ABSTRACT
We developed a new technique, the medial orbital pericone local anesthetic block, that surgeons can use a secondary block when inferotemporal retrobulbar or peribulbar/periocular injection of local anesthetics results in incomplete anesthesia. Unlike secondary local injections placed in the superonasal quadrant of the orbit, our technique injects the anesthetic into the fat compartment of the nasal side of the globe, a site that is relatively avascular and lacks vital anatomic structures. In more than 15,000 patients, this method proved an effective, safe means of secondary block and promoted orbicularis oculi muscle akinesia.
Subject(s)
Anesthesia, Local/methods , Ophthalmologic Surgical Procedures , Anesthetics/administration & dosage , Humans , Injections , Nerve Block/methods , Oculomotor Muscles/innervation , OrbitABSTRACT
BACKGROUND AND OBJECTIVES: Intradermal injection of local anesthetics prior to percutaneous needle insertion is often painful. This study evaluated the effect of diluting lidocaine and mepivacaine with balanced salt solution on perception of pain on intradermal injection. METHODS: Twenty healthy volunteers were each intradermally injected with six solutions in random order. These solutions were: normal saline (NS), 0.9% benzyl alcohol in NS, 0.2% lidocaine in NS, 0.2% lidocaine in balanced salt solution, 0.2% mepivacaine in NS, and 0.2% mepivacaine in balanced salt solution. Discomfort of each injection was reported on a 0-2 pain scale. The degree of anesthesia at each site was evaluated by pinprick every minute for 20 minutes. RESULTS: Benzyl alcohol and lidocaine and mepivacaine in balanced salt solution caused the least injection pain. However, mepivacaine in NS and NS alone caused the most pain. The anesthetic effect of benzyl alcohol was judged adequate for only 4 minutes whereas both lidocaine and mepivacaine in either NS or balanced salt solution gave adequate anesthesia for at least 15 minutes. CONCLUSIONS: The dilution of lidocaine and mepivacaine with balanced salt solution produces a solution that is both painless on injection and of moderate duration.
Subject(s)
Injections, Intradermal/adverse effects , Lidocaine/administration & dosage , Mepivacaine/administration & dosage , Pain/etiology , Sodium Chloride/administration & dosage , Adult , Double-Blind Method , Female , Humans , Male , Pain/prevention & controlSubject(s)
Blood Volume Determination , Maternal-Fetal Exchange , Abortion, Therapeutic , Anesthesia, Inhalation , Blood , Body Weight , Carbon Dioxide/blood , Female , Fetus/anatomy & histology , Gestational Age , Hematocrit , Hemoglobins , Humans , Hydrogen-Ion Concentration , Hysterectomy , Oxygen/blood , Pregnancy , Serum Albumin, Radio-IodinatedABSTRACT
PIP: 106 patients undergoing abortion were anesthetized at random with 1 of 3 techniques; ketamine only (53 cases), thiopental followed by ketamine with nitrous oxide-oxygen maintenance (37 cases), or thiopental nitrous oxide-oxygen, d-tubocurarine (61 cases). The intravenous ketamine anesthesia was the easiest to administer for the staff, but 41.5% of the patients stated they would not want ketamine anesthesia again. Recovery room time for the no-ketamine group was shorter than in the 2-ketamine groups. Patients receiving Ketamine were most frequently nauseated. 24.5% of the ketamine-only patients reported unpleasant sensations on going to sleep.^ieng
