Combination of lidocaine/prilocaine with tramadol for short time anaesthesia-analgesia in chelonians: 18 cases (original) (raw)
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The use of topical lidocaine/prilocaine cream prior to childhood circumcision under local anesthesia
Ambulatory Surgery, 2001
A prospective study was conducted to evaluate the efficacy of prior application of topical eutectic mixture of local anesthetics, EMLA, in alleviating the pain associated with infiltration local anesthetic (LA) for circumcision in children and to assess its impact on the outcome. A total of 173 children aged 3-13 years requiring circumcision were randomly assigned to have EMLA or placebo cream applied over the root of the penis 1 h before subcutaneous ring block. A blinded observer rated the pain response on a 10-point visual scale during needle insertion, injection of local anesthetic and circumcision. Children needing conversion to general anesthesia (GA) were counted as failures. A total of 89 and 82 boys were included in the EMLA group and placebo group, respectively. Significantly lower pain scores were recorded for needle puncture in the former group (P B 0.001), whilst pain scores for injection and during circumcision were not statistically different between the two groups (P = 0.037 and 0.138, respectively). A total of 88 out of the 89 boys pre-treated with EMLA completed the procedure, whereas seven boys in the placebo group necessitated conversion to GA (P= 0.022). The converted cases had higher values for all pain scores and tended to be younger. Therefore, EMLA cream is a useful adjunct to LA for childhood circumcision because it effectively reduces the sharp pain induced by needle puncture. However, careful patient selection is required for a low conversion rate to GA.
Journal of Andrology, 2006
Although topical anesthetic blockage for penile surgeries has been substantially reported in the medical literature, its methodology, reliability, and reproducibility have not been consistent. We report on several methods of topical blocks for local anesthesia in patients with indications for penile surgeries. From March 1993 to March 2003, a total of 1131 men, ages 19 to 87, underwent penile surgeries in which 165, 203, 708, 45, and 10 patients received penile implantation, modified Nesbit procedure, venous surgery, venous patches, and arterial revascularization respectively, under pure local anesthesia on an outpatient basis. They were categorized into the implant, Nesbit, venous, patch, and arterial groups respectively. Proximal dorsal nerve blockage, peripenile infiltration, and topical injection, although challenging, were sufficient local anesthesia for patients in the last 4 patient groups. A new method of crural blockade, however, was also required for optimal anesthesia of the cavernous nerve for implantation purposes. The anesthetic effects and postoperative results were satisfactory. Common immediate side effects included puncture of the corpus spongiosum or the deep dorsal vein as well as the innominate vessel, subcutaneous ecchymosis, transient palpitations, and acceptable low level of pain. There were no significant late complications. In the implant group, however, 6.1% of patients (10/165) had experienced pain over the perineum for 1 to 2 weeks postoperatively. Overall there were statistical differences in scoring between the 5 groups in which the implant group stood out when a visual analog scale of 100 mm was used. Topical nerve blockades proved to be reliable, simple, and safe, with minimal complications. They offer the advantages of less morbidity, reduced effects of anesthesia, protection of privacy, and a rapid return to preoperative daily activity.
Comparison of local anaesthetic effects of tramadol with prilocaine for minor surgical procedures
British Journal of Anaesthesia, 2003
Background. Recent studies have shown that a local anaesthetic action of tramadol 5% was able to induce a sensory block to pinprick, touch, and cold similar to that of lidocaine 1%. The aim of this study was to compare the local anaesthetic effects of tramadol hydrochloride with prilocaine. Methods. Sixty ASA I or II patients, undergoing excision of the cutaneous lesions under local anaesthesia, were included in the study. Patients were randomly assigned to receive either 1 ml of tramadol 5% (Group T, n=30) or 1 ml of prilocaine 2% (Group P, n=30) intradermally, in a double-blinded fashion. The degree of the burning sensation and pain at the injection site was documented. Sensory block was assessed 1 min after injection. The patient was asked to report the degree of sensation and to grade touch and pinprick sensation. Two minutes after drug administration, incision was performed and intensity of pain, felt by the patient was evaluated on a four-point scale (0±3). Any local adverse effects were recorded. Results. There was no difference in the quality of block between the two groups. Side effects were noted in both groups with a signi®cant increase in the incidence of local reaction (rash) in Group T (seven patients) when compared with Group P (one patient) (P<0.05). Seven patients in Group T vs four patients in Group P complained of burning at the injection site (P>0.05). Conclusions. Intradermal tramadol 5% can provide a local anaesthesia similar to the prilocaine but the incidence of local adverse effects is higher.
Laboratory Animals, 1990
An assessment was made of the effects of topical application of a eutectic mixture of local anaesthetics (EMLA cream) in a number of species of laboratory animals. Application of EMLA cream enabled percutaneous insertion of catheters into the cephalic vein in dogs and cats and the marginal ear vein in rabbits without causing any detectable pain or discomfort. Application to the tail in rats prior to percutaneous cannulation of the lateral tail vein did not produce a significant reduction in the behavioural responses to venepuncture. EMLA cream represents a useful refinement of current techniques for intravenous injection in some species, and is especially valuable when the procedure is to be undertaken by an inexperienced operator.
International journal of research in medical sciences, 2024
Background: Pain in the postoperative period is of particular concern. It is a major barrier in the uptake of circumcision. There are various systemic and local analgesics for the management of postoperative pain. However, data regarding efficacy is scarce. Therefore, the present pilot study was conducted to compare the efficacy of lidocaine and prilocaine spray with oral analgesics for the relief of pain. Methods: After obtaining ethics approval and written informed consent, 100 patients meeting the inclusion and exclusion criteria were included. After circumcision, patients were randomized into group A (Lidocaine and prilocaine spray) and group B (Oral analgesics). Pain was assessed by visual analogue scale (VAS) score and patient reported comfort levels were assessed in the postoperative period till 72 hours. Findings were noted and analysed. Results: Both the groups were similar in terms of demographic characteristics and baseline characteristics. The VAS score was significantly lower in group A and the patient-reported comfort level was significantly more in group A. Conclusions: We recommend that the lidocaine and prilocaine spray is better in relieving pain in the postoperative period following circumcision as compared to oral analgesics.
Penile Ischemia as a Complication of Epinephrine Use in Penile Nerve Block: Truth or Myth?
Research and Reports in Urology
The administration of a local anesthetic agent with epinephrine is controversial in penile surgery because of necrosis risk resulting from prolonged vasoconstriction of terminal vessels. We reported a case of an 8-year-old boy suffering from ischemia in the glans of the penis and epidermolysis of the penile skin after circumcision with penile nerve block using anesthetic agents containing epinephrine. The addition of epinephrine to the anesthetic agent (lidocaine) in penile nerve block before circumcision remains controversial. It remains controversial because multiple factors can cause skin necrosis after the circumcision. The adverse effect of epinephrine use in circumcision remains unproven because of a lack of scientific evidence. The administration of epinephrine in penile surgery is the decision of the physician.
The Effect of Spinal Anaesthesia on Penile Tumescence
Journal of Anesthesiology
It is a common observation that following spinal anaesthesia, the penis usually elongates. The aim of this study was to determine the degree of change in penile length following spinal anaesthesia. Consecutive urosurgical patients undergoing spinal anaesthesia were recruited for this study. Those who received general anaesthesia or incomplete spinal blocked were also excluded. The flaccid length of the penis was measured before and after the administration of spinal anaesthesia. Penile length 15 minutes post-spinal anaesthesia was measured and recorded. The change in length was tested for statistical significant difference, the age of patient; diagnosis and type of surgery were also recorded. Forty three patients completed the study. Benign prostatic hypertrophy constituted 41.9% of the surgical indications. While 53.5% of the patients were ASA I, 39.5% and 7.0% of them were ASA II and III respectively. While the mean initial penile length was 12.1 ± 0.53 cm and the mean final length was 15.7 ± 0.53 cm, the mean maximal change in penile length was 3.6±1.5 cm; p<0.0001. There was no statistical correlation between age and mean differential change in length of penis (r=-0.2842, p=0.43). It was therefore concluded that there was a significant change in penile length (tumescence) following successful spinal anaesthesia.
International Brazilian Journal of Urology, 2013
To evaluate the postoperative analgesic efficacy of penile block, caudal block and intravenous paracetamol administration following circumcision. Materials and Methods: In this prospective randomized study a total of 159 patients underwent circumcision under general anesthesia at urology clinic of Ufuk University Faculty of Medicine and Sorgun State Hospital between May 2012 and September 2012. The patients were randomized to three groups to receive penile block (Group 1), caudal block (Group 2) and intravenous paracetamol administration (group 3). Pain measurement of the patients was done via CHEOPS scoring system at 30,60,120 and 180 minutes postoperatively and compared. Statistical tests were performed with a conventional statistics program and statistical significance was set at a p value of < 0.05. Results: The mean age of the patients was 5.7 years. Patients in group 1 had significantly lower pain score at 30 minutes compared to other two groups. At 60 minutes groups 1 and 2 had significantly lower score compared to group 3. At 120 and 180 minutes no difference between the groups was observed. No significant major complications were observed in all 3 groups. Conclusion: Penile block and caudal block provide similar pain scores and painless postoperative periods after circumcision under general anesthesia. Intravenous paracetamol is insufficient at the early postoperative period. The three procedures were shown to be safe for analgesia following circumcision. INTRODuCTION Penile surgery constitutes an important portion of pediatric urological surgery. Postoperative analgesia is an important issue especially in the pediatric population. Successfull pain relief decreases morbidity, and mobilization in the early postoperative period decreases the need for narcotic analgesics (1). Penile block, caudal block, penile ring infiltration, topical local anesthetic application and administration of paracetamol are commonly employed for pain relief after penile surgery (2). Regional techniques were shown to be more