Systemic local‐anaesthetic‐type drugs in chronic pain: A systematic review A randomized clinical trial of a brief hypnosis intervention to control venepuncture-related pain of paediatric cancer patients Intraperitoneal local anaesthetic for shoulder pain after day-case laparoscopy Using non-nutritive sucking and oral glucose solution with neonates to relieve pain: a randomised controlled trial. Evaluation of the S‐Caine Peel for Induction of Local Anesthesia for Laser‐Assisted Tattoo Removal: Randomized, Double‐Blind, Placebo‐Controlled, Multicenter Study Acupuncture fails to reduce but increases anaesthetic gas required to prevent movement in response to surgical incision A review of prospectively controlled comparisons of epidural with non-epidural forms of pain relief during labour. A clinical comparison of topical piroxicam and EMLA cream for pain relief and inflammation in laser hair removal Audiovisual distraction as an adjunct to pain and anxiety relief during minor surgery. Effects of the extradural administration of morphine, or bupivacaine, on the endocrine response to upper abdominal surgery. Evidence‐based management of pain after laparoscopic cholecystectomy: a PROSPECT review update Evaluation of a Novel Topical Anesthetic Agent for Cutaneous Laser Resurfacing: A Randomized Comparison Study Lidocaine 10% spray to the cervix reduces pain during intrauterine device insertion: a double-blind randomised controlled trial An assessment of the value of intraperitoneal bupivacaine for analgesia after laparoscopic sterilization Comparative local anaesthetic blocks in the diagnosis of cervical zygapophysial joint pain A systematic review of comparative studies indicates that paravertebral block is neither superior nor safer than epidural analgesia for pain after thoracotomy Local anaesthetic effect of topical amethocaine gel in neonates: randomised controlled trial Local anaesthetic on Filshie clips for pain relief after tubal sterilisation: a randomised double-blind controlled trial Effect of piroxicam gel for pain control and inflammation in Nd:YAG 1064-nm laser hair removal. Local anaesthetic for transrectal ultrasound-guided prostate biopsy: a prospective, randomized, double blind, placebo-controlled study. Sucrose and non-nutritive sucking for the relief of pain in screening for retinopathy of prematurity: a randomised controlled trial Intraabdominal local anaesthetics for postoperative pain relief following abdominal hysterectomy: a randomized, double-blind, dose-finding study Two Randomized, Double‐Blind, Placebo‐Controlled Studies Evaluating the S‐Caine Peel for Induction of Local Anesthesia Before Long‐Pulsed Nd: YAG Laser Therapy for Leg Veins
Basic research indicates that systemic local‐anaesthetic‐type drugs that block sodium channels are effective in pain due to nerve damage . These drugs were first used as analgesics in the 1950s and they are still commonly used to try to relieve neuropathic pain and incident pain caused by cancer . As they are potentially toxic , these drugs should not be used without proven effectiveness . For these reasons , a systematic review of r and omized controlled trials of systemically administered local‐anaesthetic‐type drugs in chronic pain was performed . Main outcomes were pain relief or pain intensity difference and adverse effects .  Twenty‐one reports were found , and four publications were excluded . In the remaining 17 studies ( 450 patients ) , 10 used intravenous lignocaine , two used intranasal lignocaine , four used oral mexiletine and one used oral tocainide ABSTRACT Venepuncture for blood sampling can be a distressing experience for a considerable number of children . A prospect i ve controlled trial was conducted to compare the efficacy of a local anaesthetic ( EMLA ) with a combination of EMLA with self‐hypnosis in the relief of venepuncture‐induced pain and anxiety in 45 paediatric cancer out patients ( age 6–16 years ) . A secondary aim of the trial was to test whether the intervention will have a beneficial effect on  parents ’ anxiety levels during their child ’s procedure . Patients were r and omized to one of three groups : local anaesthetic , local anaesthetic plus hypnosis , and local anaesthetic plus attention . Results confirmed that patients in the local anaesthetic plus hypnosis group reported less anticipatory anxiety , and less procedure‐related pain and anxiety , and were rated as demonstrating less behavioural distress during the procedure than patients in the other two groups . Parents whose children were r and omized to the local anaesthetic plus hypnosis condition experienced less anxiety during their child ’s procedure than parents whose children had been r and omized to the other two conditions . The therapeutic benefit of the brief hypnotic intervention was maintained in the follow‐up . The present findings are particularly important in that this study was a r and omized , controlled trial conducted in a naturalistic medical setting . In this context , convergence of subjective and objective outcomes was reached with large effect sizes that were consistently supportive of the beneficial effects of self‐hypnosis , an intervention that can be easily taught to children , is noninvasive and poses minimal risk to young patients and their parents Laparoscopy is frequently associated with postoperative shoulder pain that may last several days . We have assessed the analgesic effect of intraperitoneal local anaesthetics during day-case diagnostic laparoscopy . 80 young women were r and omly assigned to one of four groups of 20 patients each : group 1 , no peritoneal administration ; group 2 , 80 ml saline injected under direct vision in the right subdiaphragmatic area at the start of the procedure ; group 3 , 80 ml 0.5 % lignocaine with adrenaline ( 320,000 dilution ) ; group 4 , 0.125 % bupivacaine with adrenaline ( 800,000 dilution ) . Scapular pain was assessed with a visual analogue pain scale , and information about nausea , vomiting , abdominal pain , and analgesic requirements during the first 48 h was sought . Both local anaesthetics were more effective in reducing postoperative shoulder pain than either control or saline . Analgesic requirements were greater in the non-treatment groups than in the local anaesthetic groups . Intraperitoneal local anaesthetic administration during laparoscopy is both a non-invasive and an efficient method of reducing the intensity of scapular pain AIM To compare the efficacies of non-nutritive sucking and glucose solution as pain-relief interventions for neonates undergoing a venipuncture procedure . BACKGROUND Neonates may be subjected to painful procedures . The individual efficacies of non-nutritive sucking or oral glucose solution used alone on pain-relief for neonates still remain controversial . DESIGN A r and omised , parallel-group controlled trial was design ed . METHODS A total of 105 neonates were r and omly assigned to one of the three groups : non-nutritive sucking , glucose solution , or control group . When a neonate underwent a venipuncture during a newborn screening test , his/her pain manifestations were videotaped and subsequently measured using the Neonatal Infant Pain Scale . Both the stability analysis and the analysis of repeated relationships were performed by generalised estimating equations . RESULTS The level of pain was regressed over the study variables ( time and group ) and covariate ( gestational age ) . Both the non-nutritive sucking and glucose solution groups had significantly lower pain scores than the control group during the venipuncture and recovery phases . Furthermore , non-nutritive sucking seemed to be more effective than glucose solution . CONCLUSION Nurses can use a pain assessment tool and the pain-relief intervention to improve the quality of neonatal care in clinical practice . This study indicates that either non-nutritive sucking or glucose solution can effectively decrease the level of pain . RELEVANCE TO CLINICAL PRACTICE If a painful procedure on neonates is inevitable , simple , convenient and effective pain-relief methods such as non-nutritive sucking or glucose solution can be provided alone . Based on a neonate 's condition , nurses can provide 2 ml of 25 % glucose solution through a syringe for a breastfeeding infant before an invasive procedure if nipple confusion is the concern Background Topical anesthetics are important tools for many dermatologic procedures . The S-Caine Peel is composed of a 1:1 ( w : w ) eutectic mixture composed of lidocaine base 7 % , USP , and tetracaine base 7 % , USP . It is applied as a cream , dries on exposure to air , and forms a flexible membrane , which can be easily peeled off . Objective To evaluate the effectiveness of the S-Caine Peel in providing clinical ly useful local dermal anesthesia for laser-assisted tattoo removal and to monitor the nature and frequency of adverse events associated with the safety of the S-Caine Peel . Methods Thirty adult patients undergoing laser-assisted tattoo removal were enrolled in this multicentered , r and omized , double-blind , placebo-controlled study . Each subject received both the S-Caine Peel and placebo simultaneously for 60 minutes . The primary efficacy parameter was a 100 mm visual analog scale ( VAS ) for patient self- assessment of pain . Secondary efficacy parameters included both the investigator 's and an independent observer 's evaluation of subject pain ( 4-point categorical scale : no pain through severe pain ) and the patient 's and the investigator 's overall impression of the local anesthetic . Results Mean VAS scores were 42 mm for the S-Caine Peel and 66 mm for placebo treatment sites ( p= .001 ) . Patients received adequate pain relief in 50 % of S-Caine Peel sites versus 7 % of placebo sites ( p= .002 ) . The percentage of those who would like to use the S-Caine Peel again were 43 % for the S-Caine Peel compared with 7 % for placebo ( p= .005 ) . Investigators ' evaluations revealed that 70 % of patients had less pain at S-Caine Peel treatment sites compared with 10 % with less pain at placebo sites ( p < .001 ) , and 70 % of the S-Caine Peel – treated sites achieved adequate anesthesia versus 10 % of placebo sites ( p < .001 ) . The independent witness assessed less pain in 67 % of S-Caine Peel – treated sites versus 10 % of the placebo sites ( p= .002 ) . One occurrence of moderate to severe erythema was noted at both an S-Caine Peel and a placebo treatment site on removal of the S-Caine Peel after 60 minutes , which self-resolved quickly . There was no statistical difference between the two groups . Other side effects were limited to local mild , transient erythema at the application sites . Conclusion Administration of the S-Caine Peel for 60 minutes prior to laser-assisted tattoo removal was effective in significantly reducing pain levels associated with the procedure Background : Acupuncture is used for clinical pain relief but has not been evaluated under clinical anaesthesia . This study was design ed to compare movement in response to surgical incision in anaesthetized patients subjected to electro‐acupuncture ( EA ) or sham procedures .  Our hypothesis was that EA stimulation would reduce the requirements for anaesthetic gas OBJECTIVE To assess the extent to which hypotheses about potential adverse effects of epidural analgesia during labour can be tested using evidence from controlled comparisons of epidural with non-epidural forms of pain relief . INCLUSION CRITERIA Prospect i ve studies in which an attempt had been made to use r and om allocation to generate comparable groups of women receiving epidural and non-epidural forms of pain relief during labour . IDENTIFICATION OF RELEVANT STUDIES : Systematic h and search of a total of 36 anaesthetic , obstetric and general journals , and more than 30 other journals ( 1950 - 1990 ) , and a search of MEDLINE ( 1966 - 1990 ) . DATA COLLECTION Data were abstract ed from published reports of 9 controlled trials , involving a total of 600 women . It was possible to obtain some missing information and data from the investigators . RESULTS Very few postulated effects of epidural block during labour can be confirmed or rejected on the basis of the evidence generated by the small number of controlled trials . Evidence derived from these trials confirms that epidural block provides more effective relief of pain than alternatives ; and that if it is continued during the second stage of labour , it can cause a substantial increase in the use of instrumental delivery . CONCLUSIONS Considering the very widespread use of epidural block during labour , remarkably little is known about its short-term and long-term effects . In view of hypotheses about potentially important adverse effects , there is still a need to conduct larger , better design ed r and omised controlled trials The aim of this study was to compare the efficacy of topical piroxicam and EMLA cream on pain control and subsequent inflammation in neodymium : yttrium – aluminum – garnet ( Nd : YAG ) 1,064 nm laser hair removal in female volunteers . Fifty female volunteers were enrolled in this prospect i ve , r and omized , double-blind , clinical study over a 6-month period . Patients were r and omly assigned to receive topical piroxicam as group Piroxicam or EMLA cream as group EMLA . Topical analgesics were applied to the treatment sites for 60 min . The pain scores [ on a visual analog scale ( VAS ) ] and side effects were recorded before the hair removal , during the hair removal , at the end of the hair removal , and 1 h , 2 h and 24 h after the hair removal . Patients ’ characteristics and the treatment setting s of the Nd : YAG 1,064 nm laser were similar in the two groups . The pain scores ( VAS ) were similar , and satisfaction was high in both groups after the hair removal . The number of blanching and erythema episodes were significantly higher in group E than in group P ( P < 0.001 ) . Inflammatory side effects were less frequent in group P than in group E after the procedure ( P < 0.001 ) . This study showed that topical piroxicam and EMLA provided adequate and similar pain relief after Nd : YAG 1,064 nm laser hair removal in female volunteers . Topical piroxicam was associated with fewer inflammatory side effects than was EMLA cream , because of its anti-inflammatory effect after the procedure BACKGROUND Minor surgery for ingrown toenails can provoke anxiety and the anaesthetic injection can be acutely painful . Distraction techniques may reduce the associated pain and anxiety . OBJECTIVE To investigate an audiovisual distraction ( Bedscapes ) on pain and anxiety during  minor surgery  for the correction of ingrown toenail . METHOD In a r and omised controlled trial , patients ( N=152 ) with ingrown toenails requiring surgical correction under local anaesthesia were allocated  to receive Bedscapes+st and ard care or st and ard care alone .  Pain levels due to local anaesthetic injection were assessed post-procedure , and anxiety levels were assessed pre- and post-procedure in both groups . Follow-up focus groups were conducted with 14 patients allocated to the Bedscapes group , and one-to-one interviews were held with four podiatrists . RESULTS Participants with high pre-procedure anxiety scores experienced greater pain on injection , and older patients reported lower pain than younger patients , regardless of group allocation . Bedscapes did not reduce pain or anxiety , and was apparently no more effective than interpersonal interaction between podiatry staff and the patient . CONCLUSIONS Pain of injected anaesthesia correlates closely with pre-operative anxiety . Formal audiovisual distraction has no added benefit over interpersonal interaction in the alleviation of pain and anxiety in patients undergoing nail surgery The endocrine response , and the relief of pain , following the extradural administration of morphine or a local anaesthetic agent bupivacaine ( 0.5 % ) were studied for 24h after abdominal surgery  and compared with a control group given conventional i.v . morphine after operation . Sample s were taken before and at 2 , 4 , 6 , 12 and 24 h after skin incision . Pain relief in both extradural groups was significantly better when compared with the control group . In all three groups , the plasma concentration of cortisol was increased immediately after surgery . Thereafter , significantly lower values were seen in the extradural groups . Plasma adrenaline concentration was lower immediately after surgery only in the group given the extradural local anaesthetic . Plasma noradrenaline concentration remained unchanged after extradural local anaesthesia while an intermediate increase occurred after extradural morphine .  Plasma noradrenaline concentration was significantly greater in the controls compared with both extradural groups . Our results indicate that extradural analgesia with a local anaesthetic drug can suppress the increases in the plasma concentrations of the catecholamines and cortisol after surgery . In contrast to extradural local anaesthetic extradural morphine can not suppress the endocrine response immediately after surgery . However , later in the postoperative period , extradural morphine can suppress the endocrine response , thus indicating that postoperative pain is a factor involved in the stress response following surgery Background : Significant pain can be experienced after laparoscopic cholecystectomy . This systematic review aims to formulate PROSPECT ( PROcedure SPECific Postoperative Pain ManagemenT ) recommendations to reduce postoperative pain after laparoscopic cholecystectomy . Methods : R and omised controlled trials published in the English language from January 2006 ( date of last PROSPECT review ) to December 2017 , assessing analgesic , anaesthetic , or operative interventions for laparoscopic cholecystectomy in adults , and reporting pain scores , were retrieved from MEDLINE and Cochrane data bases using PRISMA ( Preferred Reporting Items for Systematic Review s and Meta‐Analyses ) search protocol s. PROSPECT methodology was used , and recommendations were formulated after review and discussion by the PROSPECT group ( an international group of leading pain specialists and surgeons ) . Results : Of 1988 r and omised controlled trials identified , 258 met the inclusion criteria and were included in this review . The studies were of mixed method ological quality , and quantitative analysis was not performed because of heterogeneous study design and how outcomes were reported . Conclusions : We recommend basic analgesic techniques : paracetamol + NSAID or cyclooxygenase‐2 specific inhibitor + surgical site local anaesthetic infiltration . Paracetamol and NSAID should be started before or during operation with dexamethasone ( GRADE A ) . Opioid should be reserved for rescue analgesia only ( GRADE B ) . Gabapentanoids , intraperitoneal local anaesthetic  , and  transversus abdominis plane blocks  are not recommended ( GRADE D ) unless basic analgesia is not possible . Surgically , we recommend low‐pressure pneumoperitoneum , postprocedure saline lavage , and aspiration of pneumoperitoneum ( GRADE A ) . Single‐port incision techniques are not recommended to reduce pain ( GRADE A ) BACKGROUND A variety of topical anesthetic compounds are available for use prior to minimally or moderately painful cutaneous laser procedures . A novel lidocaine/tetracaine-based peel has recently been developed that is applied to the skin as a cream and , once air dried , is removed as a flexible film that may prove useful in providing adequate dermal anesthesia for dermatologic laser surgery . OBJECTIVE To evaluate the clinical efficacy of a novel topical anesthetic peel preparation for induction of local anesthesia prior to full-face cutaneous laser resurfacing . METHODS A series of 20 patients undergoing full-face single-pass CO2 laser resurfacing were enrolled in a double-blind institutional review board (IRB)-approved study protocol in which two different topical anesthetic products were compared . A 4 cm × 4 cm area of one cheek was r and omized to receive the novel lidocaine/tetracaine-based cream peel ( S-Caine ) while a 4 cm × 4 cm area on the contralateral side received EMLA cream with occlusion for 30 minutes prior to laser treatment . Patients rated the level of pain experienced during laser treatment on each side using a visual analog scale . Independent assessment s of observed discomfort and side effects were recorded RESULTS Pain scores were significantly lower using the novel lidocaine/tetracaine-based cream peel formulation compared with the EMLA cream . Side effects associated with application of the anesthetic peel were limited to mild transient erythema and skin blanching . CONCLUSION A novel topical lidocaine/tetracaine-based cream peel provides safe and effective dermal anesthesia for single-pass CO2 laser skin resurfacing Objective Fear of pain during intrauterine device ( IUD ) insertion can be a barrier to widespread use of this safe and highly effective contraceptive method . Our objective was to determine the effectiveness of topical 10 % lidocaine spray for pain control during IUD insertion . Methods A total of 200 subjects with the request for IUD insertion were included in the study . The patients were r and omly divided into two groups : lidocaine spray ( n=100 ) and placebo ( n=100 ) . The pain experienced during the procedure was measured immediately after insertion by a st and ard Visual Analogue Scale ( VAS ) administered by a separate research er with maintenance of allocation concealment . Results The mean pain score during the procedure was 1.01±1.20 in the lidocaine spray group and 3.23±1.60 in the placebo spray group ( p<0.001 ) . Lidocaine spray treatment significantly lowered the overall procedural pain score compared with placebo . Conclusions Significant pain reduction during IUD insertion can be achieved by using 10 % lidocaine spray alone . Lidocaine spray can be accepted as a non-invasive , easy to apply and more comfortable local anaesthetic method for IUD insertion . Trial registration number NCT02020551 Central to high quality day-case care is the provision of good analgesia with minimal side effects . The success of  laparoscopic sterilisation  as a day case procedure may be hampered by severe post-operative pain1 . Opioid drugs have a poor side effect profile ; a reduction in their use should contribute significantly to patient care . Local anaesthetic blocks used to improve post-operative pain relief after laparoscopic sterilisation include combined rectus sheath and mesosalpinx block2 , but an extra surgical procedure is involved . Small volumes of concentrated bupivacaine applied directly to the fallopian tubes are safe and effective3 . Since pain after laparoscopic sterilisation may arise from manipulation of pelvic organs during visualisation of the fallopian tubes , as well as from the direct application of Filshie clips , this study was design ed to assess the analgesic effect , as measured by visual analogue scores for pain and post-operative analgesic requirements , of a large volume of dilute bupivacaine instilled into the pelvic peritoneal cavity & NA ; The utility of r and omised , double‐blind , controlled , comparative local anaesthetic blocks for the diagnosis of cervical , zygapophysial joint pain was studied in 47 patients with chronic neck pain following whiplash injury . Each patient was investigated with radiologically controlled blocks of the medial branches of the cervical , dorsal rami to anaesthetise the target cervical , zygapophysial joint . The blocks were performed using either lignocaine or bupivacaine , r and omly allocated , and the patients ' responses were assessed in a double‐blind fashion . Any positive response was subsequently assessed by repeating the block with the complementary anaesthetic . Only those patients experiencing a longer period of pain relief from the bupivacaine were considered to have true‐positive responses . Forty‐four patients had pain relief from two blocks at a single level , of whom 34 had longer pain relief from bupivacaine . This result is unlikely to have occurred by chance ( P = 0.0002 ) . The duration s of pain relief obtained from the anaesthetics were consistent with the known characteristics of these drugs with bupivacaine lasting significantly longer than lignocaine ( P = 0.0003 ) . A subgroup of 13 patients were identified with unexpected , prolonged responses to one or both of the anaesthetics . Comparative , diagnostic blocks are a valid technique in the identification of painful zygapophysial joints , and constitute an implementable alternative to normal saline controls Abstract Background The “ gold st and ard ” for pain relief after thoracotomy has been thoracic epidural analgesia ( TEA ) . The studies comparing TEA with  paravertebral block ( PVB ) and recent review s recommend PVB as a novel , safer method than TEA . Methods A systematic search of the Cochrane and PubMed data bases for prospect i ve , r and omized trials ( RCTs ) comparing TEA and PVB for post-thoracotomy analgesia was done . We assessed how TEA and PVB were performed , methods of r and omization , assessment of pain relief , and complications . Abstract s only were excluded . Results Ten studies were included , comprising 224 patients r and omized to TEA , 243 to PVB .  The studies were heterogeneous . Therefore , a systematic narrative review with our evaluations is presented . Only 3/10 trials reported the method of r and omization . Pain during coughing was reported in only 5/10 , pain assessment not specified in 5/10 . Only 1/10 trials found PVB superior to TEA , but placed TEA catheters too low ( < T7 ) . TEA was superior to PVB in 1/10 , during first 1.5 days . PVB and TEA were equally effective in 8/10 . 5/10 trials found PVB had less hypotension or urinary retention . None of the studies used appropriate and optimal TEA  : TEA  was started after end of surgery in half , catheters placed too low ( 2/10 ) , too high ( 1/10 ) , not reported in ( 1/10 ) . 7/10 infused local anaesthetic only , 2/10 added fentanyl , 1/10 added morphine , and none added adrenaline . PVB infusions had higher concentration of bupivacaine ( 5 mg/ml ) in 2/10 , 1/10 added fentanyl , 1/10 added ornipressin . Loading doses were higher in 5/10 , and with more concentrated solutions in 5/10 of PVB than in the TEA group . Conclusions 10 heterogeneous , mostly small , studies comparing TEA and PVB for post-thoracotomy analgesia do not allow conclusions on which method has superior analgesic efficacy and safety . The main method ological problem was that none of the studies use optimal thoracic epidural analgesia , with siting of catheters inappropriate in some and the epidural infusion containing too concentrated local anaesthetic because opioid and adrenaline were not added . Anatomical considerations ( the paravertebral space comprises parts of the epidural space and contains spinal cord arteries ) and personally experienced complications with PVB ( paraplegia ) convince us that PVB must have higher risk of , infrequent but serious , spinal cord complications than TEA . Percutaneous PVB may puncture pleura and lung . Some surgeons expressed satisfaction with PVB because the method omits costly acute pain services for monitoring on surgical wards and saves time in the operating room . They are , however , bound to experience serious complications from PVB , sooner or later . To our knowledge , optimally conducted epidural analgesia has not been compared with PVB . Current literature and our experience with both techniques for up to four decades , indicate that PVB may be an alternative for  post-thoracotomy pain  when TEA is infeasible for various patient-related reasons ( Breivik et al. , 2009 ) . Severely disturbed haemostasis is a contraindication for PVB and TEA . Higher concentrations of local anaesthetics are needed to obtain intercostal nerve blocks and epidural analgesia with PVB , risking local anaesthetic intoxication . Robust monitoring regimen for effects and adverse effects is as important for PVB as for TEA AIM To assess the efficacy of amethocaine as a topical local anaesthetic in neonates . METHODS A r and omised , double blind controlled trial compared 4 % amethocaine gel ( Ametop ) with placebo in 60 healthy neonates ( 29 to 42 weeks of gestation ) in the first week after birth . Either 1.5 g 4 % w/w amethocaine ( gel ) or 1.5 g placebo gel were applied to the dorsum of one foot . No gel was applied to the other foot . Each foot was occluded and left for one hour . Local anaesthesia was then assessed by eliciting the cutaneous withdrawal reflex in response to stimulation with a series of grade d nylon filaments ( von Frey hairs ) . The reflex was first elicited from the control and then the treated foot . The difference in filament thickness and deforming weight required to elicit the reflex was recorded . RESULTS In infants treated with amethocaine , 17 of 31 ( 54.8 % ) showed evidence of local anaesthetic action compared with five of 29 ( 17.2 % ) in the placebo group ( p=0.003 ) . The mean difference in deforming weight required to elicit the reflex was 18.8 g in the amethocaine group compared with 3.9 g in the placebo group ( p=0.02 ) . The apparent local anaesthetic action of the placebo can be explained by habituation to repeated stimulation . CONCLUSIONS It is concluded that topical amethocaine gel has a local anaesthetic action on neonatal skin which merits further investigation . An effective and safe surface local anaesthetic would be valuable for the relief of procedure related pain in neonates Pain during tubal sterilisation is thought to be due to either ischaemia or pressure at the site of impact of sterilising devices on the fallopian tubes . We have evaluated the effectiveness of an application of 2 % lignocaine gel to Filshie clips to relieve postoperative pain . In a r and omised double-blind placebo-controlled study , 80 healthy women undergoing tubal sterilisation under general anaesthesia at the County Hospital , Lincoln , UK , were allocated to be sterilised by Flishie clips covered with 2 % lignocaine gel or K-Y gel as placebo .  Pelvic pain was assessed , with a 100 mm visual analogue scale , at 1 hour , at hospital discharge , and time of first analgesia or any other time analgesia was dem and ed . The lignocaine-treated group had significantly longer time to first analgesia , less pain at 1 hour , less nausea and vomiting , and shorter recovery time . Fewer lignocaine-treated patients needed additional analgesia and they required fewer opioids . There was no case of failed sterilisation or adverse reaction to lignocaine . The application of local anaesthetic gel to Filshie clips is a safe , non-invasive , and effective method of relieving postoperative pain during laparoscopic tubal sterilisation BACKGROUND Laser-assisted hair removal is a variably uncomfortable and painful procedure . OBJECTIVE The aim of this study was to investigate the efficacy of piroxicam gel on pain control and subsequent inflammation in Nd : YAG 1064 nm laser hair removal in women volunteers . METHODS Fifty women volunteers were enrolled in this prospect i ve , r and omised , placebo-controlled study over a 6-month period . Subjects were r and omly assigned to receive piroxicam gel as Group P or saline as a control group . Topical analgesic and saline were applied to the treatment sites for 45 minutes . The pain scores ( VAS ) and side effects were recorded before the hair removal , during the hair removal , at the end of the hair removal , and after 1 hour , 2 hours and 24 hours after the hair removal . RESULTS Subject characteristics and treatment setting s in Nd : YAG 1064 nm laser were similar in both groups . The pain scores ( VAS ) were significantly lower in the Group P than those of the control group during the hair removal ( p < 0.001 ) . Inflammatory side effects such as erythema , edema , and folliculitis , were more frequent in the control group than those of Group P during the procedure ( p < 0.001 ) . CONCLUSION This study showed that piroxicam gel provided adequate pain relief after Nd : YAG 1064 nm laser hair removal in women volunteers .  Piroxicam gel was associated with lesser inflammatory side effects when compared to placebo because of its anti-inflammatory effect after the procedure OBJECTIVE To evaluate the efficacy of local anaesthetic ( LA ) infiltration in decreasing the discomfort experienced by patients undergoing transrectal ultrasound (TRUS)-guided biopsy of prostate . PATIENTS AND METHODS 98 patients were r and omized to receive 3x3ml of 1 % lidocaine ( n=55 ) or saline ( n=43 ) . The injection sites were basolaterally on each side to infiltrate the neuro-vascular bundle and one at the apex . Generally 12 systematic r and om biopsies were performed after which patients were asked to grade the pain of the whole procedure using a visual analogue scale ranging from 0 to 10 . RESULTS The LA group had a significantly lower pain score compared with placebo . The mean pain scores were 3.0 and 4.3 ( p<0.001 ) , respectively . Using an unpaired t-test , the difference between means was -1.96 to -0.51 with 95 % confidence interval . There were no significant problems associated with the infiltration of either saline or LA . CONCLUSION Local anaesthesia for TRUS biopsy is simple and well tolerated . It significantly reduces the pain associated with the procedure . We recommend its usage as a part of st and ard TRUS biopsy of the prostate Background : Screening is necessary for infants at risk of retinopathy of prematurity . Despite local anaesthetic drops , infants find eye examinations distressing , displaying behavioural and physiological changes indicating acute pain .  Oral sucrose and non-nutritive sucking reduce pain responses associated with invasive procedures . Objective : To evaluate the use of oral sucrose and /or pacifier for reducing pain responses during eye examinations . Methods : Forty infants < 32 weeks gestation or < 1500 g birth weight , in two neonatal units , were r and omised to one of four interventions administered two minutes before their first screening examination : 1 ml sterile water as placebo ( group 1 , n = 10 ) , 1 ml 33 % sucrose solution ( group 2 , n = 10 ) , 1 ml sterile water with pacifier ( group 3 , n = 9 ) , or 1 ml 33 % sucrose solution with pacifier ( group 4 , n = 11 ) . Examinations were videotaped . Two observers , blind to the intervention , assessed recordings . Pain responses were scored using the premature infant pain profile ( PIPP ) . Results : The groups were similar in gestation , birth weight , and age at examination . Mean PIPP scores were 15.3 , 14.3 , 12.3 , and 12.1 for groups 1 , 2 , 3 , and 4 respectively . Analysis of variance showed a significant difference in PIPP score between groups ( p = 0.023 ) . Infants r and omised to pacifiers scored lower than those without pacifiers ( p = 0.003 ) . There was no difference between groups receiving sucrose and those receiving water ( p = 0.321 ) . Conclusions : Non-nutritive sucking reduced distress responses in infants undergoing screening for retinopathy of prematurity . The difference in response was large enough to be detected by a vali date d assessment tool . No synergistic effect of sucrose and pacifier was apparent in this group Background and objective Local anaesthetics administered intraabdominally have been found to reduce analgesic requirements postoperatively after hysterectomy . This study was design ed to assess the optimal dose of local anaesthetics for best pain relief . Methods Sixty patients undergoing abdominal hysterectomy were r and omly divided into three groups to receive 10 ml h−1 infusion of levobupivacaine intraabdominally postoperatively for 48 h in a double-blind manner : group L , 7.5 mg h−1 ; group M , 12.5 mg h−1 and group H , 17.5 mg h−1 . Pain intensity was measured using the numeric rating scale , ketobemidone consumption over 48 h was measured with a patient-controlled analgesia pump , recovery parameters , expiratory muscle strength , time to home readiness , plasma concentration of levobupivacaine and health-related quality of life were all measured at defined time points postoperatively . Results No differences were found between the active groups in pain intensity , recovery parameters or health-related quality of life . Pain intensity was maximal during 0–4 h and during coughing . Expiratory muscle strength decreased significantly during 0–4 h in all active groups , with no differences between the groups . Plasma concentration of levobupivacaine was below known toxic concentrations in humans , and no patient had symptoms of local anaesthetic toxicity . Health-related quality of life showed improved scores at 3 months after the operation compared with preoperative values , but no differences between the groups were found in any of the parameters . Conclusion Satisfactory analgesia can be achieved with low doses of levobupivacaine administered intraabdominally , except during the early postoperative period . No advantages were seen in this study when higher doses of levobupivacaine were administered as a continuous infusion for postoperative pain relief BACKGROUND Topical anesthetics are valuable tools for many dermatologic procedures . OBJECTIVE To evaluate the efficacy and safety of S-Caine Peel composed of 1:1 ( wt : wt ) mixture of 7 % lidocaine and 7 % tetracaine in the induction of local anesthesia before long-pulsed Nd : YAG laser therapy for leg veins . METHODS Two r and omized , double-blinded , placebo-controlled trials were performed . In study 1 , 60 adults received S-Caine Peel and placebo cream  for 30 or 60 minutes . Efficacy was evaluated by a patient visual analog scale and impression . The pain scale and impression were evaluated by the investigator and an independent observer . In study 2 , 40 adults received 60- and 90-minute applications . RESULTS In study 1 , the 30- and 60-minute application times were grouped : Patients had adequate pain relief in 48 % of S-Caine sites versus 23 % of placebo sites ( P<0.001 ) . Investigators reported none-to-mild pain in 50 % of active sites versus 33 % of placebo sites ( P = 0.007 ) , with adequate anesthesia in 65 % of active sites versus 43 % of placebo sites ( P = 0.002 ) . The independent witness assessed none-to-mild pain in 52 % of active sites versus 37 % of placebo sites ( P = 0.067 ) . In study 2 , investigators rated none-to-mild pain in 75 % of 60-minute and 85 % of 90-minute S-Caine sites versus 30 % and 50 % of placebo sites ( P = 0.012 and P = 0.002 , respectively ) , with adequate anesthesia in 70 % and 85 % of 60- and 90-minute of active sites versus 25 % and 20 % of placebo sites ( P = 0.029 and P = 0.001 , respectively ) . The independent witness rated none to mild pain in 80 % and 85 % of 60 and 90 minute of S-Caine sites versus 35 % and 50 % of placebo sites ( P = 0.008 and P = 0.004 ) . CONCLUSION The S-Caine Peel provides safe and highly effective local anesthesia when applied for at least 60 minutes for laser therapy of leg veins . Facile removal of the peel provides a unique advantage and ease in administration
In general , active non-invasive anaesthetic methods seemed to provide favourable results compared to placebo or no anaesthesia , and topical anaesthetic drugs and PSF seemed to result in a better pain reduction than skin cooling .
However , the current evidence is insufficient to provide recommendations for daily clinical practice .
Future studies should also evaluate sex differences in pain perception , have uniformity with regard to vali date d pain measurement scales and address clinical ly significant differences in pain reduction besides statistically significant differences
Pain is a common side-effect of dermatological laser procedures .
Non-invasive anaesthetic drugs and anaesthetic procedures can be used to provide pain relief and increase patient satisfaction and treatment efficacy .
However , it remains unclear which method provides the best pain relief .
The objective of this systematic review was therefore to assess the efficacy and safety of non-invasive anaesthetic methods during dermatological laser procedures .