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References 1. Vnuk D, Nesek-Adam V, Pecin M, Musulin A, Lemo N, Brajenovic N, Brcic Karaconji I, Radisic B, Smolec O, Lipar M: Hemodynamic effects of epidural lidocaine vs lidocaine - adrenaline in dogs. Vet arhiv 2011, 81: 585-595. 2. Habibian S, Bigham AS, Aali E: Comparison of lidocaine, tramadol and lidocaine-tramadol for epidural analgesia in lambs. Res Vet Sci 2011, 3: 434-438. 3. Jones RS: Epidural analgesia in the dog and cat. Vet J 2001, 161: 123-131. 4. Bernards CM, Kopacz DJ: Effect of adrenaline on lidocaine clearance in vivo. Anesthesiology 1999, 91

References 1. Cuvillon P, Nouvellon E, Ripart J, Boyer JC, Dehour L, Mahamat A, et al. A comparison of the pharmacodynamics and pharmacokinetics of bupivacaine, ropivacaine (with epinephrine) and their equal volume mixtures with lidocaine used for femoral and sciatic nerve blocks: a double-blind randomized study. Anesth Analg. 2009;108:641-649. 2. Ye F, Feng YX, Lin JJ. A ropivacaine-lidocaine combination for caudal blockade in haemorrhoidectomy. J Int Med Res 2007;35:307-313. 3. Hansen TG. Ropivacaine: A pharmacological review. Expert Rev Neurother. 2004

Abstract

Background: Before nasal endoscopy, topical intranasal anesthetics and decongestant are usually used to relieve patients’ pain and discomfort. Two methods of drug administration are usually performed, nasal packing vs. nasal spray.

Objective: We compared the efficacy of nasal packing vs. nasal spray with 4% lidocaine and 3% ephedrine in patients undergoing rigid nasal endoscopy in terms of pain, discomfort, clarity of view of lateral nasal anatomy and overall patient and examiner preference.

Methods: A single-blinded randomized controlled clinical trial was conducted in 86 adult patients undergoing rigid nasal endoscopy at the Outpatient Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Thailand. Nasal cavities were randomly selected to receive nasal packing or nasal spraying before nasal endoscopic procedure. Outcomes were assessed for differences in pain, discomfort, clarify of nasal anatomy during nasak endoscopic procedures as well as patient and examiner preference.

Results: There were statistically and clinically significant differences between the nasal spray groups and nasal packing groups during drug administration in the number of patients who had less pain, 46 (56.1%) vs. 17 (20.7%), patients’ pain score 2.36 vs. 3.20 and patient preference, 63.4% vs. 30.5%, respectively. During nasal endoscopic procedure, there were no clinically and statistically significant difference in the number of patients who had less pain, less discomfort, pain score and discomfort score. There was also no statistically and clinically significant difference for the choice of method of drug administrations for nasal endoscopic examination in the future. During nasal endoscopy, the endoscopist could see the middle meatus and superior meatus more clearly when nasal packing group had been performed and the endoscopist expressed a clear preference for nasal packing.

Conclusions: Nasal packing provided a clearer view of lateral nasal wall anatomy. This method of drug administration was preferred by the endoscopist. There were no clinically and statistically significance differences between both methods in terms of patients’ overall preference.

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prevention of pain on propofol injection in the hand: a prospective, randomized, double-blind, vehicle-controlled, dose-finding study in Japanese adult surgical patients, Clin. Ther. 27 (2005) 588–593; 10.1016/j.clinthera.2005.05.003. 10. P.-L. Lin, S.-Z. Fan, C.-H. Huang, H.-H. Huang, M.-C. Tsai, C.-J. Lin and W.-Z. Sun, Analgesic effect of lidocaine patch 5 % in the treatment of acute herpes zoster: a double-blind and vehicle-controlled study, Region. Anesth. Pain M. 33 (2008) 320–325. 11. L. Perioli, V. Ambrogi, S. Giovagnoli, M. Ricci, P. Blasi and C. Rossi

et al. An evidence-based treatment algorithm for anal fissure. Tech Colproctol. 2006; 10:177-180. 14. Perrotti P, Bove A, Carmine A et al. Topical nifedipine with lidocaine ointment vs. active control for treatment of chronic anal fissure: results of a prospective, randomized, double-blind study. Dis Colon Rect. 2002; 45: 1468-75. 15. Perry WB, Dykes SL, Buie WD, et al. Practice Parameters for the Management of Anal Fissures (3rd Revision). Dis Colon Rectum. 2010; 53: 1110-5. 16. Katsinelos P, Kountouras J, Paroutoglou G, et al. Aggressive treatment of acute anal

References 1. Aitkenhead A, Coventry DM. Textboook of Anaesthesia (5th edition), Churchill Livingstone Elsevier, 2007, 315-345. 2. Auroy Y, Benhamou D, Bargues L, et al. Major complication of regional anesthesia in France. Anesthesiology 2002; 97:1274-1280. 3. Sinnott CJ, Cogswell III LP, Johnson A, Strichartz GR. On the mechanism by which epinephrine potentiates lidocaine’s peripheral nerve block. Anesth Analg. 2010;111(3):808-10. 4. Vucković I, Dilberović F, Kulenović A, Divanović KA, Voljevica A, Kapur E. Injection pressure as a marker of intraneural injection

–8. 10. Collard V, Mistraletti G, Taqi A, Asenjo JF, Feldman LS, Fried GM, Carli F. Intraoperative esmolol infusion in the absence of opioids spares postoperative fentanyl in patients undergoing ambulatory laparoscopic cholecystectomy. Anesth Analg 2007; 105(5):1255–62. 11. Fabricio TM, Mariana CR, Jordana AA, Luise AC. Systemic Lidocaine for Perioperative Analgesia: A Literature Review. Short name. J Anest&Inten Care Med 2015; 1 (1): JAICM. MS.ID.55551. 12. Vigneault L, Turgeon AF, Côté D, Lauzier F, Zarychanski R, Moore L, McIntyre LA, Nicole PC, Fergusson DA

References 1. Lazăr A, Szederjesi J, Azamfirei L, et al. Combination of Ropivacaine and Lidocaine for Long Lasting Locoregional Anesthesia. Acta Medica Marisiensis, 2014;60:41-43. 2. Ashish R.S, David M S. Axillary Brachial Plexus Block. Anesthesiol Res Pract, 2011; 2011: 173796. 3. Coventry DM, Barker KF, Thomson M. Comparison of two neurostimulation techniques for axillary brachial plexus blockade. Br J Anaesth, 2001; 86:80-83. 4. Kapral S, Greher M, Huber G, et al. Ultrasonographic guidance improves the success rate of interscalene brachial plexus blockade

of epinephrine and norepinephrine contained in 2% lidocaine on hemodynamics of the carotid and cerebral circulation in older and younger adults, Anesth Pain Control Dent 1992; 40(6): 476-479. 22. Forth W., Henschler D., Rummel W., Allgemeine und speziale Pharmakologie und Toxikologie, Wiessenschaftsverlag, Bibliographisches Institut, Mannheim/Wien/Zrich, 1987. (German).