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PubMed1992

Reproductive anatomy and physiology of the stallion.

Examination of the stallion's reproductive tract involves assessments of external and internal anatomy. External examinations are performed by visual inspection, palpation, or ultrasonography and include the scrotum, testes, epididymides, penis, and prepuce. Internal examinations may be performed by rectal palpation, transrectal ultrasonography, or endoscopy and include the accessory sex glands, pelvic urethra, and inguinal rings. A fertile stallion must produce, transport, store, and deliver viable spermatozoa to the mare. The physiologic processes involved include neuroendocrine control, spermatogenesis, sperm maturation, semen delivery, and fertilization.

Animals↗
PubMed2000

Paradoxical hypotony after laser in situ keratomileusis.

We present a case of paradoxically low (0 to 2 mm Hg) intraocular pressure (IOP) measured by Goldmann applanation and Tono-Pen tonometry in an eye with corticosteroid-induced high IOP after laser in situ keratomileusis. The patient complained of blurred vision and ocular pain in both eyes. The eyes were firm by palpation, and the IOP measured by Schiotz indentation tonometry was 38 mm Hg. An interface fluid pocket was identified by slitlamp examination, and the corneal surface became steeper. These findings resolved after flap relifting, interface irrigation, and addition of antiglaucoma medications. We postulate that the paradoxically low reading by applanation tonometry was due to fluid accumulation within the flap-bed interface. The applanation tonometry reflected the interface fluid pocket pressure rather than the real high IOP. An exceedingly low IOP should be verified by palpation or by Shiotz indentation tonometry, and interface fluid should be identified.

Astigmatism↗
PubMedDate not supplied

Imaging and localization of pancreatic insulinomas.

For pancreatic insulinomas, the treatment of choice is surgical excision, which when successful is curative. Intraoperative palpation combined with ultrasonography theoretically depict almost all tumors, however the accuracy of palpation is improved by the preoperative localization. All recent advances in imaging have improved the likelihood for curative surgical resection. Our purpose is to demonstrate the characteristics of all modalities, which may be used in the preoperative localization algorithm.

Algorithms↗
PubMed2003

The value of intraoperative ultrasound during hepatic resection compared with improved preoperative magnetic resonance imaging.

BACKGROUND: Patients with colorectal metastases confined to the liver may be cured by resection. Combined bimanual palpation and intraoperative ultrasound (IOUS) augment the detection of colorectal hepatic metastases. The importance of IOUS in the surgical management of hepatic tumors has been demonstrated and should arguably be considered the final diagnostic procedure. OBJECTIVE: To determine the relevance of routine IOUS prior to hepatic resection compared with improved preoperative Magnetic resonance imaging (MRI). PATIENTS AND METHODS: Eighty patients with metastatic colorectal adenocarcinoma underwent hepatic resection between 1998 and 2001. The IOUS results were compared with preoperative MRI, bimanual palpation, and resection histopathology. The preoperative surgical plan was compared with the surgical procedure performed. Data were retrospectively analyzed. RESULTS: IOUS provided additional useful information not available preoperatively for 37 (47%) patients, including the identification of subcentimetre metastatic lesions, characterization of the lesion, and the anatomy of the hepatic vasculature. The preoperative surgical plan was changed secondary to the IOUS findings alone in 14/80 (18%) patients. IOUS did not provide any additional useful information for 43 (53%) patients. A correlation was demonstrated between the preoperative diagnosis, intraoperative findings, and resection histopathology. CONCLUSION: Accurate diagnostic studies facilitate critically decisive actions during planned hepatic resection(s). The current findings suggest that IOUS provide the most useful additional information for hepatic lesions, despite recent improvements in preoperative MRI scanning. Furthermore, routine IOUS should be employed during hepatic resection for colorectal metastases.

Adenocarcinoma↗
PubMed1988

Brachial artery lesions after cardiac catheterisation.

In a prospective study the incidence of brachial artery injury after cardiac catheterisation and the factors involved were examined. The main aim of the study however was to determine whether immediately after the injury it was possible to predict if long-term ischaemic symptoms would occur if conservative treatment was used. Five-hundred and two patients were seen pre- and post-catheterisation. Examination included inspection, palpation, segmental blood pressure measurements before and after exercise, Doppler score evaluation and in selected cases, angiography. Twenty-nine patients (5.8%) had postcatheterisation complaints of pain, pallor, hypoaesthesia or paraesthesia. A postcatheterisation wrist blood pressure index of less than 0.85, was found in 97 patients (19%). This included 22 occlusions confirmed by angiography (4.5%). Cardiac valve disease and previous catheterisations were a risk factor. All brachial artery injuries, that is to say those patients with a postcatheterisation wrist index of less than 0.85, were treated conservatively and reviewed at 6 months. Nineteen of the 72 patients seen at follow-up still had ischaemic symptoms on effort. Postinjury complaints of pain and paraesthesia had no value in predicting whether or not ischaemic symptoms would persist, whilst angiography, wrist pulse palpation, capillary refill time and the wrist pressure index at rest had very little predictive value. The Doppler score, pallor and coldness of the hand all had some value. The best predictor of long-term ischaemic symptoms was the wrist pressure index after exercise. Brachial artery injury occurs frequently after cardiac catheterisation and ischaemic symptoms thereafter are usually mild.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed2001

Compliance with follow-up and prognosis among patients with thin melanomas.

The aim of this study was to report on the compliance with follow-up among patients with thin melanomas. We also examined the prognosis of patients with recurrent disease and whether there were any differences in prognosis associated with the time between the last follow-up examination and the onset of recurrence. A retrospective analysis of the records of 513 consecutive patients (50.3% males, mean age: 52.8+/-16.9 years) with thin melanomas (<1.5 mm Breslow thickness) was carried out. The estimated cumulative proportion of patients who still continued their follow-up examinations 5 years after diagnosis of the primary tumour was 55.3% (95% Confidence Interval (CI): 50.4--60.2%). The mean annual drop-out rate was 11.2%. The drop-out rate was similar for males and females and was not influenced by the patients' age or the tumour thickness. Among 263 patients who continued follow-up, 50.2% (n=132) were not compliant with the time schedule. 20 patients presented with recurrent disease after a median of 35.9 months (25--75% percentiles: 16.7--46.5 months). Six patients who did not have a follow-up examination within 1 year before the onset of recurrence presented with more advanced disease and had a worse prognosis (median survival: 12.5 months, hazard ratio: 3.5, 95% CI: 1.1--17.1, P=0.04), than those patients, who had a recent follow-up examination before the onset of recurrence (n=14, median survival: 22.3+ months). In the majority of recurrent cases with good prognosis, metastatic disease was confined to the regional lymph nodes and the presumptive diagnosis of metastatic disease was either made by palpation or by sonography of the regional lymph nodes. The observed drop-out rate of patients during the first 5 years of follow-up is substantial and does not depend on the patients' age, sex or on the tumour thickness. Although the frequency of recurrences among patients with thin melanomas is low, regular follow-up examinations including physical examination, as well as palpation and sonography of the regional lymph nodes, are essential.

Adult↗
PubMed2002

Lack of preoperative spinous process tenderness does not affect clinical success of percutaneous vertebroplasty.

PURPOSE: Some operators use the lack of point tenderness over compression fractures to exclude patients from undergoing percutaneous vertebroplasty procedures. The purpose of this study was to determine whether this lack of tenderness portends a poorer clinical outcome after vertebroplasty than is achieved in patients with such tenderness. MATERIALS AND METHODS: The authors conducted a retrospective review of consecutive percutaneous vertebroplasty procedures performed at their institution to define two populations. Group 1 included 90 patients with tenderness to palpation over the spinous process of the fractured vertebra, whereas group 2 included 10 patients without such tenderness. This second group presented with back pain and demonstrated tenderness distant from the fracture (n = 5), tenderness lateral to the fracture (n = 4), or no focal tenderness at all (n = 1). All were treated because of edema seen on magnetic resonance (MR) imaging and/or increased activity on bone scan. Clinical outcomes were assessed by quantitative measurements of pre- and postoperative levels of pain (11-point scale) and mobility (five-point scale). RESULTS: Pain improvement of three points or greater occurred in 77 of the 85 patients (91%) in group 1 who complied with follow-up and nine of nine such patients (100%) in group 2, with mean postoperative pain levels of 1.82 and 0.33 points, respectively (P =.14). Forty of 45 patients (89%) in group 1 with impaired preoperative mobility reported improvement postoperatively, as did two of three such patients (67%) in group 2. Mean levels of postoperative impaired mobility for groups 1 and 2 were 0.27 and 0.67 points, respectively (P =.27). CONCLUSION: Pain on palpation over the fractured vertebra is not a necessary requirement in selecting patients who will benefit from percutaneous vertebroplasty. Other factors, such as MR evidence of edema or increased uptake on bone scan, should be weighed considerably in the decision to treat a patient.

Aged↗
PubMedDate not supplied

Relationship of the inguinal ligament to pelvic radiographic landmarks: anatomic correlation and its role in femoral arteriography.

PURPOSE: Because of the known risks of suprainguinal catheterization, an anatomic study of the inguinal ligament was performed in 10 cadavers. MATERIALS AND METHODS: The position of the inguinal ligament as estimated by means of palpation and use of anatomic landmarks was compared with the actual ligament position as determined by means of groin dissection. Infrainguinal contrast material injections were also performed to assess competence of the inguinal ligament against spread of hematomas. RESULTS: The radiographically determined position was an average of 15.2 mm superior to the actual ligament position (range, 3 mm below to 24 mm above). The palpated position of the ligament was an average of 7.8 mm superior to its actual position (range, 7 mm below to 23 mm above). Contrast material injections demonstrated the inability of the inguinal ligament to contain blood or fluid, with formation of retroperitoneal hematomas. CONCLUSION: Puncture of the femoral vessels should be positioned in the midportion of the femoral head, as determined with fluoroscopy for maximum safety during catheterizations.

Angiography↗
PubMedDate not supplied

Use of a pulse oximeter for determination of systolic blood pressure in a helicopter air ambulance.

INTRODUCTION: Traditional methods of determining blood pressure may be unreliable (auscultation or palpation) or unavailable (direct arterial cannulation) in the air medical environment. The authors investigated the combination of a pulse oximeter with a standard sphygmomanometer (blood pressure) cuff as an alternative method. METHOD: The pulse oximeter is applied to a finger on the same upper extremity on which a standard blood pressure cuff had been applied. A baseline blood pressure was obtained by palpation or an automated blood pressure device. One minute later, the systolic blood pressure (SBP) was determined by inflating the blood pressure cuff until the pulsatile display on the pulse oximeter was obliterated. This was taken as the systolic blood pressure. RESULTS: Complete data were obtained on 116 patients, with 223 data pairs. The SBP as obtained by the baseline method was strongly correlated with the SBP obtained by the pulse oximeter display obliteration method (r = 0.90, p < 0.001). CONCLUSION: The obliteration of the wave form display on a pulse oximeter is an accurate, convenient, inexpensive and readily available alternative method of determining SBP.

Air Ambulances↗
PubMed1994

Techniques for prospective detection of venous stenosis.

The vascular access device continues to be a bottleneck in the quest for improved dialysis efficiency and cost reduction. Stenotic lesions occur frequently in synthetic arteriovenous fistulas (AVFs), usually at the venous end, and less often in native AVFs. The reduction in blood flow and other thrombogenic effects of the stenosis, such as local turbulence, eventually lead to loss of the access. Before thrombosis occurs, reduced blood flow through the AVF limits inflow to the dialyzer and predisposes to local recirculation. Recirculation decreases the effective solute clearance of the dialyzer, jeopardizing the adequacy of treatment. Regular evaluation of the access using methods such as routine physical examination, measurement of recirculation, measurement of venous dialysis pressure, and radiographic or ultrasonic imaging when combined with percutaneous or surgical interventions have been shown to prolong access life and eliminate recirculation. Physical examination includes inspection and palpation to detect edema, palpation and auscultation to detect local increases in the intensity of a thrill or bruit, and optional occlusion of the fistula during dialysis to detect recirculation. Recirculation can be measured directly using classical solute dilution techniques or indicator dilution methods provided by a variety of devices now appearing on the market. Recirculation may also be detected indirectly from the results of urea modeling. The difference between modeled and expected urea clearance is a measure of recirculation provided no other error (eg, in blood flow) contributes to the difference. Pressure monitoring has proven useful in many centers. A strict protocol is required to normalize other influences such as blood flow and needle size that may alter pressure independently of access stenosis. Duplex Doppler ultrasonography has been evaluated and found useful in several studies but suffers from relatively high cost and operator dependency. Controlled studies of these screening techniques are needed, especially for those that incur high costs.

Blood Circulation↗
PubMed1995

Temporomandibular disorders after early Class II treatment with bionators and headgears: results from a randomized controlled trial.

Symptoms and signs of temporomandibular disorders were assessed in children enrolled in a randomized controlled trial of early treatment for Class II malocclusion. Children (mean age of 9.8 years) were assigned to a treatment protocol (bionator, n = 60; observation, n = 60; headgear/bite plane, n = 71) using randomized block stratification. Temporomandibular joint (TMJ) sounds, joint capsule pain to palpation, and muscle pain to palpation were scored as binary responses (present/absent in a subject). Determinations were made by blinded, calibrated examiners initially (DC1) and after a Class I molar correction was achieved or 2 years had elapsed (DC3). Univariate relationships among explanatory factors (group assignment, gender, age, time interval between DC1 and DC3, Class II severity, mandibular plane angle, preparatory treatment, whether Class I molar relation was achieved) and binary responses were explored using Chi square tables and ANOVA methods. Logistic regression modeled the relationship between binary responses and the explanatory variables. At DC1, the 3 groups were equivalent in the explanatory variables (P > .05). Subjects with a TMJ sound, joint pain, and/or muscle pain at follow-up were more likely those who had the sign at baseline (P < .01). Early treatment with bionators and headgear/bite planes did not place healthy children without these signs at risk for developing these signs. Only increasing age (for the development of sounds, P < .04) and failure to achieve a Class I molar relation (for development of muscle pain, P < .04) placed sign-free children at greater risk. Subjects with TMJ pain at baseline were 7 times more likely to have pain at follow-up if they had been treated with a headgear/bite plane or observed than if they had been treated with a bionator (P = .007). We conclude that an immediate benefit or risk for children receiving early Class II treatment with bionators and headgear/bite planes with respect to temporomandibular joint function does not exist with the prospect that Class II children with TMJ capsule pain may benefit from bionator therapy.

Activator Appliances↗
PubMed2004

Pain mapping of adhesions.

STUDY OBJECTIVE: To determine the nature and location of adhesions and their relationship to abdominal pain in patients undergoing awake microlaparoscopy. DESIGN: Retrospective analysis (Canadian Task Force classification II-1). SETTING: University teaching hospital. PATIENTS: Thirty women ages 26-49 years with chronic pelvic pain were studied over a 9-month period. INTERVENTION: Patients were kept awake during their laparoscopy to determine the site and degree of pain when the adhesions were palpated. MEASUREMENTS AND MAIN RESULTS: Patients with abdominal pain and a history suggestive that the pain was due to adhesions underwent an awake laparoscopy. Visual analog scores were used to evaluate the pain on palpation of the adhesion as it related to the nature of the adhesion as well as the location of the adhesion. Filmy adhesions that allowed for movement between two structures had the highest association with pain. Fixed adhesions that did not allow movement had the lowest pain scores. Adhesions that had a relationship to the peritoneum had a high association with pain. CONCLUSION: Filmy adhesions between a movable structure, such as an ovary, and the peritoneum had the highest pain scores. Fixed or dense adhesions, no matter where they were located, had the lowest pain scores.

Abdominal Pain↗
PubMed2001

Magnetic resonance elastography: non-invasive mapping of tissue elasticity.

Magnetic resonance elastography (MRE) is a phase-contrast-based MRI imaging technique that can directly visualize and quantitatively measure propagating acoustic strain waves in tissue-like materials subjected to harmonic mechanical excitation. The data acquired allows the calculation of local quantitative values of shear modulus and the generation of images that depict tissue elasticity or stiffness. This is significant because palpation, a physical examination that assesses the stiffness of tissue, can be an effective method of detecting tumors, but is restricted to parts of the body that are accessible to the physician's hand. MRE shows promise as a potential technique for 'palpation by imaging', with possible applications in tumor detection (particularly in breast, liver, kidney and prostate), characterization of disease, and assessment of rehabilitation (particularly in muscle). We describe MRE in the context of other recent techniques for imaging elasticity, discuss the processing algorithms for elasticity reconstruction and the issues and assumptions they involve, and present recent ex vivo and in vivo results.

Acoustics↗
PubMedDate not supplied

The effect of alendronate sodium on spinal fusion: a rabbit model.

BACKGROUND CONTEXT: Bisphosphonates affect bone remodeling and increase bone mass through the inhibition of osteoclasts. Their effect on osteoblasts, and the balance between osteoblastic and osteoclastic activity on bone turnover and healing, is not completely understood. Specifically, the effect of bisphosphonates on spinal fusion has yet to be determined. With the increasing use of bisphosphonates in the elderly population, this effect needs to be delineated. PURPOSE: To evaluate the effect of alendronate sodium after an intertransverse process spinal fusion in a rabbit model. STUDY DESIGN/SETTING: Randomized double-blinded in vivo study of the effect of alendronate sodium in a spinal fusion model. METHODS: Fifty New Zealand white rabbits underwent a posterolateral L5-L6 intertransverse process arthrodesis with autogenous iliac crest bone graft. The rabbits were then randomly divided into two groups. Group I received 3 cc of saline placebo per oral gavage, and Group II received 200 micrograms (approximately 0.05 mg/kg/day) of alendronate sodium dissolved in 3 cc of saline per day for 8 weeks. Upon completion, the rabbits were sacrificed and the lumbar spines harvested, radiographed and graded for motion across the fusion site with manual palpation. Two independent pathologists then prepared and sectioned each left and right fusion mass. Three random x10 fields were examined and graded for both the cephalad and caudad ends of each section (516 fields). Fusion quality was graded using an established histological scoring scale (score 0 to 7 based on fibrous and bone content of the fusion mass). RESULTS: Two rabbits died on the day of operation, and 48 rabbits survived the operation. Five additional rabbits died within the first 2 postoperative weeks. Thus, 43 rabbits (21 in Group I, 22 in Group II) completed the 8-week course of treatment. Grading each side separately, 26 of 42 fusion masses (62%) in Group I and 24 of 44 fusion masses (55%) in Group II had radiographic evidence of fusion (p=.76). With gross palpation, 11 of 21 motion segments (52%) in Group I versus 13 of 22 motion segments (59%) in Group II were determined to have a solid fusion (p=.76). Histologically, Group I had a higher median score (6.0; range, 0 to 7 vs. 1.0; range, 0 to 7; p<.0001) and a higher fusion rate (76% vs. 45%; p=.004) than Group II. CONCLUSIONS: Alendronate sodium appears to inhibit or delay bone fusion in a rabbit model. Presumably, this occurs as a result of uncoupling the balanced osteoclastic and osteoblastic activity inherent to bone healing. These findings suggest that a discontinuance of alendronate sodium postoperatively during the acute fusion period may be warranted.

Administration, Oral↗
PubMed2003

Impact of participation in the Halifax County Preterm Birth Prevention Project.

OBJECTIVES: (1). To determine if participation in the Halifax County Preterm Birth Prevention Project (HCPBPP) reduced the risk of preterm birth; (2). to evaluate the degree to which specific components of the HCPBPP contributed to preterm-birth risk reduction. METHODS: A nested case-control study was conducted among women residing in Halifax County who gave birth at the IWK Grace Health Centre during the final year of the HCPBPP. Cases, defined as women who delivered preterm (<37 weeks), and controls, defined as women who delivered at full term, were recruited to complete interviewer-administered questionnaires. Three controls per case were sequentially selected. The exposures of interest were overall participation and compliance with specific components of the program. Univariate and multivariate statistical methods were employed to evaluate the effect of exposure to the preterm-birth prevention program. RESULTS: Seventy cases and 210 controls were enrolled in the study. Although 82% of subjects participated in some aspect of the HCPBPP, only 8% of high-risk and 6% of low-risk women complied fully with program recommendations. Exposure to project educational strategies or pelvic examinations provided no protective benefit for preterm birth in low-risk or high-risk women. However, compliance with prenatal care providers recommendations to restrict activity or monitor for uterine contractions by self-palpation was associated with a marked reduction in the risk of preterm birth among low-risk women (odds ratio, 0.20; 95% confidence interval, 0.08 0.50). CONCLUSION: Although full participation in the HCPBPP protocol was limited, the findings of this case-control study suggest that activity restriction and uterine activity monitoring by self-palpation may reduce the likelihood of preterm birth in women with no identifiable risk factors for prematurity.

Bed Rest↗
PubMed2001

Preoperative treatment of postmenopausal breast cancer patients with letrozole: A randomized double-blind multicenter study.

BACKGROUND: A randomized, double-blind, multicenter study was conducted to compare the anti-tumor activity of letrozole vs. tamoxifen in postmenopausal women with ER and/or PgR positive primary untreated breast cancer. PATIENTS AND METHODS: Three hundred thirty-seven postmenopausal women with ER and/or PgR positive primary untreated breast cancer were randomly assigned once daily treatment with either letrozole 2.5 mg or tamoxifen 20 mg for four months. At baseline none of the patients were considered to be candidates for breast-conserving surgery (BCS) and 14% of the patients were considered inoperable. The primary endpoint was to compare overall objective response (CR + PR) determined by clinical palpation. Secondary endpoints included overall objective response on ultrasound and mammography and the number of patients who qualified for BCS. RESULTS: Overall objective response rate (clinical palpation) was statistically significantly superior in the letrozole group, 55% compared to tamoxifen, 36% (P < 0.001). Secondary endpoints of ultrasound response, 35% vs. 25% (P = 0.042), mammographic response, 34% vs. 16% (P < 0.001), and BCS, 45% vs. 35% (P = 0.022) between the letrozole and tamoxifen groups, respectively, showed letrozole to be significantly superior. Both treatments were well tolerated. CONCLUSIONS: This study shows that letrozole is more effective than tamoxifen as preoperative therapy in postmenopausal patients with ER and/or PgR positive primary untreated breast cancer and is at least as well tolerated.

Aged↗
PubMed2004

Post-partum reproductive performance of crossbred dairy cattle on smallholder farms in sub-humid coastal Tanzania.

The objective of this study was to monitor the reproductive performance of dairy cows in smallholder farms under the Tanga Dairy Development Project (TDDP). The findings can be used to improve reproductive efficiency. Dates of oestrus, artificial insemination (AI) or service by bull and calving were recorded, and pregnancy was diagnosed by rectal palpation. Daily milk yields, monthly body condition score (BCS) measured on the scale of 1-9, feed availability, calf rearing, and diseases were also recorded. Milk progesterone (P4) concentration was measured by radioimmunoassay (RIA) in 1327 sequential samples collected between day 15 and 120 in 46 post-partum Zebu x Friesian crossbred dairy cows. The mean interval from calving to first P4 rise above 2 nmol/L (cyclicity) was 66.1 +/- 6.8 days. Resumption of ovarian activity postpartum was early (< 60 days) in 45%, and late (> 60 days) in 55% of the cows. In about 45% of the cows the first post-partum ovarian cycles were short (< 14 days) and had low P4 concentrations. Oestrus was missed once or several times in 34.7% of the cows, most likely indicating poor oestrus detection, silent oestrus, or farmers deliberately not taking or reporting their cows for insemination. The mean interval to conception was within 130 days postpartum. Average daily milk production was 5.7 +/- 2.2 L and the mean BCS Was 3.1 +/- 1.3. Both milk production and BCS had no clear influence on the measured reproduction parameters. Clinical uterine involution was complete within 29 +/- 2.6 days of calving in the majority of cows. Progesterone profiles and rectal palpation revealed various causes of infertility, which included anoestrus, silent oestrus, irregular oestrous cycles, and infection of the uterus. The major causes of animal culling, death, slaughter or sales include tick-borne diseases and trypanosomiasis, which have high prevalences in the area, infertility, low productivity and old age. Greater attention should be focused on reproduction and its interaction with nutrition and disease control.

Animals↗
PubMed1999

Topical wound anaesthesia in children--a temporary postoperative pain relief.

BACKGROUND: Administration of local anaesthetics into the surgical wound may modulate pain at the peripheral level. A previous study in adults has shown good analgesic effects of topical lidocaine in wounds after herniorrhaphy. METHODS: Postoperative pain relief after topical administration of 10% lidocaine aerosol in the surgical wound was investigated in a randomised, double-blind study in children undergoing inguinal hernia repair. Forty-four patients aged between 9 months and 11 years were randomised into three groups. One group received active treatment with a lidocaine aerosol 2.5-4.7 mg kg-1, one group received a placebo aerosol and one control group was untreated. Postoperative pain was evaluated by nurse assessment, self-assessment and wound palpation 0, 1, 4 and 12 h after arrival in the recovery room. RESULTS: After 1 h the incidence of pain, as estimated by behavioural assessment and self-assessment, was significantly reduced in the lidocaine group in comparison to the placebo group, but not in comparison to the control group. The reaction on wound palpation was significantly reduced in the lidocaine group compared to both the placebo and control groups. At 0, 4 and 12 h no significant differences between the groups were observed. Plasma lidocaine concentrations were measured in six patients. Maximum individual concentrations were low, ranging from 0.17 to 0.86 microgram ml-1. CONCLUSION: A very short and clinically insignificant pain relief is obtained following the administration of a lidocaine aerosol in the surgical wound. A low pain level in this model may limit the possibility to detect an effect of lidocaine.

Administration, Topical↗