Displaying publications 1 - 20 of 52 in total

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  1. Pai ARV
    J Stomatol Oral Maxillofac Surg, 2023 Dec;124(6S2):101581.
    PMID: 37544507 DOI: 10.1016/j.jormas.2023.101581
    Injection of sodium hypochlorite (NaOCl) solution instead of local anaesthetic (LA) solution is an iatrogenic error with serious consequences including medico-legal implications. Such cases have been reported despite recommended precautionary measures. The purpose of this article is to review the literature on such cases and present clinical preventive recommendations. Electronic search was conducted in PubMed/Medline, Google Scholar, Cochrane, Scopus, Lilacs, ScienceDirect, and Crossref databases for articles reporting accidental or mistaken or inadvertent injection of NaOCl instead of LA during dental or endodontic treatment. Articles reporting NaOCl accident due to extrusion or injection of NaOCl beyond root confines were excluded. A total of 11 articles were found and reviewed. Data pertaining to the patient, injected NaOCl, cause, clinical manifestations, management, hospitalization, healing and recovery, and long-term or residual effects were extracted, compiled, and analysed for interpretation and discussion. Injection of NaOCl instead of LA into the soft tissues leads to varying clinical manifestations with unpredictable extent, outcome, and recovery period. The onus lies with the clinician to prevent it. Therefore, a clinician must take all the precautionary measures and confirm the identity of LA and NaOCl solutions before delivering them. The presented clinical recommendations assist clinicians to prevent it, including its potential medico-legal consequences. However, in case of such an unfortunate event, it is crucial to immediately identify and quickly manage it to limit the tissue damage or complications.
    Matched MeSH terms: Anesthetics, Local/therapeutic use
  2. Chua AW, Chua MJ, Harrisberg BP, Kumar CM
    Anaesth Intensive Care, 2024 Mar;52(2):82-90.
    PMID: 38041616 DOI: 10.1177/0310057X231215826
    Two recent cases of central retinal artery occlusion under otherwise uncomplicated sub-Tenon's block that resulted in significant visual loss after cataract surgery prompted us to undertake a literature review of such cases. We identified 97 cases of retinal artery occlusion after ophthalmic surgery under regional anaesthesia that had no immediate signs of block-related complications. These occurred after various intraocular (87%) and extraocular (13%) operations, across a wide range of ages (19-89 years) on patients with (59%) or without (39%) known risk factors. The anaesthetic techniques included 40 retrobulbar blocks, 36 peribulbar blocks, 19 sub-Tenon's blocks, one topical anaesthetic and one unspecified local anaesthetic. Different strengths of lidocaine, bupivacaine, mepivacaine and ropivacaine, either alone or in various combinations, were used. The details of the anaesthetic techniques were often incomplete in the reports, which made comparison and analysis difficult. Only nine cases had their cause (optic nerve sheath injury) identified, while the mechanism of injury was unclear in the remaining patients. Various mechanisms were postulated; however, the cause was likely to be multifactorial due to patient, surgical and anaesthetic risk factors, especially in those with compromised retinal circulation. As there were no definite risk factors identified, no specific recommendations could be made to avoid this devastating outcome. We have provided rationales for some general considerations, which may reduce this risk, and propose anaesthetic options for ophthalmic surgery on the fellow eye if required, based both on our literature review and our personal experience.
    Matched MeSH terms: Anesthetics, Local/adverse effects
  3. Lim HJ, Hasan MS, Chinna K
    Rev Bras Anestesiol, 2016 Jul-Aug;66(4):341-5.
    PMID: 27155777 DOI: 10.1016/j.bjan.2016.04.006
    A high sodium concentration is known to antagonize local anesthetics when infiltrated around neural tissue. Thus, we hypothesized that the onset time for sensory and motor blockade, in supraclavicular brachial plexus block using ropivacaine diluted with dextrose would be shorter than with saline.
    Matched MeSH terms: Anesthetics, Local
  4. Chua AW, Chua MJ, Harrisberg BP, Kumar CM
    Anaesth Intensive Care, 2022 09;50(5):400-402.
    PMID: 36076352 DOI: 10.1177/0310057X211063892
    Matched MeSH terms: Anesthetics, Local
  5. Nagendrababu V, Duncan HF, Whitworth J, Nekoofar MH, Pulikkotil SJ, Veettil SK, et al.
    Int Endod J, 2020 Feb;53(2):200-213.
    PMID: 31491042 DOI: 10.1111/iej.13215
    BACKGROUND: Pain management can be challenging during root canal treatment of teeth with irreversible pulpitis.

    AIM: To identify whether articaine or lidocaine is the most appropriate local anaesthetic solution for teeth with irreversible pulpitis undergoing root canal treatment.

    DATA SOURCE: The protocol of this umbrella review is registered in the PROSPERO database (CRD42019137624). PubMed, EBSCHO host and Scopus databases were searched until June 2019.

    STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS: Systematic reviews published in English comparing the effectiveness of local anaesthesia following administration of articaine or lidocaine in patients undergoing root canal treatment of teeth diagnosed with irreversible pulpitis were included. Two independent reviewers selected the studies and carried out the data extraction and the appraisal of the included reviews. Disagreements were resolved in consultation with a third reviewer.

    STUDY APPRAISAL AND SYNTHESIS METHODS: The quality of the included reviews was appraised by two independent reviewers using the AMSTAR tool (a measurement tool to assess systematic reviews). Each of the 11 AMSTAR items was given a score of 1 if the specific criterion was met, or 0 if the criterion was not met or the information was unclear.

    RESULTS: Five systematic reviews with meta-analyses were included. The AMSTAR score for the reviews ranged from 8 to 11, out of a maximum score of 11, and all reviews were categorized as 'high' quality. Two reviews scored 0 for item 8 in AMSTAR because the scientific quality of the clinical trials included in these reviews was not used in the formulation of the conclusions.

    LIMITATIONS: Systematic reviews published only in the English language were included. Only a small number of studies were available to assess pain intensity during the injection phase, the time until the onset of anaesthesia and the occurrence of adverse events.

    CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Articaine is more effective than lidocaine for local anaesthesia of teeth with irreversible pulpitis undergoing root canal treatment. There is limited evidence that injection of articaine is less painful, has more rapid onset and has fewer adverse events compared with lidocaine.

    Matched MeSH terms: Anesthetics, Local
  6. Loh JW, Taib NA, Cheong YT, Tin TS
    World J Surg, 2020 08;44(8):2656-2666.
    PMID: 32193622 DOI: 10.1007/s00268-020-05458-6
    BACKGROUND: Pre-incision wound infiltration using NSAID is an alternative method to manage post-operative pain in surgery. It is postulated that NSAID delivered peripherally exerts efficient analgesic and anti-inflammatory effect with minimal systemic complication. This study explored the efficacy of using diclofenac for wound infiltration in open thyroidectomy and parathyroidectomy as compared to conventional agent, bupivacaine.

    METHODOLOGY: The study was designed as a double-blind, randomized controlled trial involving 94 patients who underwent open thyroidectomy or parathyroidectomy in Hospital Pulau Pinang, Malaysia, from November 2015 to November 2016. The study compared the efficacy of pre-incision wound infiltration of diclofenac (n = 47) versus bupivacaine (n = 47) in post-operative pain relief. Wound infiltration is given prior to skin incision. Mean pain score at designated time interval within the 24-h post-operative period, time to first analgesia, total analgesic usage and total analgesic cost were assessed.

    RESULTS: Ninety-four patients were recruited with no dropouts. Mean age was 49.3 (SD = 14.2) with majority being female (74.5%). Ethnic distribution recorded 42.6% Chinese, 38.3% Malay, followed by 19.1% Indian. Mean duration of surgery was 123.8 min (SD = 56.5), and mean length of hospital stay was 4.7 days (SD = 1.8). The characteristics of patient in both groups were generally comparable except that there were more cases of total thyroidectomy in the diclofenac group (n = 31) as compared to the bupivacaine group (n = 16). Mean pain score peaked at immediate post-operative period (post-operative 0.5 h) with a score of 3.5 out of 10 and the level decreased steadily over the next 20 h starting from 4 h post-operatively. Pre-incision wound infiltration using diclofenac had better pain control as compared to bupivacaine at all time interval assessed. In the resting state, the mean post-operative pain score difference was statistically significant at 2 h [2.1 (SD = 1.5) vs. 2.8 (SD = 1.8), p = 0.04]. During neck movement, the dynamic pain score difference was statistically significant at post-operative 1 h [2.7 (SD = 1.9) vs. 3.7 (SD = 2.1), p = 0.02]; 2 h [2.7 (SD = 1.6) vs. 3.7 (SD = 2.0), p = 0.01]; 4 h [2.2 (SD = 1.5) vs. 2.9 (SD = 1.7), p = 0.04], 6 h [1.9 (SD = 1.4) vs. 2.5 (SD = 1.6), p = 0.04] and 12 h [1.5 (SD = 1.5) vs. 2.2 (SD = 1.4), p = 0.03]. Mean dose of tramadol used as rescue analgesia in 24 h duration was lower in the diclofenac group as compared to bupivacaine group [13.8 mg (SD = 24.9) vs. 36.2 mg (SD = 45.1), p = 0.01]. The total cost of analgesia used was significantly cheaper in diclofenac group as compared to bupivacaine group [RM 3.47 (SD = 1.51) vs. RM 13.43 (SD = 1.68), p 

    Matched MeSH terms: Anesthetics, Local/administration & dosage*; Anesthetics, Local/economics
  7. Kuppusamy S, Faizal N, Quek KF, Razack AH, Dublin N
    World J Urol, 2010 Dec;28(6):673-6.
    PMID: 20623289 DOI: 10.1007/s00345-010-0578-7
    It is still uncertain as to which form of anaesthesia is the optimum. We conducted a study to identify the best location and optimum volume of anaesthetic agent in order to achieve best pain relief and cooperation from our patients. We also assessed the need for local anaesthetic gel for probe lubrication and if the number of cores during biopsy makes a difference in the pain score.
    Matched MeSH terms: Anesthetics, Local/administration & dosage; Anesthetics, Local/therapeutic use*
  8. Chen CK, Lau FC, Lee WG, Phui VE
    J Clin Anesth, 2016 Sep;33:75-80.
    PMID: 27555137 DOI: 10.1016/j.jclinane.2016.03.007
    STUDY OBJECTIVES: To compare the anesthetic potency and safety of spinal anesthesia with higher dosages of levobupivacaine and bupivacaine in patients for bilateral sequential for total knee arthroplasty (TKA).

    DESIGN: Retrospective cohort study.

    SETTING: Operation theater with postoperative inpatient follow-up.

    PATIENTS: The medical records of 315 patients who underwent sequential bilateral TKA were reviewed.

    INTERVENTIONS: Patients who received intrathecal levobupicavaine 0.5% were compared with patients who received hyperbaric bupivacaine 0.5% with fentanyl 25 μg for spinal anesthesia.

    MEASUREMENTS: The primary outcome was the use of rescue analgesia (systemic opioids, conversion to general anesthesia) during surgery for both groups. Secondary outcomes included adverse effects of local anesthetics (hypotension and bradycardia) during surgery and morbidity related to spinal anesthesia (postoperative nausea, vomiting, and bleeding) during hospital stay.

    MAIN RESULTS: One hundred fifty patients who received intrathecal levobupivacaine 0.5% (group L) were compared with 90 patients given hyperbaric bupivacaine 0.5% with fentanyl 25 μg (group B). The mean volume of levobupivacaine administered was 5.8 mL (range, 5.0-6.0 mL), and that of bupivacaine was 3.8 mL (range, 3.5-4.0 mL). Both groups achieved similar maximal sensory level of block (T6). The time to maximal height of sensory block was significantly shorter in group B than group L, 18.2 ± 4.5 vs 23.9 ± 3.8 minutes (P< .001). The time to motor block of Bromage 3 was also shorter in group B (8.7 ± 4.1 minutes) than group L (16.0 ± 4.5 minutes) (P< .001). Patients in group B required more anesthetic supplement than group L (P< .001). Hypotension and postoperative bleeding were significantly less common in group L than group B.

    CONCLUSION: Levobupivacaine at a higher dosage provided longer duration of spinal anesthesia with better safety profile in sequential bilateral TKA.

    Matched MeSH terms: Anesthetics, Local/administration & dosage*; Anesthetics, Local/adverse effects
  9. Maharani ND, Fuadi A, Halimi RA
    Med J Malaysia, 2023 Nov;78(6):808-814.
    PMID: 38031225
    INTRODUCTION: Craniotomy tumour is brain surgery that can induce a stress response. The stress response can be measured using haemodynamic parameters and plasma cortisol concentration. The stress response that occurs can affect an increase in sympathetic response, such as blood pressure and heart rate, which can lead to an increase in intracranial pressure. Scalp block can reduce the stress response to surgery and post-operative craniotomy tumour pain. The local anaesthetic drug bupivacaine 0.25% is effective in reducing post-operative pain and stress in the form of reducing plasma cortisol levels. The adjuvant addition of clonidine 2 μg/kg or dexamethasone may be beneficial.

    MATERIALS AND METHODS: A randomised control clinical trial was conducted at the Central Surgery Installation and Hasan Sadikin General Hospital Bandung and Dr. Mohammad Husein Hospital Palembang from December 2022 to June 2023. A total of 40 participants were divided into two groups using block randomisation. Group I receives bupivacaine 0.25% and clonidine 2 μg/kg, and group II receives bupivacaine 0.25% and dexamethasone 8 mg. The plasma cortisol levels of the patient will be assessed at (T0, T1 and T2). All the patient were intubated under general anesthaesia and received the drug for scalp block based on the group being randomised. Haemodynamic monitoring was carried out.

    RESULTS: There was a significant difference in administering bupivacaine 0.25% and clonidine 2μg/kg compared to administering bupivacaine 0.25% and dexamethasone 8 mg/kg as analgesia for scalp block in tumour craniotomy patients on cortisol levels at 12 hours post-operatively (T1) (p=0.048) and 24 hours post-surgery (T2) (p=0.027), while post-intubation cortisol levels (T0) found no significant difference (p=0.756). There is a significant difference in Numeric Rating Scale (NRS) at post-intubation (T0) (p=0.003), 12 hours post-operatively (T1) (p=0.002) and 24 hours post-surgery (T2) (p=0.004), There were no postprocedure scalp block side effects in both groups.

    CONCLUSION: The study found that scalp block with 0.25% bupivacaine and 2μg/kg clonidine is more effective in reducing NRS scores and cortisol levels compared bupivacaine 0.25% and dexamethasone 8mg in tumour craniotomy patients.

    Matched MeSH terms: Anesthetics, Local/pharmacology; Anesthetics, Local/therapeutic use
  10. Nagendrababu V, Aly Ahmed HM, Pulikkotil SJ, Veettil SK, Dharmarajan L, Setzer FC
    J Endod, 2019 Oct;45(10):1175-1183.e3.
    PMID: 31551112 DOI: 10.1016/j.joen.2019.06.008
    INTRODUCTION: This systematic review compared the anesthetic efficacy between Gow-Gates (GG), Vazirani-Akinosi (VA), and mental incisive (MI) nerve blocks (NBs) with inferior alveolar nerve blocks (IANBs) in mandibular teeth with irreversible pulpitis using meta-analysis and trial sequential analysis (TSA).

    METHODS: Studies were identified from 4 electronic databases up to June 2019. Randomized clinical trials (RCTs) comparing the anesthetic success rate of GG, VA, and MI NBs with IANBs in mandibular premolars and molars with irreversible pulpitis were included. The quality of selected RCTs was appraised using the revised Cochrane risk of bias tool. Random-effects meta-analyses of risk ratio (RR) and 95% confidence intervals (CIs) were calculated, and random errors were evaluated by TSA. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach.

    RESULTS: Five RCTs were included; 2 of them were classified as low risk of bias. No significant difference was observed in the anesthesia success rate compared between GG and IA NBs (RR = 1.10; 95% CI, 0.82-1.48; I2 = 0%). Similarly, no difference was evident between MINB and IANB (RR = 1.15; 95% CI, 0.97-1.36; I2 = 0%). Overall, the cumulative success rates for the 3 anesthetic techniques were low. TSA showed a lack of firm evidence for the results of the meta-analysis between GG NB and IANB. The Grading of Recommendations, Assessment, Development and Evaluation approach evaluation showed that the evidence was of moderate quality for GG NB and IANB compared with low quality for MI and IA NBs. Because only 1 study was available comparing VA NB and IANB, a meta-analysis was not performed. The adverse effect associated with MI NB was swelling, whereas it was prolonged numbness for IANB.

    CONCLUSIONS: GG NB and IANB showed similar anesthetic efficacy compared with IANB in mandibular teeth with irreversible pulpitis. However, the success rates for each technique indicate the need for supplemental anesthesia. Further well-designed RCTs evaluating different anesthetic techniques with and without supplemental injection are required to provide stronger evidence.

    Matched MeSH terms: Anesthetics, Local
  11. Prasetyono TOH, Adhistana P
    Malays J Med Sci, 2019 Mar;26(2):66-76.
    PMID: 31447610 DOI: 10.21315/mjms2019.26.2.8
    Background: This study aimed to measure the least initial and maintenance forces of syringe and needle combinations to provide a reference for local anesthetic injection.

    Methods: An experimental study was conducted in our Physics Laboratory during September 2015. A series of syringes sized 1 mL, 3 mL, 5 mL, 10 mL and 20 mL were paired with the original needles, 27G, 27G spinal and 30G. Each combination was tested three times using a compression testing Instron 5940 Series to measure initial and maintenance forces. Statistical analysis was performed using One-way ANOVA.

    Results: The lowest initial force was shown by the combination of 1 mL syringe and 27G spinal needle. However, the 1 mL syringe showed no significant difference across the needles [F(3, 8) = 3.545; P < 0.068]. The original and 27G needle showed mean difference 0.28 (95%CI: -0.19, 0.75; P = 0.420). The lowest maintenance force was measured in the combination of 1 mL syringe and its original 26G needle. On the contrary, both the highest initial and maintenance forces were shown by the combination of 10 mL syringe and 30G needle.

    Conclusion: The 1 mL syringe with original 26G needle shows the best combination.

    Matched MeSH terms: Anesthetics, Local
  12. Afaf AA, Liu CY, Joanna OS
    Clin Ter, 2013;164(2):91-5.
    PMID: 23698199 DOI: 10.7417/CT.2013.1524
    Levobupivacaine is the S(-)enantiomer of bupivacaine, a long acting amino-ester local anaesthetic agent. Cocktail mixture of levobupivacaine and fentanyl infusion is commonly given via epidural for post-operative analgesia. The concentration of levobupivacaine for optimal pain relief with least side effects remained uncertain.
    Matched MeSH terms: Anesthetics, Local/administration & dosage*
  13. Chen CK, Phui VE, Saman MA
    Agri, 2012;24(1):42-4.
    PMID: 22399128 DOI: 10.5505/agri.2012.47450
    Meralgia paresthetica is an entrapment mononeuropathy of lateral femoral cutaneous nerve, which results in localized area of paresthesia and numbness on the anterolateral aspect of the thigh. We describe the use of alcohol neurolysis of lateral femoral cutaneous nerve in a 74-year-old female who presented with paresthesia over antero-lateral aspect of her left thigh, which was consistent with meralgia paresthetica. Diagnostic block with local anaesthetic confirmed the diagnosis but only archieved temporary pain relief. Alcohol neurolysis was then offered and patient responded well with no complication. The patient experienced prolonged pain relief at 6-month follow-up, with return of ability to ambulate and perform daily activity. Alcohol neurolysis of lateral femoral cutaneous nerve is safe, effective and able to provide sustained pain relief for recurrent meralgia paresthetica.
    Matched MeSH terms: Anesthetics, Local/administration & dosage
  14. Chik Z, Johnston A, Tucker AT, Burn RT, Perrett D
    Biomed Chromatogr, 2007 Aug;21(8):775-9.
    PMID: 17497758
    A fast and simple capillary zone electrophoresis method was developed and validated for the determination of lidocaine in skin using tape samples. Separation was performed in a 350 mm (265 mm to window) x 50 microm i.d. fused silica capillary using a background electrolyte of phosphoric acid-Tris pH 2.5. The extraction of lidocaine from tape samples was achieved using methanol, which was diluted to 50% with water before injection. Procaine was the internal standard. The migration times for procaine and lidocaine were 2.9 and 3.2 min, respectively. The limit of quantification for lidocaine was 50 microg, with signal to noise ratio greater than 10. The calibration curve was linear from 50 to 1000 microg with r(2) greater than 0.99. The CV for both within- and between-assay imprecision and the percentage of inaccuracy for the quality control samples including lower and upper limits of quantitation were 97%. The accuracy and selectivity of this method allowed the measurement of lidocaine in tape samples obtained from a skin tape stripping study of local anesthetics in healthy subjects.
    Matched MeSH terms: Anesthetics, Local/analysis*
  15. Rica MA, Norlia A, Rohaizak M, Naqiyah I
    Asian J Surg, 2007 Jan;30(1):34-9.
    PMID: 17337369
    OBJECTIVE: The aim of this study was to investigate if preemptive local infiltration (PLA) with ropivacaine could improve postoperative pain and determine its effect on drain output postmastectomy with axillary dissection.
    METHODS: This was a prospective, randomized trial comprising 30 women allocated to two groups: one to receive postoperative wound infiltration (POW) of 20 mL of 0.2% (40 mg) ropivacaine (Naropin) versus PLA with 20 mL of 0.2% ropivacaine (Naropin) diluted with 80 mL of 0.9% saline, total volume 100 mL. A visual analogue scale (0-100 mm) and angle of shoulder abduction were used for evaluation of pain. Postoperatively, all patients received oral ibuprofen 400 mg tds.
    RESULTS: There was no significant difference in postoperative pain for the first 3 days between the two groups. There were wider shoulder abduction angles in the 1st and 3rd postoperative days in the PLA group, but this was not significant. Operative time was significantly shorter in the PLA group than in the POW group (69.34+/-59.37 minutes vs. 109.67+/-26.96 minutes; p=0.02). The axillary drain was removed earlier in the preemptive group, 5.4+/-1.55 days versus 6.8+/-2.04 days in the postoperative group (p=0.04).
    CONCLUSION: We found no difference in postoperative pain between preemptive tumescent ropivacaine infiltration and postoperative ropivacaine wound infiltration.
    Matched MeSH terms: Anesthetics, Local/administration & dosage*
  16. Kiat Ang C, Leung DY, Lo S, French JK, Juergens CP
    Int J Cardiol, 2007 Apr 4;116(3):321-6.
    PMID: 16904773
    There is no consensus with respect to the use of analgesia during femoral arterial sheath removal after percutaneous coronary intervention (PCI). We performed a randomized controlled trial to assess the impact of intravenous sedation and local anesthesia during femoral sheath removal after PCI on patient comfort and the incidence of vasovagal reactions.
    Matched MeSH terms: Anesthetics, Local*
  17. Beh ZY, Hasan MS, Lai HY, Kassim NM, Md Zin SR, Chin KF
    BMC Anesthesiol, 2015;15:105.
    PMID: 26194896 DOI: 10.1186/s12871-015-0090-0
    The brachial plexus at the infraclavicular level runs deeper compared to its course proximally, giving rise to impaired needle visualisation due to the steep angle of needle insertion with the current ultrasound-guided approach. A new posterior parasagittal in-plane ultrasound-guided infraclavicular approach was introduced to improve needle visibility. However no further follow up study was done.
    Matched MeSH terms: Anesthetics, Local/administration & dosage*
  18. Chan YK, Gopinathan R, Rajendram R
    Br J Anaesth, 2000 Sep;85(3):474-6.
    PMID: 11103195
    A healthy parturient under spinal anaesthesia for Caesarean section lost consciousness for an hour, 20 min after the intrathecal injection of 2 ml of 0.5% heavy bupivacaine. The patient was haemodynamically stable before losing consciousness. The differential diagnosis is discussed.
    Matched MeSH terms: Anesthetics, Local/adverse effects*
  19. Tan TW, Chen BC, Tan HL, Chang CM
    JBI Database System Rev Implement Rep, 2017 Apr;15(4):862-872.
    PMID: 28398972 DOI: 10.11124/JBISRIR-2016-003034
    REVIEW QUESTION/OBJECTIVE: This review aims to determine the best available evidence related to the effectiveness of amylmetacresol and 2,4-dichlorobenzyl alcohol throat lozenges in patients with acute sore throat due to upper respiratory tract infection (URTI). The objective is to examine the analgesic properties of amylmetacresol and 2,4-dichlorobenzyl alcohol (AMC/DCBA) throat lozenge comparing with placebo for the relief of pain in patients with acute sore throat due to URTIs.The review question is:More specifically, the objectives are to.
    Matched MeSH terms: Anesthetics, Local/administration & dosage*
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