Alabama medicine : journal of the Medical Association of the State of Alabama
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Randomized Controlled Trial Clinical Trial
Towards less painful local anesthesia.
Local anesthesia, used for numerous procedures in all fields of medicine, has the drawback of providing significant pain upon injection. Twenty-eight volunteers were asked to compare a subcutaneous injection of plain lidocaine with an injection of lidocaine plus bicarbonate. Twenty-four of the twenty-eight volunteers reported less pain with the buffered lidocaine. ⋯ There are numerous factors that have been shown to influence the pain of injection. These include speed of injection, size of needle used, area of the body injected, and simply individual patient characteristics. Since lidocaine comes as an acid solution, local tissue irritation is likely the primary source of pain.
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Mucormycosis (synonymous with phycomycosis and zygomycosis) is a devastating fungal infection which usually involves patients with diabetes mellitus, often complicated by ketoacidosis, and malignant neoplasms, commonly leukemia and lymphoma. Clinical manifestations include rhinocerebral, pulmonary, disseminated, isolated cerebral, gastrointestinal and cutaneous disease. Common to all forms of mucormycosis is vascular invasion with production of necrotic tissue. ⋯ Successful treatment consists of early diagnosis, intensive systemic antifungal therapy with amphotericin B, aggressive surgical debridement and control of the underlying disease. In our experience with mucormycosis at Huntsville Hospital, the patients were immuno- compromised and the infection was restricted to the lung. Despite use of amphotericin B in all patients, the only one who survived underwent surgical section of infected tissue.
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A prospective comparison of conventional analgesia and patient-controlled analgesia using morphine was conducted. Each patient underwent a major gynecologic oncology procedure and was observed on the post-operative floor. All 192 patients were studied during the first three post-operative days. The findings suggest less total medication and less sedation with equal pain control in the patient-controlled analgesia group.