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Topical anaesthesia using eye drops alone compared with a combination of eyedrops and anaesthesia within the eye for cataract surgery

There are many different options for anaesthesia during cataract surgery. Using anaesthetic eye drops (topical anaesthesia) has become an increasingly popular option in modern, rapid‐turnover day case cataract surgery as it is minimally invasive, cost effective, less prone to complications and provides for faster patient rehabilitation. Many surgeons who use topical anaesthesia supplement this with anaesthetic administered within the eye (intracameral) during the surgery. This review has found that the use of intracameral lidocaine as a supplement to topical anaesthesia significantly reduces intraoperative pain perception when compared to the use of topical anaesthesia alone. No significant difference was demonstrated between the groups receiving topical anaesthesia alone and topical eye drops combined with intracameral anaesthesia in terms of the need for supplemental anaesthesia, intraoperative adverse events or corneal toxicity. We conclude that the administration of intracameral anaesthetic during surgery is an effective and safe supplementation to topical anaesthesia.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Efficacy and safety of a lidocaine/tetracaine medicated patch or peel for dermatologic procedures: a meta-analysis

BACKGROUND: To justify the use of the lidocaine/tetracaine medicated patch or peel as a preventive treatment for reducing pain and discomfort in adults and children. We reviewed randomized controlled trials (RCTs) to evaluate the efficacy and safety of the lidocaine/tetracaine medicated patch or peel compared with placebo.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Does topical Amethocaine cream increase first-time successful cannulation in children compared with a eutectic mixture of local anaesthetics (EMLA) cream? A systematic review and meta-analysis of randomised controlled trials

BACKGROUND: Cannulation of children is often required for administration of intravenous fluids and medications, but can cause pain and anxiety. Amethocaine and a eutectic mixture of local anaesthetics (EMLA) cream are two of the most commonly used local anaesthetic creams.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Sedation in Children and Young People: Sedation for Diagnostic and Therapeutic Procedures in Children and Young People [Internet]

Many children present to hospitals and dental clinics needing effective sedation or anaesthesia for painful or distressing diagnostic or therapeutic procedures. There are many sedation techniques available but there is insufficient guidance on which techniques are effective and what resources are required to deliver them safely. Sedation is not always effective enough and will occasionally require the procedure to be delayed until the child can be anaesthetised perhaps in another healthcare setting or on another day. Consequently sedation failure is both distressing for the child and has major NHS cost implications. Excessive doses of sedation can cause unintended loss of consciousness and dangerous hypoxia. In comparison, planned anaesthesia is effective, but may have resource implications. The need for sedation or anaesthesia will depend upon the type of procedure. Some types of procedures are very common and healthcare providers and practitioners need to understand whether sedation or anaesthesia is the most cost effective method of managing them

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: December 2010
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Clonidine as an adjuvant to intrathecal local anesthetics for surgery: systematic review of randomized trials

The authors concluded that adding clonidine to intrathecal local anaesthetic had beneficial effects on some, but not all measures of motor and sensory block. Adding clonidine reduced intra-operative pain but increased the risk of arterial hypotension. Given the low quality of the included studies and the possibility of publication bias, the reliability of the results is questionable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Local anaesthesia (numbing medicine) that is directly applied to the skin may be used to provide pain control for repair of lacerations

Pain control for suturing of torn skin is conventionally achieved by injecting medication into the skin, which may itself cause pain. Topical anaesthetics are directly applied to the skin and are painless to administer. Cocaine was one of the first anaesthetics to be successfully applied topically. Concerns over adverse effects with cocaine and the administrative burdens of dispensing a controlled substance led to the development of cocaine‐free anaesthetics. There are numerous cocaine‐free topical anaesthetics and these were found to be effective for enabling repair of dermal lacerations. We included 23 randomized controlled trials involving 3128 patients in this review. The small number of trials in each comparison group and the heterogeneity of outcome measures precluded quantitative analysis of data in all but one outcome, pain scores using a visual analogue scale. Additional studies are necessary to directly compare the effectiveness of different formulations of topical anaesthetics. No serious side effects were reported in the studies included in the review following use of cocaine‐containing or cocaine‐free topical anaesthetics.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Interventions for adult Eustachian tube dysfunction: a systematic review

This systematic review found insufficient evidence to draw conclusions about the effectiveness of any intervention for adults with Eustachian tube dysfunction (ETD). The quality of the evidence was generally poor. Evidence was insufficient to allow recommendation of a trial of any particular intervention. Further research is needed to establish a definition of ETD, its relation to broader middle ear ventilation problems and clear diagnostic criteria.

Health Technology Assessment - NIHR Journals Library.

Version: July 2014
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Management of Acute Otitis Media: Update

Acute Otitis Media (AOM), a viral or bacterial infection of the ear, is the most common childhood infection for which antibiotics are prescribed in the United States. In 2001, the Southern California Evidence-based Practice Center conducted a systematic review of the evidence comparing treatments of AOM.

Evidence Reports/Technology Assessments - Agency for Healthcare Research and Quality (US).

Version: November 2010
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Spasticity in Children and Young People with Non-Progressive Brain Disorders: Management of Spasticity and Co-Existing Motor Disorders and Their Early Musculoskeletal Complications

This guideline covers the management of spasticity and co-existing motor disorders and their early musculoskeletal complications in children and young people (from birth up to their 19th birthday) with non-progressive brain disorders.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: July 2012
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Systematic review and meta-analysis assessing the effectiveness of local anesthetic, vasoconstrictive, and lubricating agents in flexible fibre-optic nasolaryngoscopy

The review concluded that there was no difference in pain scores with vasoconstrictive agents, topical anaesthetics and lubricating agents for fibre-optic nasolaryngoscopy, but co-phenylcaine may cause greater taste unpleasantness and lidocaine may cause more pain. Limitations acknowledged by the authors and a lack of suitable data for meta-analysis suggest that the conclusions should be interpreted with caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Locoregional anesthesia for endovascular aneurysm repair

The review concluded that there were no significant differences in 30-day mortality or completion endoleak for locoregional anaesthesia or regional anaesthesia versus general anaesthesia for endovascular aneurysm repair, but locoregional anaesthesia had shorter operative time and hospital stay, reduced intensive care requirements and fewer postoperative complications. The limited low quality evidence needed confirmation with randomised studies.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Systematic Reviews in PubMed

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