Eye
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Randomized Controlled Trial Comparative Study Clinical Trial
Warming lignocaine reduces the pain of injection during local anaesthetic eyelid surgery.
The injection of local anaesthetic solutions is frequently a painful and unpleasant experience for patients. A double-masked randomised controlled trial was performed to study the potential benefit of warming lignocaine during local anaesthetic minor surgical procedures on the eyelids. The pain of subcutaneous injection of 1.5 ml of 2% lignocaine at room temperature (cold) and body temperature (warm) was compared in 60 patients during the surgical incision of solitary meibomian cysts of one eyelid. ⋯ The median pain score for the group receiving cold anaesthetic (19.5) was found to be greater than that for the warm group (10.0; p = 0.02). In conclusion, the simple process of warming lignocaine to 37 degrees C was found to reduce the pain associated with its injection significantly. It is recommended that this technique be more widely adopted in order to minimise patients' discomfort.
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Giant cell (temporal) arteritis is a systemic vasculitis of the elderly. Facial swelling is a rare manifestation of the arteritic process. Delay in recognition of the condition can result in profound loss of vision. ⋯ Both arteritic AION and facial swelling responded to high-dose steroid treatment. Facial swelling in giant cell (temporal) arteritis could be an indicator of risk of AION. Intravenous steroid treatment can lead to salvation of useful vision.
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Randomized Controlled Trial Comparative Study Clinical Trial
Peribulbar anaesthesia for cataract surgery: prilocaine versus lignocaine and bupivacaine.
Prilocaine has recently been introduced for use in ocular local anaesthesia. A prospective randomised double-masked study was undertaken to assess the efficacy of prilocaine 2% plain versus a mixture of lignocaine 1% and bupivacaine 0.5%, each with hyaluronidase. ⋯ Prilocaine is a useful alternative anaesthetic agent for eye surgery that has low toxicity and is effective without adrenaline.
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Although phacoemulsification with only topical anaesthesia is possible, the level of any discomfort perceived by the patient is unknown. Topical anaesthesia eliminates any risk of inadvertent ocular or orbital injury. Twenty-four patients undergoing phacoemulsification under only topical anaesthesia (g. amethocaine 1%) were compared with 23 patients undergoing the same procedure with peribulbar anaesthesia (5 ml lignocaine 2%, 5 ml bupivacaine 0.5% and 75 units hyaluronidase). ⋯ There was no difference in the amount of analgesia dispensed to the two groups on the ward post-operatively. In conclusion, topical anaesthesia provides adequate anaesthesia for phacoemulsification. Although a small increase in the level of discomfort was observed, the pain levels reported were small and may not be clinically significant when set against the reduced incidence of anaesthetic-related complications.