Het is echter wel schadelijk om overmatig te alcohol te drinken, zeker als u een infectie heeft. Dit komt de infectie eerder verergerd door het gebruik van alcohol antibiotica kopen Doorgaans worden ze voorgeschreven bij bacteriële infecties die om de één of andere reden niet uit zichzelf over gaan; ze doden dan de bacteriën.
Commentary: a prospective comparison between neutralizing the ph of 1 lidocaine with epinephrine (buffering) and preoperative skin cooling in reducing the pain of infiltration of local anesthetic
COMMENTARY: A Prospective Comparison BetweenNeutralizing the pH of 1% Lidocaine with Epinephrine(Buffering) and Pre-Operative Skin Cooling in Reducing thePain of Infiltration of Local Anesthetic
The author has indicated no significant interest with commercial supporters.
Dermatologicsurgeonshavelongbeentryingto sion, iontophoresis, skin warming, or pretreatment
find ways to eliminate patient discomfort
with tape stripping or acetone to enhance absorption
associated with dermatologic procedures. Although
and efficacy6; infusion of anesthesia using a pump to
some dermatologic procedures, such as facial resur-
control infusion rate and pressure7; regional blocks
facing and extensive procedures performed on chil-
using injectable anesthesia or intravenous anesthe-
dren, require intravenous or general anesthesia,1
sia8; tumescence 9,10 with nonneutralized or neu-
dermatologic surgical procedures usually require
tralized solution at room temperature or warmed11;
only local anesthesia, which is frequently adminis-
and the use of skin cooling via application of ice
tered via injection, to eliminate pain at the surgical
cubes, gels, ethyl chloride spray, a chilled sapphire
site. The article by Mohammed Alshahwan, MD,
plate, or a device emitting cold air.12,13
titled “A Prospective Comparison Between Neu-tralizing the pH of 1% Lidocaine with Epinephrine
The most common means to achieve anesthesia in
(Buffering) and Preoperative Skin Cooling in
dermatologic practice is to inject a premixed com-
Reducing the Pain of Infiltration of Local Anes-
bination of lidocaine and epinephrine around the
thetic,” addresses the pain inherent in infusion of
surgical site to attain excellent anesthesia so that the
procedure itself is pain free, but patients oftenexperience some degree of pain with the initial
Methods used to achieve anesthesia include injection
needle stick and infiltration of the anesthetic agent.
of an anesthetic solution of lidocaine, mepivacaine,
The author assessed patient perception of the degree
bupivacaine, etidocaine, procaine, tetracaine, or
of pain experienced using two different techniques
chloroprocaine, all with or without epinephrine,
of anesthetizing—pre-injection application of cold
around the surgical site3; application of topical
to the injection site and use of a buffered anesthetic
anesthesia, such as lidocaine, lidocaine mixed with
solution—to determine which technique provided
prilocaine, lidocaine mixed with prilocaine and
the most patient comfort during infiltration of the
dibucaine, or tetracaine over and around the surgical
anesthetic solution. He determined that buffering
site4,5; application of topical anesthesia with occlu-
the anesthetic solution with sodium bicarbonate
*Advanced Dermatology and Skin Surgery Specialists, PA, Naples, Florida; †College of Medicine, University of SouthFlorida, Tampa, Florida
2012 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc. ISSN: 1076-0512 Dermatol Surg 2012;38:1660–1661 DOI: 10.1111/j.1524-4725.2012.02485.x
provides patients with the most comfortable
4. Friedman PM, Fogelman JP, Nouri K, Levine VJ. Comparative
study of the efficacy of four topical anesthetics. Dermatol Surg
and least painful anesthesia infiltration
experience, although the difference was not
5. Friedman PM, Mafong EA, Friedman ES, Geronemus RG.
Topical anesthetics update: EMLA and beyond. Dermatol Surg2001;22:1019–6.
With nearly 3.9 million dermatologic procedures
6. Sobanko JF, Miller CJ, Alster TS. Topical anesthetics for
dermatologic procedures: a review. Dermatol Surg 2012;38:
being performed annually in the United States,14
determining the least painful and most effective
7. True RH, Elliott RM. Microprocessor-controlled local anesthesia
means of providing anesthesia will have a tre-
versus the conventional syringe techniques in hair transplantation.
mendous effect on a large patient population. This
study suggests that further comparative studies are
8. Blaheta H-J, Vollert B, Zuder D, Rassner G. Intravenous regional
anesthesia (Bier’s Block) for botulinum toxin therapy of palmar
indicated. Perhaps those studies should include
hyperhidrosis is safe and effective. Dermatol Surg 2002;28:
comparisons between aforementioned anesthetizing
techniques as well as nontraditional techniques
9. Klein JA. The tumescent technique. Am J Cosmet Surg
such as manipulation of environmental factors, forexample, sensory-stimulating tactile, auditory, and
10. Coldiron B, Coleman WP III, Cox SE, Jacob Cet al. ASDS
guidelines of care for tumescent liposuction. Dermatol Surg
visual diversions. It is likely that the overall
benefit of diminishing pain associated with
11. Yang C-H, Hsu H-C, Shen S-C, Juan W-Het al. Warm and
procedures will have the effect of decreasing
neutral tumescent anesthetic solutions are essential factors for aless painful injection. Dermatol Surg 2006;32:1119–23.
procedure-associated anxiety and enhancing overall
12. Hughes PSH. Cold air anesthesia in dermasurgery: comparative
study. Dermatol Surg 2006;32:165–6.
13. Henning JS, Firoz BF. The use of a cooling device as an analgesic
before injectable local anesthesia in the pediatric population.
14. Cao LY, Taylor JS, Vidimos A. Patient safety in dermatology: a
1. The AAD/ASDS Liaison Committee. Current issues in
review of the literature. Dermatol Online J 2010;16:3.
dermatology office-based surgery. Dermatol Surg 1999;25:806–15.
2. Al Shahwan MA. A prospective comparison between neutralizing
the ph of 1% lidocaine with epinephrine (buffering) and
Address correspondence and reprint requests to: Cyndi
pre-operative skin cooling in reducing the pain of infiltration of
Yag-Howard, MD, FAAD, Advanced Dermatology and
local anesthetic. Dermatol Surg 2012;38:1654–9.
Skin Surgery Specialists, PA, 1000 Goodlette Road, Suite
3. Koay J, Orengo I. Application of local anesthetic. Dermatol Surg
100, Naples, FL 34102, or e-mail: [email protected]
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