China
Africa
Explore chapters and articles related to this topic
Nail surgery complications
Published in Robert Baran, Dimitris Rigopoulos, Chander Grover, Eckart Haneke, Nail Therapies, 2021
Anxiety is due to fear of needle prick and heightens the perception of pain; hydroxyzine taken at bedtime the day before surgery and a short-life benzodiazepine sublingually 1 hour prior to surgery are very effective. In those patients who are extremely anxious, squeezing a stress ball with the free hand does not interfere with the surgical procedure. The physician may use a hand-held vibrating massager placed directly on the digit proximal to the site of local anesthetic injection, causing further neurodistraction by the gate theory (Clark and Jellinek 2016). EMLA cream alleviates the pain of the needle prick and buffered lidocaine the burn sensation produced by infusion of the anesthetic. Ropivacaine is painless, acts immediately, and has a long duration of action (>6 hours), as well as the benefit of some intrinsic vasoconstriction. The addition of epinephrine, if there are no contra-indications, prolongs the anesthetic effect of lidocaine, thus alleviating postoperative pain. The addition of 0.4 mg dexamethasone in the original anesthesia site, if there is no infection, may reduce swelling.
Local Anesthetics and Anesthetic Solutions: Classification, Mode of Action and Dosages
Published in Marwali Harahap, Adel R. Abadir, Anesthesia and Analgesia in Dermatologic Surgery, 2019
Lidocaine can be applied via iontophoresis: a sponge soaked with lidocaine is applied to intact skin, and a DC current applied to electrodes over the anesthetic. The onset of anesthesia is within 10 minutes, and the duration of application is approximately 15 minutes. The penetration depth is 1 to 2 cm. It is said to be as effective as EMLA cream.
Treatment
Published in William Bonnez, Guide to Genital HPV Diseases and Prevention, 2019
Lasers produce a high-energy, collimated light beam. This light is monochromatic and the wavelength determines the specific medical application. The CO2 laser is the instrument of choice for the treatment of mucoso-genital lesion because its infrared light (λ = 10,600 nm) vaporizes the intratissular water. By varying the focus of the beam the operator can either cut or vaporize the lesions. Further control is applied on how the light is emitted, either continuously or intermittently. Operator skill is important and undoubtedly contributes to the varying outcomes that have been reported in uncontrolled studies. Laser surgery is applicable to the treatment of external and internal anogenital warts—including during pregnancy—intraepithelial neoplasias, especially of the cervix, and recurrent respiratory papillomatosis. Pain is significant and local, sometimes general, anesthesia is necessary. The EMLA cream is an effective topical anesthetic for laser surgery. Up to a quarter of patients experience pain, bleeding, swelling, and scarring after the procedure.
Comparison of the onset, depth, and duration of cutaneous anesthesia between topical 10% lidocaine and EMLA creams: a randomized, intraindividual, comparative trial
Published in Journal of Dermatological Treatment, 2022
Nichchanun Junputipong, Salinee Rojhirunsakool, Poonnapa Deewongkij, Nanticha Kamanamool, Montree Udompataikul
A longer application time of EMLA cream allows deeper anesthesia (3,5). In this randomized trial, the required application time of EMLA for an anesthesia depth of 4 mm was 40.88 min. Wahlgren et al. (21) reported that the mean tolerable depth after applying EMLA cream for 60 and 120 min was approximately 2.9 and 4.5 mm, respectively. Bjerring et al. (22) reported that with a 90-min application time for EMLA cream, the anesthesia depth was 4 mm. This inconsistency in previous findings could be attributed to differences in individual pain sensations, research methodology, skin-piercing tools used, sample sizes, and the skin area, which affects anesthetic absorption. Nonetheless, taken together, an application time of at least 40 min for topical EMLA cream is suitable for most cutaneous procedures. Furthermore, from our study, when there are time limitations, applying EMLA for at least 30 min is sufficient for superficial procedures, e.g. shave biopsy, laser ablation of epidermal lesions.
Utility of lidocaine as a topical analgesic and improvements in patch delivery systems
Published in Postgraduate Medicine, 2020
Lidocaine may be combined with other anesthetics, such as prilocaine in a mixture of local anesthetics. An example of this is EMLATM, a topical cream, disc or patch (not available in all countries) containing 2.5% lidocaine and 2.5% prilocaine. With this product, local analgesia or anesthesia is achieved after 60 min with a duration of at least 2 h [36]. A gram of EMLATM cream contains 25 mg of lidocaine and 25 mg of prilocaine. EMLATM cream is indicated for topical analgesia of intact skin in connection with needle or catheter insertion, superficial surgical procedures or topical analgesia of leg ulcers. When using the cream, dosage and application time recommendations need to be carefully followed, especially in infants and children, as application to large surface areas for an extended amount of time can lead to adverse events including methemoglobinemia, seizures and life-threatening cardiovascular collapse [36].
Topical anesthetics for pediatric laser treatment
Published in Journal of Cosmetic and Laser Therapy, 2019
Marija Stevic, Ana Vlajkovic, Branislav Trifunovic, Ivan Rakic, Nina Ristic, Ivana Budic, Vesna Marjanovic, Marija Jovanovski-Srceva, Dusica Simic
Prilocaine, as a part of EMLA, is responsible for induce of methemoglobinemia, with ability to exert iron oxidation in red blood cells and thus disables oxygen transport (44). EMLA should be avoided in patients who use methemoglobinemia inducing medications (Table 2) (33). Certainly, we should be careful when using EMLA in infants younger than 3 months and preterm neonates because of associated local and hematologic side effects like transitory erythema or purpura and methemoglobinemia as a result of immaturity of erythrocyte methemoglobin reductase, the enzyme that converts methemoglobin to hemoglobin. Children with glucose-6-phosphate dehydrogenase deficiency or hemoglobinopathies are also at increased risk. Pediatric surgeons should consider side effects because EMLA may blanch pale lesions, making them more difficult to laser treatment. Allergic and systemic toxic reactions to EMLA are extremely rare (46,47).