A randomised controlled trial comparing two insertion techniques for the Laryngeal Mask Airway Flexible™ in patients undergoing dental surgery.

The Laryngeal Mask Airway Flexible™ (LMA Flexible) has been widely utilised for dental, ophthalmology and otorhinolaryngology-related procedures. Our study evaluates two different techniques of inserting the LMA Flexible for patients undergoing day-case dental surgery. One hundred and eight patients were randomly assigned into two groups based on the LMA Flexible insertion technique--either laryngoscopy-guided (n=54) or digital manipulation (standard technique; n=54). Patient and airway characteristics were recorded before induction of anaesthesia. The primary outcome was success rate at first insertion. Other outcomes assessed included fibreoptic assessment of laryngeal mask airway placement, haemodynamic changes, need for airway adjustment during surgery and sore throat. The success rate of insertion on the first attempt was higher for the laryngoscopy-assisted technique compared with the standard technique (96.3% vs 81.5%, respectively, p<0.05). Fibreoptic assessment showed that the former group had better placement of the laryngeal mask airway than the latter (59.3% vs 37% p<0.05). There were no significant differences between the two groups for haemodynamic changes. Sore throat was more common in the group with the standard technique (35.2% vs 16.7%, p<0.05). Our study suggests the use of the laryngoscope to guide insertion of the LMA Flexible for dental surgery is a better option compared with the standard technique of digital manipulation.

The acute pain service after ten years: experiences of a Singapore public hospital.

INTRODUCTION: The management of postoperative pain is an increasingly important aspect of healthcare, leading to the establishment of acute pain services in major surgical centres worldwide. The acute pain service (APS) was established in most Singapore hospitals in the 1990s. We analysed data collected in our institution over a ten-year period (1998-2007), documenting our experiences, outcomes and complications encountered by our APS. METHODS: Data was chronologically divided into two groups for analysis: years 1998-2003 (3,248 cases) and 2004-2007 (2,466 cases). Analysis included a comparison of patient profiles, modalities of analgesia used, effectiveness of pain relief, adverse effects, complications and patient satisfaction. Results were also compared to published audits and proposed standards in medical literature. RESULTS: The patient profile served by the APS remained unchanged over the years, but a move away from central neuraxial blocks was noted with an increased utilisation of patient-controlled analgesia. There was no clinically significant change in pain scores over the two periods of analysis (0.9 vs. 1.0 at rest, 3.0 vs. 3.0 on movement). There were also no statistically significant changes in the prevalence of patients reporting severe pain while on the APS (1.5 percent vs. 1.6 percent at rest, p-value is 0.66; 8.5 percent vs. 9.4 percent on movement, p-value is 0.25). Complication rates remained well within international standards and no major complications were reported. Patient satisfaction remained high (94.3 percent vs. 94.6 percent, p-value is 0.6). CONCLUSION: The move away from invasive and less targeted analgesic modalities has not compromised the quality of analgesia provided. Major morbidity remains extremely rare and incidence of complications has been reduced over the years. Patient satisfaction remains well in excess of 90 percent, and the side effects are largely well controlled. With further advancements in the provision of acute postoperative analgesia, the APS will continue to play an important role in the holistic convalescence of the surgical patient.

A randomized trial comparing two laryngeal mask airway insertion techniques.

This study was undertaken to compare laryngoscopic-guided LMA insertion with a standard insertion technique. A total of 149 patients undergoing elective general surgical and orthopaedic procedures were randomly divided into two groups. Study endpoints included ease of insertion, haemodynamic changes, local trauma bleeding, and postoperative sore throat. There were no statistically significant differences found. The laryngoscope may aid laryngeal mask airway insertion in some circumstances.

Use of EMLA cream or alfentanil for analgesia during ophthalmic nerve blocks.

This prospective double-blind study compared the effectiveness of EMLA with alfentanil and placebo in reducing the overall pain during ophthalmic nerve blocks. Seventy-five patients scheduled for cataract surgery were divided into three groups. Patients in the EMLA group had EMLA cream applied over skin areas corresponding to injection sites for retrobulbar and facial nerve blocks one hour before the nerve blocks, and placebo intravenous normal-saline injection 2 minutes before the first nerve block. The alfentanil group had placebo cream applied and intravenous alfentanil 10 micrograms.kg-1 while patients in the placebo group received placebo cream and intravenous normal-saline at similar time intervals prior to the nerve blocks. Patients then received facial nerve blocks and retrobulbar block by the same surgeon. Pain scores by patients and independent observers were significantly lower in the EMLA and alfentanil groups compared to placebo (P < 0.005) with no significant difference between the EMLA and alfentanil groups.