psd-502 and Edema

To examine the efficacy and safety of a new topical anesthetic containing a disinfection ingredient (LidoDin cream) in reducing the pain associated with venipuncture by comparing it with the proven eutectic mixture of lidocaine 2.5% and prilocaine 2.5% (EMLA cream).. A single-blind, randomized, controlled trial was conducted on a study population consisting of a convenience sample of patients aged 12 to 16 years who presented at our Emergency Department between November 2007 and April 2008. The Visual Analog Scale (VAS) was used for pain assessment. Before the study, the bactericidal effect of the LidoDin cream on skin flora was tested.. Twenty patients were enrolled to each arm of the study. Mean patient age was 13.6 years for the LidoDin group and 14.12 years for the EMLA group (P=0.347). Male patients accounted for 55% of the patients in the LidoDin group, compared with 40% in the EMLA group (P=0.527). Skin reaction scores of the LidoDin group for erythema and edema were not statistically different than those of the EMLA group (P=0.73 and P=0.75, respectively). Patient VAS scores and nurse VAS scores of the LidoDin group were not statistically different than those of the EMLA group (P=0.57 and P=0.93, respectively).. This pilot study demonstrated that LidoDin and EMLA seem to be equally safe and effective topical anesthetics for venipuncture. Future studies are planned to determine, if LidoDin reduces the rate of local skin infection in patients treated with multiple daily subcutaneous injections of medications.

Topics: Adolescent; Adult; Anesthetics, Combined; Anesthetics, Local; Child; Disinfectants; Edema; Erythema; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Pain Measurement; Phlebotomy; Prilocaine

Quality aspects of the anesthetic process are reflected in the rate of intraoperative adverse events. The purpose of this report is to illustrate how the quality of the anesthesia process can be analyzed using statistical process control methods, and exemplify how this analysis can be used for quality improvement.. We prospectively recorded anesthesia-related data from all anesthetics for five years. The data included intraoperative adverse events, which were graded into four levels, according to severity. We selected four adverse events, representing important quality and safety aspects, for statistical process control analysis. These were: inadequate regional anesthesia, difficult emergence from general anesthesia, intubation difficulties and drug errors. We analyzed the underlying process using 'p-charts' for statistical process control.. In 65,170 anesthetics we recorded adverse events in 18.3%; mostly of lesser severity. Control charts were used to define statistically the predictable normal variation in problem rate, and then used as a basis for analysis of the selected problems with the following results: Inadequate plexus anesthesia: stable process, but unacceptably high failure rate; Difficult emergence: unstable process, because of quality improvement efforts; Intubation difficulties: stable process, rate acceptable; Medication errors: methodology not suited because of low rate of errors.. By applying statistical process control methods to the analysis of adverse events, we have exemplified how this allows us to determine if a process is stable, whether an intervention is required, and if quality improvement efforts have the desired effect.

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents, Non-Steroidal; Catheterization, Peripheral; Edema; Erythema; Female; Gels; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Pain Measurement; Piroxicam; Prilocaine

To evaluate and compare the analgesic efficacy and anti-inflammatory effects of topical piroxicam gel vs eutectic mixture of local anesthetic (EMLA) cream applied to the peripheral venous cannulation site in adult volunteers.. Piroxicam gel and EMLA cream were randomly applied on the dorsum of the right and left hand of ten volunteers who acted as their own control. A venous cannula was inserted (no iv infusion) and removed after one hour. Pain scores and signs of inflammation were noted at the cannulation site up to 48 hr.. Pain scores with piroxicam gel were higher on cannulation and on advancement of the cannula (P < 0.05). Thereafter, pain scores were significantly higher with EMLA (P < 0.05). Blanching was present at all the peripheral venous sites treated with EMLA cream. Signs of inflammation (erythema, edema) were not more frequent with EMLA than with piroxicam (P > 0.05). Induration was more frequent with EMLA at six hours.. In volunteers EMLA cream is associated with less pain on cannulation and cannula advancement compared to piroxicam gel. Topical application of piroxicam gel before peripheral venous cannulation alleviates pain and, possibly, inflammation in the period subsequent to cannulation itself.

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents, Non-Steroidal; Catheterization, Peripheral; Edema; Erythema; Female; Gels; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Pain Measurement; Piroxicam; Prilocaine

We report two cases of newborns who developed marked local edema after application of a eutectic mixture of local anesthetic (EMLA) topical anesthetic cream for neonatal male circumcision (NMC). Although local edema and erythema are known potential side effects of EMLA cream, a common anesthetic used for NMC, the loss of landmarks precluding safe NMC has not previously been reported, and is described here. Although we cannot recommend an alternate local anesthetic for neonates with this reaction to EMLA, based on a review of the published data we think that serious systemic adverse events related to EMLA are extremely rare.

Topics: Administration, Topical; Anatomic Landmarks; Circumcision, Male; Edema; Foreskin; Humans; Infant, Newborn; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Prilocaine; Skin Cream

Amide local anaesthetics have previously been shown to reduce oedema and improve dermal perfusion following experimental burns. Previous studies have used invasive techniques for burn oedema quantification which do not allow continuous monitoring in the same animal. The present study used digital image colour analysis to investigate the effect of topical local anaesthetics on burn-induced extravasation of Evans blue albumin. A standardised full-thickness burn injury (1 x 1 cm) was induced in the abdominal skin of anaesthetised rats. The burn area was subsequently covered with 0.5 g of lidocaine-prilocaine cream 5% (25 mg of each in 1 g; EMLA, ASTRA, Sweden) or placebo cream during the first hour post-burn. One hour after the burn trauma, animals received Evans blue dye intravenously. Skin colour appearances were recorded by macrophotography before the burn and 5, 60. 65, 90, 120, 150, and 180 min post-burn. Colour slides were digitised and colour changes were analysed using the normalised red-green-blue (n-rgb) colour system. Results showed a significant inhibition of Evans blue extravasation between 60 and 180 min post-burn in EMLA-treated animals versus controls. Topical local anaesthetics are potent inhibitors of burn-induced plasma albumin extravasation, probably by direct action on vascular permeability and by inhibition of various steps of the pathophysiological response after burn injury.

Topics: Administration, Topical; Anesthetics, Local; Animals; Burns; Capillary Permeability; Coloring Agents; Edema; Evans Blue; Extravasation of Diagnostic and Therapeutic Materials; Follow-Up Studies; Image Processing, Computer-Assisted; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Photography; Prilocaine; Rats; Rats, Sprague-Dawley; Skin

A eutectic mixture of two anesthetic solutions is that of lidocaine and prilocaine, which is available commercially as Emla (eutectic mixture of local anesthetics). This solution is commonly used in clinics in superficial skin surgery and when inserting intravenous catheters, and we also wanted to determine its surface effects when applied onto the tympanic membranes (TM) of rats and guinea pigs as animal models. The animals were observed by otomicroscopy for 2 weeks up to 5 months after administrations of the anesthetic solution. Tissue specimens were then obtained for light microscopy and fine structural analysis. The application of Emla caused minor structural changes to the rat TM, but hardly any alterations to that of the guinea pig. The changes displayed were an overall increased thickness, with typical submucosal edema but only slight epithelial reaction. In comparison with previous results with lidocaine, phenol and Bonain's solution, Emla seemed to be harmless to the structure of the TM. However, the efficacy of Emla as a topical TM anesthetic remains to be proved in future clinical trials.

Topics: Anesthetics, Local; Animals; Collagen; Drug Combinations; Edema; Epithelium; Guinea Pigs; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Prilocaine; Rats; Rats, Inbred Strains; Tympanic Membrane