Objective To assess efficacy of mepivacaine on local anesthesia in dentistry and oral surgery and its safety. Methods Parallel group, stratified randomization, double blinded, muti-center clinical trial was designed. Two percent lidocaine with adrenaline in same cartridge was as control. Healthy patients with deep decay, pulpitis needed operative dentistry, or indication for extraction of the teeth, which located in the maxilla or front part of the mandible were included. Results Except 17 cases, 127 patients fulfilled inclusion criteria: 66 in treatment group and 61 in control group, dental filling for 60 and extraction for 67 cases, male 55 and female 72, average at 38.84 + 12.06 years. Submucous infiltration of 1.5 ml mepivacaine at labial or buccal side of the alveolar process produced onset of anesthesia in the median of 60 seconds which was same as that of lidocaine, anesthesia duration for 146.7 minutes with the median of 125 minutes, permitting painless filling or extractions. In the treatment group 81.82% freed of pain, while 15.15% had slight pain but received no extra local anesthetic for implementation of the treatment procedures, making the successful rate of 96.97%. In the mepivacaine group, 13.64% of the cases had transient elevation of the systolic pressure to the level of 145-162 mmHg, 8.33% diastolic pressure to the level of 91-93 mmHg. Only one case had transient palpitation in half minute after one minute injection of the drug with no medical care needed. All the cardiovascular reactions might result from adrenaline containing in the injections. Conclusion Mepivacaine is an effective, safe and reliable anesthetic agent for dentistry and oral surgery.
ObjectiveTo investigate the application of tension-free herniarepair under local anesthesia in senile inguinal hernia. MethodsClinical data of 163 cases of senile inguinal hernias with herniorrhaphy under local anesthesia in our department from October 2011 to October 2014 were analyzed retrospectively, including epidural anesthesia 90 patients and local anesthesia 73 patients. ResultsAll patients were successfully completed surgery. Hospital charges in local anesthesia were much cheaper than that in epidural anesthesia group (P=0.002). Hospital days in local anesthesia were much shorter than that in epidural anesthesia group (P=0.035). Lung complication in local anesthesia were much less than that in epidural anesthesia group (P=0.015). Other indicators were no significant difference between the two groups (P > 0.05). ConclusionTension-free herniorrhaphy under local anesthesia in elderly patients is safe, reliable, less invasive method with low costs, slight postoperative pain, and worthy of promotion.
ObjectiveThis study is designed to explore the indications, clinical pathway, and benefits of ultrasound-guided local anesthesia in radiofrequency endovenous obliteration (RFO) for great saphenous vein varices (GSV).MethodsA total of 350 patients diagnosed with GSV were divide into observation group (n=175) and control group (n=175). Patients in the observation group underwent local anesthesia RFO, and patients in the control group underwent intravertebral anesthesia. Comparion in the visual analogue scale pain scores (VAS) when anesthesia and after surgery, operative indexes, recovery time, satisfaction, and complications were performed.ResultsCompared with the control group, the VAS score with anesthesia time were lower (P<0.05), while in the surgery were higher (P<0.05), as well as the operative time, the first time for underground activity, normal activity time, incidences of complication of anesthesia and urinary were shorter (P<0.05), and the satisfaction rate was higher (P<0.05). There was no difference in the pain score of 12 h and 24 h after surgery, blood loss, volume of anesthetic swelling fluid, postoperative hospitalization, incidences of urinary tract infection, incisional infection, and deep vein thrombosis (P>0.05).ConclusionsThe RFO is feasible and safe after local anaesthesia. It can decrease the complication of anesthesia, that will promote the patient soon to be restored to health.
ObjectiveTo investigate the effectiveness of partial anterior cruciate ligament (ACL) suture repair with wide awake local anesthesia no tourniquet (WALANT) technique.MethodsBetween July 2017 and July 2019, 18 patients with partial ACL injury were admitted. There were 10 males and 8 females, with an average age of 40.5 years (range, 22-57 years). There were 5 cases on the left knee and 13 cases on the right knee. Forteen cases had a clear history of trauma or sports injury, and 4 cases had no obvious cause. The time from injury to operation was 1-6 months (median, 3 months). Partial ligament was sutured using WALANT technique under arthroscopy. The operation time, total hospital stay, and postoperative hospital stay were recorded. Lachman test and anterior drawer test were performed to evaluate the knee joint stability after treatment, and Lysholm and International Knee Documentation Committee (IKDC) scores were used to evaluate the knee function. Five-point Likert scaling were used to evaluate postoperative patient satisfaction.ResultsThe operation time was 30-100 minutes (mean, 64.2 minutes). The total hospital stay was 2-12 days (mean, 4.5 days). Postoperative hospital stay was 1-4 days (mean, 1.8 days). All incisions healed by first intention after operation, and no surgery-related complications occurred. All patients were followed up 12-36 months (mean, 19.1 months). Lachman test and anterior drawer test were negative after operation. Lysholm score and IKDC score at 6 and 12 months after operation were significantly higher than those before operation, and at 12 months after operation were higher than those at 6 months after operation, the differences were significant (P<0.05). At last follow-up, according to five-point Likert scaling of patient satisfaction, 7 cases were very satisfied, 10 cases were relatively satisfied, and 1 case was general. The total patient satisfaction rate was 94.4% (17/18). MRI scan showed the good ligament tension.ConclusionUsing WALANT technique to repair partial ACL injuries under arthroscopy can retain the patient’s own ligament tissue to the maximum extent and achieve satisfactory short-term effectiveness.
Objective To explore the value of wide-awake local anesthesia no tourniquet (WALANT) technique in the treatment of acute Achilles tendon rupture. MethodsIn a prospective randomized controlled trial, 48 patients with acute Achilles tendon rupture who met the criteria between March 2020 and October 2020 were randomly divided into two groups according to 1∶1 distribution, with 24 cases in each group. The study group used WALANT technique and the control group used epidural anesthesia with tourniquet for channel-assisted minimally invasive repair (CAMIR). There was no significant difference between the two groups in gender, age, injured side, cause of injury, distance from broken end of Achilles tendon to calcaneal tubercle, and time from injury to hospitalization (P>0.05). The operating room use time (from patients entering the operating room to leaving the operating room), intraoperative blood loss, hospital stay, and the highest pain score [using Numerical Rating Scale (NRS)] during operation and at 1 day after operation were recorded and compared between the two groups. The tourniquet adverse reactions in the control group were recorded. The functional recovery was evaluated by the scoring method of American Orthopedic Foot and Ankle Society (AOFAS) at 12 months after operation. ResultsThe operation was successfully completed in both groups. The operating room use time and hospital stay in the study group were significantly less than those in the control group (P<0.05), but the difference in the intraoperative blood loss between the two groups was not significant (t=0.429, P=0.670). There was no significant difference in the highest NRS score during operation between the two groups (t=1.671, P=0.101); the highest NRS score in the study group at 1 day after operation was significantly lower than that in the control group (t=−6.384, P<0.001). In the control group, 13 patients had different degrees of tourniquet adverse reactions, including tourniquet regional pain, local swelling, blisters, thigh numbness, and discomfort. The patients in both groups were followed up 12-18 months, with an average of 13.9 months. The motor function of all patients returned to normal at 12 months after operation. The difference in AOFAS scores between the two groups was not significant (t=0.345, P=0.731). There was no complication such as sural nerve injury, local infection, and secondary rupture in both groups. ConclusionThe application of WALANT combined with CAMIR technique in the treatment of acute Achilles tendon rupture has good anesthetic and effectiveness, avoids the adverse reactions of tourniquet, and reasonably saves social medical resources.
Objective To evaluate the reliability and validity of the Chinese version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) in preoperative anxiety in patients with local anesthesia. Methods From May to December 2020, a convenient sampling method was used to conduct an APAIS questionnaire survey on patients undergoing percutaneous renal biopsy in the Department of Nephrology, West China Hospital, Sichuan University, and the reliability and validity of the scale were analyzed. ResultsA total of 460 questionnaires were distributed and 444 valid questionnaires were returned, with a valid response rate of 96.5%. The Cronbach α of APAIS was 0.896, the Guttman split-half reliability was 0.811, and the content validity index was 0.891. The model fit was 12.122 for the chi-square fit index/degree of freedom, 0.916 for the goodness-of-fit index, 0.902 for the value-added fit index, 0.079 for the root mean square error of approximation, and 0.946 for the comparative fit index. The APAIS anxiety subscale score was positively correlated with the 7-item Generalized Anxiety Disorder Scale score (r=0.518, P<0.001). Conclusion The APAIS has good reliability and validity for evaluating the level of preoperative anxiety in patients with local anesthesia, but the application of the scale in other conditions requires further testing.