Background: Inferomedial injection has been suggested as a more comfortable alternative to medial peribulbar block. Aim: We aimed to explore inferomedial injection technique efficacy in minimizing pain during injection as well as intubation compared to the classic medial canthal injection technique during peribulbar block. Methods: This randomized, controlled trial included adult (18 to 70 year-old) patients scheduled for lacrimal intubation surgery. Eligible patients were divided in a random way into two groups. Group 1 (n=24) received inferomedial peribulbar injection using a 25G/ 1" length needle to inject 3 ml of lidocaine: bupivacaine (1: 1) with 30 IU hyaluronidase enzyme to improve the infiltration of the small volume of the local anesthetic drugs. The classic medial canthus injection was applied in Group 2 (n=24) using the same types and amounts of local anesthesia (LA) and the same needle length. The pain was assessed during local anesthetics injection and intubation using the verbal rating scale.
Results:In group 1 a low pain score was more frequent than in group 2 (83.3% vs. 16.7%). The median pain score at the LA injection was significantly lower in group 1 (1.0: IQR=1.0-1.0) than in group 2 (2.0: IQR=2.0-2.5). Alternatively, a comparison of the Verbal Rating Scale at intubation revealed comparable results between groups 1 and 2, with no significant differences (p>0.05). Conclusions: Inferomedial LA injection technique is feasible and less painful than the medial canthal injection. Otherwise, both techniques provided adequate intraoperative analgesia during lacrimal intubation and comparable surgeon satisfaction.
Background
Interaction with medical providers is a stressful experience for a child. The current study aimed to assess the efficacy and safety of intranasal midazolam alone versus midazolam/ketamine combination for preoperative sedation prior to ophthalmic procedures in preschool children. This randomized, controlled trial included male and female children (3 to 7 years old) who were American Society of Anesthesiologists (ASA) physical status I or II, with either disability or special needs (such as autism or Down syndrome) or were undergoing multiple operative procedures. Participants were given either intranasal midazolam (0.5 mg/kg) or a combination of intranasal midazolam (0.25 mg/kg) and ketamine (1 mg/kg). Primary outcome measures were the preoperative level of sedation, agitation, and easiness of separation. Secondary outcomes included oxygen saturation and pulse rate. Any adverse effects, such as nausea and vomiting were reported.
Results
The mean rank of the Six-point Pediatric Sedation Scale was significantly (p = 0.001) higher in the midazolam/ketamine group compared to the midazolam group (28.15 vs 18.85, respectively). The median pulse rate was significantly (p < 0.001) lower in the midazolam group than the combination group at 5, 10, 15, and 20 min after induction of anesthesia.
Conclusions
These findings indicate that intranasal ketamine and midazolam combination produced better sedation than intranasal midazolam alone in preschool children prior to ophthalmic procedures. Moreover, ketamine and midazolam combination was safer with less incidence of bradycardia.
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