Jariya Lertakyamanee

Both EMLA and placebo cream reduced pain during extracorporeal piezoelectric shock wave lithotripsy with the piezolith 2300

Background: The objectives were to determine whether a eutectic mixture of local anesthetic (EMLA) or placebo cream reduces pain during extracorporeal piezoelectric shock wave lithotripsy (EPSWL), and to determine which of the components of the application (i.e., the occlusive dressing, the cream, or the local anesthetic) contributes to analgesia. Methods: A randomized, double blind, crossover study (part 1) was performed in 12 patients who were scheduled for EPSWL procedures on an ambulatory basis who received the first treatment without any intervention and who had verbal pain scores of 70 or more (on a 0-to-100 scale). For the next two treatments at 2-week intervals, patients were randomly assigned to receive either 10 g EMLA or 10 g placebo cream and then crossed over to receive the other. The cream and occlusive dressing were left in place and immersed in water throughout the procedure. Verbal numeric pain score was assessed at 5 min after receiving the maximal tolerable intensity of shock wave and at the end of the procedure. The study continued (part 2) in 202 ambulatory patients; 125 men and 77 women, American Society of Anesthesiologists physical status I and II, subjected to EPSWL were randomly allocated into five groups who received (1) nothing on the skin (control), (2) plastic occlusive dressing, (3) placebo cream and plastic occlusive dressing, (4) EMLA cream and plastic occlusive dressing, (5) EMLA cream and plastic occlusive dressing for 60 min to achieve cutaneous anesthesia, which was removed before EPSWL. Pain score was evaluated 10 min into the procedure and at the end of the procedure. Result: Both parts of the study showed that patients who received either EMLA or placebo cream with dressing throughout the procedure experienced less pain and tolerated higher energy levels compared with the control. Patients who received only pre-EPSWL cutaneous anesthesia of EMLA and who received only the occlusive dressing did not have a reduction in pain score. Conclusions: EMLA and placebo creams under occlusive dressing reduced pain during EPSWL. The presence of the cream itself as a coupling medium contributed to analgesia. This may be a useful, simple, safe, and economical adjuvant technique to reduce pain during immersion EPSWL.

Intraperitoneal lidocaine decreases intraoperative pain during postpartum tubal ligation.

UNLABELLED We conducted a randomized, double-blinded, placebo-controlled trial to evaluate the effectiveness of intraperitoneal lidocaine, IM morphine, or both drugs together for pain relief in postpartum tubal ligation. Eighty postpartum patients scheduled to have tubal sterilization were randomly divided into four groups to receive IM isotonic sodium chloride solution (1 mL) and intraperitoneal instillation of 80 mL of isotonic sodium chloride solution (Group P); IM morphine (10 mg in 1 mL) and intraperitoneal instillation of 80 mL of isotonic sodium chloride solution (Group M); IM injection of isotonic sodium chloride solution and intraperitoneal instillation of 0.5% lidocaine in 80 mL (Group L); and both IM morphine and intraperitoneal lidocaine instillation (Group ML). The minilaparotomy was performed after local infiltration with 15 mL of 1% lidocaine. A numerical rating score was used to rate pain on a 0-10 scale during the surgical procedures. The mean pain scores were 1.2 in Group L and 0.8 in Group ML. These pain scores were significantly lower than those in Groups P and M, which were 5.5 and 6.0, respectively (P < 0.001). IMPLICATIONS Pain relief was inadequate in patients undergoing postpartum tubal ligation under local anesthesia, even after the administration of IM morphine. Instilling lidocaine into the abdominal cavity, however, effectively decreased intraoperative pain in these patients.

Comparison of propofol and ketamine-midazolam for cystoscopy: A randomized trial with clinical economic analyses

Objectives: We compared the duration and quality of recovery and the cost of anesthesia between propofol and ketamine-midazolam for cystoscopy as a model to explain the decision in a tertiary care, government hospital in a developing country. Methods: This is a randomized, double-blind trial. Forty-eight male patients were randomized to receive propofol or ketamine-midazolam. Recovery was evaluated by a series of clinical tests, modified P deletion and Stroop color tests, and the time to discharge. Patients pain score, satisfaction score and willingness to pay were evaluated. Direct medical cost from the perspective of health care provider was calculated. Cost-effectiveness and cost-benefit analyses were done. Results: Although clinical recovery was not different, both psychomotor tests showed that patients in the propofol group recovered significantly faster. They were able to stand, walk and meet the discharge criteria faster (P<0.05) and had fewer side effects. However, pain and satisfaction scores and the willingness to pay were not different. For each patient, propofol cost 12.31 US dollars more but the patient recovered 44.8 min faster than with ketamine-midazolam. When this faster recovery time was changed into monetary units, propofol did not save money but cost 9.03 US dollars per patient more than ketamine-midazolam. Patients expectation and salary scales can affect decision-making.

Growth of ambulatory surgery and anaesthesia in Thailand

Abstract Growth of ambulatory surgery and anaesthesia in Thailand has been much slower than in the United States due to non-encouraging government funding, the health care reimbursement system, and cultural factors. In contrast to the situation in most other countries, the growth that has taken place is the result of an inadequate number of beds in public hospitals and not of economic pressures from the health administrator. On the contrary, surgery with overnight hospitalization has steadily increased in private hospitals. However, with the financial crisis in Thailand and South-East Asia, ambulatory anaesthesia will eventually be promoted by both the government and insurance companies.

Ambulatory Anesthesia and Surgery in Thailand

HE EXPANSION of ambulatory anesthesia varies from country to country depending upon local needs, economical consideration, life style, culture, and the level of ancillary home health care service. Ambulatory anesthesia is now recognized as a true anesthesia subspecialty in the United States. 1 There is a rapid expansion of ambulatory surgical service with modern freestanding ambulatory units in the United States, the United Kingdom, Canada, Australia, and severn European countries. The expansion has been slow in Germany, South America, and Asia. 2 In China the practice of ambulatory surgery did not develop until recent years. 3 In Southeast Asia and Japan all elective surgeries are performed in hospitals. Freestanding surgery units have not been established in this part of the world. 4 In Thailand there is a continuing trend to have more elective surgery performed with overnight hospb talizafion in the growing private hospitals, 4 whereas in government hospitals only 15% of all operations requiring anesthesia are performed on an ambulatory basis.