Knowledge, Awareness, and Practice of Different Nerve Blocks for Mandibular Molar Root Canal Treatment

Root canal treatment is the most commonly performed procedure in dentistry in the field of endodontics. Prior to the procedure local anaesthesia is administered to ensure painless pulp extirpation and cleaning. There are various methods in which this is done by different practitioners, some prefer to administer a nerve block while a few only use an infiltration, and some use both. We wanted to assess the knowledge, awareness, and practice, regarding appropriate anaesthesia to be used while performing root canal therapy for mandibular molar, among practitioners and post graduate students in India. METHODSA total of 80 specialists volunteered to participate in the study. A simple online questionnaire with 10 relevant questions was framed and circulated to the participants. Responses that were received were verified and analysed using SPSS. RESULTS50 % of the respondents administered a classical inferior alveolar nerve block involving the IAN, lingual and long buccal nerve. 26 % of the respondents anesthetised the inferior alveolar nerve and lingual nerve and 17 % anesthetised the inferior alveolar nerve and long buccal nerve. CONCLUSIONSAnaesthesia of IAN alone should suffice during RCT of the mandibular molars. However, there is no adequate information and knowledge regarding the technique and the amount of local anaesthetic to be delivered for root canal therapy for mandibular molars thus inflicting further pain to the patient.

Phentolamine Mesylate as a Drug for Reversal of Local Anaesthesia - A Questionnaire Based Study

Local anaesthesia being the most commonly administered drug in dentistry has its prolonged action for up to 3 - 5 hours due to the addition of vasoconstrictors. The extended periods of soft tissue anaesthesia due to the addition of these vasoconstrictors can cause other problems while speaking, drinking, and eating during which there is a higher risk of experiencing self-inflicted injuries to the tongue and lips. Phentolamine mesylate is a drug which helps in the reversal of action of local anaesthesia. Hence, the objective of this study was to provide a basic knowledge about this drug to the patient and assess the interest of the patient in taking the drug when given a choice. METHODSA questionnaire-based survey was conducted among 200 patients who required the administration of inferior alveolar nerve block for their dental treatment. This questionnaire contained basic information about Phentolamine Mesylate drug along with six questions where the patient was asked as to whether or not he / she was willing to take this drug for reversal of the effect of local anaesthesia and specific reason for its usage. RESULTSAmong 200 patients, 122 patients wanted to reverse the effect of local anaesthesia by the use of the phentolamine mesylate drug. Amongst these patients, 93 wanted to take the drug orally initially and upon informing that the injection will be given in the previously anaesthetized area, 91 patients preferred to take an injection of the drug. CONCLUSIONSMajority of patients surveyed in this study wanted to reverse the effect of local anaesthesia by taking phentolamine mesylate drug. However, there is a need to increase the awareness of the type of drug used and the importance of administration of the same.

Comparison of Levobupivacaine and Lidocaine for Post-Operative Analgesia Following Tympanoplasty

A pure s-enantiomer of bupivacaine known as levobupivacaine, is now considered a safer alternative for regional anaesthesia than a racemic solution, bupivacaine since it is as efficacious as bupivacaine, but with better pharmacokinetics. Levobupivacaine is clinically tolerated well in cases requiring regional anaesthesia with both bolus administration and post-operative infusion. There are very few incidence of Adverse Drug Reactions (ADR) if administration is monitored appropriately as most ADRs are due to mistakes causing systemic exposure of drug. Hypersensitivity reaction to drug or pharmacological effects of anaesthesia though rare can also cause ADRs.1 Lidocaine (Xylocaine), is available commonly in a 0.5 % or 1 % solution, though several more concentrations are available. It is the most commonly used infiltrative amide anaesthetic. Higher concentrations show no difference in pharmacodynamics but may increase the risk of toxicity.2 The duration of action may be increased by addition of epinephrine. It can be added in concentrations of 1:100,000 or 1:200,000. This is seen to increase the maximum dose of drug and also reduces blood loss.3 Recent studies have found this combination to be safe to use in nose, ears, fingers and toes. METHODSA randomized comparative study was carried out in a tertiary care teaching hospital, Karad. A total of 112 cases was enrolled in the study who were having chronic suppurative otitis media and who require surgical management by tympanoplasty. Cases with a previous history of ear surgery were excluded. The enrolled cases were classified into group I and group II alternatively and the group I cases were given levobupivacaine 0.5 % and group II were given lidocaine 2 %. Infiltration with local anaesthetic was given in post auricular region. Perioperative analgesics were not given. Post-operative pain was measured by using VAS score and comparison of both groups was done by the Mann Whitney U test. RESULTSLevobupivacaine (8.6 mL) and lidocaine (9.2 mL) used during tympanoplasty in cases were stable throughout the procedure and no post-operative complications were noticed. The mean time of analgesic requirement was 186.43 ± 91.04 minutes and 329.54 ± 135.82 minutes respectively in levobupivacaine group and lidocaine group. The mean quantity of analgesics used was 1.95 ± 1.01 tablets and 3.34 ± 1.10 tablets in the levobupivacaine and lidocaine groups respectively.

Comparative Evaluation of Clinical Anaesthetic Efficacy of 15 % Lidocaine Spray and 20 % Benzocaine Gel during Removal of Arch Bars

Application of arch bar is considered as a gold standard for intermaxillary fixation (IMF) in the management of mandibular fractures. Both the application and removal of arch bars can inflict pain for patients who require IMF. For removal of the arch bars, local anaesthesia (local infiltration or conduction block) is often indicated. The study aimed at comparing and validating the efficacy of topical lidocaine spray and benzocaine gel in patients undergoing removal of arch bars. METHODS30 subjects were included in this prospective randomized controlled trial. Maxillary arch was chosen as the test site. 10 patients (Group A) were anaesthetized in the upper gingiva with 15 % lidocaine spray and remaining 10 patients (Group B) were anaesthetized with 20 % benzocaine gel, following which removal of arch bar was done. 10 patients were included in the control group (Group C) where 2 % lignocaine infiltration was offered only on request. Visual analog scale and Wong-Baker Faces Pain Rating Scale was used to measure the pain perceived by the patient during the procedure. RESULTSThe mean and standard deviation of the pain scores of Group A was 2.5 ± 0.70, Group B was 2.7 ± 0.67 and Control group was 5.5 ± 0.85. Both the test groups had a significant pain reduction when compared with the control group. CONCLUSIONSTopical application of both 15 % lidocaine spray and 20 % benzocaine gel provided equally efficient analgesia and can be useful alternatives to conventional local anaesthetic infiltration during arch bar removal.

The Efficacy of Two Different Concentrations of Local Anaesthetic on Pain in Mandibular Third Molar Surgery

@#Mepivacaine is a common local anaesthetic used with claims of a high safety profile. There are two commercial types, 2% mepivacaine with vasoconstrictor and 3% without vasoconstrictor. There are many suggestions regarding the usage of plain 3% without vasoconstrictor for systemic medical problems, however, there have not been any previous studies to confirm this necessity in impacted lower third molar surgery (ILTMS). This study aims to evaluate the anaesthetic efficiency and the effect on the patient of 2% and 3% mepivacaine, adding vasoconstrictor to the 3% mepivacaine. This crossover study comprised of 24 patients with bilateral, symmetrically positioned, impacted lower third molars. Patients received either 2% or 3% mepivacaine for the inferior alveolar nerve block (IANB). Onset and duration of anaesthesia, and haemodynamic considerations were analysed as primary outcomes. Furthermore, pain, duration of postoperative anaesthesia and pulp vitality were analysed as secondary outcomes. Different concentrations of mepivacaine showed similar anaesthetic onset time (p > 0.05). There was no statistically significant difference regarding the duration of anaesthesia, as well as the postoperative analgesia (p > 0.05). The two concentrations did not lead to any haemodynamic changes or complications during ILTMS. Thus, adding the vasoconstrictor to mepivacaine 3% did not cause any adverse effects on the patients intra or postoperatively. Therefore, it is possible for dentists to use only 2% mepivacaine with vasoconstrictor for IANB effectively and safely when the case necessitates the need for a vasoconstrictor, or in other words, longer duration of haemostasis.

Local Anaesthesia Systemic Toxicity (LAST) – A Stroke Mimicker

@#Local anaesthesia systemic toxicity (LAST) is an uncommon and a potentially life-threatening event that develops after peripheral nerve block. The cause may be multifactorial and may include the choice of drug, technique of block and individual patient risk factors. We report a case of a 55-year-old female who developed slurring of speech and quadriplegia after receiving a mixture of lignocaine and hydrocortisone through an intra-articular injection to the right shoulder. Neurological examination revealed hypotonia and absence of power (0/5) in all limbs. These toxic events may have resulted from an accidental intra-arterial or dural cuff injection of local anaesthesia or absorption from surrounding tissues. This case report demonstrated that an intra-articular injection in the shoulder may cause LAST and may be under-recognized as it can mimic stroke.

Pain Control : Current Understanding And Multimodal Approach In Management Of Maxillary Midline Cyst

In 1968 Mc Caffery defined pain as “Whatever the experiencing person says it is whenever he/she says it does” Pain is the most common reason individuals seek health care. Pain control in Oral And Maxillofacial Surgery is an important factor for reducing the fear Department of Oral and Maxillofacial and anxiety associated with dental procedures. In dentistry, local Bharati Vidyapeth Dental College anaesthetics form the backbone for pain control. This case report highlights the implication of splash block technique in enucleation a maxillary midline Contact no: +91-8552887325 residual cyst which would otherwise be operated under general anesthesia owing to its proximity to nasal floor.

Circuncisión neonatal con anestesia local: Resultados de un protocolo estandarizado / Neonatal circumcision with local anesthesia: Results of a standardized protocol

Introducción La circuncisión neonatal es un procedimiento frecuente en EE. UU. y en otros países, y presenta baja tasa de complicación en manos entrenadas. Sin embargo, en Chile recién está siendo incorporado clínicamente a nuestro medio. Nuestro objetivo fue establecer un protocolo local estandarizado de circuncisión neonatal con anestesia local y evaluar sus resultados y las posibles complicaciones. Pacientes y método Protocolo prospectivo estandarizado a pacientes que soliciten circuncisión neonatal cuyos criterios de inclusión fueron: niños < 60 días y < 5 kg. La técnica quirúrgica consiste en anestesia local tópica y bloqueo peneano, atrición del prepucio y mucosa redundante con clamp de Mogen® y sección con bisturí. Se evalúa protocolo utilizado desde noviembre de 2005 a octubre de 2014 por un urólogo pediatra y/o cirujano pediatra entrenados en la técnica. Se registran y analizan complicaciones y condiciones hasta el alta definitiva. Resultados En 9 años se aplicó el protocolo a 108 pacientes. La edad promedio al procedimiento fue de 9 días (1-52). Un paciente (0,9%) presentó sangrado inmediato, requiriendo cirugía posterior. Todos los pacientes fueron dados de alta definitiva de controles al mes, sin otras complicaciones. La razón para realizar el procedimiento fue por solicitud de los padres en el 100% de los casos por razones sociales o religiosas. Conclusión La circuncisión neonatal con anestesia local es un procedimiento sencillo y que en casos seleccionados tiene excelentes resultados, sin mayores complicaciones. Con el debido entrenamiento y adecuando el protocolo inicial, se puede realizar de manera ambulatoria, sin necesidad de someter al niño a los riesgos de la anestesia general en recién nacidos.

Introduction Neonatal circumcision is a common procedure in the US and other countries, with low rates of complications in trained hands. However, it has recently been incorporated into the clinical environment in Chile. Our goal was to establish a local standardised protocol for neonatal circumcision under local anaesthesia, and evaluate the results and possible complications. Patients and method A standardised prospective protocol was used on patients who underwent neonatal circumcision. The inclusion criteria were: children < 60 days and < 5 kg. The surgical technique used was topical local anaesthesia and penile block, attrition of redundant prepuce and mucosa with Mogen® clamp, and section with scalpel. The protocol was used and evaluated from November 2005 to October 2014 by a paediatric surgeon and/or paediatric urologist trained in the technique. Complications and conditions until final discharge were analysed. Results The protocol was applied to 108 patients over a 9 year period. The mean age at procedure was 9 days (1-52). One patient (0.9%) had immediate bleeding, requiring further surgery. All patients were discharged from further medical checks at 1 month, without any other complications. The reason for the procedure was by parental request in 100% of the cases, and always for sociocultural reasons. Conclusion Neonatal circumcision under local anaesthesia is a simple procedure, and has excellent results in selected patients, and with no major complications. With proper training, and adapting the initial protocol, it can be performed on an outpatient basis, without putting the neonates through the risks of general anaesthesia.

Perioperative glycaemic control in diabetic patients undergoing cataract surgery under local anaesthesia: a survey of practices of Singapore ophthalmologists and anaesthesiologists

<p><b>INTRODUCTION</b>Perioperative glycaemic control is an important aspect of clinical management in diabetic patients undergoing cataract surgery under local anaesthesia. While poor long-term glycaemic control has significant implications for surgery, perioperative hypoglycaemia or hyperglycaemia may also compromise patient safety and surgical outcomes. We aimed to survey ophthalmologists and anaesthesiologists on their approach and to identify the prevalent practice patterns in Singapore.</p><p><b>METHODS</b>This was a cross-sectional questionnaire-based survey conducted in four public hospitals in Singapore with established ophthalmology and anaesthesia units. Respondents were approached individually, and the self-administered questionnaires comprised questions related to practice patterns, clinical scenarios and awareness of pre-existing guidelines.</p><p><b>RESULTS</b>A total of 129 doctors responded to the questionnaire survey. 76 (58.9%) were from ophthalmology departments and 53 (41.1%) were from anaesthesia departments. The majority chose to withhold oral hypoglycaemic agents (82.9%) and/or insulin (69.8%), and keep the patient fasted preoperatively. A blood glucose level ≥ 17 mmol/L prompted 86.0%-93.8% of respondents to adopt a treat-and-defer strategy, while a level ≥ 23 mmol/L prompted 86.0%-96.9% of respondents to cancel the cataract surgery. The respondents were consistently more concerned about perioperative hyperglycaemia (n = 99, 76.7%) than intraoperative hypoglycaemia (n = 83, 64.3%).</p><p><b>CONCLUSION</b>The current study presented the prevalent practice patterns of ophthalmologists and anaesthesiologists in the perioperative management of diabetic patients undergoing cataract surgery in four public hospitals in Singapore. Further research in this field is required, and may be useful for the future formulation of formal guidelines and protocols.</p>

Intraperitoneal Drainage Under Local Anaesthesia In Patients Of Perforation Peritonitis Before Definitive Management: Is It Justified?

Introduction: Perforation peritonitis is one of the most frequently encounter surgical emergency around the world. In spite of advances in diagnosis, antimicrobial therapy, surgery, it remains a fatal affliction with high mortality rate. This high mortality rate makes way for innovation in techniques in addition to the persisting knowledge for a better outcome. Aims: A pilot study was conducted, to evaluate the efficacy of intraperitoneal drainage in patients of perforation peritonitis during the resuscitation period before definitive surgical treatment. Methods: This was a prospective control study, conducted on the patients of perforation peritonitis with gastro-intestinal perforation for a period of 2 years w.e.f. January, 2011 to November 2012. 100 patients were included in this study and were divided into two groups (50 each). Group I- patient with preoperative intraperitoneal drainage under local anaesthesia, group II- patient without preoperative intraperitoneal drainage, before definitive surgery. Results: The overall morbidity and mortality of the patients in group-I were comparable with those in group-II Conclusion: Intraperitoneal drainage under local anaesthesia, in patients of gastrointestinal perforation peritonitis seems to be effective in decreasing morbidity and mortality.

Peripheral Neurectomy of Infraorbital Nerve -A Treatment Option for Trigeminal Neuralgia: A Case Report.

Trigeminal neuralgia or tic douloureux is a commonly diagnosed facial pain syndrome with a female predominance and with peak occurrence in the age group of above 50 years. Treatment options range from conservative pharmacologic therapy to invasive surgical procedures. The mode of treatment is based on patient’s systemic health, compliance and severity of the disease. Peripheral neurectomy is the safest and simplest method that can be accomplished under local anesthesia with minimum risks and excellent pain relief to the patient. However, there are incidences where this mode of treatment also fails to manage the disease, and further surgical options must be considered. In this case report, we present a case of a 50-year-old female patient who has undergone peripheral neurectomy of infraorbital nerve.

Dental Anaesthesia : An Overview.

Dentists have been the founder of anaesthesia because of their day to day experience of pain while doing their job. Due to high morbidity and mortality, general anaesthesia never won the heart and trust of the dentist. Although several local anaesthetic agents were used in dental practice but they could not last long due to toxic side effects. A new chapter was written in dental anaesthesia with the invention of wonder drug “Lidocaine” and till date it remains the most popular drug amongst the dental fraternity for the majority of the dental procedures. Recently due to safe new drugs, techniques and advanced monitoring the concept of general anaesthesia for dental surgeries has reemerged and is being used with minimal morbidity and mortality at several centers. In the present review article after obtaining the literature from PUB MED/MEDLINE, books and print journals we have discussed in detail the drugs, techniques, complications along with their management, and new development in dental anaesthesia.

Subjective visual experience during cataract surgery:A survey of patients and ophthalmologists / 中华实验眼科杂志

Background Patients' experience during phacoemulsification cataract surgery is an important determinant of patient's satisfaction with surgery effectiveness.Local anaesthesia could be associated with different intraoperative visual awareness because of retention of optic nerve function.Relieving the anxiety of patients arose from intraoperative visual awareness is of important clinical significance.Objective This study was to discuss the necessity of preoperative conversation and psychological counseling and to improve the quality of surgery and the satisfaction of patients.Methods One hundred and fifty-three patients who had undergone sequential phacoemulsification and intraocular lens (IOL) implantation in the same operation under local anaesthesia from October,2010 to December,2010 in Tangdu Hospital and Xi'an First People's Hospital,received a standardized questionnaire designed based on similar questionnaires from abroad and surveyed regarding their intraoperative visual experience,including light perception,their detection of color,photopsia,and their detection of the movement of the surgeon,instrument,and changes in light intensity during cataract surgery.In another survey,seventy ophthalmologists in the Xi'an area with ≥ 10 years (33) and ＜ 10 years of experience (37) participated in a questionnaire about their recognition and response to these visual experiences,designed based on the 2010 Chinese Doctors General Questionnaire.Results During the phacoemulsification and IOL implantation,27 patients (17.6％) lost light perception,98 patients (64.1％) had light perception,28 patients (18.3％) detected more than one color,25 patients (16.3％) had photopsia,49 patients (45.1％) sensed the movement of the surgeon,26 patients (17.0％) was able to see surgical instruments,11 patients (7.2％) saw the surgeon's fingers,4 patients (2.6％) saw the surgeons,65 patients (42.5％) detected changes in light intensity and 12 patients (7.8％) saw the IOL loop and others.21.4％ of the 70ophthalmologists believed these patients might have lost light perception;while 78.3％ thought these patients retained light perception.Under local anaesthesia,93.9％ of the more experienced surgeons and 75.6％ of the junior surgeons deemed that good preoperative counseling was helpful for the patients,but only 45.5％ of the more experienced surgeons and 24.3％ of the junior surgeons counseled patients regarding intraoperative visual experience.Conclusions Most patients will experience a variety of visual sensations during phacoemulsification and IOL implantation under local anaesthesia.Many ophthalmologists are aware of these conditions.Most of the ophthalmologists believe that patients suffer from fear from these intraoperative visual experiences and claim that preoperative counseling to patients can relieve that fear,but less of them communicate these possible experiences to patients.This study offers some discussions about preoperative counseling.

Endovascular Aneurysm Repair (EVAR) for infra-renal Abdominal Aortic Aneurysm(AAA) under Local Anaesthesia - Initial Experience in Hospital Kuala Lumpur

This is our initial report on the first 4 cases of infra-renal abdominal aortic aneurysms undergoing Endovascular Aneurysm Repair (EVAR) with local anaesthesia, controlled sedation and monitoring by an anaesthetist. All 4 patients were males with a mean age of 66.7 years. Only one (1) required ICU stay of 2 days for cardiac monitoring due to bradycardia and transient hypotension post procedure. No mortality or major post operative morbidity was recorded and the mean hospital stay post procedure was 3.5 days (range 2-5 days).

Superior somatic pain relief and improved visceral pain control is achieved using pre-emptive analgesia for laparoscopic cholecystectomy: a randomized controlled trial

BACKGROUND: Laparoscopic cholecystectomy, although is less invasive than open surgery, is not completely pain free. The use of local anaesthesia to relieve pain following this procedure is a common practice. However, it remains debatable whether a pre- or post-operative drug administration is more effective. Here, we investigated the role of preemptive local anaesthetic infiltration given pre- or post-incisional, in relieving the pain during laparoscopic surgery. METHODOLOGY: A randomized controlled trial was conducted with 96 patients receiving 0.5% Bupivacaine 100mg. Group A (n=48) received post-incisional skin infiltration whilst Group B (n=48) received pre-incisional infiltration. Incisional (somatic) and intra-abdominal (visceral) pain was assessed using Visual Analog Scale (VAS) at day 0, day 1 and day 7 post-operative days. RESULT: Baseline characteristics between the two groups were similar. Incisional pain was lower in Group B as compared to Group A at day 0 (P=0.03) and day 1 (P0.05). CONCLUSION: Administration of pre-incisional local anaesthesia offers better pre-emptive pain relief measure than postincisional administration by reducing somatic and visceral pain in laparoscopic gall bladder surgery.

Complicaciones postoperatorias en la herniorrafia ambulatoria con malla: estudio comparativo de la tasa de infección del sitio operatorio con y sin profilaxis antibiótica / Antibiotic prophylaxis in mesh inguinal herniorrhapy

The use of antibiotic prophylaxis has been questioned in the inguinal herniorrhaphy with mesh. The aim of this paper is to give account of the efficiency of antibiotic prophylaxis (AP) in the prevention of wound infection in the elective inguinal herniorrhaphy with mesh under local anaesthesia in an ambulatory basis. In the present observacional analytic study, 955 patients were operated upon with a mesh technique during a 10 year period, .in the CRS Hernia Centre in Santiago. In the first group of 250 patients, lgr Cefazolin® was administered iv one hour before the operation, in the second group of 710 patients no antibiotics were used. Demographic variables, associated diseases, the length of surgery were comparable in both groups. The same team of surgeons work in both groups. Wound infection was defined as the presence of pus in the surgical wound associated with a positive bacterial culture. The rate of wound infections was 1.05 percent of the first and 0.35 percent of the second group. This difference was no significant (p < 0.08). The isolated germ was a Staphylo-coccus aureus in all cases. The treatment was ambulatory in all cases. The rate of haematoma and funiculo-testicular fluxion were low. We conclude that the rate of wound infection in mesh herniorrhaphies is low and that the antibiotic prophylaxis does not improve these results. Its routine use in these patients is not justified.

Introducción: El uso de la profilaxis antibiótica en la cirugía hemiaria con malla es controversial. El propósito del presente estudio es establecer la efectividad de la profilaxis antibiótica (PA) en la prevención de la infección del sitio operatorio (ISO) en la herniorrafía con malla efectuada en forma ambulatoria con anestesia local. Material y Método: El estudio observacional analítico se realizó dentro del Programa de Cirugía Ambulatoria del CRS Cordillera, en dos grupos consecutivos de pacientes, el primero que se sometió a PA mediante lgr de Cefazolina® intravenosa, inmediatamente antes del procedimiento quirúrgico, y el segundo en el que se prescindió de ella. Los controles postoperatorios se efectuaron al 7º y 30º día por un cirujano del grupo. Se diagnosticó ISO con la presencia de exudado purulento, con cultivo bacteriano positivo. Resultados: El estudio se efectuó en 955 pacientes operados entre 1998 y 2008. En el primer grupo, constituido por 245 pacientes se usó PA, en el segundo grupo de 710 pacientes se prescindió de ella. Las variables demográficas, antecedentes mórbidos y la duración del acto quirúrgico fueron comparables en ambos grupos. Se registraron 2 casos de infección en el primer grupo (1,05 por ciento) y dos en el segundo (0,35). Esta diferencia no fue significativa. El germen aislado fue en todos los casos el estafilococo dorado. Conclusiones: La tasa ISO en la hemiorrafia inguinal electiva ambulatoria con malla es baja y no se modificó con el uso de PA. Su empleo indiscriminado no aparece justificado en estos pacientes.

Lichtenstein tension-free herniorrhaphy: a retrospective analysis in 4011 cases / 国际外科学杂志

ObjectiveTo evaluate results of the Lichtenstein tension-free mesh repair and summaraize the clinical experience in the treatment of the inguinal hernia. MethodsIn this retrospective study, 4011 tension-free inguinal hernia repairs were performed in 3631 patients, using a polypropylene mesh (Lichtenstein technique). Results The average hospitalization was 3.8 days, the overall complication rate was 2.4％, the recurrence rate was 0.1％. ConclusionThe Lichtenstein repair for the treatment of inguinal hernia has the advantage of less postoperative pain and low recurrence and is highly suitable for day case surgery.

Excision of tracheocutaneous fistula under local anaesthesia

Tracheocutaneous fistula (TCF) is a known complication of tracheostomy. It can cause problems such as saliva leak, predispose to infection from external skin into respiratory tract and cosmetically not acceptable. Treatment of the underlying infection is paramount important. Persistence of tract after sufficient duration of observation period should be surgically treated. Cases reported in the literature are mainly regarding paediatric TCF and the procedures are usually done under general anesthesia. We describe a case of surgical treatment of an adult TCF which was done under local anaesthesia.

Cirugía ambulatoria con anestesia local en el tratamiento de la comunicación buco sinusal mediata y tardía / Ambulatory Surgery using local anaesthesia in the treatment of the mediate and late sinusal oral communication

Se realizó un estudio longitudinal y prospectivo sobre el tratamiento quirúrgico de la comunicación bucosinusal (CBS) mediata o tardía de modo ambulatorio y con anestesia local en el período comprendido entre septiembre del año 2002 y agosto del 2006 cuya muestra estuvo constituida por los 41 pacientes que con ese diagnóstico fueron tratados en el Hospital general docente "Abel Santamaría Cuadrado" (muestreo no probabilístico) en el lapso antes mencionado con el propósito de demostrar que la cirugía de la CBS mediata y tardía se puede realizar de modo satisfactorio con anestesia local y de forma ambulatoria. El trabajo se realizó cumpliendo con los principios de Bioética establecidos. Los resultados fueron procesados estadísticamente utilizando el test de comparación para los estudios comparativos sin la corrección de yates, trabajando con un nivel de confiabilidad de alfa igual o menor que 0.05. Esto permitió concluir que es posible realizar el tratamiento de la CBS mediata o tardía consistente en la antrotomía radical con técnica de Caldwel Lock de modo totalmente satisfactorio, sin complicaciones adicionales a las descritas en esta técnica, utilizando el modo ambulatorio y la anestesia local, que el transoperatorio cursó de forma satisfactoria, teniendo los pacientes una evolución post quirúrgica favorable con las múltiples ventajas que ofrece esta modalidad de tratamiento para el paciente, los familiares, la institución, la sociedad y la economía. El impacto económico es considerable con un ahorro para el hospital tanto por el tipo de anestesia, como por la cirugía ambulatoria de $30 961.174.

A longitudinal prospective study on the surgical ambulatory treatment of the mediate or late oral sinusitis communication was carried out using local anaesthesia in September 2002 and August 2006. Sample was comprised of 41 patients treated in "Abel Santamaría Cuadrado General Hospital" (non-probabilistic sample) .The present study was aimed at proving that the mediate or late surgery of the OCS is able to be ambulatory and performed under local anaesthesia. The bioethical principles were followed. Results were statistically processed using the comparative test for the comparative studies without the Yates correction and working with a confidence level of á= 0.05. It allowed concluding that is possible to prescribe the mediate or late OCS using the radical antrotomy with Caldwell Lock technique successfully. The transoperative period was also successfully using the ambulatory surgery and local anaesthesia, having many advantages for the patient, family and the facility as well as the society and economy. The economical impact is great saving $30 961.174 to the hospital.

Comparative Analysis of Local Anaesthesia and Epidural Anaesthesia in Tension-Free Herniorrhaphy / 中国普外基础与临床杂志

Objective To investigate the most suitable anaesthesia method for the tension-free herniorrhaphy.Methods A total of 422 unilateral inguinal hernia cases from 2002 to 2005 were collected and randomly divided into the local anaesthesia group and epidural anaesthesia group. Observation indices and some relative data, such as operative duration, date of ambulation, date of foodintake, length of hospital stay, operation-correlated complications, anaesthesia complications, usage rate of ancillary drug, satisfactory rate for anesthesia, cost of hospitalization, were included and recorded in the questionnaire, and all the patients who took the tension-free herniorrhaphy were asked to answer it as the follow-up research. Results It was found that the occurrence of postoperative anaesthetic complications, the cost of hospitalization, length of stay of local anaesthesia group were significantly less than those of epidural anaesthesia group, and the date of moving and the date of foodintake were also significantly earlier than those of the other group (P0.05). Conclusion The local anaesthesia is suitable for most of the tension-free herniorrhaphy, and it may be used as the conventional anaesthetic method.