing arterial blood gas sampling in emergency departments.     

Intramuscular and nerve root stimulation vs lidocaine injection to trigger points in myofascial pain syndrome.

OBJECTIVES: To compare the efficacies of an intramuscular stimulation technique and 0.5% lidocaine injection to trigger points in myofascial pain syndrome. PARTICIPANTS: Forty-three people with myofascial pain syndrome of the upper trapezius muscle. INTERVENTIONS: Twenty-two subjects were treated with intramuscular stimulation and another 21 with 0.5% lidocaine injection at all the trigger points on days 0, 7 and 14. RESULTS: Intramuscular stimulation resulted in a significant reduction in Wong-Baker FACES pain scale scores at all visits and was more effective than trigger point injection. Intramuscular stimulation also resulted in significant improvement on the Geriatric Depression Scale - Short Form. Local twitch responses occurred in 97.7% (42/43) of patients. All the passive cervical ranges of motion were significantly increased. Post-treatment soreness was noted in 54.6% of patients in the intramuscular stimulation group and 38.1% in the trigger point injection group, respectively, and gross subcutaneous haemorrhage (> 4 cm2) was seen in only one patient in the trigger point injection group. CONCLUSION: In managing myofascial pain syndrome, after one month intramuscular stimulation resulted in more significant improvements in pain intensity, cervical range of motion and depression scales than did 0.5% lidocaine injection of trigger points. Intramuscular stimulation is therefore recommended for myofascial pain syndrome.     

A Comparison of Two Different Tactile Stimulus Methods on Reducing Pain of Children During Intramuscular Injection: A Randomized Controlled Study

IntroductionPediatric patients in the emergency department often require intramuscular injection procedures, which may lead to pain, fear, and anxiety. The purpose of this study was to test a novel nonpharmacological intervention to reduce needle-related pain in the pediatric emergency department.MethodsThe study was conducted as a parallel-group, randomized controlled design. The study population consisted of 159 children aged 7 to 10 years cared for in the emergency department who received an intramuscular injection of ampicillin/sulbactam. The children were randomly assigned to Palm Stimulator, ShotBlocker, or control groups. The children’s preprocedure fear levels were evaluated using the Children’s Fear Scale, and their perceived pain levels during the procedure were evaluated using the Faces Pain Scale-Revised and Visual Analog Scale. Parents and observers also completed the pain level scores.ResultsAccording to all raters (child, parent, and observer), the Palm Stimulator group had the lowest mean Faces Pain Scale-Revised score averages (P < .001). The Visual Analog Scale score averages of the children in the Palm Stimulator group (Visual Analog Scale: M = 27.94, standard deviation = 19.13) were statistically significantly lower than the ShotBlocker (Visual Analog Scale: M = 46.07, standard deviation = 24.96) and control group (Visual Analog Scale: M = 53.43, standard deviation = 29.01) score averages (F = 14.94, η² = 0.16, P = .001).DiscussionThe results of this study support the effectiveness of the Palm Stimulator to reduce perceived pain in children during intramuscular injection administration in the pediatric emergency department.     

Effect of the Buzzy Application on Pain and Injection Satisfaction in Adult Patients Receiving Intramuscular Injections

AimThe aim of this study was to investigate the effect of the Buzzy application on pain and satisfaction during injections.BackgroundIntramuscular injections usually cause some degree of pain at the injection site. Patients are often afraid of receiving injections because they perceive that it will be painful.DesignThe study was a single-blind, randomized controlled trial.MethodPatients (n = 65) who receive diclofenac sodium intramuscularly at a state hospital in a city in the western region of Turkey were included in the study. The study data were collected by The Patient Information Form and Visual Analog Scale (VAS). Pain intensity and injection satisfaction scores were evaluated using the VAS.ResultsAccording to the findings of this research, the post-injection pain intensity and injection satisfaction scores of patients in the application group were found to be higher than in the control group.ConclusionIn conclusion, the Buzzy device has the potential to reduce injection related pain in adult patients who may be fearful of receiving such injections.     

Effect of Topical Anesthetic Cream on Pain During Periareolar Injection of Technetium Tc99m Sulfur Colloid for Sentinel Lymph Node Biopsy in Breast Cancer: A Randomized Control Trial

BackgroundInjection of Tc99m to localize nodes for sentinel lymph node biopsy is reported by patients as very painful. The purpose of this study was to determine if anesthetic cream reduces pain associated with periareolar injection of Tc99m and to help elucidate conflicting literature regarding the efficacy of anesthetic cream for this procedure.MethodsA randomized, double-blind, placebo-controlled methodology was used for adult females with breast cancer undergoing periareolar injection of Tc99m for sentinel lymph node biopsy. Pain levels were compared using anesthetic cream (2.5% lidocaine/2.5% prilocaine) vs. placebo. Patient exclusion criteria included use of opioids or adjuvant pain medication or injecting Tc99m the day before surgery. The Numerical Rating Scale was used to assess pain levels immediately after the injections.ResultsComparing 23 experimental and 26 control patients, there was no significant difference between the experimental (median = 4) and the control group (median = 5) on level of pain experienced U= 0.492, P > .05.ConclusionsThe experimental group had a slightly lower median pain score; however, there was no statistically significant difference between those who used the cream compared with those who used a placebo, supporting the conclusion that anesthetic cream does not reduce pain during Tc99m injections. This study adds to the current literature to provide a stronger position that there is no benefit to using anesthetic cream for this procedure.     

Evaluation of the efficacy of Superior Cluneal Nerve Block in low back pain: A prospective observational study

IntroductionSuperior cluneal nerve (SCN) entrapment giving rise to low back pain (LBP) remains undiagnosed many times; in this clinical study authors have evaluated therapeutic role of lidocaine injection of SCN for low back pain relief in patients with SCN entrapment.MethodsThe present study was a prospective, observational study; 25 patients with unilateral LBP over the iliac crest and buttock for more than six months not responding to conservative measures were included in this clinical trial. SCN lidocaine injection was done under fluoroscopy guidance; patients having more than 50% reduction in numeric rating scale (NRS) score, for at least 2 h following SCN injection, were enrolled in the study and followed for 6 months. The primary outcome measure was severity of LBP, measured by NRS score. Secondary outcome measures were percentage pain relief; Oswestry Disability Index (ODI) score, reduction of analgesic usage, DSM-IV score for psychological assessment. All these assessments were done prior to the procedure and at 2 weeks, 1, 3 and 6 months after the procedure.ResultsA significant reduction in the NRS scores was observed at 2 weeks, 1, 3 and 6 months after SCN lidocaine injection as compared to the baseline (P value < 0.05); authors also observed a significant pain relief and significantly reduced ODI scores, analgesic consumption and DSM scores compared to the baseline values (P value < 0.05).ConclusionA single SCN lidocaine injection provided significant pain relief in LBP patients with SCN entrapment for a period of 6 months.     

Intradermal sterile water injection versus diclofenac sodium in acute renal colic pain: A randomized controlled trial

ObjectivesWe aimed to evaluate the efficacy of intracutaneous sterile water injection (ISWI) to relieve the pain of acute renal colic compared with diclofenac and placebo.MethodsThe study included 150 patients presented to the Emergency Department with renal colic randomized into 3 groups: control group received intracutaneous injections of 0.5 cm³ isotonic saline in the flank, group A received intracutaneous injections of 0.5 cm³ ISWI in the flank, and group B received an intramuscular injection of 75 mg Diclofenac in the gluteal region. The severity of the pain was assessed by a visual analogue scale system at baseline and 30, 45 min, and 60 min after injections. Subjects with inadequate pain relief at 1 h received rescue analgesia.ResultsThe mean baseline pain score was 9.6 ± 0.61 in the ISWI group, 9.72 ± 0.64 in the diclofenac group and 9.26 ± 0.89 in the control group.The mean pain score at 30 min of the control group was reduced to 6.9 ± 1.56. This mean at 30 min after ISWI and diclofenac injections were reduced to 1.98 ± 1.41 and 1.88 ± 1.19 respectively.The mean of pain sore of the ISWI and diclofenac group at 45 and 60 min was constant.Rescue analgesics at 1 h were required by 47 patients receiving the saline injection and by 4 patients and by 7 patients receiving ISWI and diclofenac injection respectively.ConclusionsISWI and diclofenac were equally effective for the pain relief of acute renal colic.     

Using Buzzy,Shotblocker, and Bubble Blowing in a Pediatric Emergency Department to Reduce the Pain and Fear Caused by Intramuscular Injection: A Randomized Controlled Trial

IntroductionProcedural pain in general, and intramuscular (IM) injection pain in particular, is one of the most distressing and painful health care experiences for children. Pharmacologic and nonpharmacologic methods are used as forms of pain control for children undergoing acute painful interventions in emergency departments.MethodsThis study was a prospective, randomized controlled trial. The sample consisted of children aged 5 to 10 years old who required IM injections. Children were placed in 4 subgroups through randomization, using a computer program: the Buzzy (MMJ Labs. Atlanta, GA) group (n = 40), the ShotBlocker (Bionix Development Corporation, Toledo, OH) group (n = 40), the bubble-blowing group (n = 40), and the control group (n = 40). Immediately before and after the injection, the children, their parents, and an observer were asked to evaluate the child’s level of fear. The Oucher scale was also employed by the observers, children, and parents immediately after the procedure to assess the level of pain in the children in each group.ResultsNo statistically significant difference was determined between the control and intervention groups in terms gender, age, previous pain experienced with injection, the parent who was with the child, the parent’s age. A significant difference was found between the intervention and control groups in terms of levels of pain and fear during IM injection. Pain and fear were notably less in the group of children receiving the Buzzy intervention.DiscussionThe Buzzy intervention should be used when children are undergoing IM injections to reduce their levels of pain and fear.     

苄星青霉素肌内注射方法的探讨

目的：探讨减轻患者肌内注射苄星青霉素的痛苦、提高注射成功率的方法。方法：将121例肌内注射苄星青霉素患者随机分为观察组和对照组,观察组采用利多卡因稀释药液,对照组采用灭菌注射用水稀释药液。比较两组患者一次注射成功率及注射后的疼痛程度。结果：两组患者一次注射成功率无显著差异（P〉0.05）,观察组的疼痛程度较对照组明显减轻,差异有显著性（P〈0.05）。结论：利多卡因稀释药液能有效减轻患者疼痛,提高注射成功率,安全易操作,值得推广。     

The efficacy of intravenous lidocaine and its side effects in comparison with intravenous morphine sulfate in patients admitted to the ED with right upper abdominal pain suspected of biliary colic

BackgroundIntravenous (IV) Lidocaine can be used as analgesic in acute pain management in the emergency department (ED).ObjectiveEfficacy of IV Lidocaine in comparison with IV morphine in acute pain management in the ED.MethodThis is a double-blind randomized clinical trial on adult (18–64 year) patients with right upper abdominal pain suspected of biliary colic who needed pain management. Participants randomly received IV lidocaine (5 cc = 100 mg) or morphine sulfate (5 cc = 5 mg). In both groups, patients' pain scores were recorded and assessed by Numeric Rating Scale (NRS) at baseline, 10, 20, 30, 45, 60 and 120 min after drug administration. Adverse side effects of lidocaine and morphine sulfate and changes in vital signs were also recorded and compared.ResultsA total number of 104 patients were enrolled in the study, including 49 men and 55 women. IV lidocaine reduced pain in less time in comparison with morphine sulfate. Mean (±SD) basic pain score was 8.23 (±1.76) in the lidocaine group and 8.73 (±0.96) in the morphine group. Patients' mean (±SD) pain score in both groups had no significant difference during the study except that of NRS2 (10 min after drug administration), which was 5.05 (±2.69) in lidocaine group compared with 6.39 (±2.06) in the morphine group and NRS4 (30 min after drug administration), which was significantly lower (P-value = 0.01) in the morphine group [3.84(±1.73) vs 4.41(±2.82)]. Only 9 patients had adverse effects in either group.ConclusionThe findings of this study suggest that IV lidocaine can be a good choice in pain management in biliary colic and can reduce pain in less time than morphine sulfate (in 10 min) without adding significant side effects; however, our primary outcome was the comparison of these two drugs after 60 min of drug administration in pain reduction which showed no significant difference between two groups.     

Reducing the Pain of Microemulsion Propofol Injections: A Double-Blind,Randomized Study of Three Methods of Tourniquet and Lidocaine

Background

Although the new formulation of lipid-free microemulsion propofol (MP) has some advantages over the lipid emulsion, it reportedly produces more injection pain than lipid-based propofol. Intravenous lidocaine with application of a rubber tourniquet before administration of propofol is considered to be the best method for reducing injection pain; however, this technique is not perfect.

Objective

The goal of this study was to evaluate the effect of different methods of tourniquet application and lidocaine administration on MP injection pain.

Methods

This single-center, randomized controlled clinical trial was conducted in 140 patients aged 18 to 65 years. Patients were randomly divided into 4 groups (n = 35 each). Group A received MP (2 mg/kg) after lidocaine (0.6 mg/kg) with a tourniquet with arm down (venous engorgement); group B received MP after lidocaine with a tourniquet with arm up (venous gravity drainage); group C received MP with a tourniquet with arm down; and group D (control group) received MP only (with no tourniquet). In groups A and C, the tourniquet was released after MP; in group B, the tourniquet was released before MP. Injection pain was evaluated by using a verbal pain score (VPS). The bispectral index, the time from the beginning of drug injection to the loss of eyelash reflex, and time to the lowest bispectral index value were recorded.

Results

Group A showed significantly less incidence of pain than the control group when MP was injected. The mean VPS was significantly lower in groups A, B, and C than in group D (the control group). The VPS of group A was significantly lower than that in group B. Other observed values were not significantly different.

Conclusions

We concluded that intravenous retention of lidocaine with the application of a rubber tourniquet under venous engorgement of the arm reduces the incidence and intensity of MP injection pain. Clinical trial registry: UMIN000010725.     

Prospective evaluation of pain and follow-up results when pre-cooling skin versus buffering lidocaine for upper blepharoplasty

Objectives: To find out whether there is a difference in the incidence of injection pain and other complications using pre-cooling versus the buffered equivalent in upper blepharoplasty. Methods: A prospective, randomized study in patients scheduled for primary upper blepharoplasty was performed. Each subject was his/her own control by performing pre-cooling for 2 min before plain lidocaine injection in one eyelid, while the buffered solution injection was used in the other eyelid. Data were collected regarding injection pain, postoperative pain, bleeding, bruising, swelling and scar appearance. Results: Sixty patients participated in this study. Injection pain, checked immediately, revealed a mean operative pain rating of 2.20 ± 0.32 in the eye with pre-cooling versus 2.30 ± 0.35 in the buffered lidocaine (p = 0.074). A statistical difference was observed in postoperative pain after 2–4 h, with the pre-cooling group having a score of 4.00 ± 0.14 versus 4.40 ± 0.30 in the buffered lidocaine group (p = 0.021). The postoperative pain after 24 h was 2.00 ± 0.56 in the pre-cooling group versus 2.30 ± 0.23 in the buffered lidocaine group (p = 0.006). There were no statistical differences between the buffered and unbuffered lidocaine eyes after 2 days or 1 week in regard to postoperative pain, bleeding, swelling, bruising and scar appearance. Conclusions: Pre-cooling could induce similar injection pain relief to that of buffered lidocaine while maintaining longer postoperative anesthetic results than buffered lidocaine.     

The effect of the Alexander Technique on pain intensity in patients with chronic low back pain: A randomized controlled trial

ObjectiveThe present study was performed to determine the effect of the Alexander Technique on the intensity of pain in patients with chronic low back pain (LBP).MethodsThis study is a clinical trial that was performed on 80 patients with chronic LBP in Kashan, Iran. Participants were randomly assigned in control and intervention groups. To assess the participants’ LBP, a visual analog scale of pain (VAS-Pain) was completed by both groups. In the intervention group, in addition to routine care for LBP patients, the Alexander Technique was performed in three 60-min sessions per week for 12 weeks. The control group participants received routine care for LBP patients. The two groups completed the VAS-Pain scale immediately after and one month after the intervention.ResultsThe results showed that there was no statistically significant difference between the two groups in terms of demographic characteristics and mean pain intensity score before the intervention (p > 0.05). Immediately after and then one month after the intervention, there was statistically significant differences between the two groups regarding the mean scores of pain (p < 0.05). The results of repeated measures ANOVA showed that, in the intervention group, the mean score of pain had decreased over time (p < 0.05).ConclusionThe results of the present study showed that the Alexander Technique was effective in reducing the intensity of pain among the participants. We recommend the Alexander Technique as a useful and effective intervention for reducing chronic LBP.     

Effect of Spray Use on Mouth Dryness and Thirst of Patients Undergoing Major Abdominal Surgery: A Randomized Controlled Study

PurposeThe aim of this study was to determine the effect of spray use on mouth dryness and thirst of patients undergoing major abdominal surgery during the postoperative periodDesignThis research was conducted as a randomized controlled trial.MethodsOne hundred thirty patients undergoing abdominal surgery were assessed for eligibility; the sample consisted of N = 104. Subjects were randomized into one of three groups. Subjects in the control group were administered a small amount of water at room temperature using a syringe (clinic routine application, approximately 1-2 mL). Subjects in the second group were administered cold water spray orally (0.4 mL per application). Subjects in the third group were administered cold saline (0.9% NaCl) spray orally (0.4 mL per application). Applications were performed twice every hour. Subjects’ postoperative thirst severity, mouth dryness severity, oral health condition, and pH values of saliva were evaluated after 8, 20, 24, 36 and 40 hours. Subject satisfaction was evaluated at the end of the second postoperative day.FindingsIn our study, no significant difference was found between the three groups in terms of age, gender, American Society of Anesthesiologists grade (ASA), preoperative thirst and mouth dryness, and preoperative oral health condition (P > .05). A significant difference was found between the groups in terms of subjects’ thirst and mouth dryness severity scores after 8, 20, 24, 36, and 40 hours (P < .05). The intervention group that received cold water spray demonstrated statistically significant differences when compared to the control and saline moistening groups. No significant difference was found between subjects’ oral health condition and pH scores after 4, 8, 20, 24, 36, and 40 hours (P > .05).ConclusionsThe results of our study show that cold water spray was more effective on the thirst and mouth dryness scores of subjects undergoing major abdominal surgery compared to cold normal saline spray and water applied using a syringe, although it was not an effective factor on oral health condition and pH values of saliva.     

Effect of topical anesthetics on needle insertion pain during botulinum toxin type a injections for limb spasticity

Fung S, Phadke CP, Kam A, Ismail F, Boulias C. Effect of topical anesthetics on needle insertion pain during botulinum toxin type A injections for limb spasticity.ObjectiveTo compare pain perception using 3 anesthetics (eutectic mixture of local anesthetics [EMLA], vapocoolant spray, and ice) compared with a control (no anesthetic) during botulinum toxin type A (BTX-A) injections for lower limb spasticity.DesignA placebo-controlled, single-blinded study where each study patient served as their own control.SettingSpasticity clinic.ParticipantsSubjects (N=30) with ankle spasticity who visited the clinic for BTX-A injections in the gastrocnemius muscle were consecutively sampled.InterventionThe gastrocnemius muscle was divided into 4 quadrants and 1 of the 3 different anesthetic agents was applied to each quadrant with 1 quadrant using no anesthetic, control.Main Outcome MeasuresNumerical Rating Scale (NRS) and the Wong-Baker FACES scale.ResultsPain perception using the NRS and FACES scale was significantly lower using ice and EMLA compared with control and spray conditions (P<.05). Pain perception using EMLA and ice was similar. These results indicate that patients experience minimal to moderate pain during BTX-A injections.ConclusionsPain relief offered by EMLA and ice was comparable, suggesting that ice is a more convenient option because of brief application time (compared with EMLA). Spray may have made the patients more sensitive to pain and alternative approaches for using vapocoolant should be considered.     

Lidocaine for prevention of propofol injection-induced pain: A prospective, randomized, double-blind, controlled study of the effect of duration of venous occlusion with a tourniquet in adults

Background: Many patients experience pain on injection of propofol. The use of lidocaine to prevent propofol injection pain is common. The analgesic effect of pre-injected lidocaine has been found to increase when a tourniquet is used.Objective: The aim of this study was to compare the effectiveness of various venous occlusion times with lidocaine analgesia to prevent pain during propofol injection.Methods: In this prospective, randomized, double-blind, controlled study, women aged 18 to 45 years, classifed as American Society of Anesthesiologists physical sta- tus I or II, who were scheduled to undergo elective surgery under general anesthesia induced with propofol, were randomly assigned to 1 of 5 groups: group 1, 2% lidocaine 20 mg in saline in a total volume of 10 mL and no venous occlusion; group 2, 2% lidocaine 20 mg in saline in a total volume of 10 mL plus venous occlusion for 15 seconds; group 3, 2% lidocaine plus venous occlusion for 30 seconds; group 4, 2% lidocaine plus venous occlusion for 60 seconds; and group 5, saline 10 mL and no venous occlusion. When the first 25% of the calculated propofol dose was administered, patients were asked about propofol-induced pain using a verbal pain scale (0 = no pain; 1 = mild pain; 2 = moderate pain; and 3 = severe pain). All patients and the anesthesiologist who evaluated pain severity were blinded to the study preparation being used.Results: The study comprised 100 women who were randomly divided into 5 groups of 20 patients each. Significantly more patients in group 5 (18 [90%] patients; P < 0.05) reported pain compared with the other treatment groups. In groups 2, 3, and 4, in which venous occlusion was applied, pain was reported during propofol injection in 6 (30%), 7 (35%), and 2 (10%) patients, respectively. The incidence of reported pain was significantly greater in group 1 (lidocaine without venous occlusion) than in group 4 (P < 0.05); however, the incidence of pain was similar in group 1 compared with groups 2 and 3.Conclusions: The present study found that pretreatment with lidocaine 20 mg with or without venous occlusion significantly reduced the incidence and the severity of pain during the injection of propofol when compared with the group with no venous occlusion administered saline. In addition, pretreatment with lidocaine 20 mg plus venous occlusion for 60 seconds significantly reduced the incidence of propofol-induced pain compared with lidocaine without venous occlusion.     

Intranasal Fentanyl Versus Fentanyl Pectin Nasal Spray for the Management of Breakthrough Cancer Pain in Doses Proportional to Basal Opioid Regimen

The aim of this randomized, crossover, comparison study was to assess the analgesic and adverse effects of 2 nasal preparations, intranasal fentanyl (INFS) and fentanyl pectin nasal spray (FPNS), for breakthrough pain, given in doses proportional to opioid basal regimen. Each patient randomly received INFS or FPNS in doses proportional to opioid dosages used for background analgesia for 2 pairs of episodes. For each episode of breakthrough pain, pain intensity and adverse effects intensity were recorded just before starting the INFS or FPNS (T0) and 5 minutes (T5), 10 minutes (T10), and 20 minutes (T20) after the administration of the nasal drugs. Sixty-nine patients were studied. The mean age was 63.4 years, and 37 patients were males. For the present analysis, 188 episodes were considered. A statistical decrease in pain intensity was observed with both nasal drugs after 5, 10, and 20 minutes. A decrease in pain intensity of >33% was observed in 16, 102, and 159 treated episodes at T5, T10, and T20, respectively. Adverse effects were of mild nature in most cases or were preexistent because of basal opioid therapy. No differences were found in summed pain intensity difference 20 minutes after dosing. Most of patients did not find substantial preferences. INFS and FPNS were effective and well-tolerated treatments for breakthrough pain management. Both delivery systems, in doses proportional to the basal opioid regimen, provided significant analgesia within 10 minutes, without producing relevant adverse effects.PerspectiveThis article showed that INFS and FPNS in doses proportional to basal opioid regimen are equally safe and effective for the management of breakthrough pain in cancer patients. These data provide new insights on the use of nasal preparations of fentanyl.