A randomized controlled trial of three different local anesthetic methods for minor hand surgery

Purpose: Hemostasis and local anesthetic injection are essential for minor hand surgeries under local anesthesia (LA). Wide awake local anesthesia no tourniquet (WALANT) became popular for achieving hemostasis without a tourniquet. However, a recent study reported that injection is more painful than tourniquet use in minor hand surgery. Therefore, this study aimed to compare three LA methods that differ according to injection and hemostasis, namely, the combination of a tourniquet and buffered lidocaine solution (CTB), WALANT, and conventional LA. Methods: This randomized prospective single-center study included 169 patients who underwent minor hand surgery between 2017 and 2020. We randomly allocated the patients to each group and recorded the pain and anxiety score during the surgery, as well as satisfaction after the surgery. Results: Pure lidocaine injection was significantly more painful than buffered lidocaine and WALANT solution injection ( p < 0.001). Local anesthesia injection was significantly more painful than tourniquet use in all groups ( p < 0.001). The intraoperative anxiety score was significantly lower in the CTB group than in the conventional LA and WALANT groups ( p < 0.001). The satisfaction score was significantly higher in the CTB and WALANT groups than in the conventional LA group ( p < 0.001). Conclusion: CTB for minor hand surgery under LA is associated with less injection pain and patient anxiety. The tourniquet is tolerable without much pain and waiting time. Thus, CTB in minor hand surgery is a good alternative to WALANT and conventional LA.

Dexmedetomidine - Oxycodone Combination for Conscious Sedation During Colonoscopy in Obese Patients: A Randomised Controlled Trial

Background: The objective of this trial was to investigate the effectiveness and safety of dexmedetomidine plus oxycodone for conscious sedation during colonoscopy in obese patients. Methods: A total of 138 patients undergoing colonoscopy were randomly assigned into one of two groups: group Dex+oxy received sedation with dexmedetomidine plus oxycodone; while group Pro+suf received anaesthesia with propofol plus sufentanil. Parameters including blood pressure, heart rate, respiration, blood oxygen saturation, injection pain, and recovery were recorded for both groups. Results: The incidence of hypoxaemia was significantly reduced in group Dex+oxy compared with group Pro+suf (4.9% vs 20.3%, P = 0.011). Blood pressure was significantly increased, and heart rate was reduced in group Dex+oxy compared with group Pro+suf (P < 0.05). Moreover, the caecal insertion time, recovery time to orientation, and recovery time to walking were significantly reduced in group Dex+oxy compared with group Pro+suf (P < 0.05). Endoscopist satisfaction scores were significantly higher in group Dex+oxy compared with group Pro+suf (P = 0.042). Conclusion: Dexmedetomidine plus oxycodone provides effective sedation with minimal adverse effects for obese patients, while also reducing colonoscopy operation difficulty by allowing obese patients to reposition. Thus, dexmedetomidine plus oxycodone could be used safely as a conscious sedation method for colonoscopy in obese patients.Trial registration The protocol was registered at www.chictr.org.cn (ChiCTR1800017283, 21/07/2018)

A Comparison of Ondansetron and Lidocaine in Reducing Injection Pain of Propofol: A Randomized Controlled Study

Background Propofol injection pain is common. Previous studies found that ondansetron can also block sodium channels. Objective The primary outcome was the efficacy of ondansetron compared to lidocaine and placebo for the reduction of propofol injection pain. Method This trial was conducted in 240 patients, American Society of Anesthesiologists classification I-III and aged between 18-65 years old, undergoing elective surgery, and having a 20-gauge intravenous catheter at the hand dorsum. Each group of 80 patients received 8 mg of ondansetron in the O Group, 40 mg of lidocaine in the L Group and normal saline in the C Group. The study medications were blindly given then 1 minute later, the propofol was administered via the syringe pump at the rate of 600 ml/hr. for 30 seconds. Thereafter, the syringe pump of propofol was temporarily paused, and the patients were asked to rate his/her pain. Result The incidence of pain was lowest in the L group (66.2%) compared with the O (82.5%) and the C groups (85.0%) (P<0.01). The median pain score in the L, O, and C groups were 2 (0-4), 4 (2-5), and 4.5 (2-6), respectively (P<0.01). The incidences of no pain, mild, moderate, and severe pain were also significantly different in the L group (33.8%, 37.5%, 21.2%, and 7.5%, respectively) compared with those in the O group (17.5%, 31.2%, 31.2%, and 20.0%, respectively) and the C groups (15.0%, 22.5%, 40.0%, and 22.5%, respectively) (P<0.01).. Conclusion Pretreatment with intravenous lidocaine, rather than ondansetron, can reduce the incidence and intensity of propofol-induced pain.

Outcome of Corticosteroid Injection in De Quervain's Tenosynovitis

Background: De Quervain's tenosynovitis is a painful and swollen stenosing tenosynovitis of the first dorsal compartment of the wrist. After analysing the patient's medical history and doing a physical examination, a diagnosis is made. Finkelstein's test is almost always positive. Objective: The goal of this study was to investigate the effectiveness of local corticosteroid injections in the treatment of de Quervain's tenosynovitis. Material & Methods: The study enrolled fifty patients with De Querven's Tenosynovitis. NSAIDs were provided orally and topically to all patients for an average of six weeks with no obvious improvement. Using a visual analogue scale, it was determined how much soreness would be felt in the first dorsal compartment and how much pain would be felt during the Finkelstein test. The edoema was removed by injecting a mixture of 1 mL (10 mg) triamcinolone-acetonide and 1 mL of 1% lidocain hydrochloride into the affected wrist's first dorsal compartment. They were subsequently examined every two weeks for twenty-four weeks. After a local triamcinolone acetonide injection, pain and discomfort on the radial side of the wrist were alleviated, and a negative Finkelstein test was done. Results: The mean age among the patients was 36.6 years with 12.4 SD. The maximum age was 60 years and the minimum age was 25 years old. The duration of symptoms in 4-8 weeks was observed, the mean value was 6 weeks with 1.4 as SD the minimum duration recorded was 4 weeks with 8 weeks as maximum duration. At the start of the week of appearance of symptoms the pain score was 6.44 with 1.6 as SD. The minimum pain score was 4 and maximum pain score was 8. Pain score at 4 weeks was 0.66 with 1.6 as SD. As per the independent t-test the p value was less than 0.05 so the test was significant statistically. Conclusion: One or two local steroid injections in the first dorsal compartment can give considerable pain and inflammation alleviation in people with de Quervain's tenosynovitis.

Knowledge, Practice, and Attitude of patients and physicians towards insulin therapy in Type 2 DM: a cross sectional study in TASH patients and Physician from various universities in Ethiopia

Background As type 2 DM is a growing health problem worldwide early treatment and intensification of therapy will decrease the vascular complications as evidenced by large trials. Insulin therapy is delayed in this group of patients and multiple physician and patient factors are mentioned in different settings. Methods This study is a cross-sectional, quantitative descriptive study conducted on 221patients at TASH endocrine clinic and 122 physicians working at TASH, residents visiting for detachment, and Yekatit 12 hospital. Conducted on Jul 1- Sep 30, 2020, G.C Result 76% of physicians think taking insulin at the prescribed time is difficult while only 31.5% of patients think it’s difficult. Hypoglycemia is one of the most fearful parts of having diabetes for 81.1% of patients on Insulin therapy. 87% of physicians and76.6% of patients think insulin-treated diabetes controls life while. 56% of patients therapy know nothing about insulin therapy. 23% of patients said they will not accept insulin therapy the top reason being they will be afraid of insulin injection because they think it will be painful. Conclusion Physicians tend to overestimate the difficulty of insulin injection preparation and dose adjustment fears the risk of hypoglycemia when starting insulin therapy. More than half of our patients not on insulin therapy know nothing about insulin therapy which we have to improve. Even if patients not on insulin therapy overestimate insulin needle phobia and injection pain those who are already on insulin disagree with them.

Platelet-rich Plasma for Refractory Coccydynia: A Case Report

Introduction: Coccydynia is a common syndrome characterized by pain localized to the tailbone that radiates into the lower sacrum and perinium. Coccydynia affects female patients more frequently than male patients. It occurs more commonly after direct trauma from fall directly onto the coccyx. The pain is caused commonly by the strain of sacrococcygeal ligament or fracture of the coccyx and less commonly secondary to arthritis. Conservative treatment of coccydynia include simple analgesics and foam donut to prevent irritation to sacrococcygeal ligament. If pain persist, usually ganglion impar block and radiofrequency are alterative options. There are no strong evidence to support coccygectomy. Case Report: A 40-year-old presented with coccygeal pain for more than six months. The patient was seen at the pain clinic in Prince Sultan Military Medical City after failure of conservative and multiple steroid injections followed by radiofrequency therapy. We discussed with the patient a trial of a platelet-rich plasma (PRP) injection into the sacrococcygeal ligament under fluoroscopic guidance with full details endorsed to the patient including the risks and benefits of the procedures and informed consent signed before the injection. Pain severity score was taken before and about one month after each injection. The patient received a total of three PRP injections. Result: The patient reported about 30%, 70%, and 85% pain reduction after the first, second, and third injection, respectively. At six months, the patient continued to experience the same level of reduced pain without the use of regular pain medications. Conclusion: PRP can be considered as an option for the treatment of patients with refractory coccydynia.

Comparison of the Effect of Dexamethasone and Ketorolac on Pain Control in Elective Foot Surgery

Objectives: This study aimed to compare the effect of dexamethasone and ketorolac on pain control in elective foot surgery. Methods: Forty patients visiting Akhtar and Imam Hossein Hospital for lower limb orthopedic surgery were selected. They were randomly divided into two groups: (1) dexamethasone, and (2) ketorolac. The dexamethasone group received eight mg dexamethasone intravenously. Also, 90 mg ketorolac was infused in one liter of normal saline serum for 24 hours for the ketorolac group. Before injection and 2, 4, and 6 hours after the injection, pain control was measured employing the Visual Analog Scale (VAS) score. Corresponding data were then analyzed using the independent t-test. Results: The conclusions revealed that in two and four hours after injection, there was a significant difference between the two groups in the amount of VAS score. That is, the pain was weaker in the ketorolac group than in the dexamethasone group. The findings additionally proved that there was no statistically important difference in pain levels between the two groups six hours after injection. Conclusions: Overall, according to the results of the research, it can be settled that ketorolac is a better drug in foot surgery pain control than dexamethasone.