Comparing the Effect of Lidocaine-Prilocaine Cream and Infiltrative Lidocaine on Overall Pain Perception During Thoracentesis and Abdominocentesis: A Randomized Clinical Trial.

BACKGROUND: Acute pain management is a core ethical commitment to medical practice. However, there is evidence to suggest that sometimes infiltrative lidocaine (IL) is not used prior to thoracentesis and abdominocentesis due to the belief that two needles cause greater pain than one. However, topical anesthetics like lidocaine-prilocaine cream (LPC) are painless, easy to use, and have less systemic side effects. Therefore, LPC can be a suitable substitute for medical procedures. OBJECTIVES: This study was designed to compare the analgesic effects of LPC with IL in thoracentesis and abdominocentesis. METHODS: Patients were divided into two study groups, including individuals seeing a physician for a thoracentesis (N = 36) and those seeing a physician for an abdominocentesis (N = 33). Patients were randomly assigned to the IL (N = 35) or LPC (N = 34) groups for diagnostic and/or therapeutic purposes. The IL group received 100 mg of 2% lidocaine 5 minutes prior to their procedure, whereas the LPC group received 2.5 g of lidocaine-prilocaine cream. The cream was spread over a 20 - 25 cm2 area and occluded with dressing plaster for 30 minutes prior to the procedure. In both study groups, the thoracentesis and abdominocentesis were ultrasound-guided. RESULTS: The findings suggest a non-significant difference between overall pain perception in LPC and IL groups generally, as well as specifically in abdominocentesis and thoracentesis groups. Furthermore, the result remained the same after controlling for confounding variables. The number of attempts to perform successful abdominocentesis was significantly higher in the LPC than IL (P-value = 0.003) group but was not significant in the thoracentesis group (P-value = 0.131). The level of patient satisfaction in the LPC and IL groups were not significantly different (P-value > 0.05). CONCLUSIONS: Overall, LPC appears to be an appropriate alternative to IL in reducing pain during thoracentesis and abdominocentesis, but it seemed to increase unsuccessful medical procedure attempts.

Recovery of the lumbar multifidus muscle size in chronic low back pain patients by strengthening hip abductors: A randomized clinical trial.

INTRODUCTION: Decrease in cross-sectional thickness of lumbar multifidus (MF) muscles during prolonged low back pain episodes commonly occurs. Restoration of the MF muscle size can be an effective way of treating chronic low back pain (CLBP) patients. Traditionally, clinicians apply muscle stabilization exercises for these patients. Recent studies support the need for active strengthening exercises for treatment of the CLBP patients. OBJECTIVE: The MF muscles provide lumbar stability, and therefore we hypothesized that strengthening of these muscles can be more effective than the MF muscle stabilization exercises in restoration of the muscle size. DESIGN: Study design was a randomized allocation control trial with two groups of adult female CLBP patients (n = 12 each; age range of 20-45). Patients in the control group underwent stabilization exercises and the patients in the intervention group underwent the hip abductor strengthening exercises. SETTING: For all subjects of each group, the trials continued in 24 sessions distributed over 8 weeks and the MF muscles were measured in the beginning of the first session and one week after completion of the last session. MAIN OUTCOME MEASURES: Statistical significance (p-value) of the change in the average MF muscle thickness, pain, and disability scores along with for each group were estimated. RESULTS: Both regimens of exercises can significantly decrease the pain and disability: average pain and disability reductions of 46% (p-value of 0.001) and 33% (p-value of 0.02) via stabilization versus average pain and disability reductions of 65% (p-value of 0.001) and 59% (p-value of 0.001) via hip abductor strengthening. However, the hip abductor strengthening is the sole statistically significant exercise regimen (p-value of 0.014 vs 0.94) for increasing the MF muscle size. CONCLUSION: Replacement of the traditional stabilization exercises with the hip abductor strengthening exercises for effective treatment of female adults with CLBP is recommended.

Massive urethrorrhagia due to a blunt perineum injury; a report of a case with bulbar pseudoaneurysm.

Blunt perineum trauma rarely leads to massive urethrorrhagia due to the formation of a bulbar aneurysm. A 29-year-old man with unstable hemodynamic underwent a digital subtraction angiography (DSA), which revealed a pseudoaneurysm in the penile bulb supplied from both internal pudendal arteries fistulized to the urethral duct bulb. A catheter was inserted into the distal part of pudendal arteries at the pseudoaneurysm's proximity, and an intermittent embolizing agent (Gel-foam) was injected. The pseudoaneurysm was filled with Gel-foam. Despite the superiority of conservative management, urethrorrhagia's life-threatening nature calls for angiographic intervention, successfully embolized using gel-foam with negligible complications.

Comparison of Selective Local and Global Muscle Thicknesses in Females with and without Chronic Low Back Pain.

BACKGROUND: Chronic low back pain (LBP) leads to long-term physical and psychological problems and may result in acute deterioration of the pain. It is hypothesized that size changes in selected limb and pelvis muscles during contracting movements are different between healthy individuals and LBP patients. MATERIALS AND METHODS: A case-control study including two groups of 30 female participants with and without LBP symptoms was designed. Participants were 20-45 years old (36.7±6.7, healthy subjects; 34.6±6.2 LBP subjects). Ultrasonography was used to estimate the thicknesses of the quadratus lumborum (QL), gluteus medius (GMed), transversus abdominis (TrA) and lumbar multifidus (MF). Thickness changes of the muscles in a submaximal contracting position compared to the rest position were measured. Statistical analysis included an independent t-test to determine the significance of differences, and the Kolmogrov-Smirnov two-sample test to evaluate the normality and reliability. RESULTS: All muscles increased their thickness during contractions. The average increase in LBP subjects was lower than in the healthy subjects. The smaller increase in the muscle thickness of GMed in the LBP group may suggest a weakness because of imbalance in the GMed muscle of LBP patients. CONCLUSIONS: 1. Ultrasonography of local and global muscles is an appropriate device for clinical diagnosis of LBP. 2. Strengthening TrA, MF, and GMed muscles for pain prevention is effective in the prevention and treatment of LBP.