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Sakai W, Chaki T, Tachibana S, Ichisaka Y, Nawa Y, Nawa T, Yamakage M. INJEX50 could improve the success rate of local anesthesia for arterial cannulation in the pediatric intensive care unit: A randomized, double-blind, single-center study. Paediatr Anaesth 2024. [PMID: 38798122 DOI: 10.1111/pan.14940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/13/2024] [Accepted: 05/17/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Quick arterial cannulation is required in pediatric emergency situation, which require effective local anesthesia to avoid withdrawal movement. However, pediatric local anesthesia could be difficult because of withdrawal movement. Jet injectors, which are needleless and provide local anesthesia quickly, could be helpful for pediatric local anesthesia during arterial cannulation. AIMS This study aimed to examine whether new jet injector "INJEX50" could improve the success rate of local anesthesia for arterial cannulation in pediatric intensive care unit compared with the current standard of care, infiltration using a 26-gauge needle. METHODS This study was a randomized, double-blind, single-center study. Participants were infants and young children in the pediatric intensive care unit, who required an arterial line. Local anesthesia was performed with either a 26-gauge needle (group C) or INJEX50 (group I) before arterial cannulation. The primary outcome (success of local anesthesia) was the presence of withdrawal movement at the time of skin puncture for arterial cannulation. The secondary outcomes included rescue sedation during arterial cannulation. Data were analyzed using Fisher's exact test and the Mann-Whitney U-test, with values of p < .05 considered statistically significant. RESULTS Seventy patients were randomly assigned to groups C and I. The local anesthesia success rate in group I (30/35 [86%]) was significantly higher than that in group C (15/35 [43%], odds ratio, 8.00; 95% confidence interval, 2.51-25.5; p = .0005). In conclusion, INJEX50 could improve success rate of local anesthesia for arterial cannulation in pediatric intensive care unit compared with 26-gauge needle.
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Affiliation(s)
- Wataru Sakai
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
- Intensive Care Unit, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, Japan
| | - Tomohiro Chaki
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Shunsuke Tachibana
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Yuki Ichisaka
- Intensive Care Unit, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, Japan
| | - Yuko Nawa
- Intensive Care Unit, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, Japan
| | - Tomohiro Nawa
- Intensive Care Unit, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, Japan
| | - Michiaki Yamakage
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
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Kalantri S, Vora A. Eutectic solutions for healing: a comprehensive review on therapeutic deep eutectic solvents (TheDES). Drug Dev Ind Pharm 2024; 50:387-400. [PMID: 38634708 DOI: 10.1080/03639045.2024.2345131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/15/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE TheDES are formed by mixing a Hydrogen Bond Donor (HBD) and a Hydrogen Bond Acceptor (HBA) in appropriate molar ratios. These solvents have been shown to enhance drug solubility, permeability, and delivery. The main objective of the present article is to review these advantages of TheDES. SIGNIFICANCE TheDES show unique properties, such as low toxicity, biodegradability, improved bioavailability and enhanced drug delivery of poorly soluble active pharmaceutical ingredients. They are also biocompatible in nature which makes them a promising candidate for various therapeutic applications, including drug formulations, drug delivery and other biomedical uses. The development and utilization of TheDES shows significant advancement in pharmaceutical research, providing new opportunities for improving drug delivery. METHODS The current study was carried out by conducting a systematic literature review that identified relevant papers from indexed databases. Numerous studies and research are cited and quoted in this article to demonstrate the effectiveness of TheDES in enhancing drug solubility, permeability, and delivery. All chosen articles were selected considering their significance, quality, and approach to addressing issues. RESULT As a result, various TheDES were identified that can be formulated in different ways: one component can act as a vehicle for an API, either HBD or HBA can be an API, both HBD and HBA can be APIs, or the individual components of DES are not therapeutically active but the resulting DES possesses therapeutic activity. Additionally, TheDES were also recognized to enhance drug delivery and solubility for different APIs, including NSAIDs, anesthetic drugs, antifungals, and others.
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Affiliation(s)
- Sudhanshu Kalantri
- Shobhaben Pratapbhai Patel School of Pharmacy and Technology Management, Shri Vile Parle Kelavani Mandal's Narsee Monjee Institute of Management Studies, Mumbai, India
| | - Amisha Vora
- Shobhaben Pratapbhai Patel School of Pharmacy and Technology Management, Shri Vile Parle Kelavani Mandal's Narsee Monjee Institute of Management Studies, Mumbai, India
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Cozzi G, Borrometi F, Benini F, Neri E, Rusalen F, Celentano L, Zanon D, Schreiber S, Ronfani L, Barbi E. First-time success with needle procedures was higher with a warm lidocaine and tetracaine patch than an eutectic mixture of lidocaine and prilocaine cream. Acta Paediatr 2017; 106:773-778. [PMID: 28130888 DOI: 10.1111/apa.13764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 11/08/2016] [Accepted: 01/24/2017] [Indexed: 01/30/2023]
Abstract
AIM More than 50% of children report apian during venepuncture or intravenous cannulation and using local anaesthetics before needle procedures can lead to different success rates. This study examined how many needle procedures were successful at the first attempt when children received either a warm lidocaine and tetracaine patch or an eutectic mixture of lidocaine and prilocaine (EMLA) cream. METHODS We conducted this multicentre randomised controlled trial at three tertiary-level children's hospitals in Italy in 2015. Children aged three to 10 years were enrolled in an emergency department, paediatric day hospital and paediatric ward and randomly allocated to receive a warm lidocaine and tetracaine patch or EMLA cream. The primary outcome was the success rate at the first attempt. RESULTS The analysis included 172 children who received a warm lidocaine and tetracaine patch and 167 who received an EMLA cream. The needle procedure was successful at the first attempt in 158 children (92.4%) who received the warm patch and in 142 children (85.0%) who received the cream (p = 0.03). The pain scores were similar in both groups. CONCLUSION This study showed that the first-time needle procedure success was 7.4% higher in children receiving a warm lidocaine and tetracaine patch than EMLA cream.
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Affiliation(s)
- Giorgio Cozzi
- Institute for Maternal and Child Health; IRCCS Burlo Garofolo; Trieste Italy
| | - Fabio Borrometi
- Pediatric Pain Service and Palliative Care; Department of Oncology; Pausilipon Hospital; AORN Santobono Pausilipon; Naples Italy
| | - Franca Benini
- Department of Women's and Children's Health; University of Padua; Padua Italy
| | - Elena Neri
- Institute for Maternal and Child Health; IRCCS Burlo Garofolo; Trieste Italy
| | - Francesca Rusalen
- Department of Women's and Children's Health; University of Padua; Padua Italy
| | - Loredana Celentano
- Pediatric Pain Service and Palliative Care; Department of Oncology; Pausilipon Hospital; AORN Santobono Pausilipon; Naples Italy
| | - Davide Zanon
- Pharmacy and Clinical Pharmacology Unit; Institute for Maternal and Child Health; IRCCS Burlo Garofolo; Trieste Italy
| | - Silvana Schreiber
- Institute for Maternal and Child Health; IRCCS Burlo Garofolo; Trieste Italy
| | - Luca Ronfani
- Clinical Epidemiology and Health Services Research Unit; Institute for Maternal and Child Health; IRCCS Burlo Garofolo; Trieste Italy
| | - Egidio Barbi
- Institute for Maternal and Child Health; IRCCS Burlo Garofolo; Trieste Italy
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Hao J, Ghosh P, Li SK, Newman B, Kasting GB, Raney SG. Heat effects on drug delivery across human skin. Expert Opin Drug Deliv 2016; 13:755-68. [PMID: 26808472 DOI: 10.1517/17425247.2016.1136286] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Exposure to heat can impact the clinical efficacy and/or safety of transdermal and topical drug products. Understanding these heat effects and designing meaningful in vitro and in vivo methods to study them are of significant value to the development and evaluation of drug products dosed to the skin. AREAS COVERED This review provides an overview of the underlying mechanisms and the observed effects of heat on the skin and on transdermal/topical drug delivery, thermoregulation and heat tolerability. The designs of several in vitro and in vivo heat effect studies and their results are reviewed. EXPERT OPINION There is substantial evidence that elevated temperature can increase transdermal/topical drug delivery. However, in vitro and in vivo methods reported in the literature to study heat effects of transdermal/topical drug products have utilized inconsistent study conditions, and in vitro models require better characterization. Appropriate study designs and controls remain to be identified, and further research is warranted to evaluate in vitro-in vivo correlations and the ability of in vitro models to predict in vivo effects. The physicochemical and pharmacological properties of the drug(s) and the drug product, as well as dermal clearance and heat gradients may require careful consideration.
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Affiliation(s)
- Jinsong Hao
- a Department of Pharmaceutical Science and Research , School of Pharmacy, Marshall University , Huntington , WV , USA
| | - Priyanka Ghosh
- b Office of Research and Standards, Office of Generic Drugs , Center for Drug Evaluation and Research, United States Food and Drug Administration , Silver Spring , MD , USA
| | - S Kevin Li
- c Division of Pharmaceutical Sciences , James L Winkle College of Pharmacy, University of Cincinnati , Cincinnati , OH , USA
| | - Bryan Newman
- b Office of Research and Standards, Office of Generic Drugs , Center for Drug Evaluation and Research, United States Food and Drug Administration , Silver Spring , MD , USA
| | - Gerald B Kasting
- c Division of Pharmaceutical Sciences , James L Winkle College of Pharmacy, University of Cincinnati , Cincinnati , OH , USA
| | - Sam G Raney
- b Office of Research and Standards, Office of Generic Drugs , Center for Drug Evaluation and Research, United States Food and Drug Administration , Silver Spring , MD , USA
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Stevens JR, Justin Coffey M, Fojtik M, Kurtz K, Stern TA. The Use of Transdermal Therapeutic Systems in Psychiatric Care: A Primer on Patches. PSYCHOSOMATICS 2015. [DOI: 10.1016/j.psym.2015.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Pharmacokinetic and Pharmacodynamic Evaluation of a Nanotechnological Topical Formulation of Lidocaine/Prilocaine (Nanorap) in Healthy Volunteers. Ther Drug Monit 2015; 37:362-8. [DOI: 10.1097/ftd.0000000000000156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bourne CL, Brewer KL, House J. Injectable lidocaine provides similar analgesia compared to transdermal lidocaine/tetracaine patch for the incision and drainage of skin abscesses: a randomized, controlled trial. J Emerg Med 2014; 47:367-71. [PMID: 24835497 DOI: 10.1016/j.jemermed.2013.11.126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 09/16/2013] [Accepted: 11/17/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Local anesthesia used for incision and drainage of abscesses is known to be painful. STUDY OBJECTIVE We studied the analgesia provided by a lidocaine/tetracaine patch compared to injectable lidocaine during incision and drainage (I&D) of skin abscesses. METHODS This was a prospective, double-blind, randomized, controlled trial carried out in the Emergency Department (ED) of an adult tertiary referral center. Adult patients with a skin abscess in need of I&D were randomized to one of two groups. One group received a lidocaine/tetracaine patch and injectable normal saline for anesthesia. The second group received a placebo patch and injectable 1% lidocaine. A visual analog pain scale was used to record the patient's pain level prior to treatment, during the procedure, and after I&D. RESULTS There were 20 patients enrolled in the study, including 12 randomized to the lidocaine/tetracaine patch and 8 to the injectable lidocaine. Pain scores preprocedure were similar in the two groups. Pain scores during I&D and postprocedure were compared between groups using a paired t-test. Patients receiving injectable lidocaine experienced pain that was similar (50.1 ± 5.9 mm; 95% confidence interval [CI] 45.2-55.1) to those receiving the transdermal lidocaine/tetracaine patch (60.1 mm ± 11.0; 95% CI = 55.2-68.1), p = 0.04, with a power of 80% to detect a difference of 20 mm at p ≤ 0.05; although this was statistically significant, it was not clinically significant. There was also no statistical difference between the two groups in the postprocedure pain scores (p = 0.65). CONCLUSION Local injection of lidocaine provided clinically similar analgesia compared to the lidocaine/tetracaine patch during I&D of skin abscesses in the ED. Pain at presentation and after the procedure was similar in both groups. Emergency physicians should continue to use a local injected anesthetic for I&D of skin abscesses until a less painful alternative is identified.
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Affiliation(s)
- Christina L Bourne
- Division of Emergency Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Kori L Brewer
- Department of Emergency Medicine, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Joseph House
- Department of Emergency Medicine and Pediatrics, University of Michigan, Ann Arbor, Michigan
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Comparison of Topical Anesthetics for Radiofrequency Ablation of Achrocordons: Eutectic Mixture of Lignocaine/Prilocaine versus Lidocaine/Tetracaine. ISRN DERMATOLOGY 2014; 2014:743027. [PMID: 24600520 PMCID: PMC3926240 DOI: 10.1155/2014/743027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 12/17/2013] [Indexed: 11/24/2022]
Abstract
Introduction. Topical application of local anesthetics is currently considered to be the easiest, most effective, and convenient way for treatment of patients who may be undergoing superficial dermatosurgical procedures. Materials and Methods. This study compares the anesthetic potential of 2.5% lidocaine and 2.5% prilocaine topical cream with 7% lignocaine and 7% tetracaine combination cream for radio ablative dermatosurgery when applied, under occlusion, for 30 minutes. 40 subjects of achrocordons were enrolled in this split-side randomized trial. Result. The pain severity experienced by subjects in terms of visual analogue scale score was significantly lesser for lignocaine/tetracaine combination cream as compared to lidocaine/prilocaine combination. Conclusion. This small study proves the efficacy of lidocaine/tetracaine combination as a topical anesthetic cream when applied for a short time interval of 30 minutes. This will help a dermatosurgeon to perform various dermatological procedures in a better and efficient manner with a shorter waiting period for analgesia to set in.
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de Araújo DR, da Silva DC, Barbosa RM, Franz-Montan M, Cereda CMS, Padula C, Santi P, de Paula E. Strategies for delivering local anesthetics to the skin: focus on liposomes, solid lipid nanoparticles, hydrogels and patches. Expert Opin Drug Deliv 2013; 10:1551-63. [DOI: 10.1517/17425247.2013.828031] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Gammaitoni AR, Goitz HT, Marsh S, Marriott TB, Galer BS. Heated lidocaine/tetracaine patch for treatment of patellar tendinopathy pain. J Pain Res 2013; 6:565-70. [PMID: 23888118 PMCID: PMC3722138 DOI: 10.2147/jpr.s46239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The pain of patellar tendinopathy (PT) may be mediated by neuronal glutamate and sodium channels. Lidocaine and tetracaine block both of these channels. This study tested the self-heated lidocaine-tetracaine patch (HLT patch) in patients with PT confirmed by physical examination to determine if the HLT patch might relieve pain and improve function. METHODS Thirteen patients with PT pain of ≥14 days' duration and baseline average pain scores ≥4 (on a 0-10 scale) enrolled in and completed this prospective, single-center pilot study. Patients applied one HLT patch to the affected knee twice daily for 2-4 hours for a total of 14 days. Change in average pain intensity and interference (Victorian Institute of Sport Assessment [VISA]) scores from baseline to day 14 were assessed. No statistical inference testing was performed. RESULTS Average pain scores declined from 5.5 ± 1.3 (mean ± standard deviation) at baseline to 3.8 ± 2.5 on day 14. Similarly, VISA scores improved from 45.2 ± 14.4 at baseline to 54.3 ± 24.5 on day 14. A clinically important reduction in pain score (≥30%) was demonstrated by 54% of patients. CONCLUSION The results of this pilot study suggest that topical treatment that targets neuronal sodium and glutamate channels may be useful in the treatment of PT.
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Rauck R, Busch M, Marriott T. Effectiveness of a Heated Lidocaine/Tetracaine Topical Patch for Pain Associated with Myofascial Trigger Points: Results of an Open-label Pilot Study. Pain Pract 2012; 13:533-8. [DOI: 10.1111/papr.12017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 10/03/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Richard Rauck
- Carolinas Pain Institute; Winston-Salem; North Carolina; U.S.A
| | - Michael Busch
- Carolinas Pain Institute; Winston-Salem; North Carolina; U.S.A
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Fein JA, Zempsky WT, Cravero JP. Relief of pain and anxiety in pediatric patients in emergency medical systems. Pediatrics 2012; 130:e1391-405. [PMID: 23109683 DOI: 10.1542/peds.2012-2536] [Citation(s) in RCA: 196] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Control of pain and stress for children is a vital component of emergency medical care. Timely administration of analgesia affects the entire emergency medical experience and can have a lasting effect on a child's and family's reaction to current and future medical care. A systematic approach to pain management and anxiolysis, including staff education and protocol development, can provide comfort to children in the emergency setting and improve staff and family satisfaction.
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Ruetzler K, Sima B, Mayer L, Golescu A, Dunkler D, Jaeger W, Hoeferl M, You J, Sessler D, Grubhofer G, Hutschala D. Lidocaine/tetracaine patch (Rapydan) for topical anaesthesia before arterial access: a double-blind, randomized trial. Br J Anaesth 2012; 109:790-6. [DOI: 10.1093/bja/aes254] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Marriott TB, Charney MR, Stanworth S. Effects of Application Durations and Heat on the Pharmacokinetic Properties of Drug Delivered by a Lidocaine/Tetracaine Patch: A Randomized, Open-Label, Controlled Study in Healthy Volunteers. Clin Ther 2012; 34:2174-83. [DOI: 10.1016/j.clinthera.2012.08.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 08/16/2012] [Accepted: 08/17/2012] [Indexed: 11/16/2022]
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Wood D, Brown M, Jones S. Understanding heat facilitated drug transport across human epidermis. Eur J Pharm Biopharm 2012; 81:642-9. [DOI: 10.1016/j.ejpb.2012.03.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 03/12/2012] [Accepted: 03/29/2012] [Indexed: 11/28/2022]
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Kim WO, Song BM, Kil HK. Efficacy and safety of a lidocaine/tetracaine medicated patch or peel for dermatologic procedures: a meta-analysis. Korean J Anesthesiol 2012; 62:435-40. [PMID: 22679540 PMCID: PMC3366310 DOI: 10.4097/kjae.2012.62.5.435] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 06/22/2011] [Accepted: 06/24/2011] [Indexed: 11/28/2022] Open
Abstract
Background To justify the use of the lidocaine/tetracaine medicated patch or peel as a preventive treatment for reducing pain and discomfort in adults and children. We reviewed randomized controlled trials (RCTs) to evaluate the efficacy and safety of the lidocaine/tetracaine medicated patch or peel compared with placebo. Methods Ten RCTs (574 patients) were included in this systemic review. Relevant studies were identified through searches of MEDLINE, SCOPUS and the Cochrane database library. The outcome was the adequacy of cutaneous anesthesia reflected in the patient's assessment of pain intensity during minor dermatologic procedures and adverse effects after application of the lidocaine/tetracaine medicated patch or peel versus placebo. Results The efficacy of the lidocaine/tetracaine patch or peel was consistently very significantly beneficial 30 or 60 minutes after the application compared to placebo (Relative risk, RR: 2.5; Number needed to treat, NNT: 2.2). We did not identify any difference in the effectiveness of adequate analgesia between the lidocaine/tetracaine patch and peel (the number needed to treat or to harm, NNT 2.4 vs. 2.0). No serious side effects or adverse events were observed with the lidocaine/tetracaine medicated patch or peel and placebo. Minor skin reactions were transient and resolved without treatment (Odd ratio, OR: 1.4 and 95% confidence interval, CI: 0.9-2.1; NNT: 14.9). Conclusions The lidocaine/tetracaine medicated patch or peel is a well accepted, effective and safe method for minor dermatologic procedures based on pooled data of trials in terms of adequacy of cutaneous anesthesia and adverse effects.
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Affiliation(s)
- Won Oak Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Ravishankar N, Elliot SC, Beardow Z, Mallick A. A comparison of Rapydan®patch and Ametop®gel for venous cannulation*. Anaesthesia 2012; 67:367-70. [DOI: 10.1111/j.1365-2044.2011.07000.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
OBJECTIVE A randomized controlled trial compared a reusable device combining cold and vibration to standard care for pediatric venous access pain relief. METHODS Pediatric emergency department patients received either the cold vibration device placed 5 to 10 cm proximally throughout venipuncture or standard care control (primarily vapocoolant spray). Block randomization of patients with or without lidocaine cream already in place ensured equal allocation in both intervention groups. Pain was measured via self- and parent-report using the 0- to 10-point Faces Pain Scale-Revised and with coded videotaped observed behaviors. Venipuncture success, use of distraction, and access times were also assessed. RESULTS Eighty-one 4- to 18-year-olds were randomized to the device (n = 41) or standard care (n = 40) (median age, 10.09 years; 95% confidence interval [95% CI], 8.91-10.89). Median patient-reported pain scores with the device were lower than with standard care (-2; 95% CI, -4 to 0), as were parent-assessed pain scores (-2; 95% CI, -4 to -2). Observed distress behaviors were more common with standard care (2; 95% CI, 1-3) than with the device (1; 95% CI, 0-2). Venipuncture success was more likely with the device (odds ratio, 3.05; 95% CI, 1.03-9.02). There were no device refusals. CONCLUSIONS The combination of cold and vibration decreased venipuncture pain significantly more than standard care without compromising procedural success. A device incorporating these elements could overcome the common barriers to needle procedure pain control.
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Kim KH. Use of lidocaine patch for percutaneous endoscopic lumbar discectomy. Korean J Pain 2011; 24:74-80. [PMID: 21716614 PMCID: PMC3111563 DOI: 10.3344/kjp.2011.24.2.74] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 04/22/2011] [Accepted: 04/27/2011] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Lidocaine patch (L5P) has demonstrated short-term efficacy in treating both acute surgical pain and chronic neuropathic pain with tolerable side effects. Percutaneous endoscopic lumbar discectomy (PELD) is the mainstay of minimally invasive spine surgery (MISS). Sufficient analgesia during PELD surgery makes the patient consider it real MISS. This study was performed to evaluate the efficacy and adverse effects of lidocaine patch in patients who underwent PELD under local anesthesia. METHODS L5P (L group) or placebo (P group) was randomly applied on the skin of the back covering the anticipated path of the working channel before 1 hour of surgery in 100 patients who underwent a single level PELD at L4-L5. Efficacy of the lidocaine patch was assessed by patient's numeric rating scale (NRS) of pain at each stage during the surgery and by a 5-scale grading of the satisfaction with the anesthesia of the operator and patients after surgery. RESULTS Mean NRS scores at the stages of needle insertion, skin incision, serial dilation and insertion of working channel, and subcutaneous suture were significantly lower in the L group than the P group. Postoperative operator's and patients' satisfaction scores were also significantly higher in L group than in the P group. There were subtle adverse effects in both groups. CONCLUSIONS L5P provided better pain relief during PELD, especially at the stage of needle insertion, skin incision, serial dilation and insertion of working channel, and subcutaneous suture. It also provided higher patient and operator postoperative satisfaction, with only subtle adverse effects.
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Affiliation(s)
- Kyung Hoon Kim
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
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Evaluation of the Depth and Duration of Anesthesia From Heated Lidocaine/Tetracaine (Synera) Patches Compared With Placebo Patches Applied to Healthy Adult Volunteers. Reg Anesth Pain Med 2010; 35:507-13. [DOI: 10.1097/aap.0b013e3181fa69b8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Masud S, Wasnich RD, Ruckle JL, Garland WT, Halpern SW, Mee-Lee D, Ashburn MA, Campbell JC. Contribution of a heating element to topical anesthesia patch efficacy prior to vascular access: results from two randomized, double-blind studies. J Pain Symptom Manage 2010; 40:510-9. [PMID: 20678893 DOI: 10.1016/j.jpainsymman.2010.01.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Revised: 01/27/2010] [Accepted: 02/01/2010] [Indexed: 10/19/2022]
Abstract
CONTEXT Pain associated with superficial procedures, including intravenous (IV) access procedures, should be prevented when possible, especially in children. OBJECTIVES To evaluate a topical local anesthetic patch containing lidocaine 70 mg/tetracaine 70 mg with a heating element designed to warm the skin and facilitate rapid delivery of local anesthetics into the skin. The pilot study was designed to provide data to inform the design of the definitive study to evaluate the impact of controlled heat on the efficacy of the lidocaine/tetracaine patch (patch) when applied before IV cannulation. METHODS Subjects in the pilot study were randomized to eight groups that varied by heated vs. unheated patch, 20 vs. 30 minute application, and 16 vs. 18 G catheter. Subjects in the definitive study were randomized in a double-blind manner to receive either the heated or unheated patch, 20 minutes before vascular access, using a 16 G catheter in the antecubital space of the arm. In both studies, the primary efficacy measure was subject-reported pain intensity using a visual analog scale. RESULTS Pilot study: Subjects who received the heated patch (n=43) vs. the unheated patch (n=37) had lower mean pain intensity scores (14.7 vs. 23.5mm, P=0.04). Pain intensity scores did not differ significantly by application time, but the difference between the 16 and 18 G catheter groups approached statistical significance (22.8 vs. 14.9 mm, P=0.05). Definitive study: Mean pain intensity scores for the heated patch group (n=124) vs. the unheated patch group (n=126) were 14.2 and 20.5mm, respectively (P=0.006). CONCLUSION Heated patches provided significantly better pain relief compared with unheated patches. All the subjects tolerated the patches well, with few adverse effects.
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Affiliation(s)
- Salman Masud
- Shriners Hospitals for Children, University of Utah, Salt Lake City, Utah 84103-4399, USA.
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Sawyer J, Febbraro S, Masud S, Ashburn M, Campbell J. Heated lidocaine/tetracaine patch (Synera™, Rapydan™) compared with lidocaine/prilocaine cream (EMLA®) for topical anaesthesia before vascular access. Br J Anaesth 2009; 102:210-5. [DOI: 10.1093/bja/aen364] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Stowell CP, Trieu MQ, Chuang H, Katz N, Quarrington C. Ultrasound-enabled topical anesthesia for pain reduction of phlebotomy for whole blood donation. Transfusion 2008; 49:146-53. [PMID: 18954400 DOI: 10.1111/j.1537-2995.2008.01939.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Ultrasound-facilitated delivery of topical anesthetics has been used to achieve effective anesthesia within 5 minutes for venipuncture and the insertion of intravenous access devices, but has never been studied for blood donation. STUDY DESIGN AND METHODS This study was a single-center, prospective, randomized, sham treatment-controlled, single-blinded clinical evaluation. Repeat donors were randomly assigned to undergo treatment with ultrasound and topical anesthetic or sham ultrasound and placebo anesthetic before phlebotomy for whole blood donation. The primary outcome measures were pain assessments using the Verbal Categorical Scale (VCS) and the Visual Analogue Scale and the assessment of skin irritation at the target site. RESULTS One-hundred subjects were enrolled and all completed the study. Compared to the sham/placebo control group, donors receiving ultrasound/anesthetic had lower pain scores on the VCS (1.81 +/- 0.67 vs. 2.17 +/- 0.68; p = 0.01) and Visual Analog Scale (17.2 +/- 15.5 vs. 27.6 +/- 19.5; p = 0.006). The proportion of subjects in the treatment group who experienced skin irritation (8%) was similar to that in the control group (2%; p = 0.20). CONCLUSION Ultrasound-enhanced delivery of topical anesthetic was demonstrated to be a safe means of quickly achieving clinically meaningful reduction in the pain of phlebotomy for whole blood donation compared to sham/placebo treatment.
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Affiliation(s)
- Christopher P Stowell
- Department of Pathology, Blood Transfusion Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
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Singer AJ, Taira BR, Chisena EN, Gupta N, Chipley J. Warm Lidocaine/Tetracaine Patch Versus Placebo Before Pediatric Intravenous Cannulation: A Randomized Controlled Trial. Ann Emerg Med 2008; 52:41-7. [DOI: 10.1016/j.annemergmed.2008.01.336] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2007] [Revised: 01/25/2008] [Accepted: 01/30/2008] [Indexed: 11/29/2022]
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