phenylephrine-hydrochloride and Pain

Examination of the upper aerodigestive tract is an important part of ENT practice. The use of both flexible and rigid nasendoscopes is the most common way of achieving this in the out-patient setting. However, these procedures can cause pain or discomfort for the patient, and topical preparations have been used in an attempt to reduce this.. The variability in current practice amongst those performing nasendoscopy may suggest an uncertainty as to what constitutes best practice for this procedure. A systematic review of the literature was undertaken in an attempt to clarify this.. A literature search of the Cochrane ENT group trials register, the Cochrane central register of controlled trials (CENTRAL), CINAHL (1982-2007), MEDLINE (1950-2007) and EMBASE (1974-2007) was performed. Reference lists of selected studies were scanned for additional research material.. Eighteen studies relevant to this review were identified. The evidence suggests that local anaesthetic is not beneficial when performing flexible nasendoscopy, neither alone nor in combination with a vasoconstrictor. Water is better than lubricant for flexible endoscope passage and gives a superior optical outcome. Further research is required on the use of endosheaths for flexible and rigid nasendoscopy.

Topics: Anesthetics, Local; Drug Combinations; Endoscopy; Humans; Nasal Cavity; Nose; Pain; Pain Measurement; Randomized Controlled Trials as Topic; Vasoconstrictor Agents

Pain and itch sensations are induced by depolarization of distinct populations of unmyelinated type C, and possibly other, neurons. Both sets of neurons and sensations serve critical protective mechanisms that maintain the integrity and patency of the upper airways. When noxious or pruritic stimuli are applied on the afferent nerve ending, pain and itch are appreciated at the thalamic and parietal cortex. In the mucosa, this neuronal depolarization spreads via the peripheral efferent axon response mechanism. Neuropeptides such as substance P and calcitonin gene-related peptide are released from neurosecretory varicosities on the nociceptive C fibers. The exact functions of axon responses differ between humans and rodents, and in health and disease. Separate itch- and pain-specific peripheral type C fibers, secondary relay interneurons in the spinal cord dorsal horn, anatomical locations in the lateral spinothalamic tract, and thalamic nuclei demonstrate that all nociceptive nerves are not the same. Other types of irritant-sensitive trigeminal neurons might be discovered that could mediate other unique sensations, specific axon responses, or central nervous system functions.

Topics: Axons; Humans; Nerve Fibers; Neurons; Nose; Pain; Pruritus; Sensation; Spinal Cord; Trigeminal Nerve

BACKGROUND : Transnasal endoscopy presents a technical difficulty when inserting the flexible endoscope. It is unclear whether a particular breathing method is useful for transnasal endoscopy. Therefore, we conducted a prospective randomized controlled trial to compare endoscopic operability and patient tolerance between patients assigned to nasal breathing or oral breathing groups. METHODS : 198 eligible patients were randomly assigned to undergo transnasal endoscopy with nasal breathing or with oral breathing. Endoscopists and patients answered questionnaires on the endoscopic operability and patient tolerance using a 100-mm visual analog scale ranging from 0 (non-existent) to 100 (most difficult/unbearable). The visibility of the upper-middle pharynx was recorded. RESULTS : Patient characteristics did not differ significantly between the groups. Nasal breathing showed a higher rate of good visibility of the upper-middle pharynx than oral breathing (91.9 % vs. 27.6 %;

Topics: Endoscopes; Endoscopy; Endoscopy, Gastrointestinal; Humans; Nose; Pain; Prospective Studies

Topics: Child; Child, Preschool; COVID-19; COVID-19 Testing; Humans; Male; Nose; Pain; Pain Measurement; Pharynx; Pilot Projects; SARS-CoV-2; Specimen Handling

Pressure ulcers related to oronasal masks used with noninvasive ventilation (NIV), along with patient discomfort, occur due to improper fit of the mask. We developed a personalized fitting device using a 3-dimensional (3D) scanning solution to prevent the formation of NIV mask-related pressure ulcers. This study aimed to evaluate the effectiveness of the proposed personalized fitting device.. We conducted a randomized crossover experimental study of 20 healthy participants to study the use of this personalized fitting device between the face and an NIV mask designed with 3D solutions. The fitting device was not used under the NIV mask for the control. The outcome measures were the presence of blanchable erythema, standardized redness intensity, discomfort level, and contact pressure.. The incidence of blanchable erythema and standardized redness intensity values were significantly lower for subjects who used the fitting device when worn for 30 min (. Personalized fitting devices that incorporate 3D scanning solutions may contribute to the prevention of NIV mask-related pressure ulcers and the reduction of discomfort.

Topics: Adult; Cheek; Cross-Over Studies; Equipment Design; Erythema; Female; Forehead; Humans; Imaging, Three-Dimensional; Male; Masks; Noninvasive Ventilation; Nose; Pain; Pressure; Pressure Ulcer; Printing, Three-Dimensional

To evaluate the efficacy of topical lidocaine 2% gel in reducing the pain associated with the insertion of nasal continuous positive airway pressure (nCPAP) prongs in preterm infants.. A pilot randomized controlled trial. Sixty preterm infants, categorized into lidocaine (n=30) and control groups (n=30). The primary outcome was Premature Infant Pain Profile (PIPP) score, secondary outcomes included salivary cortisol, presence of cry, the duration of first cry, and adverse effects of lidocaine.. There were no statistically significant differences between lidocaine and control groups regarding PIPP scores (mean±SD: 7.2±2.3 vs. 9.3±3.0, respectively, P=0.086). None of the infants in the lidocaine group had severe pain defined as a PIPP score>12, compared with 3 (10%) infants in the control group (P=0.056). Salivary cortisol concentrations were not significantly different between the lidocaine and control groups (mean±SD: 2.57±1.79 vs. 4.82±1.61 μg/dL, respectively, P=0.11). Standardized effect sizes for topical lidocaine were medium to large for reduction in PIPP scores and large for reduction in salivary cortisol (Cohen d=-0.78 and -1.32, respectively). No adverse effects were reported in infants receiving lidocaine.. Our data suggest that topical lidocaine did not reduce the pain associated with the insertion of nCPAP prongs in preterm infants. However, the trends for lower PIPP scores in the lidocaine group and the effect sizes for lidocaine on PIPP scores and salivary cortisol were large enough so that a large-scale randomized clinical trial is warranted to confirm or refute our results. Such a study should compare 2 or more active pain interventions during nCPAP application, rather than evaluating a single intervention versus placebo or no treatment.

Topics: Administration, Topical; Anesthetics, Local; Continuous Positive Airway Pressure; Female; Gels; Humans; Hydrocortisone; Infant, Newborn; Infant, Premature; Lidocaine; Male; Nose; Pain; Pain Measurement; Pilot Projects; Saliva; Treatment Failure

Ketofol is a mixture of propofol and ketamine in various concentrations. It is accepted as a suitable combination in procedural sedation and analgesia. The mixture of propofol and ketamine with different respiratory and hemodynamic effects may result in fewer dose-related side effects and a probable synergistic effect. This study was designed to compare the adverse effects and quality of analgesia of 2 different intravenous concentrations of ketofol in patients undergoing closed reduction of the nose.. This randomized double-blinded study was conducted on 100 patients who underwent closed reduction of nose. The patients were divided into 2 groups of 50, and received either a combination of propofol/ketamine (1:1) (Group I) or propofol/ketamine (3:1) (Group II). Hemodynamic changes, including systolic blood pressure, diastolic blood pressure, heart rate and O2sat, and side effects such as hallucination, vomiting, coughing and apnea, were recorded.. Data analysis showed that the demographic characteristics (age, height, and weight) were similar in 2 groups, and there were no significant differences between the 2 groups. There was no significant hemodynamic change between both groups. However, there was a decrease in hallucination and vomiting in the group that received higher concentration of ketofol (ketamine/propofol of 1:3).. There was no significant hemodynamic change between both groups that received concentrations of 1:1 and 3:1 propofol /ketamine. However, there was a reduction in hallucination, vomiting, and recovery duration in the group that received higher concentration of propofol. In conclusion, increasing the concentration of propofol can be useful with fewer side effects and lower duration of recovery.

Topics: Adolescent; Adult; Analgesia; Anesthetics, Intravenous; Child; Conscious Sedation; Double-Blind Method; Drug Combinations; Female; Fracture Fixation, Internal; Humans; Ketamine; Male; Middle Aged; Nose; Pain; Pain Management; Propofol; Skull Fractures; Young Adult

Experts advocate the use of a standard nasal cannula to provide oxygen at flow rates of up to 15 L/minute during emergency intubation. However, because of concerns about potential patient discomfort, some providers avoid providing nasal cannula oxygen at flow rates greater than 6 L/minute. This trial is designed to determine the participants' ability to tolerate 10 minutes of nasal cannula oxygen at higher flow rates.. This was a prospective, randomized, crossover trial of healthy volunteers at an emergency department in New Zealand. Participants were randomized to first receive either higher-flow (15 L/minute) or lower-flow (6 L/minute) nasal cannula oxygen for 10 minutes. After a 1-hour washout period, they received the alternate flow rate for 10 minutes. The primary outcome was the ability to tolerate 10 minutes of the nasal cannula oxygen at each flow rate. The secondary outcome was the difference in discomfort between the flow rates as measured on a 100-mm visual analog scale.. All 77 of the participants (100%) were able to tolerate 10 minutes at both flow rates. Participants rated the higher-flow nasal cannula oxygen as a mean of 25 mm (SD 20 mm) more uncomfortable than the lower-flow nasal cannula oxygen. One minute after the oxygen was discontinued, the mean difference in discomfort between the flow rates was a clinically insignificant 9.8 mm (SD 17 mm) more uncomfortable. There were no adverse events.. Participants were able to tolerate higher-flow nasal cannula oxygen for 10 minutes without difficulty. Higher-flow nasal cannula oxygen at 15 L/minute was associated with some discomfort, but the discomfort quickly dissipated and caused no adverse events.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Catheterization; Cross-Over Studies; Female; Humans; Male; Middle Aged; Nose; Oxygen; Oxygen Inhalation Therapy; Pain; Time Factors; Young Adult

The objective was to explore the role of specific patient-related and operator-related factors in pain perception during flexible laryngoscopy, which is one of the most common ENT procedures.. Monocentric, randomized, individual prospective study.. A total of 532 patients (145 men and 387 women), without any relevant ENT diseases, underwent laryngoscopy performed by otolaryngologists with various degrees of experience. Patient discomfort was reported using visual analog scores, and willingness to repeat the experience was also recorded.. Statistical analysis showed that greater pain was significantly associated with female patients and female otolaryngologists, whereas the pain was less severe in the cases of experienced laryngologists and older patients. Pain plays an important role in determining the willingness to repeat the examination; in fact, patients who experienced lower levels of pain during laryngoscopy were more prone to repeat the experience.. This article explores the importance of the extrinsic factors that are related to the patient and the otolaryngologist in determining the level of pain associated with laryngoscopy. Our study indicated that laryngoscopy is generally a well-tolerated procedure, causing little overall discomfort, but that a subgroup of patients may experience more pain than others, which may affect the patient's perspective toward undergoing a similar future experience. Our analysis may be helpful for clinicians in understanding pain perception during a routine procedure, enabling them to focus more on that subgroup of patients who are more prone to pain.. 1b.

Topics: Endoscopy; Equipment Design; Female; Fiber Optic Technology; Follow-Up Studies; Humans; Male; Middle Aged; Nose; Otorhinolaryngologic Diseases; Pain; Pain Measurement; Pain Perception; Prognosis; Prospective Studies

To evaluate the preemptive analgesia effects of both the parecoxib sodium and the pentazocine in patients undergoing nasal endoscopic surgery.. In the randomized, double blind, controlled study, 120 patients undergoing septoplasty were divided into 3 groups (n = 40): group A received parecoxib 40 mg by muscle injection 30 min before the operation; group B received pentazocine 30 mg; group C received an equal volume of saline. The preemptive analgesia effect was evaluated with VAS scores which recorded at different time points. The proportion of participants using rescue analgesia after the operation were recorded as additional measures of preemptive analgesia.. Intra-operative as well as the postoperative pain scores were less in the group A and group B than in the control group. Fewer participants required rescue medication after operation with parecoxib as well as pentazocine than placebo. However there were no difference in the preemptive effects between the group A and group B.. Administration of both the parecoxib and pentazocine before the nasal endoscopic surgery can provide preemptive analgesia without serious adverse side effects that deserves popularization in the clinic.

Topics: Analgesia; Analgesics; Double-Blind Method; Endoscopy; Humans; Isoxazoles; Nasal Surgical Procedures; Nose; Pain; Pain, Postoperative; Pentazocine

Routine esophagogastroduodenoscopy (EGD) is increasingly performed without sedation. Transoral (TO) and transnasal (TN) EGD offer different patient comfort and complications.. For a controlled, randomized, clinical trial comparing TN-EGD with TO-EGD without sedation, patients were assigned to TN-EGD using a thin endoscope (group 1, 93 patients), or TO-EGD using a standard endoscope (group 2, 90 patients). Physician-rated procedural time and complications as well as patient-rated side effects and preferences were compared. In group 3, patients (118) who had previously undergone TO-EGD, now underwent TN-EGD.. Between group 1 and 2 there was no significant difference for procedural time. Nausea (p = 0.047) and epistaxis (p < 0.001) were significantly more frequent for TN-EGD. Conversion rate from TN- to TO-EGD was low with 4.3 %. For TN-EGD, patients' tolerance was better (p < 0.001), gagging was less (p < 0.001). In case of a future EGD, patients who know both procedures (group 3), strongly vote for TN-EGD (80 %). All groups vote against sedation for future procedures (90 %/90 %/89 %).. Epistaxis can be relevant after TN-EGD, but can mostly be managed conservatively. TN-EGD is superior to TO-EGD regarding subjective and objective gagging as well as procedural tolerance. Patients who experienced both access routes, prefer TN-EGD. TN-EGD without sedation should be aspired for patient comfort and is recommended for routine use.

Topics: Diagnostic Tests, Routine; Endoscopy, Digestive System; Epistaxis; Female; Gagging; Germany; Humans; Male; Middle Aged; Mouth; Nausea; Nose; Pain; Prospective Studies; Time Factors; Treatment Outcome; Vomiting

Electro-acupuncture (EA) can be effective in some pain conditions, but still there have been no randomized controlled studies of EA for treatment of acute postoperative pain in nasal septoplasty. Therefore, we did a study to test whether EA of specific points is superior to sham acupuncture for complementary analgesia after nasal septoplasty.. Ninety (90) patients with an American Society of Anesthesiology (ASA) physical status of I-II scheduled for elective septoplasty were randomly allocated to acupuncture group or control group. Postoperative pain was treated with intravenous meperidine. The time to the first analgesic request, and pain intensity on a 100-mm visual analogue scale (VAS-100) were used to evaluate postoperative pain, and the amount of postoperative meperidine and incidence of analgesia related to side-effects were recorded.. Postoperative pain intensity on VAS-100 and respiratory depression were similar in both groups (p > 0.05), but nausea and vomiting were less in the acupuncture group than in the control group (p < 0.05).. Findings from our study demonstrate that both uses of EA and 0.1 mg/kg IV morphine given intraoperatively resulted in a similar postoperative pain score, and meperidine was not given in any patient in the two groups during postoperative period because the VAS scores of all patients were less than 40 mm.

Topics: Adolescent; Adult; Analgesia; Analgesics, Opioid; Double-Blind Method; Electroacupuncture; Female; Humans; Infusions, Intravenous; Male; Meperidine; Nausea; Nose; Pain; Pain Management; Postoperative Complications; Vomiting; Young Adult

Awake fiberoptic tracheal intubation is the best choice for situations in which neck movement is limited or hazardous, and remifentanil is one of the most popular drugs that are used in these circumstances. We administered remifentanil with target-controlled and manually controlled infusion techniques in two groups of patients who had cervical trauma and semielective maxillofacial surgery.. Twenty-two patients were enrolled and randomly assigned to two groups. Bronchoscopy data were gathered in four data points. In the target-controlled infusion (TCI) group, patients received 0.8 ng · mL remifentanil as effect-site target, and in the manually controlled group, patients received remifentanil with a loading dose of 0.75 μg · kg and 0.075 μg · kg · min as maintenance. Patients were evaluated separately for recall and pain during procedure 24 hours after operation by visual analog scale. Comparison of vital signs was performed using Mann-Whitney U test. Fischer's exact test was used to analyze quantitative data when appropriate.. Preparation time was shorter in the TCI group, and remifentanil effect-site targets were higher in the TCI group. Vital signs were more stable in the TCI group. Levels of sedation were comparable in both groups. Recall and pain during endoscopy were more common in the manually controlled infusion group.. Remifentanil infusion could be recommended to provide good conscious sedation in procedures such as awake nasotracheal intubation, but target-controlled remifentanil infusion seems to provide better conditions compared with manually controlled remifentanil infusion and is easier to use.

Topics: Adolescent; Adult; Anesthetics, Intravenous; Cervical Vertebrae; Follow-Up Studies; Humans; Infusions, Intravenous; Intubation, Intratracheal; Middle Aged; Nose; Optical Fibers; Pain; Pain Measurement; Piperidines; Remifentanil; Retrospective Studies; Spinal Injuries; Treatment Outcome; Young Adult

To observe the anesthetic effect of combined superficial anesthesia and auricular point injection for nasal endoscopy surgery.. Forty cases of grade I - II as ASA for nasal endoscopy surgery were randomly divided into a combined auricular point injection and superficial anesthesia group (group A) and a simple superficial anesthesia group (group B), 20 cases in each group. Both groups accepted superficial anesthesia 2 times on the bilateral nasal cavities with cotton pieces that was immersed in the mixed solution of 1% Tetracaine 30 mL and 0.1% Adrenaline 2 mL. In group A, bilateral auricular points of Shenmen and Waibi (externol nose) were injected with 0.1 mL Vitamin B1 solution before the superficial anesthesia. After 10 min of observation, surgery was carried out. During the surgery, the patients only accepted a small amount of vasoactive substance and Fentanyl according to the changes of patient's blood pressure, heart rate and pain feeling.. The total effective rate of 90.0% in the group A was significantly better than 75.0% in the group B (P<0.05). The rate of using analgetic and vasoactive substance in the group A was obviously less than that of the group B.. Combined auricular point injection and superficial anesthesia has good anesthetic effect for nasal endoscopy surgery.

Topics: Acupuncture Points; Adult; Aged; Anesthesia; Anesthetics, Local; Ear; Endoscopy; Female; Humans; Injections; Male; Middle Aged; Nose; Pain; Tetracaine

To investigate the influence of conditioning cutaneous nociceptive inputs by a new "pinch" model on the jaw-stretch reflex and the exteroceptive suppression periods (ES1 and ES2) in jaw muscles.. The jaw-stretch reflex was evoked with the use of a custom-made muscle stretcher and electrical stimuli were used to evoke an early and late exteroceptive suppression period (ES1 and ES2) in the jaw-closing muscles. Electromyographic (EMG) activity was recorded bilaterally from the masseter and temporalis muscles. These brainstem reflexes were recorded in 19 healthy men (28.8+/-1.1 years) during three different conditions: one painful clip applied to the earlobe; one painful clip applied to the nostril, and four painful clips applied simultaneously to the earlobe, nostril, eyebrow, and lower lip. Pain intensity induced by the application of the clips was scored continuously by the subjects on a 100mm visual analogue scale (VAS).. The highest VAS pain scores were evoked by placement of four clips (79+/-0.5mm). There was no significant modulation of the jaw-stretch reflex (ANOVAs: P=0.929), the ES1 (P=0.298) or ES2 (P=0.082) in any of the three painful conditions.. Intense and tonic cutaneous pain could be elicited by this new "pinch" pain model; however, there was no significant modulation on either excitatory or inhibitory brainstem reflex responses.. The novel observation that high-intensity pinch stimuli applied to the craniofacial region fail to modulate two different brainstem reflexes is in contrast to other experimental pain studies documented facilitation of the jaw-stretch reflexes or inhibition of exteroceptive suppression periods. The clinical implication of the present findings is that only some craniofacial pain conditions could be expected to show perturbation of the brainstem reflex responses.

Topics: Adult; Brain Stem; Ear, External; Electric Stimulation; Electromyography; Eyebrows; Female; Humans; Jaw; Male; Masseter Muscle; Neural Pathways; Nose; Pain; Pain Measurement; Physical Stimulation; Reflex, Stretch; Trigeminal Nerve

Removing the nasal packing after nasal surgery is an uncomfortable and painful procedure. Since there is no controlled trial described in the literature about the local use of meperidine during packing removal, we aimed to compare the analgesic and sedative effects of the meperidine-prilocaine combination, injected into the packing 15 minutes before the procedure, with that of prilocaine during packing removal.. Fifty adult patients, for whom nasal packing removal after nasal septoplasty was scheduled, were randomly allocated into one of two groups. In the prilocaine group (Group P, n = 25), 5 ml of 1% prilocaine in saline was injected into the pack 15 minutes before removal. In the prilocaine-meperidine group (Group MP, n = 25), 5 ml fluid combination containing prilocaine (10 mg/ml) and meperidine (1 mg/kg) was injected in nasal packs. Five ml saline was injected into the package in the contra-lateral nostril in both groups as control. Visual analogue scale (VAS) score was recorded during injections (t) and packing removal (t), and the Ramsay sedation score was evaluated.. VAS score was not different from the control nostril in Group P (p > 0.05), where as it was significantly lower than the control nostril in Group MP (p < 0.05). Ramsay sedation scores were significantly higher in Group MP compared to the control nostril and actively treated nostril of Group P (p < 0.05).. The injection of prilocaine plus meperidine into the nasal pack 15 minutes before nasal packing removal provides effective analgesia and mild sedation during the procedure.

Topics: Adolescent; Adult; Analgesics, Opioid; Device Removal; Drug Combinations; Female; Formaldehyde; Hemostatics; Humans; Injections; Male; Meperidine; Middle Aged; Nasal Septum; Nose; Pain; Pain Measurement; Polyvinyl Alcohol; Prilocaine; Rhinoplasty

Previous studies have shown that nasendoscopy is made easier with the use of lubrication at the expense of the quality of the view obtained, but had no effect on the discomfort or pain experienced by the patient. We set out to determine whether the advantages of lubrication with a standard lubricant (KY Jelly) could be achieved by using water, without incurring the same disadvantages.. Single blind randomized controlled trial.. Outpatient Departments at two District General Hospitals.. One hundred and fifty participants selected sequentially from patients requiring a nasendoscopy where the endoscope would be passed far enough to view the larynx. Patients requiring topical anaesthetic were excluded.. Patients were randomly assigned to have either water or standard lubricant applied to the nasendosope prior to nasendoscopy. Levels of pain experienced by the patient were recorded on a visual analogue score as well as visual analogue scores from the clinician for the levels of difficulty in passing the endoscope. All participants who were entered the study completed the study. Endoscopy was performed by all grades of medical staff.. Levels of pain experienced by the participants were assessed by a visual analogue scale. Difficulty of passing the scope was indicated by the endoscopist using a visual analogue scale, as was the quality of image obtained.. Endoscopists found the insertion of the endoscope was easier and the image better when water was used rather than KY Jelly. There was no significant difference in reported in levels of pain experienced by the patient.. Although the use of water as a lubricant during nasendoscopy confers no additional benefit in term of the levels of pain suffered by patients during the procedure, it makes the insertion of the endoscope easier and provides a better quality image than standard lubrication.

Topics: Adult; Aged; Aged, 80 and over; Cellulose; Endoscopy; Female; Fiber Optic Technology; Glycerol; Humans; Lubrication; Male; Middle Aged; Nose; Pain; Pain Measurement; Phosphates; Propylene Glycols; Single-Blind Method; Water

To determine how lubrication of the endoscope prior to flexible fibreoptic nasendoscopy affects levels of patient discomfort and pain during endoscopy. To assess the extent to which lubrication affects the ease of nasendoscopy and the quality of the image obtained.. Single blind, randomized controlled trial.. Outpatient clinic of the Department of Otolaryngology at a secondary level referral centre.. A total of 150 participants selected sequentially from patients requiring a nasendoscopy where the endoscope would be passed far enough to view the larynx. Patients requiring topical anaesthetic were excluded. All participants who were entered in the study completed the study. Endoscopy was performed by all grades of medical staff.. Levels of discomfort and pain experienced by the participants were assessed by a visual analogue scale (VAS). Difficulty of passing the scope was indicated by the endoscopist using a VAS, as was the quality of image obtained.. There was no significant difference between mean scores for pain or discomfort of the lubricated and unlubricated groups (P = 0.46 and P = 0.82 respectively). Scores for difficulty of passing the scope were significantly lower in the lubricant group (P = 0.003) but loss of image was significantly greater (P = 0.008).. Lubrication of the endoscope prior to nasendoscopy does not reduce levels of discomfort or pain for the patient, but increases ease in insertion for the operator. However, this may be at the expense of reduced image quality.

Topics: Adult; Aged; Aged, 80 and over; Cellulose; Endoscopy; Female; Fiber Optic Technology; Glycerol; Humans; Lubrication; Male; Middle Aged; Nose; Pain; Phosphates; Propylene Glycols; Prospective Studies; Single-Blind Method

Transnasal fiberoptic laryngoscopy (TFL) is frequently performed by otolaryngologists, speech language pathologists, and various other health care providers. Historically, topical sprays have been administered to patients to decongest and anesthetize the nasal mucosa, thus minimizing the discomfort of the procedure. Recently, it was reported that patients undergoing TFL with topical anesthesia experienced no improvement in comfort compared with those who received oxymetazoline or saline. This observation is in direct opposition to our clinical experience that patients tolerate the procedure better with topical anesthesia.. We sought to compare patient comfort levels during TFL after the administration of cocaine, oxymetazoline, or saline.. Fifteen subjects undergoing TFL were prospectively evaluated. Each had TFL performed on 3 separate occasions. Before TFL, each patient received either 4% cocaine, 0.05% oxymetazoline, or saline topically administered via an atomizer to both nasal cavities (1 spray of 2-second duration). By the conclusion of the study, each patient had undergone TFL with each of the test agents. The subjects rated the discomfort they experienced on a scale ranging from 1 (minimal discomfort) to 5 (severe discomfort). Both patient and examiner were blinded to the test agent used.. The mean nasal discomfort score for saline was 2.8 +/- 1.1. The scores for oxymetazoline and cocaine were 3.4 +/- 0.9 and 2.0 +/- 0.9, respectively. Compared with saline and oxymetazoline independently, TFL with topical cocaine appeared to provide more comfort (P < 0.05 and P < 0.005).. The continued routine use of topical anesthetics such as cocaine before the performance of TFL is justified because it significantly decreases the patient's discomfort.

Topics: Administration, Topical; Adult; Anesthesia, Local; Cross-Over Studies; Double-Blind Method; Female; Fiber Optic Technology; Humans; Laryngoscopy; Male; Nose; Pain; Prospective Studies

Unsedated esophagogastroduodenoscopy (EGD) has advantages over sedated EGD - e. g., prevention of side effects related to sedation, less patient monitoring, and less expense. This study compared the feasibility and tolerance of transnasal small-caliber (TSC-EGD) and peroral small-caliber EGD (PSC-EGD) with conventional EGD (C-EGD).. A total of 150 patients referred for diagnostic EGD were randomly allocated to undergo either TSC-EGD, PSC-EGD, or C-EGD under local anesthesia if they agreed to receive sedation only on demand or in case of intolerance. Patients, endoscopists, and nurses completed questionnaires on the tolerability and quality of the examinations using a visual analogue scale (VAS), ranging from 1 (best/nonexistent) to 10 (worst/unbearable) after EGD. Small-caliber EGD and C-EGD were performed with 5.9-mm and 9.8-mm video endoscopes (Olympus), respectively.. The patients' age, sex, experience with EGD, and anxiety before EGD did not differ significantly between the three groups, each consisting of 50 patients. TSC-EGD failed in four of the 50 patients (8 %) because of a narrow nasal tract; they underwent PSC-EGD. Complete examinations, including the second part of the duodenum and biopsy sampling, were possible in all patients. Patients examined with an ultrathin instrument required sedation significantly less often (TSC-EGD 6 %, PSC-EGD 18 %, C-EGD 44 %; P < 0.01) and consequently spent less time in the recovery room. TSC-EGD was initially more painful on insertion, but caused less gagging (P<0.01) than peroral EGD during the whole procedure. TSC-EGD caused mild epistaxis in one case.. TSC-EGD was carried out safely and completely in 92 % of the patients. TSC-EGD and PSC-EGD were better tolerated and required sedation less often than conventional EGD. Transnasal diagnostic EGD appears to be a promising alternative to peroral EGD, as it is associated with less gagging and a high level of patient satisfaction.

Topics: Adult; Aged; Aged, 80 and over; Conscious Sedation; Digestive System Diseases; Endoscopy, Digestive System; Equipment Design; Feasibility Studies; Female; Humans; Intraoperative Complications; Male; Middle Aged; Mouth; Nose; Pain; Pain Measurement; Prospective Studies; Time Factors

In an outpatient gastroenterological practice setting, highly effective diagnostic procedures and patient satisfaction play an important role. Ultrathin endoscopy in unsedated patients has been shown to be more cost-effective and time-efficient in comparison with standard endoscopy. A prospective randomized study was carried out in unsedated patients to compare performance, feasibility, safety, and patient tolerance between ultrathin transnasal (UT), ultrathin oral (UO), and standard (SO) esophagogastroduodenoscopy (EGD).. A total of 200 of 600 eligible patients consented to participate in the study, and were randomly assigned to undergo UT, UO, or SO. Patients reported their tolerance of the procedure (anxiety, pain, gagging, and overall satisfaction; Likert scale 1-10), and the endoscopists reported the effectiveness of the procedure (handling, picture quality, and overall performance; Likert scale 1-10). Statistics were calculated using the Kruskal-Wallis test.. After randomization, 65, 67, and 68 patients were allocated to the UT, UO, and SO groups, respectively. Failure to achieve complete EGD by the intended route occurred in 14 patients (22 %) in the UT group. Compared to the SO group, patients in the UT and UO groups rated anxiety before the procedure as being more intense - median score (10 % quantile estimate; 90 % quantile estimate): UT, 2.0 (1.0; 4.0); UO, 2.0 (1.0; 4.0); SO, 0.0 (0.0; 2.0); p < 0.0001), whereas SO patients experienced a higher level of anxiety during the procedure ( P < 0.0001). Pain during insertion of the endoscope was the least intense in the UO group: UT, 2.0 (1.0; 5.0); UO, 1.0 (1.0; 3.0); SO, 2.0 (1.0; 4.0); P < 0.001). Gagging during insertion was more pronounced in the UO group: UT, 2.0 (1.0; 4.0); UO, 3.0 (1.0; 7.0); SO, 2.0 (1.0; 5.0); P < 0.01). The patients' score for the overall assessment was better in the SO group ( P < 0.0001). The endoscopists' overall assessment for ultrathin EGD was poorer than for standard EGD: UT, 3.0 (2.0; 5.0); UO, 3.0 (2.0; 5.0); SO, 2.0 (1.0; 3.0); P < 0.0001).. Ultrathin endoscopy through both the transnasal and oral routes has limited use in routine outpatient practice. Techniques for reducing pain and gagging may improve patient tolerance. Further technical improvements are needed to allow routine implementation.

Topics: Adult; Aged; Aged, 80 and over; Ambulatory Care; Conscious Sedation; Diagnostic Tests, Routine; Digestive System Diseases; Endoscopy, Digestive System; Equipment Design; Feasibility Studies; Female; Humans; Intraoperative Complications; Male; Middle Aged; Mouth; Nose; Pain; Pain Measurement; Practice Patterns, Physicians'; Prospective Studies

This double-blind study compares the effectiveness of two local anaesthetics with vasoconstrictive activity (10% cocaine and 4% lignocaine with adrenaline 1:1000) used in the nose. Anterior rhinomanometry was used to assess changes in nasal mucosal blood volume from a reduction in congestion of the nasal mucosa with a resulting reduction in nasal resistance. Nasendoscopy was then performed and the degree of subjective discomfort evaluated. Twenty patients presenting with nasal obstruction but without evidence of structural disease and nine healthy volunteers were entered into the study. Each received 10% cocaine in one nostril, and 4% lignocaine with adrenaline (1:1000) in the other in a double-blind study. In all subjects, there was a significant reduction of nasal resistance after the administration of both drugs (P < 0.005). The anaesthetic effects of both agents were comparable with subjects reporting only a mild discomfort during nasendoscopy. We conclude from this study that 4% lignocaine with adrenaline (1:1000) solution is as effective as 10% cocaine.

Topics: Adult; Airway Resistance; Anesthesia, Local; Anesthetics, Local; Blood Volume; Cocaine; Double-Blind Method; Endoscopy; Epinephrine; Humans; Lidocaine; Manometry; Nasal Decongestants; Nasal Mucosa; Nasal Obstruction; Nose; Pain; Pressure; Vasoconstrictor Agents

Blood pressure and pulse rate measurements were recorded in 35 patients undergoing endotracheal intubation during general anaesthesia (Group A), and 35 patients who had an awake fibreoptic intubation under local anaesthesia (Group B). The mean arterial pressure in Group A rose by a mean of 35 mmHg immediately after intubation, compared with a mean fall of 9 mmHg in Group B. The mean pulse rate in Group A rose by 24 beats per minute (b.p.m.) immediately after intubation, compared with a rise of 3 b.p.m. in Group B. Both these differences were statistically significant (P less than 0.0001 and P less than 0.001 respectively, Mann Whitney U test). Postoperative discomfort was assessed 24 h later by means of linear analogue scales. There was a statistically higher mean score in relation to nose discomfort in Group B (P less than 0.002). Awake fibreoptic intubation successfully reduces the pressor response to endotracheal intubation in normotensive adults. It is suitable for use in those patients who are at risk from the pressor response.

Topics: Anesthesia, General; Anesthesia, Local; Blood Pressure; Bronchoscopy; Deglutition; Female; Fiber Optic Technology; Humans; Hypertension; Intubation, Intratracheal; Laryngoscopy; Male; Middle Aged; Nose; Pain; Pharynx; Prospective Studies; Pulse

Sixteen healthy male volunteers had 30 mg of cocaine HCI solution or normal saline placebo impregnated in cotton-covered applicators administered intranasally on different days in a double-blind procedure. Ischemic tourniquet pain was significantly less after cocaine than it was in pretreatment control. It was also significantly less than after administration of a placebo. Responses to questionnaires concerning subjective drug effects, mood, and alertness revealed little change in psychological status associated with either cocaine or placebo. Thus, the reported decrease in pain was probably not caused by a change in affect or by altered consciousness. These results indicate that, in addition to its known properties as a local aesthetic, cocaine when applied intranasally exerts an analgesic effect.

Topics: Administration, Intranasal; Cocaine; Humans; Male; Nose; Pain

Topics: Acute Disease; Adult; Alcoholism; Amylases; Clinical Enzyme Tests; Clinical Trials as Topic; Drainage; Evaluation Studies as Topic; Humans; Informed Consent; Intubation, Gastrointestinal; Meperidine; Methods; Nose; Pain; Pancreatitis; Prospective Studies; Time Factors

Manual tools for pain assessment from facial expressions have been suggested and validated for several animal species. However, facial expression analysis performed by humans is prone to subjectivity and bias, and in many cases also requires special expertise and training. This has led to an increasing body of work on automated pain recognition, which has been addressed for several species, including cats. Even for experts, cats are a notoriously challenging species for pain assessment. A previous study compared two approaches to automated 'pain'/'no pain' classification from cat facial images: a deep learning approach, and an approach based on manually annotated geometric landmarks, reaching comparable accuracy results. However, the study included a very homogeneous dataset of cats and thus further research to study generalizability of pain recognition to more realistic settings is required. This study addresses the question of whether AI models can classify 'pain'/'no pain' in cats in a more realistic (multi-breed, multi-sex) setting using a more heterogeneous and thus potentially 'noisy' dataset of 84 client-owned cats. Cats were a convenience sample presented to the Department of Small Animal Medicine and Surgery of the University of Veterinary Medicine Hannover and included individuals of different breeds, ages, sex, and with varying medical conditions/medical histories. Cats were scored by veterinary experts using the Glasgow composite measure pain scale in combination with the well-documented and comprehensive clinical history of those patients; the scoring was then used for training AI models using two different approaches. We show that in this context the landmark-based approach performs better, reaching accuracy above 77% in pain detection as opposed to only above 65% reached by the deep learning approach. Furthermore, we investigated the explainability of such machine recognition in terms of identifying facial features that are important for the machine, revealing that the region of nose and mouth seems more important for machine pain classification, while the region of ears is less important, with these findings being consistent across the models and techniques studied here.

Topics: Animals; Cats; Face; Facial Expression; Humans; Nose; Pain; Pain Measurement

Surgical access to the second (V2, maxillary) and third (V3, mandibular) branches of the trigeminal nerve (V) has been classically through a transoral approach. Increasing expertise with endoscopic anatomy has achieved less invasive, more efficient access to skull base structures. The authors present a surgical technique using an endoscopic endonasal approach for the treatment of painful V2 neuropathy.. Endoscopic endonasal dissections using a transmaxillary approach were performed in four formalin-fixed cadaver heads to expose the V2 branch of the trigeminal nerve. Relevant surgical anatomy was evaluated and anatomic parameters for neurectomy were identified.. Endoscopic endonasal transmaxillary approaches completed bilaterally to the pterygopalatine and pterygomaxillary fossae exposed the V2 branch where it emerged from the foramen rotundum. The anatomy defined for the location of neurectomy was determined to be the point where V2 emerged from the foramen rotundum into the pterygopalatine fossa. The technique was then performed in 3 patients with intractable painful V2 neuropathy.. In our cadaveric study and clinical cases, the endoscopic endonasal approach to the pterygopalatine fossa achieved effective exposure and treatment of isolated V2 painful neuropathy. Important surgical steps to visualize the maxillary nerve and its branches and key landmarks of the pterygopalatine fossa are discussed. This minimally invasive approach appears to be a valid alternative for select patients with painful V2 trigeminal neuropathy.

Topics: Adult; Cadaver; Humans; Maxillary Nerve; Natural Orifice Endoscopic Surgery; Nose; Pain; Peripheral Nervous System Diseases; Pterygopalatine Fossa; Sphenoid Bone; Trigeminal Nerve; Trigeminal Neuralgia

Topics: Bandages, Hydrocolloid; Coronavirus Infections; COVID-19; Humans; Masks; Nose; Pain; Pain Management; Pandemics; Pneumonia, Viral; Pressure; Pressure Ulcer

Administration of local anesthetics is daily routine for most dental practitioners. Normally, the effect is achieved, and no adverse effects are seen. In this article, the authors describe the complications of immediate, intense and shooting pain, numbness, and marked pallor of the cheek, which occurred during infiltration of a local anesthetic in buccal vestibule infiltration. The patients moved suddenly because of pain and marked pallor of the cheek near the root of the nose and lower eyelid pallor was observed. The pain was very short and the injection was performed again after a few minutes. Two patients also reported an alteration of vision or paralysis of the extra-ocular muscles and drooping eyelid due to paralysis of the levator palpebrae superioris muscle and signs of numbness in the infraorbital area on the same side as the anesthesia. While 3 patients were also apprehensive and started to scare with heart palpitations, as they did not understand what was happening. Probably the anesthetic solutions were injected into an intravascular artery and passed from the extraosseous branch of posterior superior alveolar artery through to the infraorbital artery, which could produce the clinical signs observed in the present study. At the same time, the inoculation of anesthetic in the artery could be grounds for legal disputes for the dentist. In fact, in the absence of vascular disease, anomalies documented by the dentist, they would, however, respond to professional liability and be liable for damages caused to the patient. In conclusion, despite the fact that this condition requires no treatment, it could lead to the recognition of clinical signs in patient with injection of local anesthesia into the artery. At the same time, the inoculation of anesthetic in the artery could be grounds for legal disputes for the dentist.

Topics: Aged; Anesthesia, Dental; Anesthesia, Local; Anesthetics, Local; Blepharoptosis; Cheek; Dental Implantation; Dental Implants; Eyelids; Female; Humans; Injections; Male; Middle Aged; Nose; Oculomotor Muscles; Pain

Pain recognition is fundamental for safeguarding animal welfare. Facial expressions have been investigated in several species and grimace scales have been developed as pain assessment tool in many species including horses (HGS) and mice (MGS). This study is intended to progress the validation of grimace scales, by proposing a statistical approach to identify a classifier that can estimate the pain status of the animal based on Facial Action Units (FAUs) included in HGS and MGS. To achieve this aim, through a validity study, the relation between FAUs included in HGS and MGS and the real pain condition was investigated. A specific statistical approach (Cumulative Link Mixed Model, Inter-rater reliability, Multiple Correspondence Analysis, Linear Discriminant Analysis and Support Vector Machines) was applied to two datasets. Our results confirm the reliability of both scales and show that individual FAU scores of HGS and MGS are related to the pain state of the animal. Finally, we identified the optimal weights of the FAU scores that can be used to best classify animals in pain with an accuracy greater than 70%. For the first time, this study describes a statistical approach to develop a classifier, based on HGS and MGS, for estimating the pain status of animals. The classifier proposed is the starting point to develop a computer-based image analysis for the automatic recognition of pain in horses and mice.

Topics: Anesthesia, General; Anesthetics, Local; Animals; Bupivacaine; Discriminant Analysis; Ear; Facial Expression; Horses; Male; Mice; Nose; Pain; Pain Measurement; Support Vector Machine; Vasectomy

Topics: Child; Electroencephalography; Epilepsies, Partial; Humans; Male; Nose; Pain

The fruits of Xanthium strumarium L. (Asteraceae) have been used extensively in China for treatment of various diseases such as allergic rhinitis (AR), tympanitis, urticaria and arthritis or ozena. This study was designed to systemically investigate the effects of the caffeoylxanthiazonoside (CXT) isolated from fruits of X. strumarium on AR in rodent animals. Animals were orally administered with CXT. Anti-allergic activity of CXT was evaluated by passive cutaneous anaphylaxis test (PCA); acetic acid-induced writhing tests were used to evaluate the analgesic effects of CXT; acetic acid-induced vascular permeability tests were performed to evaluate anti-inflammatory effect of CXT. Then, the model AR in rats was established to evaluate the effects of CXT on AR with the following tests: the sneezing and nasal scratching frequencies, IgE level in serum, and histopathological examinations. Our results demonstrated that CXT had favorable anti-allergic, anti-inflammatory and analgesic effects. Additionally, we found that CXT was helpful to ameliorate the nasal symptoms and to down-regulate IgE levels in AR rats. Thus, we suggested that CXT can be treated as a candidate for treating AR.

Topics: Acetic Acid; Analgesics; Animals; Anti-Allergic Agents; Anti-Inflammatory Agents; Caffeic Acids; Disease Models, Animal; Down-Regulation; Drugs, Chinese Herbal; Fruit; Immunoglobulin E; Inflammation; Mice, Inbred ICR; Nose; Pain; Phytotherapy; Rats, Sprague-Dawley; Rhinitis, Allergic; Sneezing; Xanthium

A preliminary survey showed half of the participating Royal Netherlands Air Force (RNLAF) F-16 fighter pilots to have nasal integument and osteocartilagenous disorders related to wearing in-flight oxygen masks.. To make an inventory of these disorders and possible associated factors.. All RNLAF F-16 pilots were requested to fill out a semi-structured questionnaire for a cross-sectional survey. Additionally, one squadron in The Netherlands and pilots in operational theater were asked to participate in a prospective study that required filling out a pain score after each flight. Pilot- and flight-related variables on all participants were collected from the RNLAF database. A linear mixed model was built to identify associated factors with the post-flight pain score.. The response rate to the survey was 83%. Ninety of the 108 participants (88%, 6 missing) reported tenderness, irritation, pain, erythema, skin lesions, callous skin, or swelling of nasal bridge integument or architecture. Seventy-two participants (71%, 6 missing) reported their symptoms to be troublesome after a mean of 6±3 out of 10 flights (0;10, 54 missing). Sixty-six pilots participated in scoring post-flight pain. Pain scores were significantly higher if a participant had ≥3 nasal disorders, after longer than average flights, after flying abroad, and after flying with night vision goggles (respectively +2.7 points, p = 0.003; +0.2 points, p = 0.027; +1.8 points, p = 0.001; +1.2 points p = 0.005). Longer than average NVG flights and more than average NVG hours per annum decreased painscores (respectively -0.8 points, p = 0.017; -0.04 points, p = 0.005).. The majority of the RNLAF F-16 fighter pilot community has nasal disorders in the contact area of the oxygen mask, including pain. Six pilot- or flight-related characteristics influence the experienced level of pain.

Topics: Adult; Aircraft; Cartilage Diseases; Cross-Sectional Studies; Erythema; Humans; Masks; Middle Aged; Military Personnel; Nose; Occupational Diseases; Oxygen; Pain; Prospective Studies; Risk Factors; Surveys and Questionnaires; Young Adult

Migraine attacks exclusively felt in the face are very rare, the pain involving the territories supplied by the second and third branches of the trigeminal nerve.. Two patients suffering from heminasal pain attacks accompanied with typical migrainous features and responsive to oral or intranasal triptans - but not to intranasal lidocaine or oxymetazoline. In one patient, the attacks could be precipitated upon slight touching on the tip of the nose, in the other attacks were preceded by the nasal sensation typically heralding sneezing.. Migraine pain mostly develops within the innervation territory of the first branch of the trigeminal nerve, which includes the nose. Therefore, episodes of unilateral nasal pain with migrainous features could be considered a migraine with unusual topography (nasal migraine). Painful nasal attacks occasionally preceded by stimulation of trigeminal afferents in the nose, could be conceived of as migraine-tic syndrome.

Topics: Administration, Intranasal; Aged; Analgesics; Female; Functional Laterality; Humans; Male; Migraine Disorders; Nose; Pain; Tryptamines

In the limbic system, the anterior cingulate cortex (ACCX) is one of the key areas involved in the close association between pain and emotion. However, neuronal changes in ACCX nociceptive responses after stress conditioning have not yet been quantitatively investigated. We investigated the modulation of nociceptive responses in the ACCX neurons following restraint stress in rats. The present study demonstrated that stress-conditioning enhanced excitatory nociceptive responses in the ACCX following tail stimuli in the mid-term (7 days). Short-term (3 days) and long-term (21 days) of stress conditioning did not affect these responses significantly. Nociceptive responses evoked by other sites of the body (nose, back and four paws) stimulation were not changed by stress-conditioning, indicating that neural information from the tail is important for emotional system modulation. It is suggested that the emotional/affective part of the pain sensation is strongly modified by stress through neuroplasticity in the ACCX.

Topics: Action Potentials; Afferent Pathways; Analysis of Variance; Animals; Brain Mapping; Extremities; Functional Laterality; Gyrus Cinguli; Neurons; Nociception; Nose; Pain; Physical Stimulation; Rats; Rats, Wistar; Stress, Physiological; Torso

In Japanese routine clinical practice, endoscopy is generally carried out without sedation. The present study aimed to identify the factors essential for appropriate selection of transnasal esophagogastroduodenoscopy (TN-EGD) as an alternative to unsedated transoral esophagogastroduodenoscopy (TO-EGD).. Subjects in this prospective cohort study comprised consecutive outpatients who underwent EGD at a single center. Factors predicting TO-EGD-induced distress were evaluated on a visual analog scale (VAS) and analyzed. Patients were classified into a two-layered system on the basis of these predictive factors, and the severity of distress between the TN-EGD and TO-EGD groups was compared using VAS and the change in the rate-pressure product as subjective and objective indices, respectively.. In total, 728 outpatients (390 male, 338 female; mean age, 63.1 ± 0.5 years; TO-EGD group, 630; TN-EGD group, 98)met the inclusion criteria. Multivariate logistic regression analysis confirmed that age <65 years (P < 0.01; odds ratio [OR], 1.69; 95% confidence interval [CI], 1.14-2.52), gender (female; P < 0.01; OR,1.97; 95% CI, 1.34-2.91), marital status (single; P < 0.01; OR, 1.96; 95% CI, 1.18-3.27), and anxiety towards TO-EGD (P < 0.001; OR, 3.62; 95% CI, 2.44-5.37) were independently associated with intolerance. Both indices were significantly higher in the TO-EGD subgroup than in the TN-EGD subgroup in the high predictive class, but not in the low predictive class.. Predictive factors for detecting intolerance to unsedated TO-EGD may be useful to appropriately select patients who transpose unsedated TO-EGD to TN-EGD.

Topics: Endoscopy, Gastrointestinal; Female; Follow-Up Studies; Gastrointestinal Diseases; Humans; Male; Middle Aged; Mouth; Natural Orifice Endoscopic Surgery; Nose; Pain; Pain Measurement; Patient Satisfaction; Prospective Studies; Surveys and Questionnaires

Although local anesthetic injections are commonly used in dental practice, the complex neurovascular anatomy of the face can present the practitioner with unexpected complications. Several reports document adverse events related to inferior dental blocks (IDBs), whereas long buccal nerve blocks are usually performed without incident. We describe a previously unreported complication of a long buccal nerve block involving blanching, pain, and paresthesia specifically within the infraorbital arterial territory of the face. We had previously reported an identical event resulting from an IDB. We discuss the facial vascular relationships that might explain this complication and how to manage it.

Topics: Anesthetics, Local; Arteries; Cheek; Epinephrine; Eyelids; Female; Humans; Lidocaine; Lip; Middle Aged; Nerve Block; Nose; Orbit; Pain; Pallor; Paresthesia; Vasoconstrictor Agents

Perioperative analgesia in patients undergoing cleft lip and palate repair is complicated by the risk of postoperative airway obstruction. We describe a technique of combined infraorbital and external nasal nerve blocks to reduce the need for opioid analgesia. Using this technique, we have successfully performed cleft lip repair under local anesthesia alone, without general anesthesia or intravenous sedation, in adolescents and adults. In children, this technique can reduce the need for postoperative opioids. We describe this novel analgesic approach to decrease opioid requirements and minimize perioperative risk.

Topics: Adolescent; Adult; Anesthetics, Local; Cleft Lip; Female; Humans; Infant; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Nerve Block; Nose; Orbit; Pain; Pain Measurement; Prilocaine; Treatment Outcome

The primary objective of this descriptive and correlational study was to determine the level of pain and discomfort perceived by children undergoing nasendoscopy for investigation of voice and resonance disorders. The secondary objective was to explore whether gender, age, previous experience of painful or distressing medical procedures, and previous experience of nasendoscopy influenced the perception of pain during nasendoscopy. Twenty-three children self-reported the degree of pain perceived during nasendoscopy using the Wong-Baker Faces Pain Rating Scale. Parents also used this scale to rate their child's perceived pain. Otolaryngologists and speech pathologists rated the intensity and frequency of observed pain-related behaviors using the Child-Adult Medical Procedure Interaction Scale-Revised and the Procedure Behavior Checklist. Children perceived the procedure, on average, to be moderately painful, as did their parents. Only two children reported perceiving no pain during the procedure. The most frequently observed pain-related behaviors were muscle tension (86.96%), physical resistance (69.57%), requiring physical restraint (60.87%), crying (43.48%), and expressions of verbal pain (39.13%). No significant correlations were found between self-reported pain or observed pain and the variables of age, gender, previous experience of nasendoscopy, and previous experience of painful or distressing medical procedures, although children aged 4-7 years reported significantly more pain than children aged 8-18 years. Most children perceive nasendoscopy to be painful to some degree. This perceived pain occurred in conjunction with several observable pain-related behaviors that have the potential to interfere with the success of the procedure.

Topics: Adolescent; Age Factors; Child; Child, Preschool; Crying; Endoscopy; Female; Humans; Male; Muscle Tonus; Nose; Pain; Pain Measurement; Perception; Restraint, Physical; Sex Factors; Voice Disorders

Radiesse or calcium hydroxylapatite has been used for years in patients with HIV associated lipoatrophy as well as for facial wrinkles and nasolabial folds [2, 3], but can be painful to inject especially in the latter area. This discomfort can be severe enough that after an injection with Radiesse, a patient, despite excellent results, may refuse additional treatments. We hereby describe several methods of minimizing discomfort during Radiesse injections of nasolabial folds and other facial areas.

Topics: Anesthesia, Local; Anesthetics, Local; Biocompatible Materials; Durapatite; HIV-Associated Lipodystrophy Syndrome; Humans; Hypothermia, Induced; Ice; Injections; Lip; Nose; Pain; Pain Measurement; Patient Satisfaction; Skin Aging; Treatment Outcome

Topics: Bandages; Equipment Design; Humans; Infant; Intensive Care, Neonatal; Masks; Neonatal Nursing; Nose; Pain; Positive-Pressure Respiration; Posture; Silicones; Skin Care

Topics: Adult; Animals; Antimony Sodium Gluconate; Biopsy; Diagnosis, Differential; Humans; Leishmania braziliensis; Leishmaniasis, Mucocutaneous; Male; Nasal Obstruction; Nose; Nose Diseases; Pain; Trypanocidal Agents

The fashion of body piercing among adults has encouraged children to have similar procedures or imitate them by applying small magnets to sustain the jewelery used in piercing in position [Emerg. Med. J. 19 (2002) 71]. We present cases of children who have placed magnets on their nasal alae that became misplaced on to the nasal septum causing severe pain and in some cases nasal bleeding and septal perforation. We describe management of these cases.

Topics: Adolescent; Child; Epistaxis; Female; Foreign Bodies; Humans; Magnetics; Male; Nasal Obstruction; Nasal Septum; Nose; Pain; Surgical Instruments

The purpose of this study was to investigate whether parasympathetic cholinergic pathways are involved in the regulation of orofacial blood flow. The effect of atropin (1 mg, iv.) on blood flow responses in the lower lip, nose and hand during painful tooth stimulation was studied in healthy human subjects (n=8). In all subjects, tooth stimulation caused a long lasting vasodilatation in the lower lip. During stimulation there was a transient elevation in heart rate (HR) and blood pressure (BP) concomitantly with a blood flow decrease in the finger and nose. With atropin, the pain-induced HR and BP elevations and blood flow reductions in the nose and finger were decreased. However, the pain-induced blood flow increase in the lip was not changed. This study indicates that the tooth stimulation-induced vasodilatation in the lip is not based on parasympathetic cholinergic mechanisms.

Topics: Atropine; Blood Pressure; Fingers; Heart Rate; Humans; Laser-Doppler Flowmetry; Lip; Nose; Pain; Parasympatholytics; Physical Stimulation; Regional Blood Flow; Skin; Tooth; Vasodilation

Capsaicin and analogues are valuable analgesic agents when administered to mammals, including humans. However, their pungency and the effects on the cardiovascular and respiratory systems through their general activation of small calibre (nociceptive) primary afferents severely limit their use. Recently, structure activity analysis revealed that the initial pungent and general excitatory effects can be prevented by structural modifications in such a way that the analgesic activity is retained. In this paper we present SDZ 249-665, a capsaicin analogue which produced analgesia in the mouse and anti-hyperalgesic effects in the rat and guinea pig. SDZ 249-665 was administered p.o., s.c. and i.v. in models of nociceptive pain, such as tail flick latency in response to a noxious thermal stimulus and acetic acid-induced writhing in mice, and in models of inflammatory mechanical hyperalgesia induced by turpentine or carrageenan in the rat and guinea pig, respectively. SDZ 249-665 was effective in the tail flick and the writhing assays and produced significant anti-hyperalgesic effects in the inflammatory models. The efficacy of SDZ 245-665 was similar to that of capsaicin, however, it was significantly more potent. SDZ 249-665 did not produce any irritancy in a nose wipe assay in guinea pigs or an eye irritancy assay in rats, while capsaicin was clearly irritant in both cases. Furthermore, unlike capsaicin, SDZ 249-665 did not produce unwanted side effects such as bronchoconstriction and blood pressure changes in the analgesic/anti-hyperalgesic dose range. Thus, a clear analgesic therapeutic window exists for SDZ 249-665. In summary, SDZ 249-665 is a potent orally active, analgesic/anti-hyperalgesic agent in mouse, rat and guinea pig. It lacks the excitatory effects associated with capsaicin and other close analogues, and therefore provides a clear therapeutic window for use in painful conditions. In addition to this favourable profile, no sign of tolerance was detected after a 5 day repeated dose treatment.

Topics: Analgesics; Animals; Behavior, Animal; Blinking; Blood Pressure; Bronchoconstriction; Capsaicin; Carrageenan; Disease Models, Animal; Dose-Response Relationship, Drug; Drug Tolerance; Eye; Female; Ganglia, Spinal; Guinea Pigs; Hindlimb; Hyperalgesia; Irritants; Male; Mice; Mice, Inbred Strains; Nociceptors; Nose; Odorants; Pain; Pain Measurement; Rats; Rats, Sprague-Dawley; Turpentine; Urea

Topics: Adult; Duodenitis; Endoscopes; Endoscopy, Digestive System; Equipment Design; Female; Gagging; Humans; Male; Middle Aged; Nose; Pain

The effect of painful stimulation of the nasal ala and upper lip on lacrimation and cutaneous vascular responses in the forehead and cheeks was investigated in 11 normal subjects. In addition, the mechanism of the response was studied in 10 patients with a lesion compromising parasympathetic activity in the facial nerve. In normal subjects, pinching the nasal ala with forceps increased blood flow on the ipsilateral side of the forehead but not the cheek. Pinching the upper-lip induced ipsilateral vasodilation in the forehead in 3 of 11 subjects, but not in the cheek. Pinching either site increased corneal moisture proportional to the size of the vascular response in the forehead. A facial nerve lesion inhibited the ipsilateral component of the vascular response in the forehead. These findings suggest that pain within the distribution of the first or second divisions of the trigeminal nerve excites vasodilator and lacrimal reflexes in the facial nerve. The increase in cutaneous flow during this trigeminal-parasympathetic reflex appears to be limited to the forehead.

Topics: Adult; Aged; Face; Facial Paralysis; Female; Humans; Lip; Male; Middle Aged; Nose; Pain; Physical Stimulation; Reference Values; Skin; Skin Physiological Phenomena; Tears; Vasodilation

Some patients complain of altered sensation in the mouth following nasal surgery. A prospective study of 60 consecutive patients who underwent a total of 83 intranasal procedures revealed that this was a common complication, particularly following submucous resection (SMR) or intranasal antrostomies. The area affected by pain/parasthesia appears to be anatomically related to the surgical procedure(s) performed.

Topics: Adolescent; Adult; Female; Humans; Male; Middle Aged; Nasal Mucosa; Nasal Septum; Nose; Pain; Paresthesia; Postoperative Complications; Prospective Studies; Sensation Disorders; Tooth Diseases

Topics: Adult; Edema; Female; Granuloma; Humans; Male; Middle Aged; Nose; Pain; Prostheses and Implants; Rhinoplasty; Silicone Elastomers

Topics: Anesthesia, Local; Bicarbonates; Humans; Injections, Subcutaneous; Lidocaine; Nose; Pain; Sodium; Sodium Bicarbonate

Visual loss occurred after subcutaneous silicone-oil injection for cosmetic purposes. To our knowledge, this is the first instance of amaurosis caused by a subcutaneous foreign-material injection that spared the central retinal artery and affected portions of the posterior ciliary-artery distribution, including a probable cilioretinal artery. The visual-field defects produced allow a rare opportunity to view the distribution of the human posterior ciliary-artery circulation by means of this in vivo pathologic embolic process. The facial arterial anatomy pertinent to ocular embolism is also discussed.

Topics: Adult; Arterial Occlusive Diseases; Blindness; Ciliary Body; Esthetics; Eye; Female; Fluorescein Angiography; Fundus Oculi; Humans; Injections, Subcutaneous; Nose; Pain; Retinal Diseases; Silicone Oils

Topics: Atrioventricular Node; Coronary Disease; Electrocardiography; Heart Block; Humans; Male; Middle Aged; Nose; Pain; Syncope

Topics: Adolescent; Adult; Aged; Analgesia; Analgesics; Anesthesia, Local; Drug Therapy, Combination; Ear; Humans; Hypnotics and Sedatives; Middle Aged; Nose; Pain

Topics: Adolescent; Adult; Catheterization; Colonic Diseases; Conversion Disorder; Deglutition Disorders; Esophageal Achalasia; Female; Gastroesophageal Reflux; Heartburn; Humans; Male; Manometry; Middle Aged; Muscle Tonus; Nose; Pain; Pharynx; Pressure; Spasm

Topics: Adult; Airway Resistance; Atmosphere Exposure Chambers; Environmental Exposure; Humans; Male; Mucus; Nasal Mucosa; Nose; Pain; Spirometry; Statistics as Topic; Sulfur Dioxide

Topics: Animals; Brain Mapping; Cats; Corpus Callosum; Electric Stimulation; Electrophysiology; Evoked Potentials; Face; Forelimb; Hindlimb; Mouth; Neural Inhibition; Neural Pathways; Nose; Pain; Reaction Time; Skin; Somatosensory Cortex; Thalamus; Touch

Topics: Facial Neuralgia; Humans; Jaw; Nose; Otorhinolaryngologic Diseases; Pain; Paranasal Sinuses; Toothache

Topics: Adult; Carbon Disulfide; Eye; Eye Movements; Female; Fixation, Ocular; Humans; Muscle Cramp; Nausea; Nose; Pain; Postural Balance; Vertigo

Topics: Humans; Hypoxia; Nose; Nose Diseases; Olfactory Nerve; Otolaryngology; Pain; Paranasal Sinuses; Sensory Receptor Cells; Trigeminal Neuralgia

Topics: Chronic Disease; Headache; Humans; Nose; Nose Neoplasms; Otolaryngology; Pain; Paranasal Sinus Neoplasms; Paranasal Sinuses; Rhinitis; Rhinitis, Atrophic; Sinusitis; Syphilis; Tuberculosis

Topics: Humans; Neuralgia; Nose; Pain; Peripheral Nerve Injuries; Peripheral Nerves; Procaine

Topics: Humans; Nose; Nose Diseases; Pain; Tooth

Topics: Analgesia; Anesthesia; Anesthesia and Analgesia; Anesthesia, Local; Fractures, Bone; Humans; Hyaluronoglucosaminidase; Nose; Pain; Pain Management; Procaine

Topics: Anaphylaxis; Headache; Hypersensitivity; Immune System Diseases; Nose; Pain; Rhinitis