{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T12:25:51Z","timestamp":1777983951676,"version":"3.51.4"},"reference-count":26,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2024,10,9]],"date-time":"2024-10-09T00:00:00Z","timestamp":1728432000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Scleroderma and Related Disorders"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Systemic sclerosis (SSc) is a chronic autoimmune disease characterized by fibrosis and vascular abnormalities, often leading to the development of digital ulcers (DUs). DUs are painful and debilitating, significantly impacting patients\u2019 quality of life. Effective pain management during debridement is crucial, yet there is no consensus on the optimal approach. This study evaluates the efficacy and safety of digital nerve block (DNB) using lidocaine and mepivacaine for pain control during sharp debridement of DUs in SSc patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This prospective observational study was conducted from September 2023 to May 2024 at the Rheumatology Operating Unit, University of Verona. Patients were randomized to receive either 1 mL of 2% lidocaine or 2% mepivacaine for DNB. Pain levels were assessed using a categorical grading scale during the injection and debridement. The outcomes were pain control and performance of lidocaine versus mepivacaine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The cohort developed 46 ulcers. The pain was abolished in almost all patients. Lidocaine achieved faster anaesthesia (127.92\u2009\u00b1\u200934.32\u2009s) compared with mepivacaine (252.65\u2009\u00b1\u200949.89\u2009s,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Mepivacaine resulted in less pain during injection (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006). No significant difference in pain levels during debridement was observed between the two anaesthetics. Three mild adverse effects (Raynaud\u2019s phenomenon) were reported. All procedures were completed successfully, and 35 ulcers healed with a mean time of 6.1\u2009\u00b1\u20097.77\u2009weeks.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>DNB with mepivacaine provides effective pain control during DU debridement in SSc patients, with lower injection site pain and comparable efficacy to lidocaine. The procedure is safe, well-tolerated and facilitates successful ulcer healing. Further studies with larger cohorts are warranted to confirm these findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23971983241285206","type":"journal-article","created":{"date-parts":[[2024,10,10]],"date-time":"2024-10-10T09:24:10Z","timestamp":1728552250000},"page":"156-162","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and safety of digital nerve block for pain management during sharp debridement of digital ulcers in systemic sclerosis: A prospective observational study"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9335-3371","authenticated-orcid":false,"given":"Riccardo","family":"Bixio","sequence":"first","affiliation":[{"name":"Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3225-2152","authenticated-orcid":false,"given":"Francesca","family":"Mastropaolo","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Nava","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olta","family":"Veliaj","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Fracassi","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ombretta","family":"Viapiana","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maurizio","family":"Rossini","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7254-4686","authenticated-orcid":false,"given":"Luca","family":"Idolazzi","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,10,9]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kew047"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2015-207271"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005792-198011000-00001"},{"issue":"12","key":"e_1_3_3_5_2","first-page":"2423","article-title":"Natural history of ischemic digital ulcers in systemic sclerosis: single-center retrospective longitudinal study","volume":"34","author":"Hachulla E","year":"2007","unstructured":"Hachulla E, Clerson P, Launay D, et al Natural history of ischemic digital ulcers in systemic sclerosis: single-center retrospective longitudinal study. J Rheumatol 2007; 34(12): 2423\u20132430.","journal-title":"J Rheumatol"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.081044"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.130900"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2008.094193"},{"key":"e_1_3_3_9_2","article-title":"Systemic sclerosis: state of the art on clinical practice guidelines","volume":"4","author":"Smith V","year":"2018","unstructured":"Smith V, Scir\u00e8 CA, Talarico R, et al Systemic sclerosis: state of the art on clinical practice guidelines. RMD Open 2018; 4(Suppl. 1): e000782.","journal-title":"RMD Open"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/1346-8138.13275"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.5301\/jsrd.5000268"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1524-475X.11.s2.1.x"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/00152193-200404000-00040"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keq097"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2017.11.020"},{"key":"e_1_3_3_16_2","doi-asserted-by":"crossref","unstructured":"Piemonte G Benelli L Braschi F et al The Local Treatment: methodology Debridement and Wound Bed Preparation: diagnosis and Management. In2019. p. 145\u201359.","DOI":"10.1007\/978-3-319-98477-3_18"},{"key":"e_1_3_3_17_2","unstructured":"Centre (UK) NCG. Debridement. In: The prevention and management of pressure ulcers in primary and secondary care. London: National Institute for Health and Care Excellence (NICE) https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK333114\/ (2014 accessed 12 August 2024)."},{"issue":"4","key":"e_1_3_3_18_2","first-page":"12","article-title":"An international perspective on wound pain and trauma","volume":"49","author":"Moffatt CJ","year":"2003","unstructured":"Moffatt CJ, Franks PJ, Hollinworth H. An international perspective on wound pain and trauma. Ostomy Wound Manage 2003; 49(4): 12\u201314.","journal-title":"Ostomy Wound Manage"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2003.12.010"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.12968\/jowc.2001.10.1.26042"},{"issue":"1","key":"e_1_3_3_21_2","first-page":"5","article-title":"Procedural pain management in the treatment of scleroderma digital ulcers","volume":"33","author":"Giuggioli D","year":"2015","unstructured":"Giuggioli D, Manfredi A, Vacchi C, et al Procedural pain management in the treatment of scleroderma digital ulcers. Clin Exp Rheumatol 2015; 33(1): 5\u201310.","journal-title":"Clin Exp Rheumatol"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-016-3414-7"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.38098"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2665-9913(19)30164-X"},{"key":"e_1_3_3_25_2","volume-title":"Pharmacology and physiology for anesthesia: foundations and clinical application","author":"Hemmings HC","year":"2018","unstructured":"Hemmings HC, Egan TD. Pharmacology and physiology for anesthesia: foundations and clinical application. 2nd ed. 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