Postoperative Pain of Two Intraosseous Anesthetic Techniques: RESULTS

In: Anesthesia

22 Oct 2009

Forty-one adult subjects, 24 men and 17 women, from age 19 to 43 years with an average age of 26 years, participated. Because we studied a young adult population, the results of this study may not apply to children or the elderly.

The pain ratings for the infiltration injections are pre­sented in Table 1. The majority of needle insertion pain ratings were in the mild category, with no significant differences (P > .05) for females, males, or between the techniques. Anesthetic solution deposition resulted in a 22-27% incidence of moderate pain, with 1 report of severe pain. There were no significant differences (P > .05) for females, males, or between the techniques. Viagra Soft Tabs

Table 1. Percentages and Pain Ratings of the Infiltration Injections

Pain Ratings*
None Mild Moderate

Severe

N (0 mm) (1-54 mm) (55-113 mm)

(>114 mm)

Mean (SD) P-Vatuet
Stabident: infiltration
Needle insertion 41 4 (10%) 33 (80%) 4 (10%)

0 (0%)

34 (±25)
Females 17 1 (6%) 15 (88%) 1 (6%)

0 (0%)

31 (±23)
Males 24 3 (12%) 18 (75%) 3 (12%)

0 (0%)

35 (±26)
X-Tip™: infiltration
Needle insertion 41 3 (7%) 37 (90%) 1 (2%)

0 (0%)

28 (±19)

1.000

Females 17 0 (0%) 17 (100%) 0 (0%)

0 (0%)

27 (±16)

1.000

Males 24 3 (12%) 20 (83%) 1 (5%)

0 (0%)

29 (±22)

.858

Stabident: infiltration
Solution deposition 41 2 (5%) 27 (66%) 11 (27%)

1 (2%)

48 (±32)
Females 17 0 (0%) 12 (71%) 5 (29%)

0 (0%)

48 (±30)
Males 24 2 (8%) 15 (62%) 6 (25%)

1 (4%)

48 (±34)
X-Tip™: infiltration
Solution deposition 41 6 (15%) 26 (63%) 9 (22%)

0 (0%)

39 (±30)

.465

Females 17 1 (6%) 13 (76%) 3 (18%)

0 (0%)

37 (±26)

1.000

Males 24 5 (21%) 13 (54%) 6 (25%)

0 (0%)

40 (±32)

.750

* Heft Parker visual analogue scale (VAS) ratings.
t There were no significant differences (P > .05) between the 2 techniques.

The pain ratings for the intraosseous injections are presented in Table 2. Perforation resulted in a 24-25% incidence of moderate pain, with 1 report of severe pain. There were no significant differences (P > .05) for females, males, or between the techniques. Needle insertion resulted in a 5-10% incidence of moderate pain, with 1 report of severe pain. There were no significant differences (P > .05) for females, males, or between the techniques. Anesthetic solution deposition resulted in a 22-32% incidence of moderate pain, with 1 report of severe pain. There were no significant differences (P > .05) for females, males, or between the techniques. The majority of the pain ratings for guide sleeve removal, for the X-Tip™ system, were in the none to mild categories. There were no significant differences (P > .05) between the actual guide sleeve removal and mock guide sleeve removal. female viagra online

Table 2. Percentages and Pain Ratings of the Intraosseous Injections

Pain Ratings*
None Mild Moderate Severe
N (0 mm) (1-54 mm) (55-113 mm) (>114 mm) Mean (SD) P-Valuet
Stabident
Perforation 41 8 (20%)

22 (54%)

10 (24%) 1 (2%)

39 (±38)

Females 17 2 (12%)

9 (53%)

5 (29%) 1 (6%)

48 (±45)

Males 24 6 (25%)

13 (54%)

5 (21%) 0 (0%)

33 (±32)

X-Tip™
Perforation 41 6 (15%)

25 (61%)

10 (25%) 0 (0%)

39 (±37)

1.000

Females 17 2 (12%)

11 (65%)

4 (24%) 0 (0%)

37 (±37)

1.000

Males 24 4 (17%)

14 (58%)

6 (25%) 0 (0%)

40 (±38)

1.000

Stabident
Needle insertion 41 7 (17%)

29 (71%)

4 (10%) 1 (2%)

28 (±34)

Females 17 5 (29%)

10 (59%)

1 (6%) 1 (6%)

25 (±36)

Males 24 2 (8%)

19 (79%)

3 (12%) 0 (0%)

30 (±32)

X-Tip™
Needle insertion 41 10 (24%)

29 (71%)

2 (5%) 0 (0%)

15 (±21)

.482

Females 17 1 (6%)

16 (94%)

0 (0%) 0 (0%)

18 (±19)

1.000

Males 24 9 (38%)

13 (54%)

2 (8%) 0 (0%)

14 (±22)

.161

Stabident
Solution deposition 41 3 (7%)

24 (58%)

13 (32%) 1 (2%)

50 (±40)

Females 17 1 (6%)

11 (65%)

5 (29%) 0 (0%)

52 (±41)

Males 24 2 (8%)

13 (54%)

8 (33%) 1 (4%)

49 (±40)

X-Tip™
Solution deposition 41 2 (5%)

29 (71%)

9 (22%) 1 (2%)

46 (±35)

1.000

Females 17 1 (6%)

12 (71%)

4 (24%) 0 (0%)

45 (±31)

1.000

Males 24 1 (4%)

17 (71%)

5 (21%) 1 (4%)

46 (±38)

1.000

Stabident (mock removal)
Sleeve removal 41 16 (39%)

24 (58%)

1 (2%) 0 (0%)

9 (±16)

Females 17 8 (47%)

9 (53%)

0 (0%) 0 (0%)

8 (±15)

Males 24 12 (50%)

11(46%)

1 (4%) 0 (0%)

10 (±17)

X-Tip™
Sleeve removal 41 19 (46%)

21 (51%)

1 (2%) 0 (0%)

8 (±13)

1.000

Females 17 7 (41%)

10 (59%)

0 (0%) 0 (0%) 5 (±7)

1.000

Males 24 12 (50%)

11 (46%)

1 (4%) 0 (0%)

10 (±16)

1.000

* Heft Parker visual analogue scale (VAS) ratings.
t There were no significant differences (P > .05) between the 2 techniques.

The postinjection pain ratings for the IO injections are presented in Table 3. At the time subjective anesthesia wore off, postinjection pain ratings were similar for the Stabident and X-Tip™ systems, with no statistical differences for females, males, or between the techniques. The incidence of moderate pain was 7-15%, with no reports of severe pain. At postoperative days 1-3, significantly (P < .05) more males experienced postoperative pain with the X-Tip™ system than with the Stabident system. There was a 25% incidence of moderate to severe postoperative pain on day 1 (with decreasing incidence over the next 2 days), with the X-Tip™ system in males. Cialis Jelly

Table 3. Summary of Pain Ratings for Postinjection Survey With the Intraosseous Injection

Pain Ratings*
None Mild Moderate

Severe

N

(0 mm)

(1-54 mm) (55-113 mm)

(>114 mm)

Mean (SD) P-Valuet
Stabident
Day Ot 41

15 (37%)

23 (56%) 3 (7%)

0 (0%)

19

(±24)
Females 17

7 (41%)

9 (53%) 1 (6%)

0 (0%)

16

(±24)
Males 24

8 (33%)

14 (0%) 2 (8%)

0 (0%)

20

(±24)
X-Tip™
Day Of 41

9 (22%)

26 (63%) 6 (15%)

0 (0%)

31

(±33) 1.000
Females 17

5 (29%)

9 (53%) 3 (18%)

0 (0%)

30

(±36) 1.000
Males 24

4 (17%)

17 (71%) 3 (12%)

0 (0%)

32

(±30) 1.000
Stabident
Day 1 41

14 (34%)

25 (61%) 1 (2%)

1 (2%)

22

(±29)
Females 17

7 (41%)

8 (47%) 1 (6%)

1 (6%)

29

(±39)
Males 24

7 (29%)

17 (71%) 0 (0%)

0 (0%)

17

(±29)
X-Tip™
Day 1 41

7 (17%)

24 (58%) 8 (20%)

2 (5%)

37

(±40) .305
Females 17

5 (29%)

9 (53%) 3 (18%)

0 (0%)

28

(±35) 1.000
Males 24 2 (8%) 15 (62%) 5 (21%)

2 (8%)

44

(±43) .020t
Stabident
Day 2 41

25 (61%)

14 (34%) 1 (2%)

1 (2%)

12

(±26)
Females 17

9 (53%)

7 (41%) 0 (0%)

1 (6%)

19

(±33)
Males 24

16 (67%)

7 (29%) 1 (4%)

0 (0%)

7

(±18)
X-Tip™
Day 2 41

15 (37%)

19 (46%) 7 (17%)

0 (0%)

27

(±37) .185
Females 17

9 (53%)

7 (41%) 1 (6%)

0 (0%)

17

(±28) 1.000
Males 24

6 (25%)

12 (50%) 6 (25%)

0 (0%)

35

(±42) .022*
Stabident
Day 3 41

31 (76%)

9 (22%) 0 (0%)

1 (2%)

6

(±23)
Females 17

13 (76%)

3 (18%) 0 (0%)

1 (6%)

11

(±33)
Males 24

18 (75%)

6 (25%) 0 (0%)

0 (0%)

3

(±11)
X-Tip™
Day 3 41

17 (42%)

19 (46%) 5 (12%)

0 (0%)

19

(±31) .076
Females 17

10 (59%)

6 (35%) 1 (6%)

0 (0%)

11

(±25) 1.000
Males 24

7 (29%)

13 (54%) 4 (17%)

0 (0%)

24

(±35) .009t
* Heft Parker visual analogue scale (VAS) ratings
t Ratings at the time anesthesia wore off.
f There was a statistically significant difference (P < .05) between the 2 techniques.

Postoperative sequelae of the intraosseous injections are presented in Table 4. There was a 5-20% incidence of swelling and a 5-15% incidence of soreness to chewing. There were no significant differences (P > .05) between the 2 techniques. levofloxacin tablets

Table 4. Postoperative Sequelae of the Intraosseous Injections

Swelling Swelling
Technique Without Exudate With Exudate Soreness to Chewing
Stabident 2/41 (5%) 0/41 (0%) 2/41 (5%)
1 male, 1 female 1 male, 1 female
X-Tip™ 8/41 (20%) 1/41 (2%) 6/41 (15%)
7 males, 1 female 1 male 4 males, 2 females
P-value* .070 1.00 .289
* There were no significant differences (P > .05) between the 2 techniques.

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