scholarly journals Local Anesthesia Versus Local Anesthesia and Conscious Sedation for Inguinal Hernioplasty: Protocol of a Randomized Controlled Trial

2017 ◽  
Vol 6 (2) ◽  
pp. e20 ◽  
Author(s):  
Pierre-Anthony Leake ◽  
Patrick J Toppin ◽  
Marvin Reid ◽  
Joseph M Plummer ◽  
Patrick O Roberts ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Local Anesthesia ◽  
Conscious Sedation ◽  
Controlled Trial ◽  
Inguinal Hernioplasty ◽  
Randomized Controlled

TWIN MIXED LOCAL ANESTHESIA IN THIRD MOLAR SURGERY - RANDOMIZED CONTROLLED TRIAL

2021 ◽  
Author(s):  
Shivangi Gaur ◽  
Madhulaxmi Marimuthu ◽  
P Wahab ◽  
Dr Navaneetha Krishnan ◽  
Subhashini Ramasubbu
Keyword(s):  
Randomized Controlled Trial ◽  
Local Anesthesia ◽  
Controlled Trial ◽  
Third Molar ◽  
Third Molar Surgery ◽  
Randomized Controlled

scholarly journals Long-Term Functional Patency and Cost-Effectiveness of Arteriovenous Fistula Creation under Regional Anesthesia: a Randomized Controlled Trial

2020 ◽  
Vol 31 (8) ◽  
pp. 1871-1882
Author(s):  
Emma Aitken ◽  
Rachel Kearns ◽  
Lucian Gaianu ◽  
Andrew Jackson ◽  
Mark Steven ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Cost Effectiveness ◽  
Local Anesthesia ◽  
Regional Anesthesia ◽  
Controlled Trial ◽  
Secondary Patency ◽  
University Hospitals ◽  
Clinical Trial Registry ◽  
Randomized Controlled ◽  
Life Years

BackgroundRegional anesthesia improves short-term blood flow through arteriovenous fistulas (AVFs). We previously demonstrated that, compared with local anesthesia, regional anesthesia improves primary AVF patency at 3 months.MethodsTo study the effects of regional versus local anesthesia on longer-term AVF patency, we performed an observer-blinded randomized controlled trial at three university hospitals in Glasgow, United Kingdom. We randomly assigned 126 patients undergoing primary radiocephalic or brachiocephalic AVF creation to receive regional anesthesia (brachial plexus block; 0.5% L-bupivacaine and 1.5% lidocaine with epinephrine) or local anesthesia (0.5% L-bupivacaine and 1% lidocaine). This report includes findings on primary, functional, and secondary patency at 12 months; reinterventions; and additional access procedures (primary outcome measures were previously reported). We analyzed data by intention to treat, and also performed cost-effectiveness analyses.ResultsAt 12 months, we found higher primary patency among patients receiving regional versus local anesthesia (50 of 63 [79%] versus 37 of 63 [59%] patients; odds ratio [OR], 2.7; 95% confidence interval [95% CI], 1.6 to 3.8; P=0.02) as well as higher functional patency (43 of 63 [68%] versus 31 of 63 [49%] patients; OR, 2.1; 95% CI, 1.5 to 2.7; P=0.008). In 12 months, 21 revisional procedures, 53 new AVFs, and 50 temporary dialysis catheters were required. Regional anesthesia resulted in net savings of £195.10 (US$237.36) per patient at 1 year, and an incremental cost-effectiveness ratio of approximately £12,900 (US$15,694.20) per quality-adjusted life years over a 5-year time horizon. Results were robust after extensive sensitivity and scenario analyses.ConclusionsCompared with local anesthesia, regional anesthesia significantly improved both primary and functional AVF patency at 1 year and is cost-effective.Clinical Trial registry name and registration numberLocal Anaesthesia versus Regional Block for Arteriovenous Fistulae, NCT01706354

scholarly journals Gastroscopy Should Come Before Colonoscopy Using CO2 Insufflation in Same Day Bidirectional Endoscopies: A Randomized Controlled Trial

2019 ◽  
Vol 3 (3) ◽  
pp. 120-126
Author(s):  
Fahd Jowhari ◽  
Lawrence Hookey
Keyword(s):  
Carbon Dioxide ◽  
Randomized Controlled Trial ◽  
Primary Outcome ◽  
Conscious Sedation ◽  
Controlled Trial ◽  
Patient Comfort ◽  
Clinical Indication ◽  
Randomized Controlled ◽  
Co2 Insufflation ◽  
Carbon Dioxide Co2

Abstract Background and Aims Same day bidirectional endoscopies (esophagogastroduodenoscopies [EGD]s and colonoscopies) are routinely performed. However, the best sequence of procedures is unknown, as is whether the use of carbon dioxide (CO2) affects the preferred sequence of procedures. This study aims to determine the preferred sequence of procedures and choice of insufflation gas (air or CO2) in patients undergoing same day bidirectional endoscopies. Methods Two hundred adults with a clinical indication for same day bidirectional endoscopies were randomized equally into four groups: A1 (EGD first, CO2 as insufflator); A2 (EGD first, air as insufflator); B1 (colonoscopy first, CO2 as insufflator); and B2 (colonoscopy first, air as insufflator). All procedures were performed with conscious sedation (Midazolam/Fentanyl). The primary outcome was patients’ overall comfort/satisfaction with the procedures and sedation received, as assessed by questionnaires and validated scoring scales (Nurse-Assessed Patient Comfort Score [NAPCOMS], La Crosse [WI]) collected during the procedures, before discharge, and on day 7 postprocedure. Results Two hundred patients were randomized, with data available for 186. Mean Midazolam dose between groups was significantly less in the EGD first groups (P=0.01). During the procedures, no differences were found in patients’ comfort as per the nurse reported NAPCOMS scores (P=0.19) or the Lacrosse (WI) endoscopy scores (P=0.05). On postprocedure days 0 and 7, no differences were found in the patients’ reported Lacrosse (WI) scores, nausea, sore throat, dizziness, satisfaction with sedation or overall level of procedural satisfaction (P>0.05 for each). However, bloating and discomfort were significantly lower in the CO2 arms (P<0.001). Conclusions This randomized controlled trial using validated patient comfort scoring assessments for same day bidirectional endoscopies demonstrated that the sequence of procedures affects the sedation used but does not affect overall patient comfort or satisfaction. Lesser sedation is needed in the EGD first group, and less postprocedural abdominal pain/discomfort and bloating is seen with CO2 insufflation.

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