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: vohenosh; October 29th, 2011

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Trick of the Trade: Topical anesthetic cream for cutaneous abscess drainage in children

: vohenosh; May 24th, 2011

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Abscess drainage can be painful and time consuming in the ED. Can this article help?

Trick of the Trade:

Apply a topical anesthetic cream on skin abscesses prior to incision and drainage (I and D).

In this press-released article in American Journal of Emergency Medicine, the authors found that application of a topical 4% lidocaine cream (LMX 4) was associated with spontaneous cutaneous abscess drainage in children.

Study Design:

Retrospective chart review of children presented with skin abscess to an urban ED.

Excluded are pilonidal abscess, paronychia or abscess involving genitalia.

A subset of 300 patients were selected (100 at each of 3 academic sites).

Data collection:

The treating physician decided whether a topical anesthetic should be used.

The sites used a topical lidocaine cream (LMX 4). The cream is applied on the abscess with an occlusive dressing for 30-40 minutes. They looked at abscess treatment and return visits.

Results:

169 children required treatment in the ED.

110 received topical anesthetic (younger, more MRSA, less surrounding cellulitis) and 59 did not.

Mean abscess size was not different between the two groups: 3.4 ± 2.4 with topical anesthetic vs 4.0 ± 2.7 cm without topical anesthetic, p = 0.22).

26/110 (24%) abscesses with topical anesthetic spontaneously drained in the ED vs 0/59 (0%) without a topical anesthetic.

For the the topical anesthetic group, 26/110 (24%) needed procedural sedation. In contrast, 24/59 (41%) abscess without topical anesthetic needed procedural sedation. (OR 0.45)

22% in the topical anesthetic group returned to the ED (2% needed intervention) versus 34% in the no topical anesthetic group (none needed intervention).

How would this change my practice?

I would consider using topical anesthetic cream prior to abscess drainage. Even though it might still need I and D, I might avoid a procedure sedation.

Study limitation

Because this study was a retrospective study, selection bias may have occurred. Specifically, providers may have preferentially applied topical anesthetic or chosen procedural sedation, based on undocumented characteristics. It was nice to see that mean abscess size was not different between the two groups.

Reference

Cassidy-Smith T, Mistry RD, Russo CJ, McCans K, Brown N, Capano-Wehrle LM, Drago LA, Vitale PA, Baumann BM. Topical anesthetic cream is associated with spontaneous cutaneous abscess drainage in children. Amer J Emerg Med. 2010 - in press. PMID: 21129885

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Vibrator use is common, linked to sexual health

: vohenosh; May 17th, 2011

Two Indiana University studies conducted among nationally representative samples of adult American men and women show that vibrator use during sexual interactions is common, with use being reported by approximately 53 percent of women and 45 percent of men ages 18 to 60. Not only is vibrator use common, but the two studies also show that vibrator use is associated with more positive sexual function and being more proactive in caring for one's sexual cheap cialis.

The studies, led by researchers at the Center for Sexual Health Promotion in IU's School of Health, Physical Education and Recreation, are the first to publish data about vibrator use from nationally representative samples of the U.S. population. This lack of data has existed despite a longstanding practice by many physicians and therapists to recommend vibrator use to help treat sexual dysfunctions or to improve sexual enjoyment.

One study surveyed women. The other surveyed men. Both were published this week by the "Journal of Sexual Medicine," a leading peer-reviewed journal in the area of urology and sexual health.

"The study about women's vibrator use affirms what many doctors and therapists have known for decades -- that vibrator use is common, it's linked to positive sexual function such as desire and ease of orgasm, and it's rarely associated with any side effects," said Debby Herbenick, associate director of the Center for Sexual Health Promotion.

Michael Reece, director of the Center for Sexual Health Promotion, said the studies are important for the contributions they make to an understanding of the sexual behaviors and sexual health of adults in today's society.

"The study about male vibrator use is additionally important because it shows that vibrator use is also common among men, something that has not been documented before," Reece said. "Also, both studies help us to further understand the way in which American consumers are turning to the marketplace for products that promote their sexual health, and that has important economic implications."

The studies are the first to document insights into how and why people use vibrators, examine side effects and to explore associations with sexual health behaviors, sexual enjoyment and quality of life measures.

The studies were funded by Church & Dwight Co. Inc., maker of Trojan® brand sexual health products. Here are some of the findings from the studies, which involve survey responses from 2,056 women and 1,047 men ages 18-60.

For women:

More than half of the women (52.5 percent) had used a vibrator with nearly one in four having done so in the past month.

Vibrator users were significantly more likely to have had a gynecological exam during the past year and to have performed genital self-examination during the previous month.
Vibrator use was positively related to several aspects of sexual function (desire, arousal, lubrication, orgasm, pain and overall function) with recent vibrator users scoring themselves higher on most sexual function domains, suggesting more positive sexual function.

Most women (71.5 percent) reported having never experienced any side effects associated with vibrator use. Those side effects that were reported were typically rare and of a short duration.

For men:

The prevalence of men who had incorporated a vibrator into sexual activities during their lives was 44.8 percent, with no statistical differences between the rates of vibrator use between men who identified as heterosexual and those who identified as gay or bisexual.

Heterosexual men most commonly reported having used vibrators during foreplay or intercourse with a female partner, with 91 percent of those who had used a vibrator reporting that they had done so during such activities with women.

Of men who have used vibrators, 10 percent had done so in the past month, 14.2 percent in the past year and 20.5 percent more than one year ago.

Men who reported having used vibrators, particularly those with more recent use, were more likely to report participation in sexual health promoting behaviors, such as testicular self-exam.

Men who had used vibrators recently also scored themselves higher on four of the five domains of sexual function, as measured by the International Index of Erectile Function (erectile function, intercourse satisfaction, orgasmic function and sexual desire).

The study specifically sought to establish nationally representative rates of vibrator use among men and women in the United States. Vibrators are electrical devices that produce pulses of variable amplitude and frequency to enhance sexual arousal in men and women by stimulating the genitals. Marketed widely to women through the Internet, women's magazines, boutiques and in-home sex toy parties, they also are available in drug stores and other mainstream retailers.