Local anesthetic agents that have been warmed to body temperature might reduce the burning, stinging pain that patients often feel during injection, according to Canadian researchers.

Their study was published online by the Annals of Emergency Medicine, the journal of the American College of Emergency Physicians, but it holds significant patient care possibilities for any clinician delivering injectable analgesics.

"Because local anesthetic injections are planned procedures (and thus pain is predictable), all efforts should be made to prevent or at least minimize iatrogenic pain," the study's authors write. "Warming of local anesthetic solutions can be performed in almost any clinical setting in which local anesthetics are used by utilizing equipment already available for other purposes," such as fluid or syringe warmers, controlled water baths, incubators or even a clinician's hands.

The analysis of 18 studies and a total of 831 patients found that the shots that were administered warm rather than at room temperature showed a consistent and "clinically meaningful reduction in pain," for reasons that are not entirely clear. However, this effect was evident regardless of the injection's size, its method of delivery (subcutaneous or intradermal) or whether it was buffered.

The simple, cost-free warming process will not negatively impact the stability of the anesthetic, the researchers note, and may make a huge difference in patient satisfaction, especially among pediatric patients.

David Bernard

At the end of the day, it doesn't matter if a healthcare worker wore a long-sleeved coat or short-sleeved scrubs: The bacterial contamination on the garments and the worker's arms end up being about the same, according to researchers at the University of Colorado.

The findings counter the assumption that long-sleeved coats gather more bacteria and may transmit more bacteria to patients. "Our data do not support discarding white coats for uniforms that are changed on a daily basis, or for requiring health care workers to avoid long-sleeved garments," says lead researcher Marisha Burden, MD.

In the study, published online at the Journal of Hospital Medicine, researchers gathered cultures from the wrists, cuffs and pockets of 50 physicians who wore newly laundered long-sleeved lab coats and 50 who wore short-sleeved scrubs.

Three hours into the workday, nearly 50% of the bacteria count for the entire day had already been gathered in both groups, says Dr. Burden. "By the end of an 8-hour work day, we found no data supporting the contention that long-sleeved white coats were more heavily contaminated than short-sleeved uniforms."

Kent Steinriede

The American Academy of Orthopaedic Surgeons is alerting its members to the potential side effects of metal-on-metal hip implants and is working with national medical societies to identify patients at risk for adverse reactions following joint replacement surgeries involving the devices.

The organization is responding to a recent public health comment from the U.S. Food and Drug Administration. The FDA's comment expressed concerns over the erosion of tiny particles from metal ball and cup implants during routine use. These particles can linger in the space around the implant, potentially entering the patient's bloodstream, says the FDA, which could negatively impact the heart, nervous system and thyroid gland.

The comment offers guidance for orthopedic surgeons using metal-on-metal components and for facilities hosting their implantation, and asks caregivers to report related problems to its Medwatch adverse event reporting program.

In an effort to address the FDA's concerns, AAOS has updated the patient education page of its website and assisted in the development of the American Joint Replacement Registry to track data on devices and outcomes.

Daniel Cook

Are loaner instruments on the rise in your facility? If so, you're hardly alone. More and more facilities are borrowing instruments, implants and other devices from vendors, other facilities and other departments. It's also not uncommon for surgeons to arrive at your facility with their own instruments in tow, especially if they're performing a specialty procedure that you host infrequently. In this week's InstaPoll, we want to know from whom you're borrowing instruments. Check back next week for the results.

Today's ORs are showing signs of age and are in need of a remodel, according to the results of last week's InstaPoll. Nearly 6 out of 10 (59%) of our poll respondents reported that their ORs are more than 10 years old. The results, based on 71 responses: