Digital nerve blocks: A systematic review and meta-analysis.

Study objective: Digital nerve blocks (DNBs) provide local anesthesia for minor procedures of the digits. Several DNB techniques have been described, but it is unclear which technique provides adequate anesthesia with the least pain. DNB techniques can be grouped into a dorsal approach, which requires 2 injections, versus 3 different types of volar approaches, which require a single injection. We performed a meta-analysis to compare DNB techniques with respect to time to anesthesia (TTA), duration of anesthesia (DOA), and pain of injection. We also reviewed data on degree and distribution of anesthesia and discuss the techniques preferred by study participants and clinicians performing injections. Data Sources: We searched MEDLINE, EMBASE, and CENTRAL databases with terms "digital block," "digital nerve block," "local anesthetic," "local anesthesia," "lidocaine," and/or "bupivacaine." Study Selection: Randomized controlled trials (RCTs) were prioritized, though high-quality prospective cohort studies were also eligible. All included studies evaluated DNB techniques or anesthetics. There were 23 papers (21 RCTs, 2 prospective descriptive studies) included. Data Extraction: DNBs studied included dorsal ring block, traditional dorsal block, transthecal block, modified transthecal block, and volar subcutaneous digital blocks. Outcomes measured included TTA, DOA, pain of injection scores, and degree of anesthesia. Results: Overall, mean TTA was 4.5 minutes (95% confidence interval [CI] 3.5, 5.6), mean DOA was 187 minutes (95% CI 104.3, 269.7), and mean pain score was 2.1 out of 10 (95% CI 1.3, 2.8) without significant differences between studies or techniques. Conclusions: There were no significant differences in the outcomes of TTA, DOA, and pain of injection between different DNB techniques. Single-injection volar approaches may be preferred by participants and clinicians over dorsal approaches that require 2 injections, particularly with respect to pain. However, 2-injection dorsal approaches may have better coverage of the proximal dorsal surface based on degree and distribution of anesthesia.

Perceived risks and reported behaviors associated with osteoporosis and its treatment.

This study investigates older American women's knowledge and risk perceptions about osteoporosis and its treatment. Our results indicate that older U.S. women undervalue the health impact of osteoporosis; they consider it controllable, and neither life threatening nor dreaded relative to other possible diseases or conditions. At least 1/3 of older women in a diagnosed and general sample also confused osteoporosis with arthritis. Women scored highest on osteoporosis knowledge questions related to items under their personal control, such as diet or exercise. Further, women who understood the effects of a particular behavior on osteoporosis were more likely to act in accordance with that knowledge than were women who did not understand those effects.

The acoustic startle response in DBA/2 and C57BL/6 mice: relationship to auditory neuronal response properties and hearing impairment.

The acoustic startle response (ASR) was elicited with tone pips in sensorineural hearing-impaired DBA/2 mice and in non-impaired C57BL/6 mice. The influence of stimulus frequency and intensity on ASR amplitude varied as a function of both strain and age. Previous neurophysiological findings indicate that ASR amplitude is correlated with the proportion of neurons in the cochlear nucleus and inferior colliculus that respond to the ASR stimulus frequencies and to the excitability of neurons in these structures. ASR amplitude is not highly correlated with threshold sensitivity. These observations suggest several neural correlates of ASR amplitude and have implications regarding central neuronal response properties associated with sensorineural hearing loss.