Search Results (16)

Background: Effective pain management in children is essential, particularly when administering local anaesthesia. This study was undertaken to compare pain perception in children after application of pre-cooled and plain topical anaesthetic gel during local anaesthetic administration. Methods: A randomised, single-blinded controlled trial was conducted among 51 children between the ages of 6 and 12, visiting the paediatric clinic, Jazan (REC-45/10/1070). Children were allocated into one of the following three groups using a simple randomisation having a 1:1:1 allocation ratio into Group I (n = 17): Plain topical anaesthetic gel, Group II (n = 17): Pre-Cooled topical anaesthetic gel, and Group III (n = 17). An ice pack was applied for a period of 1 min at the injection site. The intensity of pain and the behaviour of the children were assessed using Face, Leg, Activity, Cry, Consolability (FLACC), the Modified Wong–Baker Scale (WBS) and the Frankel Behaviour Rating Scale (FBRS). Results: A significant difference in FBRS scores was observed during anaesthesia, with the highest median score [3 (3,3)] in the pre-cooled topical anaesthetic gel group (p value < 0.001). FLACC scores varied significantly among groups, with the ice pack group [3 (3, 3)] and [4 (4, 5)] showing the highest median score (p value < 0.001). WBS scores also differed significantly between groups (p value < 0.001) with a lower value in the pre-cooled topical gel group [0 (0, 0), 2 (0, 2)]. Conclusions: This study concluded that, the use of a pre-cooled topical anaesthetic gel before LA administration reduced the pain better than that of plain anaesthetic gel and ice pack application at the injection site during infiltration. Full article

Background/Objectives: Natural products are gaining increasing importance due to the large variety of biological activities exerted by their constituents. Among these, the products deriving from Acmella oleracea (L.) R.K. Jansen can be exploited for their local anaesthetic, myorelaxant, anti-inflammatory/analgesic, and antifungal properties. In this regard, there is a need to develop novel formulations for the topical delivery of A. oleracea-derived extracts to widen their use in the pharmaceutical and cosmetic fields. Methods: Nanoformulations, i.e., nanoemulsions (NEs) and microemulsions (MEs), were investigated as a strategy to encapsulate an extract from A. oleracea at the nanoscale level in water and then incorporated into xanthan gum-based hydrogels. Results: Only NEs provided a physically stable formulation, while the precipitation of solid hydrophobic components from the extract was observed during ME preparation under all tested conditions despite the use of ethyl oleate as an oily co-solvent. The optimized NE-based hydrogel remained physically stable over six months, as confirmed by rheological measurements and polarized optical microscope observation, without a phase separation phenomenon. Therefore, NEs resulted more suitable nanodispersed systems than MEs for the encapsulation of A. oleracea extract, which contains a large amount of hydrophobic constituents that are solid at room temperature. Furthermore, the sustained spilanthol release across an artificial membrane (Franz cell apparatus) and the cytotoxic profile on HaCaT cell line support its potential topical application. Conclusions: The outcomes of this study provided valuable insights into the formulation of A. oleracea extract, broadening its fields of applicability, including topical administration. Full article

Background: Atrial fibrillation, the most frequent and prevalent cardiac arrhythmia, often requires external cardioversion to ensure rhythm control. As healthcare professionals, nurses play a key role in autonomous intervention implementation. The aim was to update current evidence on the efficacy of nurse-led external direct current cardioversion. Methods: A systematic review of primary quantitative studies in English or Italian was conducted with no temporal filter. Seven database searches were interrogated. A total of nine articles were included, for which validity was evaluated and analysed. The review was performed using PRISMA guidelines for systematic reviews. Study characteristics were examined to determine if a meta-analysis was possible, and odds ratio was used as the effect size measure. Results: Data analysis led to the development of selected topics. The success rate of nurse-led direct current cardioversion appears to be high, at >80% (eight out of nine studies) in safe conditions. High-level professional training was required of nurses. There seemed to be no clear consensus on the management of anaesthetic aspects and medical support during the procedure. Meta-analyses of three studies found that there was no risk (M1-OR 0.89, CI [0.58, 1.36]; M2-OR 0.90, CI [0.59, 1.37]) difference between nurse-led DCCV and that performed by other clinicians. Few studies reported data on patient satisfaction, cost effectiveness, and waiting time. Conclusions: This review confirms that nurse-led external direct current cardioversion appears to be successful and safe in restoring sinus rhythm. A high level of nurse training and definition of a shared protocol could allow for effective implementation in more countries and settings. Full article

Deep eutectic solvents (DESs) and ionic liquids (ILs) offer novel opportunities for several pharmaceutical applications. Their tunable properties offer control over their design and applications. Choline chloride (CC)-based DESs (referred to as Type III eutectics) offer superior advantages for various pharmaceutical and therapeutic applications. Here, CC-based DESs of tadalafil (TDF), a selective phosphodiesterase type 5 (PDE-5) enzyme inhibitor, were designed for implementation in wound healing. The adopted approach provides formulations for the topical application of TDF, hence avoiding systemic exposure. To this end, the DESs were chosen based on their suitability for topical application. Then, DES formulations of TDF were prepared, yielding a tremendous increase in the equilibrium solubility of TDF. Lidocaine (LDC) was included in the formulation with TDF to provide a local anaesthetic effect, forming F01. The addition of propylene glycol (PG) to the formulation was attempted to reduce the viscosity, forming F02. The formulations were fully characterised using NMR, FTIR and DCS techniques. According to the obtained characterisation results, the drugs were soluble in the DES with no detectable degradation. Our results demonstrated the utility of F01 in wound healing in vivo using cut wound and burn wound models. Significant retraction of the cut wound area was observed within three weeks of the application of F01 when compared with DES. Furthermore, the utilisation of F01 resulted in less scarring of the burn wounds than any other group including the positive control, thus rendering it a candidate formula for burn dressing formulations. We demonstrated that the slower healing process associated with F01 resulted in less scarring potential. Lastly, the antimicrobial activity of the DES formulations was demonstrated against a panel of fungi and bacterial strains, thus providing a unique wound healing process via simultaneous prevention of wound infection. In conclusion, this work presents the design and application of a topical vehicle for TDF with novel biomedical applications. Full article

Lidocaine is a local anaesthetic drug with an amphiphilic structure able to self-associate, under certain conditions, in molecular aggregates playing the role of both carrier and drug. The aim of this study was to determine the optimal conditions for obtaining vesicular carriers, called lidosomes. The new formulations were obtained using both lidocaine and lidocaine hydrochloride and different hydration medias (distilled water, acid, and basic aqueous solution). Lidosomes formulations were characterized in terms of size, ζ-potential, drug retained, stability formulation, and ex vivo permeation profile. Moreover, lidosomes were incorporated in two different gel structures: one based on carboxymethylcellulose and one based on pluronic F-127 to achieve suitable properties for a topical application. Results obtained showed that lidocaine showed a better performance to aggregate in vesicular carriers in respect to hydrochloride form. Consequently, only formulations comprised of lidocaine were studied in terms of skin permeation performance and as carriers of another model drug, capsaicin, for a potential combined therapy. Lidocaine, when in form of vesicular aggregates, acted as percutaneous permeation enhancer showing better permeation profiles with respect to drug solutions. Moreover, lidosomes created a significant drug depot into the skin from which the drug was available for a prolonged time, a suitable feature for a successful local therapy. Full article

Field evidence indicates that livestock producers are motivated by access to products that readily deliver pain management during husbandry interventions and, more recently, viral epidermal infectious diseases, including FMD. There has been impressive adoption in Australia of a farmer-applied spray-on topical anaesthetic wound formulation (TAF; Tri-Solfen^®, Medical Ethics, Australia), initially for managing pain of the breech modification ‘mulesing’ procedure that reduces susceptibility of sheep to flystrike. Over 120 million lambs have now received pain relief and cattle producers have commenced using the TAF for a range of husbandry procedures. This product has demonstrated efficacy for surgical castration and tail docking of lambs, surgical castration and dehorning of calves, surgical castration of piglets, debridement of lesions of the hoof for lame cattle and, importantly, treatment of clinical FMD lesions, including decubitus ulcerations occurring from prolonged recumbency. Multimodal use of an NSAID for improved pain management is advocated, particularly meloxicam, available by prescription from veterinarians for injection and as an oral formulation (Ilium Buccalgesic^®, Troy Laboratories, Australia), with current work assessing the potential for prolonged delivery in molasses blocks. Increased use of TAF with NSAIDs significantly reduces pain and suffering in livestock, with enhanced healing of FMD lesions, reduced viral loads from Orf infections in lambs and diminished necessity of ‘antibiotic cover’, assisting antimicrobial-resistance (AMR) stewardship. Full article

Piglet castration results in acute pain and stress to the animal. There is a critical need for effective on-farm methods of pain mitigation. Local anaesthesia using Tri-Solfen^® (Animal Ethics Pty Ltd., Melbourne, Australia), a topical local anaesthetic and antiseptic formulation instilled to the wound during surgery, is a newly evolving on-farm method to mitigate castration pain. To investigate the efficacy of Tri-Solfen^®, instilled to the wound during the procedure, to alleviate subsequent castration-related pain in neonatal piglets, we performed a large, negatively controlled, randomised field trial in two commercial pig farms in Europe. Piglets (173) were enrolled and randomised to undergo castration with or without Tri-Solfen^®, instilled to the wound immediately following skin incision. A 30 s wait period was then observed prior to completing castration. Efficacy was investigated by measuring pain-induced motor and vocal responses during the subsequent procedure and post-operative pain-related behaviour in treated versus untreated piglets. There was a significant reduction in nociceptive motor and vocal response during castration and in the post-operative pain-related behaviour response in Tri-Solfen^®-treated compared to untreated piglets, in the first 30 min following castration. Although not addressing pain of skin incision, Tri-Solfen^® is effective to mitigate subsequent acute castration-related pain in piglets under commercial production conditions. Full article

Tri-Solfen^® is a combination topical anaesthetic and antiseptic solution containing lidocaine, bupivacaine, adrenaline and cetrimide. Applied to wounds, it is reported to reduce the pain experienced by calves following thermocautery disbudding. While lidocaine and bupivacaine are widely used in medicine, conflicting data exist on the impact of these compounds when applied directly to the surgical wound. To investigate the safety of Tri-Solfen^® applied to thermocautery disbudding wounds of calves, experiments were performed to measure (i) the safety of Tri-Solfen^® (including in overdose situations); and (ii) the impact of Tri-Solfen^® application at recommended doses on disbudding wound healing under field conditions. Haematological, biochemical and urinalysis parameters did not show clinically significant differences between placebo and Tri-Solfen^® groups (1×, 3× and 5× dose). No adverse health impacts were reported. Histopathological analysis of wounds noted a reduction in bacterial colonies in Tri-Solfen^®-treated wounds. Under field conditions, no negative impacts on wound healing were noted. Conversely, there was reduced incidence of abnormal wounds, with an associated trend toward improved average daily gain at days 11–12 in Tri-Solfen^®-treated animals. These data are considered to support the safety of topical anaesthesia, as formulated in Tri-Solfen^®, to the thermocautery disbudding wound in calves. Full article

Pleural disease diagnostics represent a sprawling topic that has enjoyed a renaissance in recent years from humble beginnings. Whilst pleural patients are heterogeneous as a population and in the aetiology of the disease with which they present, we provide an overview of the typical diagnostic approach. Pleural fluid analysis is the cornerstone of the diagnostic pathway; however, it has many shortcomings. Strong cases have been made for more invasive upfront investigations, including image-guided biopsies or local anaesthetic thoracoscopy, in selected populations. Imaging can guide the diagnostic process as well as act as a vehicle to facilitate therapies, and this is never truer than with the recent advances in thoracic ultrasound. Full article

New Zealand deer farming centres on the production of meat and velvet antler. Velvet antler removal is a painful procedure and currently, New Zealand Animal Welfare regulations dictate surgical removal of velvet antlers under lignocaine anaesthesia. To improve our knowledge on the efficacy and duration of other local anaesthetics to mitigate pain after antler removal, it is important to accurately assess and quantify pain arising from antler removal. Therefore, the current study was designed to validate mechanical nociceptive threshold (MNT) testing using a Wagner hand-held algometer, and to apply this methodology to assess the efficacy and duration of action of articaine for antler removal in deer. Baseline force (N) required to elicit the nociceptive response was recorded in 40 yearling male red deer on three alternate days. Ten of the 40 animals were selected for antler removal after administration of 4% articaine hydrochloride as a ring block. The duration of analgesic efficacy of articaine was assessed by algometry across 5 time points. There was a significant difference in MNTs among the three days (day 3 versus day 1 (p < 0.0001), day 2 versus day 1 (p < 0.0001), and day 1 versus day 2 (p < 0.01)). Positive correlations were observed between weight, antler length and thresholds. The MNT values remained above 20N for 6 h after removal of velvet antlers under the articaine ring block. This study provides valuable information about the use of MNT in red deer. These findings lay a foundation for future studies in the topics of peri-operative and postoperative pain management in deer antler removal, and a possible alternative use for articaine. Full article

We examined several procedures for surgical tail docking; with and without general anaesthesia (GA), including the use of a topical wound gel formulation to provide pain relief (PR) and improve healing after surgery, containing local anaesthetics lignocaine and bupivacaine, with cetrimide and adrenalin. Forty-four lambs were recruited into four equal cohorts: Groups A and C, the tail was excised with a scalpel without anaesthesia or stitches; Groups B and D, the tail was surgically excised and stitched under GA; Groups C and D wounds were immediately sprayed with PR. Behavioural observations identified that Groups A and C displayed significantly less pain-related behaviours than Groups B and D shortly after the procedure, especially if treated with PR. Similarly, the mean of days when animals showed no signs of wound infection was longer in the groups not undergoing stitching. Finally, treatment with PR appeared to reduce the cortisol response and avoided the elevation of serum amyloid A in lambs where the tail was excised without general anaesthesia. In conclusion, surgical tail-docking without GA but where wounds are immediately sprayed with PR, appears as an affordable and more welfare-appropriate method for conducting tail docking in lambs. Full article

The application of patient blood management (PBM) combined with tranexamic acid administration (TXA) results in decreased total blood loss volume (TVB) and transfusions in total hip replacements (THRs). Dosages, timing, and routes of administration of TXA are still under debate as all these aspects, as well as interpatient variations, may affect the efficacy of the protocol. This study aims to examine the effectiveness of timing and route of administration of TXA in combination with PBM by reducing the TBV following THR surgery. Consecutive primary uncemented THRs operated by a single surgical and anaesthetic team had the data prospectively collected and then retrospectively studied. Five treatment groups were formed, reflecting the progressive evolution of our protocol. Group 1 included patients managed with PBM alone (preoperative erythrocyte mass optimisation to at least 14 g/dL haemoglobin (Hb), hypotensive spinal anaesthesia and restrictive red blood cell transfusion criteria). Group 2 included patients with PBM and topical 3 g TXA diluted in normal saline to a total volume of 50 mL. Group 3 were patients with PBM and an IV dose of 20 mg/kg TXA at induction, followed by 20 mg/kg TXA as a continuous infusion for the duration of the operation. Group 4 consisted of patients managed as per Group 3 plus another 20 mg/kg TXA at three-hour post-procedure. Group 5 (combined): PBM and IV TXA as per Group 4 and topical TXA as per Group 2. A generalised linear model with the treatment group as an independent variable was modelled, using TBV as the dependent variable. The transfusion rate for all groups was 0%. TBV at 24 h, oscillated from 613.5 ± 337.63 mL in Group 1 to 376.29 ± 135.0 mL in Group 5. TBV at 48 h oscillated from 738.3 ± 367.3 mL (PBM group) to 434 ± 155.2 mL (PBM + combined group). The multivariate regression model confirmed a significant decrease of TBV in all groups with TXA compared with the PBM-only group. Overweight and preoperative Hb were confirmed to significantly influence TBV. The optimal regime to achieve the least TBV and a transfusion rate of 0% requires PBM and one loading 20 mg/kg dose of TXA, followed by continuous infusion of 20 mg/kg for the duration of the operation in uncemented THRs. Additional doses of TXA did not add a clear benefit. Full article

Dehorning causes pain and distress to cattle, and there is a need to provide effective and practical analgesia to improve animal welfare. We conducted an experiment to determine the effect of a modified post-operative topical wound management formulation containing two local anaesthetics (TA) on the plasma cortisol concentration (PCC) of scoop-dehorned calves. Two months old Holstein-Friesian heifer calves (n = 30) were randomly allocated to sham dehorning control (CON), scoop dehorning (D), or scoop dehorning with immediate post-operative application of the TA (DTA). Blood samples were obtained via jugular venepuncture prior to sham or actual dehorning, and 40 min, 1.5, 4 and 24 h later. PCC changed significantly over time (p < 0.01). There was a trend for lower PCC in DTA calves compared to D calves (p = 0.09), with the PCC area under the curve lowest in CON calves as compared to D and DTA calves (p = 0.02). Cortisol concentrations were similar between D and DTA at all time points. The TA did not reduce cortisol concentrations up to 24 h following treatment and the cortisol response likely reflects the pain induced by the procedure, the effect of handling and restraint, and haemorrhaging which limited adherence of the TA actives. A multimodal analgesic approach, as assessed through multiple pain indicators, should be the focus of future work. Full article

Multiple physiological and neuroendocrine changes consistent with stress and pain have been demonstrated in cattle spayed via the Willis dropped ovary technique (WDOT). The procedure is routinely conducted without the use of anaesthetics or analgesics and has major implications for animal welfare. This study aimed to evaluate the effect of a topical anaesthetic (TA), haemostatic wound dressing, and meloxicam on pain behaviour and haemorrhage in the acute period following spaying. Yearling Brahman heifers (n = 75) were randomly allocated to the following treatment groups: (1) rectal palpation/control (CON); (2) WDOT spay (S); (3) WDOT spay with meloxicam (SM); (4) WDOT spay with TA (STA); and (5) WDOT spay with TA and meloxicam (STAM). Individual behavioural responses, body weight, packed cell volume (PCV), and total plasma protein (TPP) were monitored for up to 24 h following treatment. Head tucking behaviour and tail stiffness was increased in all spay groups compared to the CON group (p < 0.001), with the lowest proportional increase in the SM group. Rumination was initially reduced in S, SM, and STA heifers compared to CON heifers (p < 0.001), though SM heifers ruminated more than S heifers (p < 0.001). CON and SM heifers stood with an arched back the least, spent the most time eating, and spent less time lying down and more time standing compared to other treatment groups (p < 0.001). There was no significant effect of treatment on weight change (p = 0.519), PCV (p = 0.125) or TPP (p = 0.799). The administration of meloxicam is suggested as an effective, currently available method for improving the welfare of cattle undergoing WDOT spaying. Full article

The use of pain relief during castration and dehorning of calves on commercial beef operations can be limited by constraints associated with the delivery of analgesic agents. As topical anaesthetic (TA) and buccal meloxicam (MEL) are now available in Australia, offering practical analgesic treatments for concurrent castration and dehorning of beef calves, a study was conducted to determine their efficacy in providing pain relief when applied separately or in combination. Weaner calves were randomly allocated to; (1) no castration and dehorning/positive control (CONP); (2) castration and dehorning/negative control (CONN); (3) castration and dehorning with buccal meloxicam (BM); (4) castration and dehorning with topical anaesthetic (TA); and (5) castration and dehorning with buccal meloxicam and topical anaesthetic (BMTA). Weight gain, paddock utilisation, lying activity and individual behaviours following treatment were measured. CONP and BMTA calves had significantly greater weight gain than CONN calves (p < 0.001). CONN calves spent less time lying compared to BMTA calves on all days (p < 0.001). All dehorned and castrated calves spent more time walking (p = 0.024) and less time eating (p < 0.001) compared to CONP calves. There was a trend for CONP calves to spend the most time standing and CONN calves to spend the least time standing (p = 0.059). There were also trends for the frequency of head turns to be lowest in CONP and BMTA calves (p = 0.098) and tail flicks to be highest in CONN and BM calves (p = 0.061). The findings of this study suggest that TA and MEL can potentially improve welfare and production of calves following surgical castration and amputation dehorning. Full article