Peribulbar anaesthesia using a combination of lidocaine, bupivocaine and clonidine in vitreoretinal surgery

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Calenda Emile

2002-01-01

Full Text Available Purpose: The efficacy and safety of peribulbar anaesthesia was assessed using a combination of lidocaine, bupivacaine and clonidine during eye surgery. Methods: We prospectively studied 100 vitreo-retinal surgical procedures performed by several surgeons. The exclusion criteria included age below 30 years and, axial length of the orbit above 28 mm. Peribulbar was performed using Hamilton′s technique. A mixed anaesthetic solution of equal quantity of lidocaine 2% and bupivacaine 0.5% with clonidine (1mg/kg was injected. Patients received a mean volume of 14.5 ml ± 3.5 of the mixture. Akinesia and analgesia were assessed 15 minutes later by the surgeon. Whenever required, supplemental lidocaine 2% (3 ml by sub- Tenon infiltration was added by the surgeon. Supplemental injections were given only to patients who failed to develop analgesia. Results: The mean age of patients (male 52%, female 48% was 66 years ± 10 (mean ± SD, range 44-90. The 100 surgical procedures were made up of vitrectomy ± gas ± silicone oil (22/100, vitrectomy and lensectomy (6/100, vitrectomy and epiretinal membrane ± laser coagulation ± gas ± silicone oil (35/100, scleral buckling or encircling ± gas (36/100, and cryosurgery ± gas (1/100. Analgesia was adequate throughout surgery without any supplementation in 85% of cases and with a sub-Tenon infiltration in 99%. Akinesia was complete in 84%, mild in 12% and absent in 4% of cases. The sub-Tenon injection was performed in 15% of cases. Three patients (3% were agitated during surgery. No neurologic or cardiac complication was seen. In one patient, the systolic blood pressure decreased from 170 to 110 mmHg, 30 minutes after the institution of the peribulbar block. Conclusion: Our results show that peribulbar anaesthesia in the proposed mixture offers excellent analgesia in 85% of patients, and in 99% of the patients when supplemented by a subtenon injection. The current mixture of lidocaine, bupivacaine and

Analgesia for pain control during extracorporeal shock wave lithotripsy: Current status

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Narmada P Gupta

2008-01-01

Conclusion: The ideal analgesic, offering optimal pain control, minimal side effects, and cost-effectiveness is still elusive. Opioids administered using various techniques, provide effective analgesia, but require active monitoring of patient for potential adverse effects. Combination therapy (oral NSAID and occlusive dressing of EMLA, DMSO with lidocaine offers an effective alternative mode for achieving analgesia with minimal morbidity. This therapy avoids the need for general anesthesia, injectable analgesics, and opioids along with their side effects.

ROPIVACAINE VERSUS LIDOCAINE FOR EPISIOTOMY-A RANDOMISED DOUBLE BLIND STUDY

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Pushpalatha Nagaraj

2017-04-01

Full Text Available BACKGROUND Episiotomy is a most common surgical procedure for parturients during vaginal delivery. The problem encountered with episiotomy is pain, which is maximum during first 24 hours and may be severe enough to disturb the puerperium. This study aims to compare analgesic efficacy of analgesics, ropivacaine and lidocaine for perineal infiltration during episiotomy. MATERIALS AND METHODS We conducted a randomised double blind study for a period one year from August 2013 in a tertiary hospital. 100 parturients were included. RESULTS Ropivacaine 0.75% compared to lidocaine 2% did not show any statistical significant changes at suturing and after 4 hours; however, there were great statistically significant changes in VAS scores after 8 hours, 12 hours, 24 hours of episiotomy suturing. Ropivacaine group did not require systemic analgesics for 24 hours, but lidocaine group required systemic analgesics after 4 hours of suturing. Both groups (Ropivacaine and Lidocaine did not have any adverse effects. CONCLUSION Ropivacaine can be used safely for episiotomy wound infiltration thereby reducing the need for systemic analgesia.

Adding magnesium to lidocaine for intravenous regional anesthesia

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Parviz Kashefi

2008-06-01

Full Text Available

• BACKGROUND: Magnesium (Mg has been used as an adjuvant medication in postoperative analgesia. We planed this study to assess the effects of Mg, when added to lidocaine in intravenous regional anesthesia (IVRA on the tourniquet pain.
• METHODS: Forty patients undertaking hand surgery were randomly allocated into 2 groups to be given IVRA. They received 20 ml lidocaine 1% diluted with 20 ml saline to a total of 40 ml in the group L (n = 20 or 7.5 ml magnesium sulfate 20% plus 20 ml lidocaine 1% diluted with 12.5 ml saline to a total of 40 ml in the group M (n = 20. Sensory and motor block onset and recovery times, anesthesia and operation qualities were recorded. Before and after the tourniquet use at 5, 10, 15, 20, 30, 40, and 50 minutes, hemodynamic variables, tourniquet pain, and analgesic use were noted. Subsequent to the tourniquet deflation, at 6, 12, and 24 hours, hemodynamic variables, pain, time to first analgesic requirement, analgesic use and side effects were recorded.
• RESULTS: Shortened sensory and motor block onset times were established in group M (P < 0.05. Visual analog scale (VAS scores were less in group M at 20, 30, 40, and 50 minutes after tourniquet inflation (P < 0.05. Intraoperative, analgesic requirement was less in group M (P < 0.05. Anesthesia excellence, as determined by the anesthesiologist and surgeon, was significantly better in group M (P < 0.05. Time to the first analgesic requirement in group M was 53.75 ± 6.94 minutes and in group L was 40.76 ± 14.55 minutes (P < 0.05. Postoperative VAS scores were higher at 6, 12, and 24 hours in group L (P < 0.05.
• CONCLUSIONS: Adding Mg to lidocaine for IVRA enhanced the quality of anesthesia and analgesia without causing side effects.
• KEYWORDS: Magnesium sulfate, intravenous regional anesthesia, postoperative pain.

Intravenous lidocaine for postmastectomy pain treatment: randomized, blind, placebo controlled clinical trial

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Tania Cursino de Menezes Couceiro

2015-06-01

Full Text Available BACKGROUND AND OBJECTIVE: Postoperative pain treatment in mastectomy remains a major challenge despite the multimodal approach. The aim of this study was to investigate the analgesic effect of intravenous lidocaine in patients undergoing mastectomy, as well as the postoperative consumption of opioids. METHODS: After approval by the Human Research Ethics Committee of the Instituto de Medicina Integral Prof. Fernando Figueira in Recife, Pernambuco, a randomized, blind, controlled trial was conducted with intravenous lidocaine at a dose of 3 mg/kg infused over 1 h in 45 women undergoing mastectomy under general anesthesia. One patient from placebo group was. RESULTS: Groups were similar in age, body mass index, type of surgery, and postoperative need for opioids. Two of 22 patients in lidocaine group and three of 22 patients in placebo group requested opioid (p = 0.50. Pain on awakening was identified in 4/22 of lidocaine group and 5/22 of placebo group (p = 0.50; in the post-anesthetic recovery room in 14/22 and 12/22 (p = 0.37 of lidocaine and placebo groups, respectively. Pain evaluation 24 h after surgery showed that 2/22 and 3/22 patients (p = 0.50 of lidocaine and placebo groups, respectively, complained of pain. CONCLUSION: Intravenous lidocaine at a dose of 3 mg/kg administered over a period of an hour during mastectomy did not promote additional analgesia compared to placebo in the first 24 h, and has not decreased opioid consumption. However, a beneficial effect of intravenous lidocaine in selected and/or other therapeutic regimens patients cannot be ruled out.

Predictive Value of Lidocaine infusion for treatment success of Oxcarbazepine long-term therapy in patients with Neuropathic Pain Syndrome

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Maurer, Konrad; Schipper, Sivan; Gantenbein, Andreas; Alon, Eli; Sandor, Peter S

2013-01-01

INTRODUCTION: Pharmacotherapy in patients with neuropathic pain syndromes (NPS) can be associated with long periods of trial and error before reaching satisfactory analgesia. The aim of this study was to investigate whether a short intravenous (i.v.) infusion of lidocaine may have a predictive value for the efficacy of oxcarbazepine. METHODS: In total, 16 consecutive patients with NPS were studied in a prospective, uncontrolled, open-label study design. Each patient received i.v. lidocaine...

Analgesic efficacy of equimolar 50% nitrous oxide/oxygen gas premix (Kalinox®) as compared with a 5% eutectic mixture of lidocaine/prilocaine (EMLA®) in chronic leg ulcer debridement.

Science.gov (United States)

Traber, Juerg; Held, Ulrike; Signer, Maria; Huebner, Tobias; Arndt, Stefan; Neff, Thomas A

2017-08-01

Chronic foot and leg ulcers are a common health problem worldwide. A mainstay of chronic ulcer therapy is sharp mechanical wound debridement requiring potent analgesia. In this prospective, controlled, single-centre, crossover design study, patients were assigned to either the administration of topical analgesia with 5% lidocaine/prilocaine cream or the inhalation of an analgesic 50% N 2 O/O 2 gas premix. Primary outcome parameter was level of pain at maximum wound depth during debridement as measured by a visual analogue scale. Secondary outcomes included level of pain after debridement, overall duration of treatment session, duration and completeness of debridement, and the patient's subjective perception of analgesic quality during debridement. Pain level increased from 0·60/0·94 (first/second debridement; baseline) to 1·76/2·50 (debridement) with 5% lidocaine/prilocaine and from 1·00/1·35 (baseline) to 3·95/3·29 (debridement) with 50% N 2 O/O 2 gas premix. Patient satisfaction was 90·48%/94·44% (first/second debridement) with topical 5% lidocaine/prilocaine analgesia and 90·48%/76·47% with the inhalation of 50% N 2 O/O 2 gas premix. Debridement was completed in a significantly higher percentage of 85·71%/88·89% (first/second debridement) with 5% lidocaine/prilocaine than with 50% N 2 O/O 2 gas premix (42·86%/58·82%) (odds ratio 6·7; P = 0·001). This study provides sound evidence that analgesia with topically administered 5% lidocaine/prilocaine cream is superior to the use of inhaled 50% N 2 O/O 2 gas premix in chronic leg ulcer debridement. © 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Comparative Study of Intrathecal Dexamethasone with Epinephrine as Adjuvants to Lidocaine in Cesarean Section

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Fereshteh Naziri

2013-09-01

Full Text Available Background: Different additives have been used with local anesthetics to provide prolonged duration of sensory block in spinal anesthesia. The aim of present study was to evaluate the onset and duration of sensory block of intrathecal dexamethasone and epinephrine as adjuvants to lidocaine in patients who were candidate for cesarean section. Materials and Methods: This double-blind clinical trial research was conducted on 90 pregnant women candidate for cesarean section under spinal anesthesia. Patients were randomly allocated to receive intrathecally either 75 mg hyperbaric lidocaine plus 100 μg epinephrine or 75 mg hyperbaric lidocaine plus 4 mg dexamethasone or 75 mg hyperbaric lidocaine. The onset and duration of sensory block as well as postoperative analgesia were assessed. Results: The time to reach the peak sensory block in lidocaine group was shorter than that of other two groups (p<0.001. Duration of sensory block in the control group, dexamethasone group, and epinephrine group were 64.16±7.99 min, 74.79±12.78 min, and 99.30±10.93 min, respectively (p<0.001. Conclusion: The present research shows that intrathecal dexamethasone and intrathecal epinephrine as adjuvant to lidocaine increases sensory block duration in the women candidate for cesarean section.

Research on lidocaine in the application of induced abortion

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Hai-Tao Tong

2015-01-01

Objective:To observe the effect of lidocaine in the application of induced abortion.Methods:A total of 120 pregnant women with 6-10 week gestational age and ASA I-II level who were volunteered to receive induced abortions from January, 2010 to January, 2013 were included in the study, among which 60 cases were given lidocaine during the operation and served as the observation group, while 60 cases were not given lidocaine during the operation and served as the control group. The heart rate, blood pressure, the change of oxygen saturation, pain, and the occurrence of abortion syndrome before and after operation between the two groups were compared.Results:The fineness rates of analgesia and anesthesia evaluation in the observation group were significantly higher than those in the control group (P0.05). The postoperative heart rate and blood pressure in the control group were significantly lower than those before operation and in the observation group with a slow recovery (P0.05). The occurrence rate of abortion syndrome in the observation group was significantly lower than that in the control group (P<0.05). Conclusions:Application of lidocaine in the induced abortion can relieve the pain and reduce the occurrence rate of abortion syndrome with a simple and safe operation; therefore, it deserves to be widely recommended.

Effect of intraperitoneal and incisional port site lidocaine on pain relief after gynecological laparoscopic surgery: A randomized controlled study

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Nahla W. Shady

2018-03-01

Conclusions: This study clearly depicts that incisional and intraperitoneal infiltration of lidocaine is an easy, safe, inexpensive, and noninvasive method that provides good analgesia during the early post-operative period and also provides early recovery from laparoscopic surgery.

Anesthetic effects of different volumes of lidocaine for spermatic cord block in cattle.

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Neves, Ana C; Santos Júnior, Juracy Cb; Marucio, Rodrigo L; Midon, Monica; Luna, Stelio Pl

2017-03-01

To evaluate three volumes of lidocaine for spermatic cord block to perform castration in cattle. Randomized blinded clinical study. Thirty mixed-breed Nellore cattle, aged 28-40 months and weighing 395±21 (352-452) kg [mean±standard deviation (range)]. Cattle were restrained in a chute and allowed to stand without sedation. Three milliliters of 2% lidocaine without epinephrine were infiltrated subcutaneously at each site of scrotal incision in all animals. The animals were allocated to three groups of 10 animals each. Lidocaine 2% was injected into each spermatic cord using a volume of 2, 3 or 4 mL in groups A, B, or C, respectively. The total volumes of lidocaine used were 10, 12, and 14 mL in groups A, B, and C, respectively. The duration of surgery and the retraction of the testicle (scored as positive or negative according to retraction of the testicle) during the procedure were recorded. The data were statistically analyzed by one-way anova followed by Tukey's and chi-square tests. Differences were considered significant when pcastration and following incisional infiltration of lidocaine, in adult cattle weighing about 400 kg. Copyright © 2017 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.

Recovery of storage and emptying functions of the urinary bladder after spinal anesthesia with lidocaine and with bupivacaine in men.

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Kamphuis, E T; Ionescu, T I; Kuipers, P W; de Gier, J; van Venrooij, G E; Boon, T A

1998-02-01

The aim of this study was to evaluate and compare the effects of spinal anesthesia with lidocaine and with bupivacaine on urinary bladder function in healthy men who were scheduled for minor orthopaedic surgical procedures. Twenty men were randomly allocated to receive either bupivacaine or lidocaine. Before spinal anesthesia, filling cystometry was performed with the patient in the supine position and a pressure flow study was done with the patient in the standing position. After operation, cystometric measurements were continued until the patient could void urine spontaneously. The levels of analgesia and of motor blockade were recorded. The urge to void disappeared immediately after injection of the local anesthetics. There was no difference in the duration of lower extremity motor blockade between bupivacaine and lidocaine. Detrusor blockade lasted significantly longer in the bupivacaine group (means +/- SD, 460 +/- 60 min) than in the lidocaine group (235 +/- 30 min). Total fluid intake and urine volume accumulated during the detrusor blockade were significantly higher in the bupivacaine group than in the lidocaine group. In the bupivacaine group, the total volume of accumulated urine (875 +/- 385 ml) was also significantly higher than cystometric bladder capacity (505 +/- 120 ml) with the risk of over distension of the bladder. Spontaneous voiding of urine did not occur until segmental sensory analgesia had regressed to the third sacral segment. Spinal anesthesia with lidocaine and with bupivacaine causes a clinically significant disturbance of bladder function due to interruption of the micturition reflex. The urge to void disappears quickly and bladder function remains impaired until the block has regressed to the third sacral segment in all patients. With long-acting local anesthetics, the volume of accumulated urine may exceed the cystometric bladder capacity. With respect to recovery of urinary bladder function, the use of short-acting local anesthetics

Does ultrasound-guided lidocaine injection improve local anaesthesia before femoral artery catheterization?

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Spiliopoulos, S.; Katsanos, K.; Diamantopoulos, A.; Karnabatidis, D.; Siablis, D.

2011-01-01

Aim: To present the results of a prospective, randomized, single-centre study investigating local anaesthesia before percutaneous common femoral artery (CFA) puncture and catheterization with the use of ultrasound-guided injection of lidocaine versus standard infiltration by manual palpation. Materials and methods: Patients scheduled to undergo diagnostic or therapeutic transfemoral catheter-based procedures gave informed consent and were randomized in two groups. In the first arm local anaesthesia with lidocaine hydrochloride 1% was performed under ultrasound guidance (group U/S), while in the second arm the standard method of manual artery palpation was applied (group M). In both groups, subsequent CFA catheterization was achieved under ultrasound guidance. The primary study endpoint was peri-procedural pain level evaluated with a visual-analogue scale (VAS score 0-10). Results: Between January 2009 and 2010, 200 patients (161 men, mean age 63 ± 12 years) were equally assigned to each group without any significant differences in baseline demographics. Patients in group U/S experienced significantly less pain during CFA catheterization in comparison with group M with a difference of three points in mean VAS score reported (1.6 ± 1.6 versus 4.6 ± 1.9, p < 0.0001). In addition, significantly less volume of lidocaine was used in group U/S compared to group M (16 ± 2.7 versus 19 ± 0.8 ml, p < 0.001).Total vascular access time was similar in both groups (4.4 ± 1.3 versus 4.5 ± 1.3 min). Overall complications included two small groin haematomas in each group. Conclusion: Ultrasound-guided local anaesthesia of the CFA prior to percutaneous transcatheter procedures is safe and achieves superior levels of analgesia with minimal patient pain and discomfort compared to the standard method of manual palpation.

Does ultrasound-guided lidocaine injection improve local anaesthesia before femoral artery catheterization?

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Spiliopoulos, S., E-mail: stavspiliop@upatras.g [Department of Diagnostic and Interventional Radiology, Patras University Hospital, School of Medicine, Patras (Greece); Katsanos, K.; Diamantopoulos, A.; Karnabatidis, D.; Siablis, D. [Department of Diagnostic and Interventional Radiology, Patras University Hospital, School of Medicine, Patras (Greece)

2011-05-15

Aim: To present the results of a prospective, randomized, single-centre study investigating local anaesthesia before percutaneous common femoral artery (CFA) puncture and catheterization with the use of ultrasound-guided injection of lidocaine versus standard infiltration by manual palpation. Materials and methods: Patients scheduled to undergo diagnostic or therapeutic transfemoral catheter-based procedures gave informed consent and were randomized in two groups. In the first arm local anaesthesia with lidocaine hydrochloride 1% was performed under ultrasound guidance (group U/S), while in the second arm the standard method of manual artery palpation was applied (group M). In both groups, subsequent CFA catheterization was achieved under ultrasound guidance. The primary study endpoint was peri-procedural pain level evaluated with a visual-analogue scale (VAS score 0-10). Results: Between January 2009 and 2010, 200 patients (161 men, mean age 63 {+-} 12 years) were equally assigned to each group without any significant differences in baseline demographics. Patients in group U/S experienced significantly less pain during CFA catheterization in comparison with group M with a difference of three points in mean VAS score reported (1.6 {+-} 1.6 versus 4.6 {+-} 1.9, p < 0.0001). In addition, significantly less volume of lidocaine was used in group U/S compared to group M (16 {+-} 2.7 versus 19 {+-} 0.8 ml, p < 0.001).Total vascular access time was similar in both groups (4.4 {+-} 1.3 versus 4.5 {+-} 1.3 min). Overall complications included two small groin haematomas in each group. Conclusion: Ultrasound-guided local anaesthesia of the CFA prior to percutaneous transcatheter procedures is safe and achieves superior levels of analgesia with minimal patient pain and discomfort compared to the standard method of manual palpation.

Efficacy and safety of intravenous lidocaine for postoperative analgesia and recovery after surgery

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Weibel, S; Jokinen, J; Pace, N L

2016-01-01

BACKGROUND: Improvement of postoperative pain and other perioperative outcomes remain a significant challenge and a matter of debate among perioperative clinicians. This systematic review aims to evaluate the effects of perioperative i.v. lidocaine infusion on postoperative pain and recovery in p...

Analgesic and physiological effect of electroacupuncture combined with epidural lidocaine in goats.

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Cui, Lu-Ying; Guo, Ni-Ni; Li, Yu-Lin; Li, Meng; Ding, Ming-Xing

2017-07-01

To investigate physiological and antinociceptive effects of electroacupuncture (EA) with lidocaine epidural nerve block in goats. Prospective experimental trial. Forty-eight hybrid male goats weighing 27 ± 2 kg. The goats were randomly assigned to six groups: L2.2, epidural lidocaine (2.2 mg kg -1 ); L4.4, epidural lidocaine (4.4 mg kg -1 ); EA; EA-L1.1, EA with epidural lidocaine (1.1 mg kg -1 ); EA-L2.2, EA with epidural lidocaine (2.2 mg kg -1 ); and EA-L4.4, EA with epidural lidocaine (4.4 mg kg -1 ). EA was administered for 120 minutes. Epidural lidocaine was administered 25 minutes after EA started. Nociceptive thresholds of flank and thigh regions, abdominal muscle tone, mean arterial pressure (MAP), heart rate (HR), respiratory frequency (f R ) and rectal temperature were recorded at 30, 60, 90, 120, 150 and 180 minutes. Lidocaine dose-dependently increased nociceptive thresholds. There were no differences in nociceptive thresholds between L4.4 and EA from 30 to 120 minutes. The threshold in EA-L2.2 was lower than in EA-L4.4 from 30 to 120 minutes, but higher than in EA-L1.1 from 30 to 150 minutes or in L4.4 from 30 to 180 minutes. The abdominal muscle tone in EA-L2.2 was higher at 30 minutes, but lower at 90 and 120 minutes than at 0 minutes. There were no differences in muscle tone between L4.4 and L2.2 or EA-L4.4, and between any two of the three EA-lidocaine groups from 0 to 180 minutes. The f R and HR decreased in L4.4 at 60 and 90 minutes compared with 0 minutes. No differences in f R , HR, MAP and temperature among the groups occurred from 30 to 180 minutes. EA combined with 2.2 mg kg -1 epidural lidocaine provides better antinociceptive effect than 4.4 mg kg -1 epidural lidocaine alone in goats. EA provided antinociception and allowed a decrease in epidural lidocaine dose. Copyright © 2017 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights

Quality of analgesia after lower third molar surgery: A randomised, double-blind study of levobupivacaine, bupivacaine and lidocaine with epinephrine

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Brajković Denis

2015-01-01

Full Text Available Background/Aim. Surgical extraction of lower third molars is followed by mild or severe postoperative pain which peaks at maximal intensity in the first 12 hours and has a significant impact on a patient’s postoperative quality of life. The use of long-acting local anaesthetics is a promising strategy to improve postoperative analgesia. The aim of the present study was to investigate analgesic parameters and patient satisfaction after using 0.5% levobupivacaine (Lbup, 0.5% bupivacaine (Bup and 2% lidocaine with epinephrine 1:80,000 (Lid + Epi for an inferior alveolar nerve block following lower third molar surgery. Methods. A total of 102 patients (ASA I were divided into three groups, each of which received either 3 mL of Lbup, Bup or Lid + Epi. The intensity of postoperative analgesia was measured using a verbal rating scale (VRS. The total amounts of rescue analgesics were recorded on the first and during seven postoperative days. Patients satisfaction was noted using a modified verbal scales. Results. A significantly higher level of postoperative pain was recorded in Lid + Epi group compared to Bup and Lbup groups. No significant differences were seen between Bup and Lbup, but a significant reduction in the need for rescue analgesics was seen postoperatively in both Lbup and Bup (50% in comparison with Lid + Epi (80% in the first 24 hours. The same significant trend in rescue analgesic consumption was recorded for seven postoperative days. Patients’ overall satisfaction was significantly lower for Lid + Epi (10% than for Lbup (56% and Bup (52%. Conclusion. The use of a new and long-acting local anaesthetic 0.5% levobupivacaine is clinically relevant and effective for an inferior alveolar nerve block and postoperative pain control after third molar surgery. In our study Lbup and Bup controled postoperative pain more efficiently after lower third molar surgery compared to Lid + Epi. [Projekat Ministarstva nauke Republike Srbije, br. 175021

Deuteration of lidocaine

International Nuclear Information System (INIS)

Haedener, A.

1988-01-01

Stepwise deuteration of the acidic methylene group of lidocaine on a large scale using a moderate excess of 2 H 2 O in triethylamine/pyridine at 200 0 is described. The efficient and economical preparation of bideuterated lidocaine facilitates the use of this compound as an excellent internal standard in lidocaine determination or as a tracer in lidocaine pharmacokinetics. (author)

Deuteration of lidocaine

Energy Technology Data Exchange (ETDEWEB)

Haedener, A.

1988-01-01

Stepwise deuteration of the acidic methylene group of lidocaine on a large scale using a moderate excess of /sup 2/H/sub 2/O in triethylaminepyridine at 200/sup 0/ is described. The efficient and economical preparation of bideuterated lidocaine facilitates the use of this compound as an excellent internal standard in lidocaine determination or as a tracer in lidocaine pharmacokinetics.

Predictive value of lidocaine for treatment success of oxcarbazepine in patients with neuropathic pain syndrome.

Science.gov (United States)

Schipper, Sivan; Gantenbein, Andreas R; Maurer, Konrad; Alon, Eli; Sándor, Peter S

2013-06-01

Pharmacotherapy in patients with neuropathic pain syndromes (NPS) can be associated with long periods of trial and error before reaching satisfactory analgesia. The aim of this study was to investigate whether a short intravenous (i.v.) infusion of lidocaine may have a predictive value for the efficacy of oxcarbazepine. In total, 16 consecutive patients with NPS were studied in a prospective, uncontrolled, open-label study design. Each patient received i.v. lidocaine (5 mg/kg) within 30 min followed by a long-term oral oxcarbazepine treatment (900-1,500 mg/day). During an observation period of 28 days, treatment response was documented by a questionnaire including the average daily pain score documented on a numeric rating scale (NRS). A total of 6 out of 16 patients (38%) were lidocaine responders (defined as pain reduction >50% during the infusion), and 4 of 16 (25%) were oxcarbazepine responders. In total, 6 out of 16 participants (38%) discontinued oxcarbazepine treatment due to side effects. In an interim analysis predictive value of the lidocaine infusion was low with a Kendall's tau correlation coefficient of 0.29 and coefficient of determination R(2) of 0.119 (95% confidence interval -0.29 to 0.72). As a consequence of this low correlation, the study was discontinued for ethical reasons. In conclusion, lidocaine infusion has a low predictive value for effectiveness of oxcarbazepine-if at all.

Small-dose hypobaric lidocaine-fentanyl spinal anesthesia for short duration outpatient laparoscopy. I. A randomized comparison with conventional dose hyperbaric lidocaine.

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Vaghadia, H; McLeod, D H; Mitchell, G W; Merrick, P M; Chilvers, C R

1997-01-01

A randomized, single-blind trial of two spinal anesthetic solutions for outpatient laparoscopy was conducted to compare intraoperative conditions and postoperative recovery. Thirty women (ASA physical status I and II) were assigned to one of two groups. Group I patients received a small-dose hypobaric solution of 1% lidocaine 25 mg made up to 3 mL by the addition of fentanyl 25 micrograms. Group II patients received a conventional-dose hyperbaric solution of 5% lidocaine 75 mg (in 7.5% dextrose) made up to 3 mL by the addition of 1.5 mL 10% dextrose. All patients received 500 mL of crystalloid preloading. Spinal anesthesia was performed at L2-3 or L3-4 with a 27-gauge Quincke point needle. Surgery commenced when the level of sensory anesthesia reached T-6. Intraoperative hypotension requiring treatment with ephedrine occurred in 54% of Group II patients but not in any Group I patients. Median (range) time for full motor recovery was 50 (0-95) min in Group I patients compared to 90 (50-120) min in Group II patients (P = 0.0005). Sensory recovery also occurred faster in Group I patients (100 +/- 22 min) compared with Group II patients (140 +/- 27 min, P = 0.0001). Postoperative headache occurred in 38% of all patients and 70% of these were postural in nature. Oral analgesia was the only treatment required. Spinal anesthesia did not result in a significant incidence of postoperative backache. On follow-up, 96% said they found spinal needle insertion acceptable, 93% found surgery comfortable, and 90% said they would request spinal anesthesia for laparoscopy in future. Overall, this study found spinal anesthesia for outpatient laparoscopy to have high patient acceptance and a comparable complication rate to other studies. The small-dose hypobaric lidocaine-fentanyl technique has advantages over conventional-dose hyperbaric lidocaine of no hypotension and faster recovery.

Intravenous lidocaine for post-operative pain relief after hand-assisted laparoscopic colon surgery: a randomized, placebo-controlled clinical trial.

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Tikuišis, R; Miliauskas, P; Samalavičius, N E; Žurauskas, A; Samalavičius, R; Zabulis, V

2014-04-01

Perioperative intravenous (IV) infusion of lidocaine has been shown to decrease post-operative pain, shorten time to return of bowel function, and reduce the length of hospital stay. This randomized, prospective, double-blinded, placebo-controlled clinical trial evaluated the impact of IV lidocaine on the quality of post-operative analgesia and other outcomes after hand-assisted laparoscopic colon surgery. Sixty four patients with colon cancer scheduled for elective colon resection were involved in this study. Patients were randomized to receive either lidocaine infusion [lidocaine group (LG)] or normal 0.9 % saline infusion [placebo group (PG)] for a period of 24 h. Anaesthetic and surgical techniques were standardized. Twenty-four-hour post-operative analgesia in the recovery area was maintained by continuous infusion of 0.1 μg/kg/h fentanyl. The primary outcome of the study was post-operative pain control. Pain was assessed using visual analogue scale (VAS) scores at 2, 4, 8, 12, and 24 h after surgery. Patients with a VAS score >3 were treated with ketorolac 30 mg as needed. Secondary outcomes included time to resumption of bowel function and length of hospital stay. Data in the two groups were compared using the two-tailed Student's t test. All statistical tests were two-tailed at a significance level of 0.05. Demographic characteristics and clinical features of both groups were similar. Intensity of pain at rest in LG compared with PG was significantly lower during the first 24 h post-operatively. LG patients reported significantly less pain during movements at 2-, 12-, and 24-h post-surgery than PG patients. The study showed that ketorolac consumption was significantly higher in PG: mean ketorolac consumption in LG was 43.77 ± 13.86 mg and in PG 51.67 ± 13.16 mg (p = 0.047). Compared with placebo, lidocaine infusion produced a 32 % reduction in time to the first drink (Cohen's d = 3.85), 16 % reduction in time to the first full diet

Comparison of skin anesthetic effect of liposomal lidocaine, nonliposomal lidocaine, and EMLA using 30-minute application time.

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Bucalo, B D; Mirikitani, E J; Moy, R L

1998-05-01

Liposomes are microscopic phospholipid vessels that have been utilized to extend the action of topical medications. Previous studies have demonstrated that liposomal vehicles can prolong the action of a variety of medications, including antifungals, anesthetics, interferon, and antineoplastic agents. The purpose of this study was to examine the degree and duration of anesthesia produced by lidocaine in a liposomal vehicle compared with lidocaine in a nonliposomal vehicle and compared with EMLA. The topical preparations in this study were allowed to contact the skin for a 30-minute period prior to evaluation of anesthetic effectiveness. Unoccluded and Tegaderm-occluded topical preparations were evaluated in two separate arms of the study. Thirteen healthy volunteers (three male, 10 female) were recruited for the nonocclusion arm of the study. Six healthy volunteers (two male, four female) were recruited for the occlusion arm of the study. Subjects with a history of allergy to lidocaine, a history of seizures, cardiac or respiratory difficulty, pregnant patients, and patients less than 18 years old were excluded. Written informed consent was obtained from all patients prior to testing. The volar forearms of the volunteers were swabbed with isopropyl alcohol and allowed to dry. A template was then utilized to mark 2 x 2-cm squares with a skin marker on both volar forearms. In total, nine squares corresponding to nine test areas were marked. The nine test preparations were applied to the test areas in a double-blinded fashion using a clean swab stick. The test preparations were then allowed to remain on the skin for 30 minutes in either occluded or nonoccluded from depending upon the arm of the study. Following the 30-minute application period, the test preparations were wiped off with clean gauze. Testing for anesthesia was performed by following a previously published method utilizing gentle pinpricks. A new pinprick apparatus was used for each patient. Pinprick

4% lidocaine versus 4% articaine for inferior alveolar nerve block in impacted lower third molar surgery.

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Boonsiriseth, Kiatanant; Chaimanakarn, Sittipong; Chewpreecha, Prued; Nonpassopon, Natee; Khanijou, Manop; Ping, Bushara; Wongsirichat, Natthamet

2017-03-01

No study has compared lidocaine with articaine, each at a concentration of 4% and combined with epinephrine. The purpose of this study was to compare the effectiveness of 4% lidocaine with that of 4% articaine, with a concentration of 1:100,000 epinephrine added to each, in an inferior alveolar nerve block for surgery on impacted lower third molars. This study was conducted at the Faculty of Dentistry, Mahidol University in Bangkok, Thailand. The randomized, single-blind, comparative split-mouth study was carried out in patients with symmetrically impacted lower third molars, as identified on panoramic radiographs. Each patient underwent surgery for the removal of the lower third molars by the same surgeon under local anesthesia at two separate visits, 3 weeks apart. The onset and duration of local anesthesia, intra-operative pain, surgical duration, and number of additional anesthetics administered were recorded. The subjective and objective onset of action for the local anesthetics showed statistically significant differences (P inferior alveolar nerve block was clinically more effective in the onset of subjective and objective anesthesia as compared with the use of 4% lidocaine. Based on the pain scores from the visual analogue scale, 4% lidocaine provided more analgesia during the procedure, and patients noted less intra-operative pain than with 4% articaine; however, the difference was not clinically significant.

The Amide Local Anesthetic Lidocaine in Cancer Surgery—Potential Antimetastatic Effects and Preservation of Immune Cell Function? A Narrative Review

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Thiên-Nga Chamaraux-Tran

2017-12-01

Full Text Available Surgical removal of the primary tumor in solid cancer is an essential component of the treatment. However, the perioperative period can paradoxically lead to an increased risk of cancer recurrence. A bimodal dynamics for early-stage breast cancer recurrence suggests a tumor dormancy-based model with a mastectomy-driven acceleration of the metastatic process and a crucial role of the immunosuppressive state during the perioperative period. Recent evidence suggests that anesthesia could also influence the progress of the disease. Local anesthetics (LAs have long been used for their properties to block nociceptive input. They also exert anti-inflammatory capacities by modulating the liberation or signal propagation of inflammatory mediators. Interestingly, LAs can reduce viability and proliferation of many cancer cells in vitro as well. Additionally, retrospective clinical trials have suggested that regional anesthesia for cancer surgery (either with or without general anesthesia might reduce the risk of recurrence. Lidocaine, a LA, which can be administered intravenously, is widely used in clinical practice for multimodal analgesia. It is associated with a morphine-sparing effect, reduced pain scores, and in major surgery probably also with a reduced incidence of postoperative ileus and length of hospital stay. Systemic delivery might therefore be efficient to target residual disease or reach cells able to form micrometastasis. Moreover, an in vitro study has shown that lidocaine could enhance the activity of natural killer (NK cells. Due to their ability to recognize and kill tumor cells without the requirement of prior antigen exposure, NKs are the main actor of the innate immune system. However, several perioperative factors can reduce NK activity, such as stress, pain, opioids, or general anesthetics. Intravenous lidocaine as part of the perioperative anesthesia regimen would be of major interest for clinicians, as it might bear the potential

Synthesis and Analgesic Properties of Lidocaine Derivatives with Substituted Aminobenzothiazoles.

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Ahmadi, Abbas; Khalili, Mohsen; Mohammadinoude, Mohammad Kazem; Nahri-Niknafs, Babak

2016-01-01

Local anesthetics are the most widely consumed drugs in the practice of medicine which provide a loss of sensation in a certain body part without loss of consciousness or impairment of central control of essential functions. Lidocaine (I) is the most commonly local anaesthetic drug which is widely used in all species due to its fabulous diffusing and penetrating properties as well as prompt onset of surgical analgesia. In this study, new aminobenzothiazole (with many useful biological and pharmacological properties) analogues were synthesized by changing of amine moiety of I. Both acute and chronic pain properties of new compounds (II-VI) were studied by using the tail immersion and formalin tests on mice and the outcomes were compared with control and lidocaine groups. According to the results, aminobenzothiazole derivatives are better candidates than diethylamine group for replacement on amine moiety of I. Also, derivatives with electron-withdrawing groups on this amine (V and VI) could decrease pain better than electron-donating ones (II and III) (specially on position 6 of this amine, II and V) which may be of concern for blockade of specific sodium channels by these new compounds.

Multi-modal-analgesia for pain management after Hallux Valgus surgery: a prospective randomised study on the effect of ankle block

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Rolf Christer

2007-12-01

Full Text Available Abstract Background Pain and emesis are the two major complaints after day case surgery. Local anaesthesia has become an important part of optimizing intra and post-operative pain treatment, but is sometimes not entirely sufficient. The aim of the present study was to study the effect of adding an ankle block to a multi-modal analgesic approach on the first 24-hour-need for rescue analgesia in patients undergoing elective Hallux Valgus surgery. Type of study Prospective, randomized patient-blind study comparing ankle block with levo-bupivacaine, lidocaine and Saline placebo control. Methods Ninety patients were studied comparing ankle block (15 cc using levo-bupivacaine 2.5 mg/ml, lidocaine 10 mg/ml or placebo (saline on day-case elective Hallux Valgus surgery, supported by general anaesthesia in all cases. Primary study endpoint was number of patient's requiring oral analgesics during the first 24 post-operative hours. Results Ankle block had no effect on need for rescue analgesia and pain ratings during the 1st 24 postoperative hours, there was no difference seen between placebo and any of the two active local anaesthesia studied. The only differences seen was that both lidocaine and levo-bupivacaine reduced the intra-operative need for anaesthetic (sevoflurane and that levo-bupivacaine patients had a lower need as compared to the lidocaine patients for oral analgesics during the afternoon of surgery. Conclusion Adding a single shot ankle block to a multi-modal pain management strategy reduces the need for intra-operative anaesthesia but has no major impact of need of rescue analgesics or pain during the first 24-hour after surgery.

Lidocaine attenuates anisomycin-induced amnesia and release of norepinephrine in the amygdala

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Sadowski, Renee N.; Canal, Clint E.; Gold, Paul E.

2011-01-01

When administered near the time of training, protein synthesis inhibitors such as anisomycin impair later memory. A common interpretation of these findings is that memory consolidation requires new protein synthesis initiated by training. However, recent findings support an alternative interpretation that abnormally large increases in neurotransmitter release after injections of anisomycin may be responsible for producing amnesia. In the present study, a local anesthetic was administered prior to anisomycin injections in an attempt to mitigate neurotransmitter actions and thereby attenuate the resulting amnesia. Rats received lidocaine and anisomycin injections into the amygdala 130 and 120 min, respectively, prior to inhibitory avoidance training. Memory tests 48 hr later revealed that lidocaine attenuated anisomycin-induced amnesia. In other rats, in vivo microdialysis was performed at the site of amygdala infusion of lidocaine and anisomycin. As seen previously, anisomycin injections produced large increases in release of norepinephrine in the amygdala. Lidocaine attenuated the anisomycin-induced increase in release of norepinephrine but did not reverse anisomycin inhibition of protein synthesis, as assessed by c-Fos immunohistochemistry. These findings are consistent with past evidence suggesting that anisomycin causes amnesia by initiating abnormal release of neurotransmitters in response to the inhibition of protein synthesis. PMID:21453778

Epidural analgesia for labour: maternal knowledge, preferences and informed consent.

LENUS (Irish Health Repository)

2012-02-29

Epidural analgesia has become increasingly popular as a form of labour analgesia in Ireland. However obtaining true inform consent has always been difficult. Our study recruited 100 parturients who had undergone epidural analgesia for labour, aimed to determine the information they received prior to regional analgesia, and to ascertain their preferences regarding informed consent. Only 65 (65%) of patients planned to have an epidural. Knowledge of potential complications was variable and inaccurate, with less than 30 (30%) of women aware of the most common complications. Most women 79 (79%) believed that discomfort during labour affected their ability to provide informed consent, and believe consent should be taken prior to onset of labour (96, 96%). The results of this study helps define the standards of consent Irish patients expect for epidural analgesia during labour.

Rabbit analgesia.

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Barter, Linda S

2011-01-01

With the increasing popularity of rabbits as household pets, the complexity of diagnostic and surgical procedures performed on rabbits is increasing, along with the frequency of routine surgical procedures. More practitioners are faced with the need to provide adequate analgesia for this species. Preemptive analgesia prior to planned surgical interventions may reduce nervous system changes in response to noxious input, as well as reduce postoperative pain levels and analgesic drug requirements. Concurrent administration of analgesic drugs to anesthetized rabbits undergoing painful procedures is warranted both pre- and intraoperatively as well as postoperatively. This article discusses the neuropharmacologic and pharmacologic aspects of pain in rabbits, and reviews current protocols for the use of analgesic drugs. Published by Elsevier Inc.

Labour analgesia with intrathecal fentanyl decreases maternal stress.

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Cascio, M; Pygon, B; Bernett, C; Ramanathan, S

1997-06-01

Lumbar epidural analgesia (LEA) decreases maternal stress as measured by maternal circulating plasma catecholamine concentrations. Intrathecal fentanyl (ITF) provides effective labour analgesia but its effect on maternal epinephrine (Epi) and norepinephrine (NE) concentrations is not known. This study assesses whether ITF reduces maternal stress in the same manner as conventional LEA. Twenty-four healthy women in active labour received either 25 micrograms ITF (n = 12) or epidural lidocaine 1.5% (n = 12) for analgesia. Venous blood samples were collected before anaesthesia and at five minute intervals for 30 min following anaesthesia for the measurement of plasma Epi and NE by high performance liquid chromatography. Maternal blood pressure (BP), heart rate (HR), visual analog scores (VAS) to pain and pruritus were recorded at the same time. Both ITF and LEA decreased pain VAS scores, maternal BP, and plasma Epi concentrations with only minimal effects on plasma NE concentrations. Intrathecal fentanyl (ITF) and LEA reduced plasma epi to a similar extent, with ITF reducing the levels slightly faster than LEA. Intrathecal fentanyl(ITF) and LEA reduced plasma Epi concentrations by 52% and 51%, respectively (P value < 0.01). We conclude that ITF is as effective as LEA in producing pain relief in the labouring patient. Intrathecal Fentanyl (ITF) is also capable of reducing maternal plasma epinephrine concentration, thus avoiding the possibly deleterious side effects of excess amounts of this catecholamine during labour.

The effect of lidocaine on neutrophil respiratory burst during induction of general anaesthesia and tracheal intubation.

LENUS (Irish Health Repository)

Swanton, B J

2012-02-03

BACKGROUND AND OBJECTIVE: Respiratory burst is an essential component of the neutrophil\\'s biocidal function. In vitro, sodium thiopental, isoflurane and lidocaine each inhibit neutrophil respiratory burst. The objectives of this study were (a) to determine the effect of a standard clinical induction\\/tracheal intubation sequence on neutrophil respiratory burst and (b) to determine the effect of intravenous lidocaine administration during induction of anaesthesia on neutrophil respiratory burst. METHODS: Twenty ASA I and II patients, aged 18-60 years, undergoing elective surgery were studied. After induction of anaesthesia [fentanyl (2 microg kg-1), thiopental (4-6 mg kg-1), isoflurane (end-tidal concentration 0.5-1.5%) in nitrous oxide (66%) and oxygen], patients randomly received either lidocaine 1.5 mg kg-1 (group L) or 0.9% saline (group S) prior to tracheal intubation. Neutrophil respiratory burst was measured immediately prior to induction of anaesthesia, immediately before and 1 and 5 min after lidocaine\\/saline. RESULTS: Neutrophil respiratory burst decreased significantly after induction of anaesthesia in both groups [87.4 +\\/- 8.2% (group L) and 88.5 +\\/- 13.4% (group S) of preinduction level (P < 0.01 both groups)]. After intravenous lidocaine (but not saline) administration, neutrophil respiratory burst returned towards preinduction levels, both before (97.1 +\\/- 23.6%) and after (94.4 +\\/- 16.6%) tracheal intubation. CONCLUSION: Induction of anaesthesia and tracheal intubation using thiopentone and isoflurane, inhibit neutrophil respiratory burst. This effect may be diminished by the administration of lidocaine.

Effectiveness of intra-articular lidocaine injection for reduction of anterior shoulder dislocation: randomized clinical trial.

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Tamaoki, Marcel Jun Sugawara; Faloppa, Flavio; Wajnsztejn, André; Archetti Netto, Nicola; Matsumoto, Marcelo Hide; Belloti, João Carlos

2012-01-01

Shoulder dislocation is the most common dislocation among the large joints. The aim here was to compare the effectiveness of reduction of acute anterior shoulder dislocation with or without articular anesthesia. Prospective randomized trial conducted in Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp). From March 2008 to December 2009, 42 patients with shoulder dislocation were recruited. Reductions using traction-countertraction for acute anterior shoulder dislocation with and without lidocaine articular anesthesia were compared. As the primary outcome, pain was assessed through application of a visual analogue scale before reduction, and one and five minutes after the reduction maneuver was performed. Complications were also assessed. Forty-two patients were included: 20 in the group without analgesia (control group) and 22 in the group that received intra-articular lidocaine injection. The group that received intra-articular lidocaine had a statistically greater decrease in pain over time than shown by the control group, both in the first minute (respectively: mean 2.1 (0 to 5.0), standard deviation, SD 1.3, versus mean 4.9 (2.0 to 7.0, SD 1.5; P < 0.001) and the fifth minute (respectively: mean 1.0; 0 to 3.0; SD = 1.0 versus mean 4.0; 1.0 to 6.0; SD = 1.4; P < 0.001). There was one failure in the control group. There were no other complications in either group. Reduction of anterior shoulder dislocation using intra-articular lidocaine injection is effective, since it is safe and diminishes the pain. ISRCTN27127703.

Comparison of placebo and intrauterine lidocaine with/or without rectal diclofenac sodium suppositories used in office endometrial biopsy.

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Kaya, Cengiz; Sener, Elif Bengi; Koksal, Ersin; Ustun, Yasemin Burcu; Celik, Handan; Sahinoglu, Ali Haydar

2015-01-01

To compare the effects of intrauterine lidocaine, intrauterine lidocaine plus rectal diclofenac, and a placebo on analgesia and to determine the satisfaction of patients and surgeons in cases of endometrial biopsy. The double-blind, randomised, placebo-controlled study was conducted in the Department of Obstetrics and Gynaecology of the Ondokuz Mayis University, Samsun,Turkey, from April 2013 to January 2014, and comprised patients scheduled for in-office endometrial biopsy.They were divided into three groups: Group P, 5ml of 0.9% saline intrauterine; Group L, 5ml of 2% lidocaine intrauterine; and Group LD, 5ml of 2% lidocaine intrauterine ± 10min before the procedure plus 50mg of rectal diclofenac sodium. Haemodynamic changes and visual analogue scale scores were recorded during the preoperative period, when the cervix was grasped with a tenaculum, immediately after intrauterine instillation, during uterine curettage and at postoperative 10 min. The patient and the surgeon were questioned about their satisfaction 15 min after the procedure. SPSS 21 was used for statistical analysis. The 90 patients in the study were divided into three equal groups of 30(33.33%) each. There were no statistically significant inter-group differences in age, bodyweight, parity, number of postmenopausal patients, haemodynamic parameters and American Society of Anesthesiologists scores (p>0.05 in all categories). In Group P, the visual analogue scale score estimated when the cervix was grasped with the tenaculum was lower when compared with Group L and Group LD (p=0.029 and p=0.007, respectively). At other measurement time points, the scores did not differ between the groups. The groups did not differ with respect to patient and surgeon satisfaction and complication rates (p>0.05). Intrauterine lidocaine or intrauterine lidocaine plus rectal diclofenac application had no effect on visual analogue scale scores, patient satisfaction and vasovagal reaction.

Topical anesthetic versus lidocaine infiltration in arteriovenous fistula cannulation

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Anisha George

2014-01-01

Full Text Available Background: End stage renal disease (ESRD patients on maintenance hemodialysis undergo arterio-venous fistula (AVF cannulation prior to each hemodialysis session for blood access. Prior to cannulation lidocaine infiltration is done, which is often perceived as painful. Eutectic mixture of local anesthetic (EMLA has been found to significantly reduce pain associated with radial artery cannulation compared with lidocaine infiltration. Aims: To evaluate the efficacy of EMLA compared to infiltration of lidocaine in hemodialysis patients for AVF cannulation. Materials and Methods: A single-centre, crossover study of patients with an AVF on regular maintenance hemodialysis was performed in the dialysis unit of a tertiary care teaching hospital. The site of AVF, number of attempts for AVF cannulation and cannula insertion time were recorded. The patients were asked about the acceptability of application of the anesthetic, delay between anesthetic and cannulation and to score the pain on cannulation. Results: Fifty patients were included in the study. With the visual analog scale, pain score on infiltration was 4.8. Pain score on cannulation after topical application was 2.9 and after infiltration, 2.0. The number of attempts for cannulation and the cannula insertion time were similar. Anesthesia was more stressful in the injectable group rather than the topical group (P < 0.001. Delay between anesthetic and cannulation was unacceptable in the topical group (P < 0.001. Patient compliance was better during infiltration compared to topical (P < 0.005. Mean pain score during infiltration of anesthetic was significantly higher than cannulation pain after either anesthetic, although pain on cannulation was higher in the topical group (P < 0.001. Conclusions: EMLA offers a suitable alternative to lidocaine infiltration for patients using AVF for blood access.

Cardiovascular effects of a continuous rate infusion of lidocaine in calves anesthetized with xylazine, midazolam, ketamine and isoflurane.

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Araújo, Marcelo A; Dias, Bianca P; Bovino, Fernanda; Deschk, Maurício; Abimussi, Caio Jx; Oliva, Valéria Nls; Rodrigues, Celso A; Santos, Paulo Sp

2014-03-01

To assess the cardiovascular changes of a continuous rate infusion of lidocaine in calves anesthetized with xylazine, midazolam, ketamine and isoflurane during mechanical ventilation. Prospective, randomized, cross-over, experimental trial. A total of eight, healthy, male Holstein calves, aged 10 ± 1 months and weighing 114 ± 11 kg were included in the study. Calves were administered xylazine followed by ketamine and midazolam, orotracheal intubation and maintenance on isoflurane (1.3%) using mechanical ventilation. Forty minutes after induction, lidocaine (2 mg kg⁻¹ bolus) or an equivalent volume of saline (0.9%) was administered IV followed by a continuous rate infusion (100 μg kg⁻¹ minute⁻¹) of lidocaine (treatment L) or saline (treatment C). Heart rate (HR), systolic, diastolic and mean arterial pressures (SAP, DAP and MAP), central venous pressure (CVP), mean pulmonary arterial pressure (mPAP), pulmonary arterial occlusion pressure (PAOP), cardiac output, end-tidal carbon dioxide (Pe'CO2 ) and core temperature (CT) were recorded before lidocaine or saline administration (Baseline) and at 20-minute intervals (T20-T80). Plasma concentrations of lidocaine were measured in treatment L. The HR was significantly lower in treatment L compared with treatment C. There was no difference between the treatments with regards to SAP, DAP, MAP and SVRI. CI was significantly lower at T60 in treatment L when compared with treatment C. PAOP and CVP increased significantly at all times compared with Baseline in treatment L. There was no significant difference between times within each treatment and between treatments with regards to other measured variables. Plasma concentrations of lidocaine ranged from 1.85 to 2.06 μg mL⁻¹ during the CRI. At the studied rate, lidocaine causes a decrease in heart rate which is unlikely to be of clinical significance in healthy animals, but could be a concern in compromised animals. © 2013 Association of Veterinary Anaesthetists

Pain thresholds, supra-threshold pain and lidocaine sensitivity in patients with erythromelalgia, including the I848Tmutation in NaV 1.7.

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Helås, T; Sagafos, D; Kleggetveit, I P; Quiding, H; Jönsson, B; Segerdahl, M; Zhang, Z; Salter, H; Schmelz, M; Jørum, E

2017-09-01

Nociceptive thresholds and supra-threshold pain ratings as well as their reduction upon local injection with lidocaine were compared between healthy subjects and patients with erythromelalgia (EM). Lidocaine (0.25, 0.50, 1.0 or 10 mg/mL) or placebo (saline) was injected intradermally in non-painful areas of the lower arm, in a randomized, double-blind manner, to test the effect on dynamic and static mechanical sensitivity, mechanical pain sensitivity, thermal thresholds and supra-threshold heat pain sensitivity. Heat pain thresholds and pain ratings to supra-threshold heat stimulation did not differ between EM-patients (n = 27) and controls (n = 25), neither did the dose-response curves for lidocaine. Only the subgroup of EM-patients with mutations in sodium channel subunits Na V 1.7, 1.8 or 1.9 (n = 8) had increased lidocaine sensitivity for supra-threshold heat stimuli, contrasting lower sensitivity to strong mechanical stimuli. This pattern was particularly clear in the two patients carrying the Na V 1.7 I848T mutations in whom lidocaine's hyperalgesic effect on mechanical pain sensitivity contrasted more effective heat analgesia. Heat pain thresholds are not sensitized in EM patients, even in those with gain-of-function mutations in Na V 1.7. Differential lidocaine sensitivity was overt only for noxious stimuli in the supra-threshold range suggesting that sensitized supra-threshold encoding is important for the clinical pain phenotype in EM in addition to lower activation threshold. Intracutaneous lidocaine dose-dependently blocked nociceptive sensations, but we did not identify EM patients with particular high lidocaine sensitivity that could have provided valuable therapeutic guidance. Acute pain thresholds and supra-threshold heat pain in controls and patients with erythromelalgia do not differ and have the same lidocaine sensitivity. Acute heat pain thresholds even in EM patients with the Na V 1.7 I848T mutation are normal and only nociceptor

Effectiveness of intra-articular lidocaine injection for reduction of anterior shoulder dislocation: randomized clinical trial

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Marcel Jun Sugawara Tamaoki

Full Text Available CONTEXT AND OBJECTIVE: Shoulder dislocation is the most common dislocation among the large joints. The aim here was to compare the effectiveness of reduction of acute anterior shoulder dislocation with or without articular anesthesia. DESIGN AND SETTING: Prospective randomized trial conducted in Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp. METHODS: From March 2008 to December 2009, 42 patients with shoulder dislocation were recruited. Reductions using traction-countertraction for acute anterior shoulder dislocation with and without lidocaine articular anesthesia were compared. As the primary outcome, pain was assessed through application of a visual analogue scale before reduction, and one and five minutes after the reduction maneuver was performed. Complications were also assessed. RESULTS: Forty-two patients were included: 20 in the group without analgesia (control group and 22 in the group that received intra-articular lidocaine injection. The group that received intra-articular lidocaine had a statistically greater decrease in pain over time than shown by the control group, both in the first minute (respectively: mean 2.1 (0 to 5.0, standard deviation, SD 1.3, versus mean 4.9 (2.0 to 7.0, SD 1.5; P < 0.001 and the fifth minute (respectively: mean 1.0; 0 to 3.0; SD = 1.0 versus mean 4.0; 1.0 to 6.0; SD = 1.4; P < 0.001. There was one failure in the control group. There were no other complications in either group. CONCLUSION: Reduction of anterior shoulder dislocation using intra-articular lidocaine injection is effective, since it is safe and diminishes the pain. CLINICAL TRIAL REGISTRATION: ISRCTN27127703.

Oral administration of analgesia and anxiolysis for pain associated with bone marrow biopsy.

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Talamo, Giampaolo; Liao, Jason; Bayerl, Michael G; Claxton, David F; Zangari, Maurizio

2010-03-01

Medical literature provides only scarce data about the degree of pain experienced by patients undergoing a bone marrow aspiration and biopsy (BMAB), and little is known about the factors that can modify the perception of pain. In this study, we evaluated the effectiveness of a combination of analgesia and anxiolysis in reducing the pain score of patients undergoing BMAB. Eighty-four consecutive adult patients underwent BMAB after local anesthesia with 5 mL of lidocaine hydrochloride 1% aqueous solution in the left posterior superior iliac crest. Analgesia was obtained with acetaminophen 650 mg and oxycodone 10 mg, and anxiolysis was obtained with lorazepam 2 mg, all drugs given once orally 30 min before the procedure. We assessed the pain level with the Wong-Baker Faces Pain Rating Scale, which distinguishes six levels of pain, from 0 to 5. The 34 patients who received an oral administration of analgesia and anxiolysis reported pain at lower levels, i.e., in the range of 0-2, more frequently than the 50 patients who underwent BMAB without analgesia/anxiolysis (78% vs 64%, respectively). Among several predictors analyzed using a multivariate regression model, three were found to be associated with decreased pain level: the use of analgesia/anxiolysis, male sex, and increase in age (all with p values <0.05). Length of the extracted bone specimen, body mass index, and need of a spinal needle for anesthesia in obese patients did not predict for pain level. An oral administration of prophylactic regimen of analgesia and anxiolysis, at the above-mentioned doses, produced a statistically significant reduction of the perception of pain in patients undergoing BMAB, but its effect did not seem to provide a major and clinically significant reduction of pain level.

Acute Lidocaine Toxicity: a Case Series

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Mitra Rahimi

2018-06-01

Full Text Available Introduction: Parenteral form of lidocaine is the best-known source of lidocaine poisoning. This study aimed to evaluate the characteristics of acute lidocaine toxicity.Methods: In this retrospective cross-sectional study, demographics, clinical presentation, laboratory findings, and outcome of patients intoxicated with lidocaine (based on  ICD10 codes admitted to Loghman Hakim Hospital, during April 2007 to March 2014 were analyzed.Results: 30 cases with the mean age of 21.83 ± 6.57 year were studied (60% male. All subjects had used either 6.5% lidocaine spray or 2% topical formulations of lidocaine. The mean consumed dose of lidocaine was 465 ± 318.17 milligrams. The most frequent clinical presentations were nausea and vomiting (50%, seizure (33.3%, and loss of consciousness (16.7%. 22 (73.3% cases had normal sinus rhythm, 4 (13.3% bradycardia, 2 (6.7% ventricular tachycardia, and 2 (6.7% had left axis deviation. 11 (36.6% cases were intubated and admitted to intensive care unit (ICU for 6.91 ± 7.16 days. Three patients experienced status epilepticus that led to cardiac arrest, and death (all cases with suicidal intention.Conclusion: Based on the results of this study, most cases of topical lidocaine toxicity were among < 40-year-old patients with a male to female ratio of 1.2, with suicidal attempt in 90%, need for intensive care in 36.6%, and  mortality rate of 10%.

[Comparative effects of vitamin C on the effects of local anesthetics ropivacaine, bupivacaine, and lidocaine on human chondrocytes].

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Tian, Jun; Li, Yan

2016-01-01

Intra-articular injections of local anesthetics are commonly used to enhance post-operative analgesia following orthopedic surgery as arthroscopic surgeries. Nevertheless, recent reports of severe complications due to the use of intra-articular local anesthetic have raised concerns. The study aims to assess use of vitamin C in reducing adverse effects of the most commonly employed anesthetics - ropivacaine, bupivacaine and lidocaine - on human chondrocytes. The chondrocyte viability following exposure to 0.5% bupivacaine or 0.75% ropivacaine or 1.0% lidocaine and/or vitamin C at doses 125, 250 and 500μM was determined by Live/Dead assay and annexin V staining. Expression levels of caspases 3 and 9 were assessed using antibodies by Western blotting. Flow cytometry was performed to analyze the generation of reactive oxygen species. On exposure to the local anesthetics, chondrotoxicity was found in the order ropivacaineC effectively improved the reduced chondrocyte viability and decreased the raised apoptosis levels following exposure to anesthesia. At higher doses, vitamin C was found efficient in reducing the generation of reactive oxygen species and as well down-regulate the expressions of caspases 3 and 9. Vitamin C was observed to effectively protect chondrocytes against the toxic insult of local anesthetics ropivacaine, bupivacaine and lidocaine. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

Comparative effects of vitamin C on the effects of local anesthetics ropivacaine, bupivacaine, and lidocaine on human chondrocytes.

Science.gov (United States)

Tian, Jun; Li, Yan

2016-01-01

Intra-articular injections of local anesthetics are commonly used to enhance post-operative analgesia following orthopedic surgery as arthroscopic surgeries. Nevertheless, recent reports of severe complications due to the use of intra-articular local anesthetic have raised concerns. The study aims to assess use of vitamin C in reducing adverse effects of the most commonly employed anesthetics - ropivacaine, bupivacaine and lidocaine - on human chondrocytes. The chondrocyte viability following exposure to 0.5% bupivacaine or 0.75% ropivacaine or 1.0% lidocaine and/or vitamin C at doses 125, 250 and 500 μM was determined by LIVE/DEAD assay and annexin V staining. Expression levels of caspases 3 and 9 were assessed using antibodies by Western blotting. Flow cytometry was performed to analyze the generation of reactive oxygen species. On exposure to the local anesthetics, chondrotoxicity was found in the order ropivacaineC effectively improved the reduced chondrocyte viability and decreased the raised apoptosis levels following exposure to anesthesia. At higher doses, vitamin C was found efficient in reducing the generation of reactive oxygen species and as well down-regulate the expressions of caspases 3 and 9. Vitamin C was observed to effectively protect chondrocytes against the toxic insult of local anesthetics ropivacaine, bupivacaine and lidocaine. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

Intramuscular diclofenac vs periprostatic lidocaine injection for controlling pain undergoing transrectal ultrasound guided prostatic biopsy

International Nuclear Information System (INIS)

Alam, S.I.

2017-01-01

Background: Transrectal ultrasound (TRUS) technique for getting prostatic tissue for histopathology is now the standard procedure for malignant lesions of the prostate and imperative diagnostic investigation of patients with clinical specks of prostatic neoplasia. During TRUS guided biopsy, pain control has been important issue therefore, highly potent analgesia before this procedure should be considered on high priority according to current census. Therefore, we compared intramuscular diclofenac injection with sensory blockade of injection lidocaine to abolish pain undergoing prostatic biopsy with TRUS technique. Methods: Total 200 patients were selected for this study having raised PSA values and suspicious nodule on Digital Rectal Examination. These patients were segregated into two groups by randomization. Group Ar eceived intramuscular diclofenac and group Bw ere infiltrated with lidocaine injection for sensory blockade. Results: Patients in group A was having mean age of 64.5±5.8 years while for group B patients was 65.6±4.9 years (p=0.16). Both groups have statistically insignificant difference in their mean PSA values (p=0.24) and mean prostatic volume (p=0.22). The mean pain scores on visual analogue scale in groups A was 3.5±0.8 and in group B it was 2.4±0.8 (p<0.001). 60% group A patients reported with mild or no pain compared to 90% in group B. (p<0.001). Conclusion: Local blockade with lidocaine injection has better pain control as compared to patients experienced pain with intramuscular diclofenac used for prostatic biopsy through TRUS technique.

Analgesic efficacy of lidocaine for suction-assisted lipectomy with tumescent technique under general anesthesia: a randomized, double-masked, controlled trial.

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Danilla, Stefan; Fontbona, Montserrat; de Valdés, Victoria Diaz; Dagnino, Bruno; Sorolla, Juan Pablo; Israel, Guillermo; Searle, Susana; Norambuena, Hernán; Cabello, Rodrigo

2013-08-01

Suction-assisted lipectomy is one of the most common procedures performed in plastic surgery. To minimize blood loss and to obtain adequate analgesia, a liquid solution is infiltrated into the subcutaneous plane before suction. The objective of this study was to determine whether the use of lidocaine in the infiltration solution reduces postoperative pain. A prospective, randomized, double-masked, clinical trial was designed. Each side of patients' body zones to be treated with suction-assisted lipectomy was randomized to receive infiltration solution with or without lidocaine. Treatment allocation was performed using computer-generated random numbers in permuted blocks of eight. Pain was assessed using the visual analogue scale and registered 1, 6, 12, 18, and 24 hours after the procedure. The trial was stopped after a first interim analysis. The use of lidocaine in the dilute solution reduced pain by 0.5 point on the visual analogue scale (95 percent CI, 0.3 to 0.8; p<0.001). The effect was independent of the suctioned body zone (p=0.756), and lasted until 18 hours after surgery. Its analgesic effect was lost at the 24-hour postoperative control. Pain increased an average of 0.018 point on the visual analogue scale per hour (95 percent CI, 0.001 to 0.036; p=0.043). The use of lidocaine in the infiltration solution is effective in postoperative pain control until 18 hours after surgery. Nevertheless, its clinical effect is limited and clinically irrelevant, and therefore it is no longer used by the authors. Therapeutic, I.

Influence of anatomic location of lidocaine patch 5% on effectiveness and tolerability for postherpetic neuralgia

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Nalamachu S

2013-06-01

effective and generally well tolerated for each anatomic area evaluated, although application to the head was tolerated less well compared with the trunk and extremities.Keywords: acute herpes zoster, analgesia, efficacy, lidocaine, postherpetic neuralgia, topical therapies

Buffered lidocaine and bupivacaine mixture - the ideal local anesthetic solution?

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Best, Corliss A; Best, Alyssa A; Best, Timothy J; Hamilton, Danielle A

2015-01-01

The use of injectable local anesthetic solutions to facilitate pain-free surgery is an integral component of many procedures performed by the plastic surgeon. In many instances, a solution that has both rapid onset and prolonged duration of analgesia is optimal. A combination of lidocaine and bupivacaine, plain or with epinephrine, is readily available in most Canadian health care settings where such procedures are performed, and fulfills these criteria. However, commercially available solutions of both medications are acidic and cause a burning sensation on injection. Buffering to neutral pH with sodium bicarbonate is a practical method to mitigate the burning sensation, and has the added benefit of increasing the fraction of nonionized lipid soluble drug available. The authors report on the proportions of the three drugs to yield a neutral pH, and the results of an initial survey regarding the use of the combined solution with epinephrine in hand surgery.

New lidocaine lozenge as topical anesthesia compared to lidocaine viscous oral solution before upper gastrointestinal endoscopy

DEFF Research Database (Denmark)

Mogensen, Stine; Treldal, Charlotte; Feldager, Erik

2012-01-01

To evaluate the effect and acceptance of a new lidocaine lozenge compared with a lidocaine viscous oral solution as a pharyngeal anesthetic before upper gastrointestinal endoscopy (UGE), a diagnostic procedure commonly performed worldwide during which many patients experience severe discomfort...

Sublingual administration of detomidine to calves prior to disbudding: a comparison with the intravenous route.

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Hokkanen, Ann-Helena; Raekallio, Marja R; Salla, Kati; Hänninen, Laura; Viitasaari, Elina; Norring, Marianna; Raussi, Satu; Rinne, Valtteri M; Scheinin, Mika; Vainio, Outi M

2014-07-01

To study the effects of oromucosal detomidine gel administered sublingually to calves prior to disbudding, and to compare its efficacy with intravenously (IV) administered detomidine. Randomised, prospective clinical study. Twenty dairy calves aged 12.4 ± 4.4days (mean ± SD), weight 50.5 ± 9.0 kg. Detomidine at 80 μg kg(-1) was administered to ten calves sublingually (GEL) and at 30 μg kg(-1) to ten control calves IV (V. jugularis). Meloxicam (0.5 mg kg(-1) ) and local anaesthetic (lidocaine 3 mg kg(-1) ) were administered before heat cauterization of horn buds. Heart rate (HR), body temperature and clinical sedation were monitored over 240 minutes. Blood was collected from the V. cephalica during the same period for drug concentration analysis. Pharmacokinetic variables were calculated from the plasma detomidine concentration-time data using non-compartmental methods. Statistical analyses compared routes of administration by Student's t-test and linear mixed models as relevant. The maximum plasma detomidine concentration after GEL was 2.1 ± 1.2 ng mL(-1) (mean ±SD) and the time of maximum concentration was 66.0 ± 36.9 minutes. The bioavailability of detomidine was approximately 34% with GEL. Similar sedation scores were reached in both groups after administration of detomidine, but maximal sedation was reached earlier in the IV group (10 minutes) than in the GEL group (40 minutes). HR was lower after IV than GEL from 5 to 10 minutes after administration. All animals were adequately sedated, and we were able to administer local anaesthetic without resistance to all of the calves before disbudding. Oromucosally administered detomidine is an effective sedative agent for calves prior to disbudding. © 2014 The Authors Veterinary Anaesthesia and Analgesia published by John Wiley & Sons Ltd on behalf of Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia.

Studies on the interaction of lidocaine with plasma proteins

International Nuclear Information System (INIS)

Adotey, J.

1985-01-01

This study sought to quantitate lidocaine's interaction with alpha-1-acid glycoprotein (AAG), human serum albumin (HSA), and AAG in the presence of HSA, and to determine the extent of displacement of lidocaine from its binding site(s) by selected cardiovascular drugs (dipyridamole, disopyramide and quinidine). Since the limited experimental work reported in this area has involved the use of a single lidocaine concentration, this study involved the evaluation of a range of lidocaine concentrations. Lidocaine interaction with plasma proteins (AAG and HSA) was studied at 37 0 C using an isothermal equilibrium dialysis system and 14 C-lidocaine HCl. A dialysis membrane (M.W. cutoff 12,000 to 14,000) separated the two chambers of each dialysis cell. The extent of 14 C-lidocaine dialysis was studied with respect to both drug and protein concentrations. Aliquots of each chamber of each of the cells were subjected to liquid scintillation counting (LSC) analyses for 14 C-lidocaine. The ratio of bound to free (R/F) lidocaine was evaluated as a function of AAG concentration from the LSC data. Scatchard and/or Rosenthal analyses were employed to evaluate n and k values where appropriate. Linear and multiple linear regression analyses of the data were appropriately performed

Effect of ketoprofen, lidocaine local anesthesia, and combined xylazine and lidocaine caudal epidural anesthesia during castration of beef cattle on stress responses, immunity, growth, and behavior.

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Ting, S T L; Earley, B; Hughes, J M L; Crowe, M A

2003-05-01

To determine the effects of burdizzo castration alone or in combination with ketoprofen (K), local anesthesia (LA), or caudal epidural anesthesia (EPI) on plasma cortisol, acute-phase proteins, interferon-gamma production, growth, and behavior of beef cattle, 50 Holstein x Friesian bulls (13 mo old, 307 +/- 5.3 kg) were assigned to (n = 10/treatment): 1) control (handled; C); 2) burdizzo castration (B); 3) B following K (3 mg/ kg of BW i.v.; BK); 4) B following LA (8 mL into each testis and 3 mL s.c. along the line where the jaws of the burdizzo were applied with 2% lidocaine HCl; BLA); and 5) B following EPI (0.05 mg/kg of BW of xylazine HCl and 0.4 mg/kg of BW of lidocaine HCl as caudal epidural; BEPI). The area under the cortisol curve against time was lower (P castration groups than in C. On d 7, haptoglobin and fibrinogen concentrations remained higher (P castration increased plasma cortisol and acute-phase proteins, and suppressed immune function and growth rates. Local anesthesia prolonged the increase in acute-phase proteins. Ketoprofen was more effective than LA or EPI in decreasing cortisol and partially reversed the reduction in ADG following castration. The use of K or EPI was more effective than LA in decreasing pain-associated behavioral responses observed during the first 6 h after treatment. Systemic analgesia with ketoprofen, a non-steroidal antiinflammatory drug, was more effective in reducing inflammatory responses associated with castration than LA or EPI.

Topical lidocaine patch 5% for acute postoperative pain control.

LENUS (Irish Health Repository)

Gilhooly, D

2011-02-01

A 39-year-old para 3 woman presented for elective caesarean section (lower segment caesarean section (LSCS)) for breech presentation. The patient had a strong history of atopy and anaphylaxis to paracetamol, codeine, penicillin and latex. The patient was asthmatic, triggered by aspirin. Epidural anaesthesia was unsuccessful and LSCS was carried out under spinal anaesthesia. Postoperatively the patient was unwilling to take analgesic medication due to fear of an allergic reaction. Three 5% lidocaine patches were applied to the wound for postoperative analgesia. This reduced the patient\\'s visual analogue scale pain score from 10\\/10 to 5\\/10 at rest and 10\\/10 to 7\\/10 with movement. Transcutaneous electrical nerve stimulation was added and this improved associated back pain, reducing the pain further to 2\\/10. This is the first description of lignocaine patch 5% for postoperative LSCS pain. It is suggested that this method of delivery of local anaesthetic, which is easy to apply and has minimal side effects, should be considered not as a sole agent but as part of a multimodal technique to address postoperative LSCS pain.

The efficacy of a lidocaine-infused pain pump for postoperative analgesia following elective augmentation mammaplasty or abdominoplasty.

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Chavez-Abraham, Victor; Barr, Jason S; Zwiebel, Paul C

2011-08-01

Postoperative pain management following aesthetic plastic surgery traditionally has been achieved by systemic administration of several narcotic pain medications. Because this method can lead to undesirable side effects such as sedation, nausea, vomiting, and respiratory depression, a more efficacious method of postoperative analgesia with fewer side effects needs to be implemented in outpatient cosmetic surgery. From March of 2003 until December of 2008, 690 patients underwent augmentation mammaplasty and 215 patients underwent abdominoplasty. All of these patients were equipped with an elastomeric continuous infusion pump postoperatively and were prescribed oral narcotics. Prior to 2003, patients were prescribed only oral narcotics postoperatively. A retrospective chart review of patients before and after implementation of the pain pump was undertaken to review the perceived pain patients experienced postoperatively with and without the pump. The self-administration of oral narcotics was also assessed. Patients equipped with the pain pump experienced a statistically significant decrease in perceived pain compared to those without the pump (augmentation mammaplasty: 2.27 vs. 3.68, p use of the oral narcotic Vicodin™ at 72 h postoperatively (5 mg hydrocodone/500 mg acetaminophen, Abbott Laboratories, Abbott Park, IL) (augmentation mammaplasty: 26.5 mg/2650 mg vs. 49 mg/4900 mg, p reduce both the amount of pain patients experience and the quantity of narcotics used postoperatively.

Relapse of Neuromyelitis Optica Spectrum Disorder Associated with Intravenous Lidocaine

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Akiyuki Uzawa

2011-01-01

Full Text Available Lidocaine unmasks silent symptoms and eases neuropathic pain in multiple sclerosis patients; however, the effects of lidocaine in neuromyelitis optica have never been reported. We describe the case of a 59-year-old Japanese woman with neuromyelitis optica spectrum disorder who developed optic neuritis 1 day after intravenous lidocaine injection for treating allodynia. Her symptom seemed to result from a relapse of neuromyelitis optica induced by lidocaine administration, and not because of the transient effects of intravenous lidocaine administration. The possibility that lidocaine administration results in relapse of neuromyelitis optica due to its immunomodulating effects cannot be ruled out.

Comparison of Morphine, Morphine-Lidocaine, and Morphine-Lidocaine-Ketamine Infusions in Dogs Using an Incision-Induced Pain Model.

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Chiavaccini, Ludovica; Claude, Andrew K; Meyer, Robert E

We aimed to compare antinociceptive effects of IV infusions of morphine (M), morphine-lidocaine (ML), or morphine-lidocaine-ketamine (MLK) combined, in a mild-to-moderate pain model in dogs. Eighteen adult hounds were heavily sedated with IV morphine (0.2 mg/kg) and dexmedetomidine to undergo thoracic skin incisions. After reversal, dogs were randomly assigned to receive loading doses of lidocaine and ketamine (MLK), lidocaine and saline (ML), or equivalent volume of saline (M), followed by 18 hr constant infusions of morphine (0.12 mg/kg/hr), lidocaine (3 mg/kg/hr) and ketamine (0.6 mg/kg/hr); morphine (0.12 mg/kg/hr) and lidocaine (3 mg/kg/hr); or morphine (0.12 mg/kg/hr), respectively. Pain was assessed with Short Form Glasgow Composite Measure Pain Scale and mechanical nociception with von Frey filaments (VFFS). Data were analyzed with linear mixed model on ranks. Independently of treatment, Short Form Glasgow Composite Measure Pain Scale was significantly higher than baseline for 24 hr (p < .0001), while VFFS was significantly lower than baseline for 48 hr post-recovery (p < .0001), with no difference between MLK and M groups. The ML group recorded significantly lower VFFS (p = .02) than the M group for the entire study. In conclusion, there was no significant analgesic difference between MLK and M alone.

Preemptive analgesia I: physiological pathways and pharmacological modalities.

LENUS (Irish Health Repository)

Kelly, D J

2012-02-03

PURPOSE: This two-part review summarizes the current knowledge of physiological mechanisms, pharmacological modalities and controversial issues surrounding preemptive analgesia. SOURCE: Articles from 1966 to present were obtained from the MEDLINE databases. Search terms included: analgesia, preemptive; neurotransmitters; pain, postoperative; hyperalgesia; sensitization, central nervous system; pathways, nociception; anesthetic techniques; analgesics, agents. Principal findings: The physiological basis of preemptive analgesia is complex and involves modification of the pain pathways. The pharmacological modalities available may modify the physiological responses at various levels. Effective preemptive analgesic techniques require multi-modal interception of nociceptive input, increasing threshold for nociception, and blocking or decreasing nociceptor receptor activation. Although the literature is controversial regarding the effectiveness of preemptive analgesia, some general recommendations can be helpful in guiding clinical care. Regional anesthesia induced prior to surgical trauma and continued well into the postoperative period is effective in attenuating peripheral and central sensitization. Pharmacologic agents such as NSAIDs (non-steroidal anti-inflammatory drugs) opioids, and NMDA (N-methyl-D-aspartate) - and alpha-2-receptor antagonists, especially when used in combination, act synergistically to decrease postoperative pain. CONCLUSION: The variable patient characteristics and timing of preemptive analgesia in relation to surgical noxious input requires individualization of the technique(s) chosen. Multi-modal analgesic techniques appear most effective.

Transversus abdominis plane block as a component of multimodal analgesia for laparoscopic cholecystectomy.

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Oksar, Menekse; Koyuncu, Onur; Turhanoglu, Selim; Temiz, Muhyittin; Oran, Mustafa Cemil

2016-11-01

To evaluate and compare intercostal-iliac transversus abdominis plane (TAP) and oblique subcostal TAP (OSTAP) blocks for multimodal analgesia in patients receiving laparoscopic cholecystectomy. A prospective, randomized, double-blinded clinical study. Operating room, postoperative recovery area, and ward. In total, 60 laparoscopic cholecystectomy patients (43 women, 17 men, American Society of Anesthesiologists grades I-II) were enrolled from the general surgery department of our tertiary care center. The patients were assigned to 1 of the 3 groups. Group 1 received TAP blocks (n=20), group 2 received OSTAP blocks (n=20), and group 3 patients were used as controls and received patient-controlled analgesia (PCA) only (n=20). After the induction of anesthesia, blocks were performed bilaterally in study groups 1 and 2, using 20mL of lidocaine (5mg/mL). PCA with intravenous tramadol was routinely provided for all patients during the first 24hours. The intraoperative use of remifentanil, postoperative visual analog scale (VAS) scores, demand for PCA, and total analgesic consumption were recorded. The patients in the control group had greater analgesic demands and analgesic consumption than did those in groups 1 and 2. However, patients in the OSTAP group had lower VAS scores than did those in groups 1 and 3. The demand for analgesia was greater in the control group than in groups 1 and 2. Moreover, lower VAS scores were recorded in the OSTAP group than in groups 1 and 3 and were positively correlated with total PCA consumption among all patients. However, postoperative VAS scores were negatively correlated with the total intraoperative consumption of remifentanil at 24hours. TAP and OSTAP blocks improved postoperative analgesia in patients receiving laparoscopic cholecystectomy, which resulted in lower VAS scores and reduction in total analgesic consumption. Copyright © 2016 Elsevier Inc. All rights reserved.

Preemptive analgesic effect of lidocaine in a chronic neuropathic pain model Efeito analgésico preemptivo da lidocaína em modelo de dor crônica neuropática

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Leonardo M. Batista

2009-12-01

Full Text Available Preemptive analgesia inhibits the progression of pain caused by surgical lesions. To analyze the effect of lidocaine on postoperative pain relief, we performed compression of the right sciatic nerve in Wistar rats and observed the differences on behavior between the group that received lidocaine and the group that was not treated with the local anesthetics pre-operatively. Group 1 was not operated (control; group 2 underwent the sciatic nerve ligature without lidocaine; group 3, underwent surgery with previous local infiltration of lidocaine. Group 2 showed significantly longer scratching times with a peak on day 14 post-operative (p=0.0005 and reduction in the latency to both noxious (p=0.003 and non-noxious (p=0.004 thermal stimulus. Group 3 presented significantly shorter scratching times (p=0.004 and longer latency times when compared to Group 2. Preemptive use of lidocaine 2% can potentially reduce the postoperative neuropathic pain associated with sciatic nerve compression.A analgesia preemptiva inibe a progressão da dor causada por lesão cirúrgica. Para analisar o efeito da lidocaína na diminuição da dor pós-operatória, submetemos ratos Wistar a compressão cirúrgica do nervo ciático e observamos diferenças em alguns padrões de comportamento entre o grupo tratado com lidocaína pré-operatória e o grupo não-tratado com o anestésico local. O grupo 1 não foi operado (controle; o grupo 2, submetido a ligadura do nervo ciático sem lidocaína, apresentou significativo aumento do tempo de coçar-se com um pico no 14º pós-operatório (p=0.0005 e redução na latência para os estímulos térmicos nocivo (p=0.003 e não-nocivo (p=0.004; o grupo 3, operado com a droga preemptiva, demonstrou significativo decréscimo no tempo de coçar-se (p=0.004 e maiores tempos de latência quando comparados aos do grupo 2. O uso preemptivo da lidocaína 2% pode, potencialmente, reduzir a dor neuropática pós-operatória associada à compress

The effects of preoperative oral administration of carprofen or tramadol on postoperative analgesia in dogs undergoing cutaneous tumor removal.

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Karrasch, Nicole M; Lerche, Phillip; Aarnes, Turi K; Gardner, Heather L; London, Cheryl A

2015-08-01

This prospective, blinded, controlled clinical study compared the effects of pre-emptive oral administration of carprofen or tramadol on pain scores and analgesic requirement in dogs undergoing cutaneous tumor removal. Thirty-six client-owned dogs presenting for cutaneous tumor removal were randomly assigned to receive carprofen, tramadol, or no treatment prior to surgery. Pain was assessed using a visual analog scale (VAS), the Modified Glasgow Composite Measure Pain Score (MGCMPS), and algometry at enrollment, prior to premedication, at extubation, then hourly for the first 4 h, and every 4 h for 24 h. Dogs scoring ≥ 7 (MGCMPS), or having a VAS measurement ≥ 40 mm were given rescue analgesia. There were no significant differences in pain VAS, MGCMPS, or algometry. There were no differences in rescue analgesia requirement, or time to rescue analgesia among groups. Carprofen, tramadol, or no pre-emptive analgesia, combined with pre-operative hydromorphone and rescue analgesia, resulted in satisfactory analgesia in the 24-hour postoperative period.

OUR EXPERIENCE WITH EPIDURAL LABOUR ANALGESIA

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Uršula Reš Muravec

2003-12-01

, headache, a drop in blood pressure were not increased in none of the regional analgesia technique group.Conclusions. Since regional analgesic techniques offer excellent labour pain relief with minimal adverse effects on labour outcome, it is reasonable to proceed using them in the future, as well as to thoroughly inform the parturient about this effective method of pain relief prior to labour.

Electroencephalographic Changes Associated with Antinociceptive Actions of Lidocaine, Ketamine, Meloxicam, and Morphine Administration in Minimally Anaesthetized Dogs

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Ubedullah Kaka

2015-01-01

Full Text Available Effects of ketamine and lidocaine on electroencephalographic (EEG changes were evaluated in minimally anaesthetized dogs, subjected to electric stimulus. Six dogs were subjected to six treatments in a crossover design with a washout period of one week. Dogs were subjected to intravenous boluses of lidocaine 2 mg/kg, ketamine 3 mg/kg, meloxicam 0.2 mg/kg, morphine 0.2 mg/kg and loading doses of lidocaine 2 mg/kg followed by continuous rate infusion (CRI of 50 and 100 mcg/kg/min, and ketamine 3 mg/kg followed by CRI of 10 and 50 mcg/kg/min. Electroencephalogram was recorded during electrical stimulation prior to any drug treatment (before treatment and during electrical stimulation following treatment with the drugs (after treatment under anaesthesia. Anaesthesia was induced with propofol and maintained with halothane at a stable concentration between 0.85 and 0.95%. Pretreatment median frequency was evidently increased (P<0.05 for all treatment groups. Lidocaine, ketamine, and morphine depressed the median frequency resulting from the posttreatment stimulation. The depression of median frequency suggested evident antinociceptive effects of these treatments in dogs. It is therefore concluded that lidocaine and ketamine can be used in the analgesic protocol for the postoperative pain management in dogs.

A comparison of buffered lidocaine versus ELA-Max before peripheral intravenous catheter insertions in children.

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Luhmann, Janet; Hurt, Sarah; Shootman, Mario; Kennedy, Robert

2004-03-01

Peripheral intravenous catheter (PIV) insertion is a common, painful experience for many children in the pediatric emergency department. Although local anesthetics such as injected buffered lidocaine have been shown to be effective at reducing pain and anxiety associated with PIV insertion, they are not routinely used. ELA-Max, a topical local anesthetic, has the advantage of needle-free administration but has not been compared with buffered lidocaine for PIV insertion. To compare the reduction of pain and anxiety during PIV insertion provided by subcutaneous buffered 1% lidocaine or topical ELA-Max in children. A randomized trial in children 4 to 17 years old undergoing PIV insertion with 22-gauge catheters was conducted. Children received either buffered lidocaine or ELA-Max. Buffered lidocaine was administered by using 30-gauge needles to inject 0.1 to 0.2 mL subcutaneously just before PIV insertion. ELA-Max was applied to the skin and occluded with Tegaderm 30 minutes before PIV insertion. Self-reported Visual Analog Scale (VAS) questionnaires (rating on a scale of 1-10; 1 = no pain, anxiety) were completed by patients and their parents before PIV insertion to assess baseline perceptions about pain and anxiety associated with PIV insertion and immediately after PIV insertion to assess pain and anxiety associated with the experience. After PIV insertion, the nurse who inserted the PIV also completed a VAS questionnaire assessing technical difficulty and satisfaction with the local anesthesia. A blinded observer also completed a VAS questionnaire to assess pain and anxiety associated with the PIV insertion. Data were analyzed by using chi2 and t tests. Sixty-nine subjects were enrolled, and questionnaires were competed by all (mean age: 12.1 +/- 4.5 years; 61% female). There were no differences for buffered lidocaine and ELA-Max groups in age, gender, race, prior IV experience, or baseline pain and anxiety. There were no significant differences between buffered

The Report of Suicide by Ingestion of Lidocaine Topical Spray

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Hossein Hassanian-Moghaddam

2014-09-01

Full Text Available Background: Lidocaine is a local anesthetic and antiarrhythmic agent. There are reports on accidental and intentional cases of poisoning following injection of lidocaine while rare are the fatal cases realized after oral ingestion of lidocaine. Suicidal poisoning with lidocaine pharmaceutical formulations is rare since no pharmaceutical dosage forms for oral use are available except gels and sprays used as local anesthetics in dentistry. Cases: Three cases of suicidal poisoning by ingestion of the content of lidocaine topical spray are reported in the present study. The cases developed episodes of seizure requiring diazepam and other therapeutic modalities upon admission. Eventually, one of the cases expired. Conclusion: To the best of our knowledge, this study is the first reported case of suicidal poisoning after ingestion of this formulation which highlights the fact that lidocaine topical spray formulation may be used for committing suicide. Ingestion of lidocaine present in topical spray can induce varying levels of toxicity that can even be fatal.

Anesthetic duration of lidocaine with 10% dextran is comparable to lidocaine with 1:160 000 epinephrine after intraosseous injection in the rabbit.

Science.gov (United States)

Ito, Emiko; Ichinohe, Tatsuya; Shibukawa, Yoshiyuki; Aida, Hidetaka; Kaneko, Yuzuru

2007-09-01

To compare the effects of 10% dextran and epinephrine on intraosseous injection with lidocaine in rabbits. Twenty male Japanese white rabbits were used. The effect of intraosseous injection was evaluated using an electromyogram (EMG) of the digastric muscle after electrical pulp stimulation. Two percent lidocaine alone (L), 2% lidocaine containing 1:80000 epinephrine (LE8), 2% lidocaine containing 1:160 000 epinephrine (LE16), and 2% lidocaine containing 10% dextran (LD) were tested. Electromyogram recordings were repeated before and 30 seconds, 1, 2, 3, 4, 5, 7, 10, 12, 15, and 20 minutes after the intraosseous injection. Thereafter, recordings were repeated every 5 minutes until the EMG recovered to the control value. There was no difference in the onset time between the 4 groups. The order of the duration of maximum effect was LE8 >LE16 = LD >or=L. The order of the duration of anesthesia was LE8 >LE16 = LD >L. Ten percent dextran potentiates local anesthetic effects of 2% lidocaine in intraosseous injection. The potency of 10% dextran is comparable to 1:160 000 epinephrine.

Does the use of ketamine or nitroglycerin as an adjuvant to lidocaine improve the quality of intravenous regional anesthesia?

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Elmetwaly Khaled

2010-01-01

Full Text Available Aims: To compare and evaluate the effect of adding ketamine or nitroglycerin (NTG as adjuncts to lidocaine for intravenous regional anesthesia (IVRA on intraoperative and postoperative analgesia, sensorial and motor block onset times, and tourniquet pain. Settings and Design: A prospective, randomized, double-blind study was carried out. Materials and Methods: Seventy-five patients undergoing hand surgery were divided into three groups as follows: control group receiving lidocaine 2%, LK group receiving lidocaine 2% with ketamine, and LN group administered lidocaine 2% with NTG. Sensory and motor blocks′ onset and recovery times were recorded. Visual analog scale (VAS for tourniquet pain was measured after tourniquet application and it was also used to measure postoperative pain. Analgesic consumption for tourniquet pain and postoperatively were recorded. Results: Sensory block onset times were shorter in the LK (4.4 ± 1.2 minutes and LN (3.5 ± 0.9 minutes groups compared with the control group (6.5 ± 1.1 minute (P < 0.0001 and motor block onset times were shorter in the LK (7.3 ± 1.6 minutes and LN (3.6 ± 1.2 minutes groups compared with the control group (10.2 ± 1.5 minutes (P< 0.0001. Sensory recovery time prolonged in the LK (6.7 ± 1.3 minutes and LN (6.9 ± 1.1 minutes groups compared with the control group (5.3 ± 1.4 minutes (P = 0.0006 and < 0.0001, respectively. Motor recovery time prolonged in the LK (8.4 ± 1.4 minutes and LN (7.9 ± 1.1 minutes groups compared with the control group (7.1 ± 1.3 minutes (P = 0.0014 and 0.023, respectively. The sensory and motor block onset times were also shorter in LN group than in the LK group (3.5 ± 0.9 versus 4.4 ± 1.2 minutes, P=0.004; and 3.6 ± 1.2 versus 7.3 ± 1.6 minutes, P < 0.0001, respectively. The amount of fentanyl required for tourniquet pain was less in adjuvant groups when compared with control group. It was 13.6 ± 27.9 and 27.6 ± 34.9 μg in LK group and LN groups

Use of wound soaker catheters for the administration of local anesthetic for post-operative analgesia: 56 cases.

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Abelson, Amanda L; McCobb, Emily C; Shaw, Scott; Armitage-Chan, Elizabeth; Wetmore, Lois A; Karas, Alicia Z; Blaze, Cheryl

2009-11-01

To describe the administration of local anesthetic through wound soaker catheters for post-operative veterinary patients and to characterize complications. Retrospective study of hospital records. Records of patients in which a wound soaker catheter was placed post-operatively between November 1, 2004 and July 1, 2006 at a veterinary teaching hospital. Records in which a limb amputation was performed between January 1, 2002 and August 1, 2007 and in which a wound soaker catheter was not placed were reviewed for historic control. A total of 56 cases were identified in which a wound soaker catheter was placed post-operatively including 52 dogs, 2 cats, and 2 goats. Twenty canine cases were identified in which limb amputation was performed and no wound soaker catheter was placed. The majority of surgical procedures for which a wound soaker catheter was placed included thoracic limb amputation (46.4%) and pelvic limb amputation (35.7%). Wound soaker catheters remained in place for an average of 1.6 +/- 0.5 days. Feline and caprine patients received intermittent bupivacaine boluses every 6 hours. Canine patients received continuous lidocaine infusions. Complications included disconnection of the catheter from the infusion (7.7%), one seroma, and one suspected lidocaine neurotoxicity. Incisional infections were noted in 3/56 (5.3%) limb amputations with wound soaker catheters placed which was not higher than the incisional infection rate found in the historic control cases 3/20 (15%). Use of the wound soaker catheter was a viable means of providing local analgesia in post-operative veterinary patients. Studies are needed to evaluate efficacy of pain management, and to further investigate techniques for catheter placement and maintenance which may help to optimize the analgesia achieved using this technique.

Effects of lidocaine injections into the lateral parabrachial nucleus on dipsogenic and pressor response to central angiotensin 2 in rats

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Menani, Jose Vanderlei; Beltz, Terry G.

1995-01-01

This study investigated the effects of bilateral injections of the local anesthetic, lidocaine, into the lateral parabrachial nucleus (LPBN) on the dipsogenic and pressor responses induced by intracerebroventricular (i.c.v.) injection of angiotensin 2 (ANG 2). Centrally injected ANG 2 (50 ng/1 microliter) induced water intake ( IO.2 +/- 0.8 ml/h) and pressor responses (22 +/- 1 mmHg). Prior bilateral injection of 10% lidocaine (200 nl) into the LPBN increased the water intake (14.2 +/- 1.4 ml/h), but did not change the pressor response (17 +/- 1 mmHg) to i.c.v. ANG 2. Lidocaine alone injected into the LPBN also induced a pressor response (23 +/- 3 mmHg). These results showing that bilateral LPBN injection of lidocaine increase water intake induced bv i.c.v. ANG 2 are consistent with electrolytic and neurotoxic lesion studies and suggest that the LPBN is associated with inhibitory mechanisms controlling water intake induced by ANG 2. These results also provide evidence that it is feasible to reversibly anesthetize this brain area to facilitate fluid-related ingestive behavior.

DOES THE ADDITION OF DEXAMETHASON TO LOCAL ANESTHETIC PROLONG THE ANALGESIA OF INTERSCALEN PLEXUS BRACHIALIS BLOCK IN PATIENTS WITH SHOULDER SURGERY?

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Nancheva Jasminka

2016-07-01

Full Text Available Abstract: Introduction: Peripherial nerve blocks is a suitable alternative to general anesthesia especially for one-day case surgery. Interscalene approach of plexus brachialis block as much as supraclavicular and infraclavicular provide reliable, safe, effective, low cost and most complete anesthesia with satisfactory postoperative analgesia for upper limb surgery. Postoperative analgesia of plexus brachialis blocks can be prolonged by using different drugs as adjuvants with local anesthetics. Dexamethasone has been shown to prolong the duration of postoperative analgesia when given as an adjunct for peripheral nerve blocks. The investigation was randomized, prospective, double blinded and controlled study. Objective: The study was designed to compare the effects of dexamethasone administered as an adjunct to bupivacaine in interscalene brachial plexus block on the onset, duration and postoperative analgesia in patients under the shoulder surgery. Methods: A prospective, double-blind study was undertaken in patients scheduled for shoulder surgeries under the interscalene brachial plexus block. We enrolled 60 patients, ASA I-II both sexes, aged 19-65 years, weighing 54-89 kg, divided to two groups G1 and G2. The brachial plexus block was performed by interscalene approach and mixture of 2% lidocaine (12ml and 0.5% bupivacaine (22 ml either alone or combined with dexamethasone (4 mg. The block was performed by using double technique neurostimulator/ultrasound technique. Results: In our investigation we found a significant increase in onset and duration of motor and sensory block in Group G2 (with dexamethasone as compared to Group G1 patients (p < 0.01. Conclusion: Addition of dexamethasone to local anesthetic drugs in interscalene plexus brachialis block, significantly prolongs the duration of analgesia and motor block in patients undergoing shoulder arthroscopy. Moreover, it is a remarkably safe and costeffective method of providing

21 CFR 522.1662b - Oxytetracycline hydrochloride with lidocaine injection.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Oxytetracycline hydrochloride with lidocaine... FORM NEW ANIMAL DRUGS § 522.1662b Oxytetracycline hydrochloride with lidocaine injection. (a) Specifications. The drug contains 50 or 100 milligrams of oxytetracycline hydrochloride and 2 percent lidocaine...

Epidural analgesia in cattle, buffalo, and camels

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Zuhair Bani Ismail

2016-12-01

Full Text Available Epidural analgesia is commonly used in large animals. It is an easy, cheap, and effective technique used to prevent or control pain during surgeries involving the tail, anus, vulva, perineum, caudal udder, scrotum, and upper hind limbs. The objectives of this article were to comprehensively review and summarize all scientific data available in the literature on new techniques and drugs or drug combinations used for epidural anesthesia in cattle, camel, and buffalo. Only articles published between 2006 and 2016 were included in the review. The most common sites for epidural administration in cattle, camels, and buffalos were the sacrococcygeal intervertebral space (S5-Co1 and first intercoccygeal intervertebral space (Co1-Co2. The most frequently used drugs and dosages were lidocaine (0.22-0.5 mg/kg, bupivacaine (0.125 mg/kg, ropivacaine (0.11 mg/kg, xylazine (0.05 mg/kg, medetomidine (15 μg/kg, romifidine (30-50 μg/kg, ketamine (0.3-2.5 mg/kg, tramadol (1 mg/kg, and neostigmine (10 μg/kg, and the clinical applications, clinical effects, recommendations, and side effects were discussed.

Low-dose intravenous lidocaine as treatment for proctalgia fugax.

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Peleg, Roni; Shvartzman, Pesach

2002-01-01

Proctalgia fugax is characterized by a sudden internal anal sphincter and anorectic ring attack of pain of a short duration. Description of the influence of intravenous lidocaine treatment for proctalgia fugax. A 28-year-old patient suffering of proctalgia fugax for 8 months. Conventional treatment efforts did not improve his condition. A single dose of an intravenous lidocaine infusion completely stopped his pain attacks. Based on the experience reported in this case and the potential benefit of this treatment for proctalgia fugax, controlled studies comparing intravenous lidocaine with placebo should be conducted to confirm the observation and to provide a more concrete basis for the use of intravenous lidocaine for this indication.

Under Utilization of Local Anesthetics in Infant Lumbar Punctures

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Gorchynski, Julie

2008-01-01

Full Text Available Background: Lumbar Puncture (LP is an invasive procedure frequently used to diagnose meningitis among the pediatric population. Neonates and infants have not routinely received local anesthesia prior to LP. Study Objective: To determine whether emergency medicine physicians and pediatricians use local analgesics on neonates and infants prior to performing an LP and to identify which local anesthetics, if any, were used. Methods: Prospective, cohort study of all infants, six months of age or less, that received an LP in the emergency department (ED or inpatient pediatric units for suspected meningitis during a period of year at a university tertiary care hospital. Results: A total sample population of 111 infants that received an LP within the study period. A control population of 42 adults received an LP. Only 40.4% (45/111 of the infants received local analgesia prior to LP: either 1% lidocaine, EMLA or a combination of the two. Infants were less likely to receive lidocaine or EMLA prior to LP compared to adult subjects (OR= 0.27; 95% CI0.12 to 0.62. No neonates that were less than one month of age received local procedural anesthesia by emergency medicine or pediatric physicians. ED physicians’ use of local anesthesia prior to LP increased with increasing age of the infant. The pediatricians in this study used local anesthesia prior to LP when the infant was at least five months of age. Discussion: The data objectively support recent literature regarding the under use or lack of use of analgesia prior to LP among neonates and infants. Local anesthetics should be used routinely without exception prior to performing an LP in the pediatric population.

Local anesthetic effects of Lidocaine cream: randomized controlled trial using a standardized prick pain.

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Herberger, Katharina; Krause, Karoline; Maier, Kristina; Zschocke, Ina; Radtke, Marc; Augustin, Matthias

2012-12-01

ELA-max (4% lidocaine) and EMLA cream (lidocaine-prilocaine 2.5%) are topicals used for superficial anesthesia. Only few studies have been published on their comparative effectiveness in close-to-practice pain models. (1) To evaluate the analgesic efficacy of lidocaine cream compared with lidocaine-prilocaine cream and placebo. (2) To assess the safety and tolerability. Randomized, three-arm, double-blind trial in 40 healthy volunteers comparing the anesthetic effects of Lidocaine and lidocaine-prilocaine cream to placebo at various time points (0-120 min). A standardized pain was induced by lancet pricks and measured by a visual analogue scale. Intra-individual comparison between the test areas was performed in a cross-over design. Lidocaine showed significantly reduced pain compared to placebo at all assessment points. Pain reduction was achieved significantly earlier using lidocaine occlusively (30 min). No significant differences were found concerning the anesthetic efficacy of lidocaine and lidocaine-prilocaine cream. There were no relevant adverse events. This study confirms that a topical preparation with 4% lidocaine is an effective and safe treatment option for superficial anesthesia. It supports the claim that an occlusive application is more rapid in action. 4% lidocaine is of value as a rapidly-acting local anesthetic for the treatment of minor surgical procedures.

Preventive analgesia

DEFF Research Database (Denmark)

Dahl, Jørgen B; Kehlet, Henrik

2011-01-01

This paper will discuss the concepts of pre-emptive and preventive analgesia in acute and persistent postsurgical pain, based on the most recent experimental and clinical literature, with a special focus on injury-induced central sensitization and the development from acute to chronic pain. Recent...... of preventive analgesia for persistent postoperative pain are promising. However, clinicians must be aware of the demands for improved design of their clinical studies in order to get more conclusive answers regarding the different avenues for intervention. Summary: The concept of preventive analgesia is still...

Effects of entonox in comparison of lidocaine on pain severity during episiotomy incision in nulliparous women: A randomized control trial

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Azam Honarmandpour

2017-01-01

Full Text Available Background & Aim: Episiotomy is one of the most common surgical procedures in obstetrics, which requires analgesia. Entonox gas is known to have analgesic and sedative properties. However, no studies have been found on the analgesic effects of Entonox on episiotomy incision. Therefore, this study aimed to compare the effects of Entonox and lidocaine on pain intensity during episiotomy incision in nulliparous women. Materials and Methods: This randomized controlled trial was conducted on 120 term nulliparous women, who met the inclusion criteria. Subjects were selected by randomized sampling and equally divided into two groups of intervention and control (n=60. In the intervention group, Entonox gas was applied two minutes before episiotomy incision until the end of the procedure. On the other hand, the control group received 5 ml of lidocaine 2% as routine care before episiotomy incision. Data were collected using visual analogue scale to compare the study groups in terms of pain intensity. In addition, patient satisfaction with pain management technique during episiotomy and side effects of Entonox were assessed. Data analysis was performed in SPSS version 22 using Mann-Whitney U and Chi-square tests, and P value of less than 0.05 was considered statistically significant. Results: In this study, no significant difference was observed between the intervention and control groups regarding pain intensity (P=0.52. Moreover, no significant difference was observed in the satisfaction level of the two groups (P=0.70. Conclusion: According to the results of this study, Entonox could be used as an effective and noninvasive alternative to lidocaine to reduce pain during episiotomy incision without significant side effects.

Comparison of the Concentrations of Lidocaine in Different Body Fluids/Tissues after Subarachnoid Space and Intravenous Administration of a Lethal Dose of Lidocaine

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Nan Zhang

2015-01-01

Full Text Available The objective of the study was to compare the concentration of lidocaine in different body fluids/tissues after subarachnoid space and intravenous administrations of a lethal dose of lidocaine. Totally 18 dogs were used in the experiment. Six dogs were given subarachnoid anesthesia, another were given an intravenous injection of a dose of 75 mg/kg weight of lidocaine hydrochloride in 5 min and the last 6 dogs were used as the blank control dogs and given a subarachnoid space injection or a femoral artery injection of the same volume of sodium chloride. As soon as its vital signs disappeared, each dog was dissected and the specimen, such as brain, cerebrospinal fluid (CSF in lateral ventricle, CSF in subarachnoid space, spinal cord (cervical spinal cord, thoracic spinal cord, lumbar spinal cord, and waist spinal cord, heart, lung, liver, spleen, kidney, bile, urine, heart blood, peripheral blood, muscle in injection location, and muscle in no injection location, were collected for analysis of lidocaine immediately. Analysis was performed with gas chromatography-mass spectrometry (GC-MS. From the maximum to the minimum, the order of lidocaine concentration detected in the subarachnoid space-administered dogs was as follows: CSF in subarachnoid space, waist spinal cord, thoracic spinal cord, CSF in lateral ventricle, lumbar spinal cord, cervical spinal cord, lung, kidney, muscle in injection location, heart, brain, spleen, heart blood, liver, peripheral blood, bile, muscle in no injection location, and urine. The order of lidocaine concentration detected in the intravenously administered dogs was as followed: Kidney, heart, lung, spleen, brain, liver, peripheral blood, bile, heart blood, cervical spinal cord, thoracic spinal cord, muscle in injection location, lumbar spinal cord, muscle in no injection location, CSF in subarachnoid space, urine, and CSF in lateral ventricle. The maximum concentration of lidocaine was detected in the subarachnoid

Evaluation of lidocaine treatment and risk factors for death associated with gastric dilatation and volvulus in dogs: 112 cases (1997-2005).

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Buber, Tali; Saragusty, Joseph; Ranen, Eyal; Epstein, Ana; Bdolah-Abram, Tali; Bruchim, Yaron

2007-05-01

To determine clinical features, outcome, risk factors for death, and efficacy of IV administration of lidocaine as a prophylactic treatment for ischemic reperfusion injury in gastric dilatation and volvulus (GDV) in dogs. Retrospective case series. 112 dogs with GDV. Data pertaining to breed; time lag to admission; clinical, clinicopathologic, and surgical findings; lidocaine treatment; and postoperative complications were assessed for association with outcome. German Shepherd Dogs (28.6%) and Great Danes (17%) were significantly over-represented. Risk factors for death included time lag (> or = 5 hours vs 38 degrees C [ 100.4 degrees F]) at admission (40.0% vs 14.9%), presence or absence of ARF (67.0% vs 23.3%), presence or absence of suspected gastric wall necrosis (59.3% vs 16.0%), and untreated gastric wall necrosis, compared with treated gastric wall necrosis (100% vs 47.6%). Overall mortality rate was 26.8%; no significant differences were detected in mortality rate or postoperative complications between dogs that received lidocaine IV prior to surgical intervention (52.0%) and dogs that did not (48.0%). Mean +/- SD hospitalization time was longer in the lidocaine treatment group (3.5 +/- 1.9 days vs 2.5 +/- 1.4 days). Presence of the identified risk factors should warrant aggressive treatment. Lidocaine treatment was not associated with mortality rate or postoperative complications, but was associated with prolonged hospitalization time.

Intravenous lidocaine infusion--a new treatment of chronic painful diabetic neuropathy?

DEFF Research Database (Denmark)

Kastrup, J; Petersen, P; Dejgård, A

1987-01-01

after lidocaine infusion compared to after saline infusion (P less than 0.05 and P less than 0.02, respectively). The duration of the individual effect ranged from 3 to 21 days. Lidocaine infusion had no effect on the objective measurements of neuropathy. Intravenous lidocaine infusion seems to be a new...

Kidney ischemia and reperfunsion syndrome: effect of lidocaine and local postconditioning

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IGOR NAGAI YAMAKI

Full Text Available ABSTRACT Objective: to evaluate the effects of blocking the regulation of vascular tone on the ischemia and reperfusion syndrome in rats through the use of lidocaine in the postconditioning technique. Methods: we randomized 35 rats into seven groups of five animals: Group 1- Control; Group 2- Ischemia and Reperfusion; Group 3- Ischemia, Reperfusion and Saline; Group 4- Ischemic Postconditioning; Group 5- Ischemic Postconditioning and Saline; Group 6- Lidocaine; Group 7- Ischemic Postconditioning and Lidocaine. Except for the control group, all the others were submitted to renal ischemia for 30 minutes. In postconditioning groups, we performed ischemia and reperfusion cycles of five minutes each, applied right after the main ischemia. In saline and lidocaine groups, we instilled the substances at a rate of two drops per minute. To compare the groups, we measured serum levels of urea and creatinine and also held renal histopathology. Results: The postconditioning and postconditioning + lidocaine groups showed a decrease in urea and creatinine values. The lidocaine group showed only a reduction in creatinine values. In histopathology, only the groups submitted to ischemic postconditioning had decreased degree of tubular necrosis. Conclusion: Lidocaine did not block the effects of postconditioning on renal ischemia reperfusion syndrome, and conferred better glomerular protection when applied in conjunction with ischemic postconditioning.

Lidocaine/L-Menthol Binary System: Cocrystallization versus Solid-State Immiscibility

OpenAIRE

Corvis , Yohann; Négrier , Philippe; Lazerges , Mathieu; Massip , Stéphane; Léger , Jean-Michel; Espeau , Philippe

2010-01-01

International audience; We present the synthesis, structure determination, and thermodynamic properties of a never reported cocrystal prepared with lidocaine and L-menthol. The temperature-composition phase diagram of the lidocaine/L-menthol binary system was achieved using differential scanning calorimetry and X-ray diffraction experiments. The present study demonstrates that the only way to perform a phase equilibrium survey of the lidocaine/L-menthol system is to prepare the binary mixture...

Lidocaine for systemic sclerosis: a double-blind randomized clinical trial

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Trevisani Virgínia FM

2011-02-01

Full Text Available Abstract Background Systemic sclerosis (scleroderma; SSc is an orphan disease with the highest case-specific mortality of any connective-tissue disease. Excessive collagen deposit in affected tissues is a key for the disease's pathogenesis and comprises most of the clinical manifestations. Lidocaine seems to be an alternative treatment for scleroderma considering that: a the patient's having excessive collagen deposits in tissues affected by scleroderma; b the patient's demonstrating increased activity of the enzyme prolyl hydroxylase, an essential enzyme for the biosynthesis of collagen; and c lidocaine's reducing the activity of prolyl hydroxylase. The aim of this study was to evaluate the efficacy and safety of lidocaine in treating scleroderma. Methods A randomized double-blind clinical trial included 24 patients with scleroderma randomized to receive lidocaine or placebo intravenously in three cycles of ten days each, with a one-month interval between them. Outcomes: cutaneous (modified Rodnan skin score, oesophageal (manometry and microvascular improvement (nailfold capillaroscopy; improvement in subjective self-assessment and in quality of life (HAQ. Results There was no statistically significant difference between the groups for any outcome after the treatment and after 6-months follow-up. Improvement in modified Rodnan skin score occurred in 66.7% and 50% of placebo and lidocaine group, respectively (p = 0.408. Both groups showed an improvement in subjective self-assessment, with no difference between them. Conclusions Despite the findings of a previous cohort study favouring the use of lidocaine, this study demonstrated that lidocaine at this dosage and means of administration showed a lack of efficacy for treating scleroderma despite the absence of significant adverse effects. However, further similar clinical trials are needed to evaluate the efficacy of lidocaine when administered in different dosages and by other means.

Radioiodination and Biological Evaluation of Lidocaine for Diagnostic Purposes

International Nuclear Information System (INIS)

Attallah, K.M.

2011-01-01

Lidocaine is a common local anesthetic drug. 125 I-Lidocaine was prepared with labeling yield about 95%. The conditions required to obtain this yield were 50 μg substrate, 50 μg CAT, 5-10 min reaction time, ph 7 and at room temperature. Different chromatographic techniques (electrophoresis and thin layer chromatography TLC) were used to evaluate the radiochemical yield and purity of the labeled product. Biodistribution studies were carried out in normal Albino Swiss mice and the result indicate the possibility of using 125 I-Lidocaine to be used as imaging agent

Analgesia adjuvante e alternativa Analgesia adyuvante y alternativa Adjuvant and alternative analgesia

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Nilton Bezerra do Vale

2006-10-01

Full Text Available JUSTIFICATIVA E OBJETIVOS: Embora a dor aguda e a crônica sejam habitualmente controladas com intervenções farmacológicas, 14 métodos complementares de analgesia adjuvante e alternativa (AAA podem reduzir o uso e abuso na prescrição de analgésicos e diminuir os efeitos colaterais que eventualmente comprometem o estado fisiológico do paciente. CONTEÚDO: Todos os mecanismos antiálgicos atuam através da via espinal de controle da comporta de Melzack e Wall e/ou através da transdução do sinal nos sistemas de neurotransmissão e neuromodulação central relacionados com analgesia, relaxamento e humor: peptidérgico, monaminérgico, gabaérgico, colinérgico e canabinóide. A analgesia adjuvante complementar é habitualmente utilizada nos tratamentos fisiátricos, ortopédicos, reumatológicos, obstétricos e com acupuntura. A analgesia alternativa complementar pode potencializar os métodos analgésicos convencionais, a exposição à luz do sol matutino, luz e cores sob luz artificial, o tempo (T - anestésicos gerais mais potentes à noite, opióides de manhã e anestésicos locais à tarde, dieta, bom humor e riso, espiritualidade, religião, meditação, musicoterapia, hipnose e efeito placebo. CONCLUSÕES: Se a dor aguda é um mecanismo de defesa, a dor crônica é um estado patológico desagradável relacionado com a depressão endógena e a uma baixa qualidade de vida. É importante estabelecer relações interdisciplinares entre a Medicina adjuvante e alternativa nas terapias analgésicas e antiinflamatórias clássicas.JUSTIFICACIÓN Y OBJETIVOS: Aunque el dolor agudo y el crónico sean habitualmente controlados con intervenciones farmacológicas, 14 métodos complementarios de analgesia adyuvante y alternativa (AAA pueden reducir el uso y el abuso en la prescripción de analgésicos y disminuir los efectos colaterales que eventualmente comprometen el estado fisiológico del paciente. CONTENIDO: Todos los mecanismos anti

Remifentanil patient controlled analgesia versus epidural analgesia in labour. A multicentre randomized controlled trial

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Freeman Liv M

2012-07-01

Full Text Available Abstract Background Pain relief during labour is a topic of major interest in the Netherlands. Epidural analgesia is considered to be the most effective method of pain relief and recommended as first choice. However its uptake by pregnant women is limited compared to other western countries, partly as a result of non-availability due to logistic problems. Remifentanil, a synthetic opioid, is very suitable for patient controlled analgesia. Recent studies show that epidural analgesia is superior to remifentanil patient controlled analgesia in terms of pain intensity score; however there was no difference in satisfaction with pain relief between both treatments. Methods/design The proposed study is a multicentre randomized controlled study that assesses the cost-effectiveness of remifentanil patient controlled analgesia compared to epidural analgesia. We hypothesize that remifentanil patient controlled analgesia is as effective in improving pain appreciation scores as epidural analgesia, with lower costs and easier achievement of 24 hours availability of pain relief for women in labour and efficient pain relief for those with a contraindication for epidural analgesia. Eligible women will be informed about the study and randomized before active labour has started. Women will be randomly allocated to a strategy based on epidural analgesia or on remifentanil patient controlled analgesia when they request pain relief during labour. Primary outcome is the pain appreciation score, i.e. satisfaction with pain relief. Secondary outcome parameters are costs, patient satisfaction, pain scores (pain-intensity, mode of delivery and maternal and neonatal side effects. The economic analysis will be performed from a short-term healthcare perspective. For both strategies the cost of perinatal care for mother and child, starting at the onset of labour and ending ten days after delivery, will be registered and compared. Discussion This study, considering cost

Lidocaine Hydrochloride Compared with MS222 for the Euthanasia of Zebrafish (Danio rerio)

Science.gov (United States)

Collymore, Chereen; Banks, E Kate; Turner, Patricia V

2016-01-01

Despite several shortcomings, MS222 is the most commonly used chemical agent for euthanasia of zebrafish. Although lidocaine hydrochloride has some advantages over MS222, its effectiveness as a euthanasia agent for zebrafish is unknown. Larvae at 9 to 16 d postfertilization were exposed to 250 mg/L MS222 or 400, 500, 600, 700, 800, 900, or 1000 mg/L lidocaine and observed for cessation of heartbeat. Adult zebrafish were exposed to 250 mg/L MS222 or 400, 500, or 600 mg/L lidocaine; times to loss of righting reflex, cessation of opercular movement, and complete recovery; body length; aversive behavior; and gross and microscopic evidence of acute toxicity were evaluated. The heartbeat was not lost from any larvae in any group, regardless of drug or dosage. For adults, time to loss of righting reflex was greatest in the 500-mg/L lidocaine group. Opercular movement ceased earlier in all lidocaine groups compared with the MS222 group. Fish in the 500-mg/L lidocaine group were smaller than those in other groups. Fewer fish in the lidocaine groups displayed aversive behavior (erratic swimming and piping) compared with the MS222 group. No fish in the lidocaine hydrochloride groups (n = 30) recovered from euthanasia, whereas one fish in the MS222 group did (n = 10). Neither the MS222 nor lidocaine groups showed any gross or histologic changes suggestive of acute toxicity. Our results suggest that lidocaine hydrochloride may be an effective alternative chemical euthanasia agent for adult zebrafish but should not be used in larval fish. PMID:27931323

Pharmacokinetics of lidocaine in nonpregnant and pregnant ewes.

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Santos, A C; Pedersen, H; Morishima, H O; Finster, M; Arthur, G R; Covino, B G

1988-12-01

The pharmacokinetics of lidocaine were studied in nonpregnant and pregnant ewes. The maternal femoral vessels were cannulated and, on the day of study, the urinary bladder was catheterized. Lidocaine HCl, 4-5 mg/kg, was administered by IV injection over 60 seconds. Serial samples of arterial blood and urine were collected over 4 hours, and drug concentrations were determined using a gas chromatographic technique. The volume of the central compartment was greater in pregnant than in nonpregnant ewes (1.51 +/- 0.20 vs. 0.96 +/- 0.16 L/kg) as was the volume of distribution at steady state (Vdss): 3.24 +/- 0.40 vs. 1.88 +/- 0.32 L/kg. The volume of distribution during the terminal exponential phase of drug elimination (Vd beta) and total clearance of lidocaine (Cl) were also higher in pregnant animals: 4.17 +/- 0.50 L/kg and 99.6 +/- 8.5 ml.min-1.kg-1, respectively; compared to 2.46 +/- 0.48 L/kg and 44.1 +/- 6.5 ml.min-1.kg-1, in nonpregnant ewes. However, the balance between these changes in Vd beta and Cl did not result in a significant difference in the elimination half-life of lidocaine (38.1 +/- 2.1 minutes in nonpregnant and 31.9 +/- 3.0 minutes in pregnant ewes). If these data are applicable to humans, the risk of drug accumulation after repeated administration of lidocaine is no greater in pregnant than in nonpregnant patients.

Effect of fentanyl and lidocaine on the end-tidal sevoflurane concentration preventing motor movement in dogs.

Science.gov (United States)

Suarez, Martin A; Seddighi, Reza; Egger, Christine M; Rohrbach, Barton W; Cox, Sherry K; KuKanich, Butch K; Doherty, Thomas J

2017-01-01

OBJECTIVE To determine effects of fentanyl, lidocaine, and a fentanyl-lidocaine combination on the minimum alveolar concentration of sevoflurane preventing motor movement (MAC NM ) in dogs. ANIMALS 6 adult Beagles. PROCEDURES Dogs were anesthetized with sevoflurane in oxygen 3 times (1-week intervals). Baseline MAC NM (MAC NM-B ) was determined starting 45 minutes after induction of anesthesia. Dogs then received 1 of 3 treatments IV: fentanyl (loading dose, 15 μg/kg; constant rate infusion [CRI], 6 μg/kg/h), lidocaine (loading dose, 2 mg/kg; CRI, 6 mg/kg/h), and the fentanyl-lidocaine combination at the same doses. Determination of treatment MAC NM (MAC NM-T ) was initiated 90 minutes after start of the CRI. Venous blood samples were collected at the time of each treatment MAC NM measurement for determination of plasma concentrations of fentanyl and lidocaine. RESULTS Mean ± SEM overall MAC NM-B for the 3 treatments was 2.70 ± 0.27 vol%. The MAC NM decreased from MAC NM-B to MAC NM-T by 39%, 21%, and 55% for fentanyl, lidocaine, and the fentanyl-lidocaine combination, respectively. This decrease differed significantly among treatments. Plasma fentanyl concentration was 3.25 and 2.94 ng/mL for fentanyl and the fentanyl-lidocaine combination, respectively. Plasma lidocaine concentration was 2,570 and 2,417 ng/mL for lidocaine and the fentanyl-lidocaine combination, respectively. Plasma fentanyl and lidocaine concentrations did not differ significantly between fentanyl and the fentanyl-lidocaine combination or between lidocaine and the fentanyl-lidocaine combination. CONCLUSIONS AND CLINICAL RELEVANCE CRIs of fentanyl, lidocaine, and the fentanyl-lidocaine combination at the doses used were associated with clinically important and significant decreases in the MAC NM of sevoflurane in dogs.

Effect of aquapuncture on postoperative analgesia after ovariohysterectomy in dogs

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Stelio Luna

2015-07-01

Full Text Available Aquapuncture (AqP consists of a water or saline solution injection into acupoints. This study aimed to evaluate the effect of aquapuncture on post-operative analgesia in bitches submitted to elective ovariohysterectomy (OHE. The study was prospective, randomised, and blinded for pain assessment. Sixteen dogs were randomly distributed in two groups of eight animals each. All animals were sedated with 0.05 mg kg-1 of acepromazine intramuscularly (IM, 30 minutes prior to induction of anaesthesia with propofol and maintenance with isoflurane. Eight animals underwent bilateral acupoint injection with 0.1 ml of 0.9% saline (AqP at Gall Bladder 34, Stomach 36, Liver 3 and Spleen 6 acupoints 15 minutes after sedation. Pain score was investigated after 0.5, 1, 2, 5, 8 and 24 hours post-operatively and was compared with a control untreated group of eight animals. Morphine, at 0.5 mg kg-1 IM, was administered when the numerical rating scale was above 33% of the maximum value, in order to control post-operative pain in both groups. There were no differences in cardiorespiratory variables and pain and sedation scores between the groups. Seven (87.5% animals from the control group required rescue analgesia at the first two postoperative hours and five (62.5% animals treated with AqP required rescue analgesia, however, only one (12.5% animal was treated at the first two hours and the remaining animals were treated from 5 hours after surgery. Aquapuncture produced residual analgesia up to 5 h after surgery and may be an option for post-operative analgesia in bitches undergoing OHE, providing that pain is assessed and rescue analgesia administered if necessary.

Adrenaline with lidocaine for digital nerve blocks.

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Prabhakar, Hemanshu; Rath, Santosh; Kalaivani, Mani; Bhanderi, Neel

2015-03-19

Surgery on fingers is a common procedure in emergency and day care surgery. Adrenaline combined with lidocaine can prolong digital nerve block and provide a bloodless operating field. Extended postoperative pain relief can reduce the need for analgesics and can facilitate hand rehabilitation. Conventionally, adrenaline is avoided at anatomical sites with end arteries such as digits, penis and pinna because of concerns about arterial spasm, ischaemia and gangrene distal to the site of drug infiltration. To assess the safety and efficacy of use of adrenaline (any dilution) combined with lidocaine (any dilution) for digital nerve blocks (fingers and toes). We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 11, 2014), MEDLINE via Ovid SP (1966 to 18 November 2014) and EMBASE via Ovid SP (1980 to 18 November 2014). We also searched specific websites, such as www.indmed.nic.in; www.cochrane-sadcct.org; and www.Clinicaltrials.gov. We included randomized controlled trials (RCTs) that compared the use of adrenaline with lidocaine and plain lidocaine in patients undergoing surgery on digits (fingers and toes). Our primary outcomes were duration of anaesthesia, adverse outcomes such as ischaemia distal to the injection site and cost analysis. Our secondary outcomes were duration of postoperative pain relief and reduced bleeding during surgery. We used standard methodological procedures expected by The Cochrane Collaboration. Two review authors independently extracted details of trial methodology and outcome data from reports of all trials considered eligible for inclusion. We performed all analyses on an intention-to-treat basis. We used a fixed-effect model when no evidence of significant heterogeneity between studies was found and a random-effects model when heterogeneity was likely. We included four RCTs with 167 participants. Risk of bias of the included studies was high, as none of them reported method of randomization, allocation concealment

Effect of lidocaine 2% on bacterial culture of bronchial fluid

International Nuclear Information System (INIS)

Samet, M.; Meybodi, F.A.A.; Mokarianpour, T.; Fallah, T.; Mongabadi, F.D.; Ayatollahi, J.; Shahcherghi, S.H.; Yazdi, M.H.A

2017-01-01

Objective:To evaluate the action of 2% lidocaine on the culture results of bronchial fluid in patients suspected of having lower respiratory tract infections. Study Design:Cross-sectional analytical study. Place and Duration of Study:Shahid Sadoughi Hospital, Yazd, Iran, from November 2014 to November 2015. Methodology:Patients suspected of lower respiratory tract infections referred to bronchoscopy unit of the Hospital were included. Those with incomplete questionnaire and bronchoscopy contraindication were excluded. Bronchial fluid was aspirated before and after local application of 2% lidocaine and cultured, according to the suspected clinical diagnosis. Finally, statistical analysis was performed using SPSS software, version 17.0. For statistical comparisons, McNemar's test was used. Level of significance was kept at p <0.05. Results:The mean age of the study population was 51.83 +-15.93 with a range of 25 - 80 years. Out of 130 patients, 60 patients had positive culture results. Nineteen (31.7%) cases had positive culture for tuberculosis and 41 (63.3%) cases had positive results for other bacteria before intervention that did not change after using 2% lidocaine (p=1). In 70 (53.84%) cases, results were negative before and after use of 2% lidocaine. Conclusion:No significant difference was found between culture results before and after the use of lidocaine. Therefore, lidocaine can be used during bronchoscopy to increase patient tolerance. (author)

Lidocaine patches reduce pain in trauma patients with rib fractures.

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Zink, Karen A; Mayberry, John C; Peck, Ellen G; Schreiber, Martin A

2011-04-01

Rib fracture pain is notoriously difficult to manage. The lidocaine patch is effective in other pain scenarios with an excellent safety profile. This study assesses the efficacy of lidocaine patches for treating rib fracture pain. A prospectively gathered cohort of patients with rib fracture was retrospectively analyzed for use of lidocaine patches. Patients treated with lidocaine patches were matched to control subjects treated without patches. Subjective pain reports and narcotic use before and after patch placement, or equivalent time points for control subjects, were gathered from the chart. All patients underwent long-term follow-up, including a McGill Pain Questionnaire (MPQ). Twenty-nine patients with lidocaine patches (LP) and 29 matched control subjects (C) were analyzed. During the 24 hours before patch placement, pain scores and narcotic use were similar (LP 5.3, C 4.6, P = 0.19 and LP 51, C 32 mg morphine, P = 0.17). In the 24 hours after patch placement, LP patients had a greater decrease in pain scores (LP 1.2, C 0.0, P = 0.01) with no change in narcotic use (LP -8.4, C 0.5-mg change in morphine, P = 0.25). At 60 days, LP patients had a lower MPQ pain score (LP 7.7, C 12.2, P rib fracture pain. Lidocaine patches resulted in a sustained reduction in pain, outlasting the duration of therapy.

Gender-specific and gonadectomy-specific effects upon swim analgesia: role of steroid replacement therapy.

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Romero, M T; Cooper, M L; Komisaruk, B R; Bodnar, R J

1988-01-01

Both gender-specific and gonadectomy-specific effects have been observed for the analgesic responses following continuous and intermittent cold-water swims (CCWS and ICWS respectively): female rats display significantly less analgesia than males, and gonadectomized rats display significantly less analgesia than sham-operated controls. The present study evaluated the effects of steroid replacement therapy with testosterone propionate (TP: 2 mg/kg, SC) upon CCWS and ICWS analgesia on the tail-flick and jump tests and hypothermia in sham-operated or gonadectomized male and female rats. Thirty days following surgery, rats received either no treatment, a sesame oil vehicle or TP for 14 days prior to, and then during testing. Relative to the no treatment condition, repeated vehicle injections in sham-operated rats eliminated the gender-specific, but did not affect the gonadectomy-specific effects upon CCWS and ICWS analgesia. TP reversed the deficits in CCWS and ICWS analgesia observed in both castrated and ovariectomized rats on both pain tests. TP only potentiated CCWS analgesia in sham-operated males on the tail-flick test. TP potentiated CCWS and ICWS hypothermia in gonadectomized rats and in male sham-operated rats. These data indicate that gonadal steroids play a major modulatory role in the etiology of swim analgesia, and that the observed gender effects are sensitive to possible adaptational variables.

The incidence of transient neurologic syndrome after spinal anesthesia with lidocaine or bupivacaine: The effects of needle type and surgical position: brief report

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Etezadi F

2011-10-01

Full Text Available "nBurning Transient Neurologic Syndrome (TNS which was first described by Schneider et al in 1993, is defined as a transient pain and dysesthesia in waist, buttocks and the lower limbs after spinal anesthesia.1,2 The incidence of TNS after spinal anesthesia with lidocaine is reported to be as high as 10-40%.3,4 This prospective study was designed to determine the incidence of TNS with two different types of drugs, lidocaine and bupivacaine, in lithotomy or supine positions as the primary outcomes and to determine the association between two different types of needles and surgical positions with the occurrence of TNS as the secondary outcome."nThe present study was conducted on 250 patients (ASA I-II, aged 18-60 years old, who were candidates for surgery in supine or lithotomy positions. According to the needle type (Sprotte or Quincke and the local anesthetic (lidocaine or bupivacaine all patients were randomly divided into four groups. After establishing standard monitoring, spinal anesthesia was performed in all sitting patients by attending anesthesiologists at L2-L3 or L3-L4 levels. The patients were placed in supine or lithotomy position, in regards to the surgical procedure. During the first three postoperative days, patients were observed for post spinal anesthesia complications, especially TNS. Any sensation of pain, dysesthesia, paresthesia or hyperalgesia in the low back area, buttocks, the anterior or posterior thigh, knees, either foot or both feet were recorded. Moreover, duration of pain, its radiation and its relation to sleep and the patients' position were all carefully considered. Ultimately, the patients' response to opioid (pethidine for analgesia was determined."nThe incidence of TNS was higher when spinal anesthesia was induced with lidocaine (68% vs. 22%, P=0.003. TNS developed in 85% of the patients in lidocaine group and 58% in bupivacaine group after surgery in lithotomy position (P=0.002. In 77 patients pain

Effect of Lidocaine and Epinephrine on Human Erythrocyte Shape and Vesiculability of Blood Cells

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Tanja Slokar

2015-01-01

Full Text Available The effect of local anesthetic composed of lidocaine and epinephrine on vesiculability of blood cells and erythrocyte shape was studied. Whole blood and plasma were incubated with lidocaine/epinephrine. Extracellular vesicles were isolated by centrifugation and washing and counted by flow cytometry. Lidocaine/epinephrine and each component alone were added to diluted blood. Shape changes were recorded by micrographs. An ensemble of captured frames was analyzed for populations of discocytes, echinocytes, and stomatocytes by using statistical methods. Incubation of whole blood and blood plasma with lidocaine/epinephrine considerably increased concentration of extracellular vesicles in isolates (for an average factor 3.4 in blood and 2.8 in plasma. Lidocaine/epinephrine caused change of erythrocyte shape from mainly discocytic to mainly stomatocytic (higher than 50%. Lidocaine alone had even stronger stomatocytic effect (the percent of stomatocytes was higher than 95% while epinephrine had echinocytic effect (the percent of echinocytes was higher than 80%. The differences were highly statistically significant p<10-8 with statistical power P=1. Lidocaine/epinephrine induced regions of highly anisotropically curved regions indicating that lidocaine and epinephrine interact with erythrocyte membrane. It was concluded that lidocaine/epinephrine interacts with cell membranes and increases vesiculability of blood cells in vitro.

Nitrous oxide for labor analgesia: Utilization and predictors of conversion to neuraxial analgesia.

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Sutton, Caitlin D; Butwick, Alexander J; Riley, Edward T; Carvalho, Brendan

2017-08-01

We examined the characteristics of women who choose nitrous oxide for labor analgesia and identified factors that predict conversion from nitrous oxide to labor neuraxial analgesia. Retrospective descriptive study. Labor and Delivery Ward. 146 pregnant women who used nitrous oxide for analgesia during labor and delivery between September 2014 and September 2015. Chart review only. Demographic, obstetric, and intrapartum characteristics of women using nitrous oxide were examined. Multivariable logistic regression was performed to identify factors associated with conversion from nitrous oxide to neuraxial analgesia. Data are presented as n (%), median [IQR], adjusted relative risk (aRR), and 95% confidence intervals (CI) as appropriate. During the study period, 146 women used nitrous oxide for labor analgesia (accounting for 3% of the total deliveries). The majority (71.9%) of women who used nitrous oxide were nulliparous, and over half (51.9%) had expressed an initial preference for "nonmedical birth." The conversion rate to neuraxial blockade was 63.2%, compared to a concurrent institutional rate of 85.1% in women who did not use nitrous oxide. Factors associated with conversion from nitrous oxide to neuraxial blockade were labor induction (aRR=2.0, CI 1.2-3.3) and labor augmentation (aRR=1.7, CI 1.0-2.9). Only a small number of women opted to use nitrous oxide during labor, analgesia was minimal, and most converted to neuraxial analgesia. Women with induced and augmented labors should be counseled about the increased likelihood that they will convert to neuraxial analgesia. Copyright © 2017 Elsevier Inc. All rights reserved.

Etoricoxib - preemptive and postoperative analgesia (EPPA in patients with laparotomy or thoracotomy - design and protocols

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Hatz Rudolf

2010-05-01

Full Text Available Abstract Background and Objective Our objective was to report on the design and essentials of the Etoricoxib protocol- Preemptive and Postoperative Analgesia (EPPA Trial, investigating whether preemptive analgesia with cox-2 inhibitors is more efficacious than placebo in patients who receive either laparotomy or thoracotomy. Design and Methods The study is a 2 × 2 factorial armed, double blinded, bicentric, randomised placebo-controlled trial comparing (a etoricoxib and (b placebo in a pre- and postoperative setting. The total observation period is 6 months. According to a power analysis, 120 patients scheduled for abdominal or thoracic surgery will randomly be allocated to either the preemptive or the postoperative treatment group. These two groups are each divided into two arms. Preemptive group patients receive etoricoxib prior to surgery and either etoricoxib again or placebo postoperatively. Postoperative group patients receive placebo prior to surgery and either placebo again or etoricoxib after surgery (2 × 2 factorial study design. The Main Outcome Measure is the cumulative use of morphine within the first 48 hours after surgery (measured by patient controlled analgesia PCA. Secondary outcome parameters include a broad range of tests including sensoric perception and genetic polymorphisms. Discussion The results of this study will provide information on the analgesic effectiveness of etoricoxib in preemptive analgesia and will give hints on possible preventive effects of persistent pain. Trial registration NCT00716833

Effects of intrathecal lidocaine on hyperalgesia and allodynia following chronic constriction injury in rats.

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Tian, Jie; Gu, Yiwen; Su, Diansan; Wu, Yichao; Wang, Xiangrui

2009-02-01

The present study investigated the effects of different doses of intrathecal lidocaine on established thermal hyperalgesia and tactile allodynia in the chronic constriction injury model of neuropathic pain, defined the effective drug dose range, the duration of pain-relief effects, and the influence of this treatment on the body and tissues. Male Sprague-Dawley rats were divided into five groups and received intrathecal saline or lidocaine (2, 6.5, 15, and 35 mg/kg) 7 days after loose sciatic ligation. Respiratory depression and hemodynamic instability were found to become more severe as doses of lidocaine increased during intrathecal therapy. Two animals in the group receiving 35 mg/kg lidocaine developed pulmonary oedema and died. Behavioral tests indicated that 6.5, 15, and 35 mg/kg intrathecal lidocaine showed different degrees of reversal of thermal hyperalgesia, and lasted for 2-8 days, while 2 mg/kg lidocaine did not. The inhibition of tactile allodynia was only observed in rats receiving 15 and 35 mg/kg lidocaine, and the anti-allodynic effects were identical in these two groups. Histopathologic examinations on the spinal cords revealed mild changes in rats receiving 2-15 mg/kg lidocaine. However, lesions were severe after administration of 35 mg/kg lidocaine. These findings indicate that intrathecal lidocaine has prolonged therapeutic effects on established neuropathic pain. The balance between sympathetic and parasympathetic nervous activities could be well preserved in most cases, except for 35 mg/kg. Considering the ratio between useful effects and side effects, doses of 15 mg/kg are suitable for intrathecal injection for relief of neuropathic pain.

The Use and Method of Action of Intravenous Lidocaine and Its Metabolite in Headache Disorders.

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Berk, Thomas; Silberstein, Stephen D

2018-03-14

Lidocaine, an amide anesthetic, has been used in the treatment of a wide variety of pain disorders for over 75 years. In addition to pain control, lidocaine is an anti-arrhythmic agent and has anti-inflammatory properties. Lidocaine's unique properties, including nonlinear pharmacokinetics, have limited its modern-day use. The purpose of this review is to offer a better understanding of the properties of this unique treatment, which we hope will allow more practitioners to offer this to their patients. An analysis of the history, pharmacokinetics, and relevant uses of lidocaine in headache medicine based on a synthesis of the medical literature and clinical experience. Lidocaine is an amide anesthetic that inhibits voltage gated sodium channels, and lidocaine metabolism occurs exclusively in the liver. One lidocaine metabolite has its own unique properties and may be an active form of the drug. Open label and retrospective studies have investigated the use of lidocaine in many headache disorders, primarily via injection or infusion. Further research into the active metabolite of lidocaine may allow for its use as a novel nonopiate treatment of chronic pain. © 2018 American Headache Society.

Tribenoside and lidocaine in the local treatment of hemorrhoids: an overview of clinical evidence.

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Lorenc, Z; Gökçe, Ö

2016-06-01

The combination of tribenoside+lidocaine (Procto-Glyvenol®) is a medical preparation for the local treatment of hemorrhoids, delivered as a suppository or rectal cream. This product has been used for decades in the therapy of hemorrhoids. This review discusses available evidence on the use of tribenoside/lidocaine in clinical practice. Papers were retrieved by a PubMed search, using different combinations of pertinent keywords (e.g. tribenoside AND hemorrhoids), without any limitations in terms of publication date and language. Documents from Authors' personal collection of literature could also be considered. Papers were selected for inclusion according to their relevance for the topic, as judged by the Authors. The efficacy of the combination of tribenoside+lidocaine in relieving symptoms caused by hemorrhoids and its safety have been assessed in several clinical studies on patients of either gender, either versus its two individual components (tribenoside and lidocaine) or versus steroids in the same setting. Five studies compared the combination treatment with each of its single components, and of these, three studies compared tribenoside+ lidocaine with a tribenoside-free semi-placebo preparation containing only lidocaine, and two studies compared this combination with lidocaine-free preparations containing only tribenoside. Tribenoside+lidocaine was compared with steroid-containing preparations in six studies. Last, two studies evaluated the efficacy and tolerability of the tribenoside+lidocaine combination in women with hemorrhoids as a consequence of pregnancy or delivery. All the above-mentioned studies were well-conducted and can provide a comprehensive evaluation of tribenoside+lidocaine in the treatment of hemorrhoids. Enough evidence exists to recommend the use of this combination therapy as a fast, effective and safe option for the local treatment of low-grade hemorrhoids.

Effect of local infiltration analgesia on post-operative pain following TVT-O: a double-blind, placebo-controlled randomized study.

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Tommaselli, Giovanni A; Di Carlo, Costantino; Formisano, Carmen; Fabozzi, Annamaria; Nappi, Carmine

2014-08-01

To evaluate the effect of a protocol of local anesthesia and epinephrine associated with sedo-analgesia on post-TVT-O pain in comparison with infiltration of saline and epinephrine. Forty-two patients undergoing TVT-O were randomized into two groups to receive periurethral infiltration with epinephrine only (group A, n = 21) or with epinephrine plus 1 % lidocaine hydrochloride (group B, n = 21). Post-operative pain was assessed using a visual analog scale (VAS) from 0 (absence of pain) to 10 (maximum pain possible), 1, 6, 12 and 24 h after the procedure. The total amount of analgesia was recorded and the proportion of women reporting a pain VAS score ≥4, 1 h after the procedure was calculated. ANOVA for repeated measures and Bonferroni correction, the Student's t test for independent samples, the Mann-Whitney U test, the Fisher exact test, or the χ (2) test for parametric was used. Pain level was significantly lower in group B 1 (p = 0.01) and 6 h (p = 0.05) after surgery, but not 12 and 24 h after the procedure. No significant difference was observed in the proportion of women requesting analgesia and in the total dosage of analgesics between the two groups. A significant higher proportion of women in group A reported a pain VAS score higher than four 1 h after surgery in comparison with patients in group B. This randomized study seems to indicate that systematic infiltration before TVT-O positioning with local anesthetic may reduce immediate post-operative pain.

The antimicrobial activity of bupivacaine, lidocaine and mepivacaine against equine pathogens

DEFF Research Database (Denmark)

Adler, D. M. T.; Damborg, P.; Verwilghen, D. R.

2017-01-01

Lameness is the most commonly reported health problem in horses, and lameness investigations which include local anaesthetic injections are routinely performed by equine practitioners. Through this process, bacteria can enter the tissues perforated by the needle and may cause local infections...... the antimicrobial activity of the local anaesthetics bupivacaine, lidocaine and mepivacaine against 40 equine clinical bacterial isolates of the Actinobacillus, Corynebacterium, Enterobacter, Escherichia, Pseudomonas, Rhodococcus, Staphylococcus and Streptococcus genera. Minimum inhibitory and minimum bactericidal...... also bactericidal. The tested local anaesthetics possessed antimicrobial activity against equine pathogens at concentrations that are routinely applied in clinical cases. However, this antimicrobial activity should not discourage antiseptic preparation prior to local anaesthetic injections....

TRPA1 activation by lidocaine in nerve terminals results in glutamate release increase

International Nuclear Information System (INIS)

Piao, L.-H.; Fujita, Tsugumi; Jiang, C.-Y.; Liu Tao; Yue, H.-Y.; Nakatsuka, Terumasa; Kumamoto, Eiichi

2009-01-01

We examined the effects of local anesthetics lidocaine and procaine on glutamatergic spontaneous excitatory transmission in substantia gelatinosa (SG) neurons in adult rat spinal cord slices with whole-cell patch-clamp techniques. Bath-applied lidocaine (1-5 mM) dose-dependently and reversibly increased the frequency but not the amplitude of spontaneous excitatory postsynaptic current (sEPSC) in SG neurons. Lidocaine activity was unaffected by the Na + -channel blocker, tetrodotoxin, and the TRPV1 antagonist, capsazepine, but was inhibited by the TRP antagonist, ruthenium red. In the same neuron, the TRPA1 agonist, allyl isothiocyanate, and lidocaine both increased sEPSC frequency. In contrast, procaine did not produce presynaptic enhancement. These results indicate that lidocaine activates TRPA1 in nerve terminals presynaptic to SG neurons to increase the spontaneous release of L-glutamate.

Synthesis of 14C labelled lidocaine (α-diethylamino acet-2,6-dimethylanilide)

International Nuclear Information System (INIS)

Zhou Zhentang; Qian Guojun; Lin Fenzhi; Zhuang Daoling; Zhang Yulong; He Zhanjun

2002-01-01

14 C-lidocaine was composed by 14 C-diethylamine reaction with ω-chloroacetic-2,6-dimethylaniline. 14 C-diethylamine was prepared from Ba 14 CO 3 via K 14 CN and 14 C-acetonitrile which was hydrogenated. Radiochemical purity of 14 C-diethylamine and 14 C-lidocaine is >99% by HPLC and TLC respectively. 14 C-lidocaine is needed for breath assay of mouse for measuring liver function

Antibacterial properties of 2% lidocaine and reduced rate of endophthalmitis after intravitreal injection.

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Tustin, Aaron; Kim, Stephen J; Chomsky, Amy; Hubbard, G Baker; Sheng, Jinsong

2014-05-01

To determine whether the application of subconjunctival 2% lidocaine/0.1% methylparaben for anesthesia may reduce rates of endophthalmitis after intravitreal (IVT) injection. We performed in vitro experiments to determine the antibacterial properties of 2% lidocaine/0.1% methylparaben (lidocaine) against causative organisms of endophthalmitis. Isolates of Staphylococcus aureus, Staphylococcus epidermidis, and Streptococcus viridans from patients with endophthalmitis were incubated with or without lidocaine. Aliquots (100 µL) were plated on Mueller-Hinton (S. aureus and S. epidermidis) or blood agar plates (S. viridans) at 0, 10, 30, 120, and 240 minutes, and colonies were counted after 24 hours. A retrospective review of 15,042 IVT injections was performed from January 2004 to February 2011 to determine the rate of endophthalmitis with or without application of subconjunctival lidocaine for anesthesia. Lidocaine demonstrated rapid bactericidal effects against all 3 organisms. After 10 minutes of exposure, there was approximately a 90% (P < 0.01), 95% (P < 0.001), and 92% (P < 0.001) reduction in colony forming units when compared with time 0 for S. aureus, S. epidermidis, and S. viridans, respectively. Complete elimination of colony forming units occurred at subsequent time points for each organism in contrast to logarithmic increase for control plates. There were a total of 0 cases of endophthalmitis of 6,853 IVT injections performed with subconjunctival lidocaine and 8 cases of endophthalmitis of 8,189 (0.1%) IVT injections performed with other methods of anesthesia (P = 0.03). Application of subconjunctival 2% lidocaine/0.1% methylparaben for anesthesia may reduce the incidence of endophthalmitis after IVT injection.

Lidocaine lozenges for pharyngeal anesthesia during upper gastrointestinal endoscopy: A randomized controlled trial

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Avinash Supe

2014-01-01

Full Text Available Background and Objectives: A novel lozenge formulation with advantages of ease of drug administration, palatable taste and improved patient compliance could be the preferred mode of topical pharyngeal anesthesia during upper gastrointestinal endoscopy (UGE. This randomized, open-label, active-controlled study was conducted to evaluate the efficacy and safety of lidocaine lozenges versus lidocaine spray in the diagnostic gastroduodenal endoscopy in Indian patients. Subjects and Methods: Two hundred and forty-seven patients of either sex (18-80 years undergoing diagnostic gastroduodenal endoscopy were randomized either to; lidocaine lozenge 200 mg or lidocaine spray 200 mg to be applied as a single dose before gastroduodenal endoscopy. Ease of procedure, level of gag reflex, ease of application of the local anesthetic, and investigators global assessment were the primary efficacy endpoints. Need for rescue medication and patient′s global assessment were secondary efficacy endpoints. The incidence of any adverse event was the safety endpoint. Between groups, comparison was done by using appropriate statistical test. Results: Investigator reported significantly lesser procedural difficulty (P = 0.0007 and suppressed gag reflex (P < 0.0001 during UGE with lidocaine lozenge compared to spray. Ease of application of local anesthetic was reported easy in significantly more patients as compared with lidocaine spray (P = 0.001. Global assessment by patient and physician was favorable toward lozenge. Incidences of adverse events were similar in both the groups. Conclusions: The study suggests that lidocaine lozenges are an easier way of applying local oropharyngeal anesthesia, produces better suppression of gag reflex and makes the procedure easier when compared with lidocaine spray.

Development of lidocaine gels for enhanced local anesthetic action.

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Shin, Sang-Chul; Cho, Cheong-Weon; Yang, Kyu-Ho

2004-12-09

In relieving local pains, lidocaine, one of ester type local anesthetics, has been used. To develop the lidocaine gels of enhanced local anesthetic effects, hydroxypropyl methylcellulose (HPMC) based bioadhesive polymer gel containing an enhancer was formulated. As the drug concentration in the gels increased up to 3%, the permeation rate of drug linearly increased, thereafter reaching a plateau. As the temperature of surrounding solutions increased, the permeation of drug increased. The activation energy of drug permeation was 3.29 kcal/mol for lidocaine. The permeation rate of drug through skin was studied using various enhancers, such as glycols, non-ionic surfactants, and bile salts. Among the enhancers studied, diethylene glycol showed the greatest enhancing effects on drug permeation through skin. The analgesic activity was examined using a tail-flick analgesimeter. In the area under the efficacy curve (AUEC) of the rat-tail flick tests, lidocaine gel containing diethylene glycol showed about 3.89-fold increase in analgesic activity compared with the control. The addition of vasoconstrictor in the gels prolonged the analgesic effects. The result of this study supports that the bioadhesive gel with efficient anesthetic effect could be developed using HPMC with combination of enhancer and vasoconstrictor.

[Effects of granisetron/lidocaine combination on propofol injection-induced pain: a double-blind randomized clinical trial].

Science.gov (United States)

Ma, Yu-shan; Lin, Xue-mei; Zhou, Jun

2009-05-01

To investigate the alleviation effect of vein pretreatment and granisetron/lidocaine combination on propofol injection-induced pain. Two hundreds patients scheduled for gynaecological laparoscopic operations were randomly divided into four groups: control group (group I), lidocaine group (group II), granisetron group (group III) and granisetron/lidocaine combination group (group IV), with 50 patients in each group. The patients in the above four groups received placebo (saline), lidocaine 20 mg, granisetron 2 mg and granisetron 2 mg plus lidocaine intravenously respectively. The patients were injected with one-forth of scheduled propofol via a dorsal hand vein after one minute of venous occlusion. The pain during the injection of propofol was evaluated. Pain occurred in 84% of patients in the control group, 46% in the lidocaine group, 52% in the granisetron group and 24% in the granisetron/lidocaine combination group. There was a significant reduction in pain incidence in the three experimental groups compared with the control group (Pgranisetron/lidocaine combination group than in the control group (Pgranisetron/lidocaine may be effective not only in attenuating pains during i.v. injection of propofol, but also in preventing postoperative nausea, vomiting and shivering.

Muscle-type nicotinic receptor blockade by diethylamine, the hydrophilic moiety of lidocaine

Directory of Open Access Journals (Sweden)

Armando eAlberola-Die

2016-02-01

Full Text Available Lidocaine bears in its structure both an aromatic ring and a terminal amine, which can be protonated at physiological pH, linked by an amide group. Since lidocaine causes multiple inhibitory actions on nicotinic acetylcholine receptors (nAChRs, this work was aimed to determine the inhibitory effects of diethylamine (DEA, a small molecule resembling the hydrophilic moiety of lidocaine, on Torpedo marmorata nAChRs microtransplanted to Xenopus oocytes. Similarly to lidocaine, DEA reversibly blocked acetylcholine-elicited currents (IACh in a dose-dependent manner (IC50 close to 70 μM, but unlike lidocaine, DEA did not affect IACh desensitization. IACh inhibition by DEA was more pronounced at negative potentials, suggesting an open-channel blockade of nAChRs, although roughly 30% inhibition persisted at positive potentials, indicating additional binding sites outside the pore. DEA block of nAChRs in the resting state (closed channel was confirmed by the enhanced IACh inhibition when pre-applying DEA before its co-application with ACh, as compared with solely DEA and ACh co-application. Virtual docking assays provide a plausible explanation to the experimental observations in terms of the involvement of different sets of drug binding sites. So, at the nAChR transmembrane (TM domain, DEA and lidocaine shared binding sites within the channel pore, giving support to their open-channel blockade; besides, lidocaine, but not DEA, interacted with residues at cavities among the M1, M2, M3 and M4 segments of each subunit and also at intersubunit crevices. At the extracellular (EC domain, DEA and lidocaine binding sites were broadly distributed, which aids to explain the closed channel blockade observed. Interestingly, some DEA clusters were located at the α-γ interphase of the EC domain, in a cavity near the orthosteric binding site pocket; by contrast, lidocaine contacted with all α-subunit loops conforming the ACh binding site, both in α-γ and �

Paediatric analgesia in an Emergency Department.

LENUS (Irish Health Repository)

Hawkes, C

2012-02-03

Timely management of pain in paediatric patients in the Emergency Department (ED) is a well-accepted performance indicator. We describe an audit of the provision of analgesia for children in an Irish ED and the introduction of a nurse-initiated analgesia protocol in an effort to improve performance. 95 children aged 1-16 presenting consecutively to the ED were included and time from triage to analgesia, and the rate of analgesia provision, were recorded. The results were circulated and a nurse initiated analgesia protocol was introduced. An audit including 145 patients followed this. 55.6% of patients with major fractures received analgesia after a median time of 54 minutes, which improved to 61.1% (p = 0.735) after 7 minutes (p = 0.004). Pain score documentation was very poor throughout, improving only slightly from 0% to 19.3%. No child had a documented pain score, which slightly improved to 19.3%. We recommend other Irish EDs to audit their provision of analgesia for children.

Radioprotective Effect of Lidocaine on Function and Ultrastructure of Salivary Glands Receiving Fractionated Radiation

Energy Technology Data Exchange (ETDEWEB)

Hakim, Samer George, E-mail: samer.hakim@mkg-chir.mu-luebeck.de [Department of Oral and Maxillofacial Surgery, University of Luebeck, Luebeck (Germany); Benedek, Geza Attila [Department of Oral and Maxillofacial Surgery, University of Luebeck, Luebeck (Germany); Su Yuxiong [Department of Oral and Maxillofacial Surgery, University of Luebeck, Luebeck (Germany); Department of Oral and Maxillofacial Surgery, Sun Yat-Sen University, Guanghua School of Stomatology, Guanghua (China); Jacobsen, Hans Christian [Department of Oral and Maxillofacial Surgery, University of Luebeck, Luebeck (Germany); Klinger, Matthias [Institute of Anatomy, University of Luebeck, Luebeck (Germany); Dendorfer, Andreas [Institute of Experimental and Clinical Pharmacology and Toxicology, University of Luebeck, Luebeck (Germany); Hemmelmann, Claudia [Institute of Medical Biometry and Statistics, University of Luebeck, Luebeck (Germany); Meller, Birgit [Department of Radiology and Nuclear Medicine, University of Luebeck, Luebeck (Germany); Nadrowitz, Roger; Rades, Dirk [Department of Radiation Oncology, University of Luebeck, Luebeck (Germany); Sieg, Peter [Department of Oral and Maxillofacial Surgery, University of Luebeck, Luebeck (Germany)

2012-03-15

Purpose: Radiation-induced xerostomia still represents a common side effect after radiotherapy for head-and-neck malignancies. The aim of the present study was to examine the radioprotective effect of lidocaine hydrochloride during fractionated radiation in an experimental animal model. Methods and Materials: To evaluate the influence of different radiation doses on salivary gland function and the radioprotective effect of lidocaine, rabbits were irradiated with 15, 25, 30, and 35 Gy (equivalent doses in 2-Gy fractions equivalent to 24, 40, 48, and 56 Gy, respectively). Lidocaine hydrochloride (10 and 12 mg/kg) was administered before every radiation fraction in the treatment groups. Salivary gland function was assessed by flow sialometry and sialoscintigraphy, and the morphologic changes were evaluated using transmission electron microscopy. Results: Functional impairment was first observed after 35 Gy and pretreatment with lidocaine improved radiation tolerance of both parotid and submandibular glands. The use of 12 mg/kg lidocaine was superior and displayed significant radioprotection with regard to flow sialometry and sialoscintigraphy. The ultrastructure was largely preserved after pretreatment with both lidocaine doses. Conclusions: Lidocaine represents an effective radioprotective agent and a promising approach for clinical application to avoid radiation-induced functional impairment of salivary glands.

Radioprotective Effect of Lidocaine on Function and Ultrastructure of Salivary Glands Receiving Fractionated Radiation

International Nuclear Information System (INIS)

Hakim, Samer George; Benedek, Gèza Attila; Su Yuxiong; Jacobsen, Hans Christian; Klinger, Matthias; Dendorfer, Andreas; Hemmelmann, Claudia; Meller, Birgit; Nadrowitz, Roger; Rades, Dirk; Sieg, Peter

2012-01-01

Purpose: Radiation-induced xerostomia still represents a common side effect after radiotherapy for head-and-neck malignancies. The aim of the present study was to examine the radioprotective effect of lidocaine hydrochloride during fractionated radiation in an experimental animal model. Methods and Materials: To evaluate the influence of different radiation doses on salivary gland function and the radioprotective effect of lidocaine, rabbits were irradiated with 15, 25, 30, and 35 Gy (equivalent doses in 2-Gy fractions equivalent to 24, 40, 48, and 56 Gy, respectively). Lidocaine hydrochloride (10 and 12 mg/kg) was administered before every radiation fraction in the treatment groups. Salivary gland function was assessed by flow sialometry and sialoscintigraphy, and the morphologic changes were evaluated using transmission electron microscopy. Results: Functional impairment was first observed after 35 Gy and pretreatment with lidocaine improved radiation tolerance of both parotid and submandibular glands. The use of 12 mg/kg lidocaine was superior and displayed significant radioprotection with regard to flow sialometry and sialoscintigraphy. The ultrastructure was largely preserved after pretreatment with both lidocaine doses. Conclusions: Lidocaine represents an effective radioprotective agent and a promising approach for clinical application to avoid radiation-induced functional impairment of salivary glands.

US-Guided Femoral and Sciatic Nerve Blocks for Analgesia During Endovenous Laser Ablation

International Nuclear Information System (INIS)

Yilmaz, Saim; Ceken, Kagan; Alimoglu, Emel; Sindel, Timur

2013-01-01

Endovenous laser ablation may be associated with significant pain when performed under standard local tumescent anesthesia. The purpose of this study was to investigate the efficacy of femoral and sciatic nerve blocks for analgesia during endovenous ablation in patients with lower extremity venous insufficiency. During a 28-month period, ultrasound-guided femoral or sciatic nerve blocks were performed to provide analgesia during endovenous laser ablation in 506 legs and 307 patients. The femoral block (n = 402) was performed at the level of the inguinal ligament, and the sciatic block at the posterior midthigh (n = 124), by injecting a diluted lidocaine solution under ultrasound guidance. After the blocks, endovenous laser ablations and other treatments (phlebectomy or foam sclerotherapy) were performed in the standard fashion. After the procedures, a visual analogue pain scale (1–10) was used for pain assessment. After the blocks, pain scores were 0 or 1 (no pain) in 240 legs, 2 or 3 (uncomfortable) in 225 legs, and 4 or 5 (annoying) in 41 legs. Patients never experienced any pain higher than score 5. The statistical analysis revealed no significant difference between the pain scores of the right leg versus the left leg (p = 0.321) and between the pain scores after the femoral versus sciatic block (p = 0.7). Ultrasound-guided femoral and sciatic nerve blocks may provide considerable reduction of pain during endovenous laser and other treatments, such as ambulatory phlebectomy and foam sclerotherapy. They may make these procedures more comfortable for the patient and easier for the operator.

Usefulness of modified intravenous analgesia: initial experience in uterine artery embolization for leiomyomata

International Nuclear Information System (INIS)

Yang, Seung Boo; Jung, Young Jin; Goo, Dong Erk; Jang, Yun Woo

2006-01-01

We wanted to evaluate the usefulness of modified intravenous analgesia for the management of pain during uterine artery embolization for leiomyomata. Between April 2004 and July 2004, 15 patients with symptomatic fibroids underwent uterine artery embolization and pain management. Except the three patients for whom the Visual Analogue Scale (VAS) score was not obtained, twelve patients were included in this study. For pain management, epidural PCA (Patient Controlled Analgesia) was used in two patients, intravenous PCA was used in two patients and modified intravenous analgesia injection was used in eight patients. For all the patients, we used the 2.8 Fr coaxial microcatheter and 500-710 μ m PVA particles for the embolic materials. The protocol of the modified intravenous analgesia injection was as follow, 1) prior to femoral artery puncture, 30 mg of ketorolac tromethamine (Tarasyn)was injected via an intravenous route. 2) At the time that the one side uterine artery embolization was finished, normal saline mixed 150 mg meperidine (Demerol) was administered through the side port of the intravenous line that was used for hydration. 3) Additional ketorolac tromethamine 30 mg was injected after 6 hour. The VAS score and side effects were then checked. After 12 hours, the VAS score was rechecked. If the VAS score was above 4, this was considered as failure of pain management. The VAS scores, complications and side effects for the modified intravenous analgesia injection were compared with that of IV PCA and epidural PCA. The average VAS score of the modified intravenous analgesia injection, intravenous PCA and epidural PCA was 1.4, 1 and 0, respectively; the number of additional intramuscular injections of analgesia was 0.5, 0.5 and 0, respectively. All the patients who underwent epidural PCA had back pain at the puncture site and 1 patient who underwent modified intravenous analgesia injection experienced mild dyspnea, but they easily recovered with such

Usefulness of modified intravenous analgesia: initial experience in uterine artery embolization for leiomyomata

Energy Technology Data Exchange (ETDEWEB)

Yang, Seung Boo; Jung, Young Jin [Soonchunhyang University, Gumi Hospital, Gumi (Korea, Republic of); Goo, Dong Erk; Jang, Yun Woo [Soonchunhyang University Hospital, Seoul (Korea, Republic of)

2006-04-15

We wanted to evaluate the usefulness of modified intravenous analgesia for the management of pain during uterine artery embolization for leiomyomata. Between April 2004 and July 2004, 15 patients with symptomatic fibroids underwent uterine artery embolization and pain management. Except the three patients for whom the Visual Analogue Scale (VAS) score was not obtained, twelve patients were included in this study. For pain management, epidural PCA (Patient Controlled Analgesia) was used in two patients, intravenous PCA was used in two patients and modified intravenous analgesia injection was used in eight patients. For all the patients, we used the 2.8 Fr coaxial microcatheter and 500-710 {mu} m PVA particles for the embolic materials. The protocol of the modified intravenous analgesia injection was as follow, 1) prior to femoral artery puncture, 30 mg of ketorolac tromethamine (Tarasyn)was injected via an intravenous route. 2) At the time that the one side uterine artery embolization was finished, normal saline mixed 150 mg meperidine (Demerol) was administered through the side port of the intravenous line that was used for hydration. 3) Additional ketorolac tromethamine 30 mg was injected after 6 hour. The VAS score and side effects were then checked. After 12 hours, the VAS score was rechecked. If the VAS score was above 4, this was considered as failure of pain management. The VAS scores, complications and side effects for the modified intravenous analgesia injection were compared with that of IV PCA and epidural PCA. The average VAS score of the modified intravenous analgesia injection, intravenous PCA and epidural PCA was 1.4, 1 and 0, respectively; the number of additional intramuscular injections of analgesia was 0.5, 0.5 and 0, respectively. All the patients who underwent epidural PCA had back pain at the puncture site and 1 patient who underwent modified intravenous analgesia injection experienced mild dyspnea, but they easily recovered with such

Anaesthetic efficacy of lidocaine/clonidine for inferior alveolar nerve block in patients with irreversible pulpitis.

Science.gov (United States)

Shadmehr, E; Aminozarbian, M G; Akhavan, A; Mahdavian, P; Davoudi, A

2017-06-01

This prospective, randomized, double-blind study aimed to compare the efficacy of lidocaine with epinephrine versus lidocaine with clonidine for inferior alveolar nerve block (IANB) and hemodynamic stability (heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure) in patients with irreversible pulpitis. One hundred patients with irreversible pulpitis in mandibular molar teeth randomly received 1.8 mL of 2% lidocaine with clonidine (15 μg mL -1 ) or 1.8 mL of 2% lidocaine with epinephrine (12.5 μg mL -1 ), using a conventional IANB technique. Endodontic access cavities were prepared 15 min after solution deposition, and all patients were required to have profound lip numbness. Success was defined as no or mild pain (visual analog scale recording) upon endodontic access cavity preparation or initial canal instrumentation. The hemodynamic parameters were measured before, during and 5, 10 and 30 min after administration. Finally, the collected data were subjected to independent t-test, chi-square and Fisher's exact test using spss software ver.20 at a significant level of 0.05. The success rates for IANB using lidocaine with epinephrine and lidocaine with clonidine solutions were 29% and 59%, respectively. The clonidine group exhibited a significantly higher success rate (P < 0.05). Five minutes after drug administration, systolic blood pressure and heart rate significantly increased in the lidocaine with epinephrine group and insignificantly decreased in lidocaine with clonidine group. For mandibular molars with irreversible pulpitis, addition of clonidine to lidocaine improved the success rate of IANB compared to a standard lidocaine/epinephrine solution. © 2016 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Anestesia epidural com ropivacaína, lidocaína ou associação de lidocaína e xilazina em cães: efeitos cardiorrespiratório e analgésico Epidural anaesthesia using ropivacaine, lidocaine or the combination of lidocaine and xylazine in dogs: cardiorespiratory and analgesic effects

Directory of Open Access Journals (Sweden)

Simone Salata Gasparini

2007-04-01

Full Text Available Este estudo investigou o efeito da ropivacaína, da lidocaína e da associação de lidocaína e xilazina na anestesia epidural de cães. Trinta cães foram tranqüilizados com acepromazina intravenosa, distribuídos em três grupos e submetidos à anestesia epidural no espaço lombo-sacro, com lidocaína 2% com vasoconstrictor (GL, ropivacaína 1% (GR ou com xilazina associada à lidocaína (GXL. Mensuraram-se as freqüências cardíaca (FC e respiratória (f, a pressão arterial sistólica (PAS, a concentração final expirada de CO2 (EtCO2, o volume minuto (VM e a temperatura retal (T. Para avaliação da analgesia somática, utilizou-se o teste do panículo e o teste térmico a 55°C. Os protocolos produziram anestesia da região retro-umbilical, sendo que a associação XL produziu bloqueio anestésico mais cranial, porém causou bradicardia moderada. A duração da anestesia foi mais prolongada nos animais dos grupos GXL (240 min e GR (250 min, quando comparada as do grupo GL (120 min.This study was aimed at investigating the effects of ropivacaine, lidocaine or lidocaine combined with xylazine for epidural anaesthesia in dogs. Thirty dogs were sedated with acepromazine IV, divided in to three groups and submitted to lumbosacral epidural anaesthesia using 2% lidocaine with adrenaline (L or 1% ropivacaine (R or xylazine combined with lidocaine (XL. Heart and respiratory rates, systolic arterial blood pressure, EtCO2, minute volume and temperature were measured. Cutaneous anaesthesia was investigated using a forceps and thermic stimulus. All protocols produced retroumbilical anaesthesia. The combination of XL produced a more cranial anaesthetic block, with moderate bradycardia. The duration of the anaesthesia was more prolonged in animals treated with XL (240min and R (250min, when compared to L alone (120min.

Cutaneous in vivo metabolism of topical lidocaine formulation in human skin

DEFF Research Database (Denmark)

Rolsted, K; Benfeldt, E; Kissmeyer, A-M

2009-01-01

Little is known about the metabolising capacity of the human skin in relation to topically applied drugs and formulations. We chose lidocaine as a model compound since the metabolic pathways are well known from studies concerning hepatic metabolism following systemic drug administration. However......, the enzymes involved are also expressed in the skin. Hence, the aim of the current study was to investigate the extent of the cutaneous in vivo metabolism of topically applied lidocaine in human volunteers. A dose of 5 mg/cm(2) of Xylocaine(R) (5% lidocaine) ointment was applied onto the buttock skin...... of the volunteers. After 2 h, residual formulation was removed, and two 4-mm punch biopsies were taken from each volunteer. The quantity of lidocaine extracted from the skin samples (epidermis + dermis) was 109 +/- 43 ng/mm(2) skin. One metabolite (monoethylglycine xylidide, MEGX) was detected in skin from 7...

Lidocaine alleviates propofol related pain much better than metoprolol and nitroglycerin

Directory of Open Access Journals (Sweden)

Asutay Goktug

2015-10-01

Full Text Available ABSTRACTBACKGROUND AND OBJECTIVES: Injection pain after propofol administration is common and maydisturb patients' comfort. The aim of this study was to compare effectiveness of intravenous(iv nitroglycerin, lidocaine and metoprolol applied through the veins on the dorsum of hand orantecubital vein on eliminating propofol injection pain.METHOD: There were 147 patients and they were grouped according to the analgesic adminis-tered. Metoprolol (n = 31, Group M, lidocaine (n = 32, Group L and nitroglycerin (n = 29, GroupN were applied through iv catheter at dorsum hand vein or antecubital vein. Pain was evalu-ated by 4 point scale (0 - no pain, 1 --- light pain, 2 --- mild pain, 3 --- severe pain in 5, 10, 15and 20th seconds. ASA, BMI, patient demographics, education level and the effect of pathwaysfor injection and location of operations were analyzed for their effect on total pain score.RESULTS: There were no differences between the groups in terms of total pain score (p = 0.981.There were no differences in terms of total pain score depending on ASA, education level,location of operation. However, lidocaine was more effective when compared with metoprolol(p = 0.015 and nitroglycerin (p = 0.001 among groups. Although neither lidocaine nor metopro-lol had any difference on pain management when applied from antecubital or dorsal hand vein(p > 0.05, nitroglycerin injection from antecubital vein had demonstrated statistically lowerpain scores (p = 0.001.CONCLUSION: We found lidocaine to be the most effective analgesic in decreasing propofolrelated pain. We therefore suggest iv lidocaine for alleviating propofol related pain at operations.

Comparison of lidocaine/tetracaine cream and lidocaine/prilocaine cream for local anaesthesia during laser treatment of acne keloidalis nuchae and tattoo removal: Results of two randomized controlled trials

NARCIS (Netherlands)

K. Greveling (Karin); E.P. Prens (Errol); ten Bosch, N.; M.B.A. van Doorn (Martijn)

2017-01-01

textabstractBackground: Pain is a common adverse effect of dermatological laser procedures. Currently, no standard topical anaesthetic cream exists for deeper dermal laser procedures. Objectives: To compare the efficacy of lidocaine/tetracaine cream and lidocaine/prilocaine cream in reducing

Efficacy and safety of bupivacaine versus lidocaine in local anesthesia of the nasopharynx: A meta-analysis.

Science.gov (United States)

Yu, Xiaoyun; Wang, Jiyun; Huang, Lizhen; Yu, Xiao; He, Zheyun

2016-09-30

To assess the efficacy and safety of bupivacaine compared with lidocaine in local anesthesia of nasopharynx through meta-analysis. A number of medical literature data bases were searched electronically. Relevant journals and references of included studies were manually searched. Two reviewers independently performed data extraction and quality assessment. Four studies were included. Visual analog scale (VAS) scores, acceptable discomfort, and bleeding scores were analyzed for bupivacaine versus lidocaine. When considering the VAS scores, bupivacaine as a local anesthetic agent was better than lidocaine in controlling the pain of postoperative patients (p bupivacaine group demonstrated a higher acceptable discomfort than the patients in the lidocaine group (p = 0.008). With regard to the bleeding scores of the patients with nasal surgery, lidocaine was better at bleeding in postoperative patients compared with bupivacaine (p = 0.0007). These results indicated that bupivacaine showed better pain control of postoperative patients and acceptable discomfort in patients with upper gastrointestinal endoscopy. Lidocaine had a significantly increased ability the pain of patients with transnasal fiberoptic nasopharyngolaryngoscopic examination and bleeding in postoperative patients. No systemic adverse events were reported. Bupivacaine was found to have better promotion to pain control than did lidocaine for the patients after nasal surgery. Lidocaine had a significantly increased inhibition of bleeding in these postoperative patients; however, the efficacy between bupivacaine and lidocaine was unclear for the patients who had transnasal endoscopic examinations.

Interaction between lidocaine hydrochloride (with and without adrenaline) and various irrigants: A nuclear magnetic resonance analysis.

Science.gov (United States)

Vidhya, Nirmal; Karthikeyan, Balasubramanian Saravana; Velmurugan, Natanasabapathy; Abarajithan, Mohan; Nithyanandan, Sivasankaran

2014-05-01

Interaction between local anesthetic solution, lidocaine hydrochloride (with and without adrenaline), and root canal irrigants such as sodium hypochlorite (NaOCl), ethylene diamine tetra-acetic acid (EDTA), and chlorhexidine (CHX) has not been studied earlier. Hence, the purpose of this in vitro study was to evaluate the chemical interaction between 2% lidocaine hydrochloride (with and without adrenaline) and commonly used root canal irrigants, NaOCl, EDTA, and CHX. SAMPLES WERE DIVIDED INTO EIGHT EXPERIMENTAL GROUPS: Group I-Lidocaine hydrochloride (with adrenaline)/3% NaOCl, Group II-Lidocaine hydrochloride (with adrenaline)/17% EDTA, Group III- Lidocaine hydrochloride (with adrenaline)/2% CHX, Group IV-Lidocaine hydrochloride (without adrenaline)/3% NaOCl, Group V-Lidocaine hydrochloride (without adrenaline)/17% EDTA, Group VI-Lidocaine hydrochloride (without adrenaline)/2% CHX, and two control groups: Group VII-Lidocaine hydrochloride (with adrenaline)/deionized water and Group VIII-Lidocaine hydrochloride (without adrenaline)/deionized water. The respective solutions of various groups were mixed in equal proportions (1 ml each) and observed for precipitate formation. Chemical composition of the formed precipitate was then analysed by nuclear magnetic resonance spectroscopy (NMR) and confirmed with diazotation test. In groups I and IV, a white precipitate was observed in all the samples on mixing the respective solutions, which showed a color change to reddish brown after 15 minutes. This precipitate was then analysed by NMR spectroscopy and was observed to be 2,6-xylidine, a reported toxic compound. The experimental groups II, III, V, and VI and control groups VII and VIII showed no precipitate formation in any of the respective samples, until 2 hours. Interaction between lidocaine hydrochloride (with and without adrenaline) and NaOCl showed precipitate formation containing 2,6-xylidine, a toxic compound.

Localization of 14C-labeled 2% lidocaine hydrochloride after intraosseous anesthesia in the rabbit.

Science.gov (United States)

Goto, Takashi; Mamiya, Hideki; Ichinohe, Tatsuya; Kaneko, Yuzuru

2011-10-01

The purpose of this study was to investigate the tissue distribution of lidocaine hydrochloride in mandibular bone marrow after intraosseous anesthesia (IOA) in rabbits. We used macroautoradiography to examine the tissue distribution of a (14)C-labeled 2% lidocaine hydrochloride solution containing 1:80,000 epinephrine ((14)C-lidocaine). Under general anesthesia, (14)C-lidocaine was injected intraosseously or paraperiosteally. After IOA, animals were divided into three groups and observed at 1 (IOA-1), 5 (IOA-5), and 10 minutes (IOA-10) after injection. After infiltration anesthesia (IA), animals were observed at 1 minute after injection. The accumulation of (14)C-lidocaine was observed around the injection site in both the IA and the IOA groups. Paraperiosteally injected (14)C-lidocaine diffused to the surrounding tissues such as the lip, whereas IOA showed concentrated accumulation around the root apex throughout the experiment. The distribution area was significantly smaller in the IOA-1 group than in the IA group. The distribution area in the IOA-5 group was larger than those in the IOA-1 and IOA-10 groups. The accumulation of (14)C-lidocaine injected by IOA in rabbits was concentrated around the root apex. These results may explain the rapid onset time of IOA. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

The influence of lidocaine topical anesthesia during transesophageal echocardiography on blood methemoglobin level and risk of methemoglobinemia.

Science.gov (United States)

Filipiak-Strzecka, Dominika; Kasprzak, Jarosław D; Wiszniewska, Marta; Walusiak-Skorupa, Jolanta; Lipiec, Piotr

2015-04-01

Methemoglobinemia is a relatively rare, but potentially life-threating medical condition, which may be induced by application of topical anaesthetic agents commonly used during endoscopic procedure. The aim of our study was to assess the influence of lidocaine used prior to transesophageal echocardiography (TEE) on the blood level of methemoglobin in vivo. Additionally we attempted to establish the occurrence rate of clinically evident lidocaine-induced methemoglobinemia on the basis of data collected in our institution. We retrospectively analyzed patient records from 3,354 TEEs performed in our echocardiographic laboratory over the course of 13 years in search for clinically evident methemoglobinemia cases. Additionally, 18 consecutive patients referred for TEE were included in the prospective part of our analysis. Blood samples were tested before and 60 min after pre-TEE lidocaine anesthesia application. Information concerning concomitant conditions and pharmacotherapy were also obtained. In 3,354 patients who underwent TEE in our institution no cases of clinically evident methemoglobinemia occurred. In the prospective part of the study, none of 18 patients [16 (89 %) men, mean age 63 ± 13] was diagnosed with either clinical symptoms of methemoglobinemia or exceeded normal blood concentration of methemoglobin. Initial mean methemoglobin level was 0.5 ± 0.1 % with mild, statistically (but not clinically) significant rise to 0.6 ± 0.1 % after 60 min (p = 0.02). Among the analyzed factors only the relation between the proton pump inhibitors intake and methemoglobin blood level rise was identified as statistically relevant (p = 0.03). In adults, pre-TEE lidocaine anesthesia with recommended dosage results in significant increase in methemoglobin blood level, which however does not exceed normal values and does not result in clinically evident methemoglobinemia.

Procedural sedation analgesia

OpenAIRE

Sheta, Saad A

2010-01-01

The number of noninvasive and minimally invasive procedures performed outside of the operating room has grown exponentially over the last several decades. Sedation, analgesia, or both may be needed for many of these interventional or diagnostic procedures. Individualized care is important when determining if a patient requires procedural sedation analgesia (PSA). The patient might need an anti-anxiety drug, pain medicine, immobilization, simple reassurance, or a combination of these interve...

Patient controlled analgesia with remifentanil versus epidural analgesia in labour : randomised multicentre equivalence trial

NARCIS (Netherlands)

Freeman, Liv M; Bloemenkamp, Kitty W; Franssen, Maureen T; Papatsonis, Dimitri N; Hajenius, Petra J; Hollmann, Markus W; Woiski, Mallory D; Porath, Martina; van den Berg, Hans J; van Beek, Erik; Borchert, Odette W H M; Schuitemaker, Nico; Sikkema, J Marko; Kuipers, A H M; Logtenberg, Sabine L M; van der Salm, Paulien C M; Oude Rengerink, Katrien; Lopriore, Enrico; van den Akker-van Marle, M Elske; le Cessie, Saskia; van Lith, Jan M; Struys, Michel M; Mol, Ben Willem J; Dahan, Albert; Middeldorp, Johanna M; Oude Rengerink, K

2015-01-01

OBJECTIVE: To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. DESIGN: Multicentre randomised controlled equivalence trial. SETTING: 15 hospitals in the Netherlands. PARTICIPANTS: Women with an

Patient controlled analgesia with remifentanil versus epidural analgesia in labour : randomised multicentre equivalence trial

NARCIS (Netherlands)

Freeman, Liv M.; Bloemenkamp, Kitty W.; Franssen, Maureen T.; Papatsonis, Dimitri N.; Hajenius, Petra J.; Hollmann, Markus W.; Woiski, Mallory D.; Porath, Martina; van den Berg, Hans J.; van Beek, Erik; Borchert, Odette W. H. M.; Schuitemaker, Nico; Sikkema, J. Marko; Kuipers, A. H. M.; Logtenberg, Sabine L. M.; van der Salm, Paulien C. M.; Rengerink, Katrien Oude; Lopriore, Enrico; van den Akker-van Marle, M. Elske; le Cessie, Saskia; van Lith, Jan M.; Struys, Michel M.; Mol, Ben Willem J.; Dahan, Albert; Middeldorp, Johanna M.

2015-01-01

Objective To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. Design Multicentre randomised controlled equivalence trial. Setting 15 hospitals in the Netherlands. Participants Women with an

Patient controlled analgesia with remifentanil versus epidural analgesia in labour: randomised multicentre equivalence trial

NARCIS (Netherlands)

Freeman, L.M.; Bloemenkamp, K.W.; Franssen, M.T.; Papatsonis, D.N.; Hajenius, P.J.; Hollmann, M.W.; Woiski, M.D.; Porath, M.; Berg, H.J. van den; Beek, E. van; Borchert, O.W.; Schuitemaker, N.; Sikkema, J.M.; Kuipers, A.H.; Logtenberg, S.L.; Salm, P.C. van der; Oude Rengerink, K.; Lopriore, E.; Akker-van Marle, M.E. van den; Cessie, S. le; Lith, J.M. van; Struys, M.M.; Mol, B.W.; Dahan, A; Middeldorp, J.M.

2015-01-01

OBJECTIVE: To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. DESIGN: Multicentre randomised controlled equivalence trial. SETTING: 15 hospitals in the Netherlands. PARTICIPANTS: Women with an

Is there a reasonable excuse for not providing post-operative analgesia when using animal models of peripheral neuropathic pain for research purposes?

Directory of Open Access Journals (Sweden)

Sara Hestehave

Full Text Available The induction of neuropathic pain-like behaviors in rodents often requires surgical intervention. This engages acute nociceptive signaling events that contribute to pain and stress post-operatively that from a welfare perspective demands peri-operative analgesic treatment. However, a large number of researchers avoid providing such care based largely on anecdotal opinions that it might interfere with model pathophysiology in the longer term.To investigate effects of various peri-operative analgesic regimens encapsulating different mechanisms and duration of action, on the development of post-operative stress/welfare and pain-like behaviors in the Spared Nerve Injury (SNI-model of neuropathic pain.Starting on the day of surgery, male Sprague-Dawley rats were administered either vehicle (s.c., carprofen (5.0mg/kg, s.c., buprenorphine (0.1mg/kg s.c. or 1.0mg/kg p.o. in Nutella®, lidocaine/bupivacaine mixture (local irrigation or a combination of all analgesics, with coverage from a single administration, and up to 72 hours. Post-operative stress and recovery were assessed using welfare parameters, bodyweight, food-consumption, and fecal corticosterone, and hindpaw mechanical allodynia was tested for assessing development of neuropathic pain for 28 days.None of the analgesic regimes compromised the development of mechanical allodynia. Unexpectedly, the combined treatment with 0.1mg/kg s.c. buprenorphine and carprofen for 72 hours and local irrigation with lidocaine/bupivacaine, caused severe adverse effects with peritonitis. This was not observed when the combination included a lower dose of buprenorphine (0.05mg/kg, s.c., or when buprenorphine was administered alone (0.1mg/kg s.c. or 1.0mg/kg p.o. for 72 hours. An elevated rate of wound dehiscence was observed especially in the combined treatment groups, underlining the need for balanced analgesia. Repeated buprenorphine injections had positive effects on body weight the first day after surgery

Effect of temperature on antibacterial activity of lidocaine to Staphylococcus aureus and Pseudomonas aeruginosa.

Science.gov (United States)

Taki, Y; Seki, K; Ikigai, H; Nishihara, S; Ueno, H; Murota, K; Masuda, S

1988-01-01

The effect of temperature on the antibacterial activity of lidocaine to Staphylococcus aureus and Pseudomonas aeruginosa was investigated in vitro. At 10 C at which S. aureus organisms do not grow and might be metabolically inactive, the antibacterial activity of lidocaine to S. aureus was not observed in a concentration of 1%, which was quite antibacterial to S. aureus at 37 C. On the other hand, at 40 C a conspicuously increased antibacterial activity to S. aureus of lidocaine was observed in a concentration of 0.25% which was not antibacterial to S. aureus organisms at 37 C. Similar results were obtained when P. aeruginosa organisms were examined in place of S. aureus, although P. aeruginosa was found to be less susceptible to lidocaine than S. aureus. The clinical significance of the thermal effect on the antibacterial activity of lidocaine was discussed in brief.

Procedural sedation analgesia

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Sheta Saad

2010-01-01

Full Text Available The number of noninvasive and minimally invasive procedures performed outside of the operating room has grown exponentially over the last several decades. Sedation, analgesia, or both may be needed for many of these interventional or diagnostic procedures. Individualized care is important when determining if a patient requires procedural sedation analgesia (PSA. The patient might need an anti-anxiety drug, pain medicine, immobilization, simple reassurance, or a combination of these interventions. The goals of PSA in four different multidisciplinary practices namely; emergency, dentistry, radiology and gastrointestinal endoscopy are discussed in this review article. Some procedures are painful, others painless. Therefore, goals of PSA vary widely. Sedation management can range from minimal sedation, to the extent of minimal anesthesia. Procedural sedation in emergency department (ED usually requires combinations of multiple agents to reach desired effects of analgesia plus anxiolysis. However, in dental practice, moderate sedation analgesia (known to the dentists as conscious sedation is usually what is required. It is usually most effective with the combined use of local anesthesia. The mainstay of success for painless imaging is absolute immobility. Immobility can be achieved by deep sedation or minimal anesthesia. On the other hand, moderate sedation, deep sedation, minimal anesthesia and conventional general anesthesia can be all utilized for management of gastrointestinal endoscopy.

Labour pain with remifentanil patient-controlled analgesia versus epidural analgesia : a randomised equivalence trial

NARCIS (Netherlands)

Logtenberg, Slm; Oude Rengerink, K; Verhoeven, C J; Freeman, L M; van den Akker, Esa; Godfried, M B; van Beek, E; Borchert, Owhm; Schuitemaker, N; van Woerkens, Ecsm; Hostijn, I; Middeldorp, J M; van der Post, J A; Mol, B W

OBJECTIVE: To distinguish satisfaction with pain relief using remifentanil patient-controlled analgesia (RPCA) compared with epidural analgesia (EA) in low-risk labouring women. DESIGN: Randomised controlled equivalence trial. SETTING: Eighteen midwifery practices and six hospitals in the

Low-dose spinal anaesthesia provides effective labour analgesia ...

African Journals Online (AJOL)

Intrathecal analgesia did not severely limit ambulation in any of the patients. ... access to epidural analgesia during labour is limited in low- resource ... world.5,6 With limited resources for epidural analgesia, spinal analgesia ... women.19,20.

Differences in maternal temperature during labour with remifentanil patient-controlled analgesia or epidural analgesia: a randomised controlled trial

NARCIS (Netherlands)

Douma, M.R.; Stienstra, R.; Middeldorp, J.M.; Arbous, M.S.; Dahan, A

2015-01-01

BACKGROUND: Epidural analgesia and remifentanil patient-controlled analgesia are two popular techniques for the treatment of labour pain, each with its own efficacy and toxicity. METHODS: Parturients requesting analgesia were randomly assigned to either patient-controlled intravenous remifentanil or

Synthesis of novel lidocaine-releasing poly(diol-co-citrate) elastomers by using deep eutectic solvents.

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Serrano, M Concepción; Gutiérrez, María C; Jiménez, Ricardo; Ferrer, M Luisa; del Monte, Francisco

2012-01-14

Poly(octanediol-co-citrate) elastomers containing high loading of lidocaine were synthesized at temperatures below 100 °C by means of using deep eutectic mixtures of 1,8-octanediol and lidocaine. The preservation of lidocaine integrity resulted in high-capacity drug-eluting elastomers. This journal is © The Royal Society of Chemistry 2012

Patient controlled analgesia with remifentanil versus epidural analgesia in labour: randomised multicentre equivalence trial

NARCIS (Netherlands)

Freeman, Liv M.; Bloemenkamp, Kitty W.; Franssen, Maureen T.; Papatsonis, Dimitri N.; Hajenius, Petra J.; Hollmann, Markus W.; Woiski, Mallory D.; Porath, Martina; van den Berg, Hans J.; van Beek, Erik; Borchert, Odette W. H. M.; Schuitemaker, Nico; Sikkema, J. Marko; Kuipers, A. H. M.; Logtenberg, Sabine L. M.; van der Salm, Paulien C. M.; Oude Rengerink, Katrien; Lopriore, Enrico; van den Akker-van Marle, M. Elske; le Cessie, Saskia; van Lith, Jan M.; Struys, Michel M.; Mol, Ben Willem J.; Dahan, Albert; Middeldorp, Johanna M.

2015-01-01

To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. Multicentre randomised controlled equivalence trial. 15 hospitals in the Netherlands. Women with an intermediate to high obstetric risk with an

Muscle injections with lidocaine improve resting fatigue and pain in patients with chronic fatigue syndrome

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Staud R

2017-06-01

Full Text Available Roland Staud,1 Taylor Kizer,1 Michael E Robinson2 1Department of Medicine, College of Medicine, 2Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA Objective: Patients with chronic fatigue syndrome (CFS complain of long-lasting fatigue and pain which are not relieved by rest and worsened by physical exertion. Previous research has implicated metaboreceptors of muscles to play an important role for chronic fatigue and pain. Therefore, we hypothesized that blocking impulse input from deep tissues with intramuscular lidocaine injections would improve not only the pain but also fatigue of CFS patients. Methods: In a double-blind, placebo-controlled study, 58 CFS patients received 20 mL of 1% lidocaine (200 mg or normal saline once into both trapezius and gluteal muscles. Study outcomes included clinical fatigue and pain, depression, and anxiety. In addition, mechanical and heat hyperalgesia were assessed and serum levels of lidocaine were obtained after the injections. Results: Fatigue ratings of CFS patients decreased significantly more after lidocaine compared to saline injections (p = 0.03. In contrast, muscle injections reduced pain, depression, and anxiety (p < 0.001, but these changes were not statistically different between lidocaine and saline (p > 0.05. Lidocaine injections increased mechanical pain thresholds of CFS patients (p = 0.04 but did not affect their heat hyperalgesia. Importantly, mood changes or lidocaine serum levels did not significantly predict fatigue reductions. Conclusion: These results demonstrate that lidocaine injections reduce clinical fatigue of CFS patients significantly more than placebo, suggesting an important role of peripheral tissues for chronic fatigue. Future investigations will be necessary to evaluate the clinical benefits of such interventions. Keywords: muscle injections, lidocaine, metaboreceptor, chronic fatigue 

Post-caesarean analgesia: What is new?

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Sukhyanti Kerai

2017-01-01

Full Text Available Adequate post-operative analgesia after caesarean section (CS is vital as it impacts the distinct surgical recovery requirements of the parturient. Although newer analgesic modalities and drugs for post-caesarean analgesia have been introduced over the recent years, review of the literature suggests suggests that we are far from achieving the goals of optimum post-operative analgesia. We conducted a systematic review of recent advances in modalities for post-caesarean analgesia. After systematic search and quality assessment of studies, we included a total of 51 randomised controlled trials that evaluated the role of opioids, transversus abdominis plane (TAP block, wound infiltration/infusion, ketamine, gabapentin and ilioinguinal-iliohypogastric nerve block (II-IH NB for post-caesarean analgesia. Administration of opioids still remains the gold standard for post-operative analgesia, but the associated troublesome side effects have led to the mandatory incorporation of non-opioid analgesics in post-CS analgesia regime. Among the non-opioid techniques, TAP block is the most investigated modality of the last decade. The analgesic efficacy of TAP block as a part of multimodal analgesia is established in post-CS cases where intrathecal morphine is not employed and in CS under general anaesthesia. Among non-steroidal anti-inflammatory drugs, COX-I inhibitors and intravenous paracetamol are found to be useful in post-operative analgesic regimen. The perioperative use of ketamine is found useful only in CS done under spinal anaesthesia; no benefit is seen where general anaesthesia is employed. Wound infiltration with local anaesthetics, systemic gabapentin and II-IH NB need further trials to assess their efficacy.

Assessment of buprenorphine, carprofen, and their combination for postoperative analgesia in olive baboons (Papio anubis).

Science.gov (United States)

Allison, Sarah O; Halliday, Lisa C; French, Jeffrey A; Novikov, Dmitri D; Fortman, Jeffrey D

2007-05-01

This study compared the efficacy of buprenorphine, carprofen, and a combination of the 2 analgesics in female baboons. Physiologic and behavioral parameters were assessed at baseline and postoperatively for 6 d by use of continuous noninvasive physiologic monitoring and twice-daily videotaping. Prior to surgery, all animals received a pre-emptive dose of either 0.01 mg/kg buprenorphine intramuscularly, 2.2 mg/kg carprofen intramuscularly, or a combination of 0.01 mg/kg buprenorphine and 2.2 mg/kg carprofen intramuscularly. All animals in the carprofen (n = 4) and buprenorphine+carprofen (n = 4) treatment groups appeared to have sufficient analgesia. Three of 4 animals in the buprenorphine group had adequate analgesia. The fourth animal had an elevated heart rate and spent less time standing during the postoperative period. In this study, the use of carprofen or a combination of carprofen plus buprenorphine provided more reliable postoperative analgesia than buprenorphine alone.

Does gestational age affect the pharmacokinetics and pharmacodynamics of lidocaine in mother and fetus?

Science.gov (United States)

Pedersen, H; Santos, A C; Morishima, H O; Finster, M; Plosker, H; Arthur, G R; Covino, B G

1988-03-01

The pharmacokinetics and pharmacodynamics of lidocaine were studied in nine chronically prepared pregnant ewes and their fetuses at a mean ( +/- SE) gestation of 119 +/- 1.0 days, and the results were compared to the data previously published for ten animals at 138 +/- 1.2 days of gestation (term 148 days). Lidocaine was infused intravenously to the mother at a constant rate of 0.1 mg.kg-1.min-1 over a period of 180 min, in order to reach a steady-state maternal plasma lidocaine concentration of approximately 2 micrograms/ml. Maternal and fetal blood samples and maternal urine were collected at intervals throughout the infusion for determination of pH, blood gases, and lidocaine concentrations. Maternal and fetal heart rate, blood pressure, and intraamniotic pressure were continuously recorded. Fetal cardiac output and organ blood flow were determined before and at the end of lidocaine infusion using radionuclide-labeled microspheres. Lidocaine tissue concentrations were determined in several maternal and fetal organs excised at the end of infusion. In both groups, the steady-state plasma concentrations of lidocaine were similar; namely, 2.3 +/- 0.17 and 2.1 +/- 0.21 micrograms/ml in preterm and term ewes, respectively. There were also no significant differences in steady-state plasma drug concentrations in preterm and term fetuses (1.3 +/- 0.11 and 1.2 +/- 0.15 micrograms/ml). The mean fetal maternal concentration ratios (F/M) were the same; namely, 0.6. Maternal urinary excretion of lidocaine correlated with urine pH, being greater in the more acid urine. Tissue uptake of drug tended to be higher in the preterm than term mothers, but only significantly so in the brain and adrenals.(ABSTRACT TRUNCATED AT 250 WORDS)

Transarterial lidocaine-lipiodol emulsion administration for relief of pain during transarterial chemoembolization of malignant tumor

International Nuclear Information System (INIS)

Wu Anle; Yan Zhiping; Zhou Kangrong; Wang Jianhua; Cheng Jiemin; Qian Sheng; Luo Jianjun; Chen Yi

2004-01-01

Objective: To assess the feasibility and efficacy of transarterial lidocaine-lipiodol emulsion administration for controlling abdominal pain and preventing the arterial spasm resulting from TACE, and to evaluate the optimal amount of lidocaine administration. Methods: In a prospective trial of 120 consecutive patients with malignant tumor who underwent TACE were divided into three groups, those who received lidocaine-lipiodol emulsion administration (group A, n=40), those who received lidocaine bolus intraarterial infusion immediately before TACE (group B, n=40) and those who received no lidocaine injection before TACE, (group C, n=40). The degree of post-procedure pain was evaluated by a subjective method (using visual analogue scales from 0 to 10), and an objective method (amount of post-procedure analgesics). Incidence and degree of arterial spasm were assessed by DSA. Results: The correlative pain incidences between the three groups showed significant difference (P 0.05). Mean dose of intramuscular analgesics for controlling intolerable pain in group A and B was significantly lower than that of group C (P<0.05). There was no difference in the incidence of arterial spasm between group A and B but it was much lower in group C. Lipiodol deposit in malignant mass was densest in group A, especially in the metastatic nodules of the liver. Conclusions: Transarterial administration of lidocaine-lipiodol emulsion can not only reduce the incidence of pain during TACE, but also prevent the arterial spasm. It is much more effective than pre-TACE administration of pethidine and intraarterial infusion of lidocaine. The authors recommond routinely for the administration of lidocaine-lipiodol emulsion. (authors)

Effects of lidocaine on lipopolysaccharide-induced synovitis in horses

OpenAIRE

Campebell,R.C.; Peiró,J.R.; Valadão,C.A.A.; Santana,A.E.; Cunha,F.Q.

2004-01-01

Lidocaine (100mg 2%) injected into the carpal joint was used to evaluate the inflammatory response induced by injection (1.5ng) of intra-articular E. coli lipopolysaccharide (LPS) endotoxin. Seventeen male Mangalarga horses aged two to three years were divided into three groups and in all animals was injected 0.9% saline (SAL) in the left carpus (LC), and in the right carpus (RC) one of the following combinations were injected: group A (n=6) LPS plus SAL; group B (n=6) LPS plus lidocaine; gro...

Clinical observation of pingyangmycin, lidocaine, iodipin emulsion and absorbable gelatine sponge granules embolization treatment for hysteromyoma

International Nuclear Information System (INIS)

Hua Cun; Zhou Guangde; Teng Jun; Zhang Kuiyang

2008-01-01

Objective: To study the feasibility and availability of uterine arterial embolization for hysteromyoma with pingyangmycin, lidocaine, iodipin emulsion and absorbable gelatine sponge granules immersed with lidocaine. Methods: The observation of pain sensation change of clinical symptoms, size of hysteromyoma, change of uterus volume together with the specimens and pathological features of 68 cases of hysteromyoma during and after the embolization by using pingyangmyein, lidocaine, iodipin emulsion and absorbable gelatine sponge granules immersed with lidocaine were carried out and compared. Results: Intramuscular analgesic injection couldn't control the pain in 13 cases, covering 19.1%, symptom remission rate was 92.3%, including 89.2% menstruation recovery, 90.8% disappearance of pelvic pain, abdominal distension and compression symptoms, 78.8% average shrinkage of tumor size and 47.5% reduction of uterus volumes. Conclusion: Pingyangmyein, lidocaine, iodipin emulsion and absorbable gelatine sponge granules immersed with lidocaine are the ideal embolization material for treating hysteromyoma. (authors)

Time Course of the Soleus M Response and H Reflex after Lidocaine Tibial Nerve Block in the Rat

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Kévin Buffenoir

2013-01-01

Full Text Available Aims. In spastic subjects, lidocaine is often used to induce a block predictive of the result provided by subsequent surgery. Lidocaine has been demonstrated to inhibit the Hoffmann (H reflex to a greater extent than the direct motor (M response induced by electrical stimulation, but the timecourse of these responses has not been investigated. Methods. An animal (rat model of the effects of lidocaine on M and H responses was therefore developed to assess this time course. M and H responses were recorded in 18 adult rats before and after application of lidocaine to the sciatic nerve. Results. Two to five minutes after lidocaine injection, M responses were markedly reduced (mean reduction of 44% and H reflexes were completely abolished. Changes were observed more rapidly for the H reflex. The effects of lidocaine then persisted for 100 minutes. The effect of lidocaine was therefore more prolonged on the H reflex than on the M response. Conclusion. This study confirms that lidocaine blocks not only alpha motoneurons but also Ia afferent fibres responsible for the H reflex. The authors describe, for the first time, the detailed time course of the effect of lidocaine on direct or reflex activation of motoneurons in the rat.

The experimental study of the effect of dexamethasone, lidocaine and contrast medium on the activity of collagenase

International Nuclear Information System (INIS)

Wu Zhiqun; Liu Weimin; Li Zhonghua; Yang Peng

2007-01-01

Objective: To study the effects of hormone, anesthetic and contrast medium on the activities of collagenase lysis. Methods: Nuclear tissues were divided into equal amount for different groups and same units of collagenase were used for the lysis. The only difference in the control group from experimental groups was that there were no dexamethasone, lidocaine or omnipaque but existing in experimental groups. Twenty four hours later, the concentrations of the hydroxyproline were determined in different groups and the data were analyzed by statistical software with computer. Results: 1. The concentrations of hydroxyproline in the dexamethasone group, lidocaine group and omnipaque group were significantly lower than that of control group, especially that of lidocaine group, P value was <0.05 or 0.01. 2. The concentrations of hydroxyproline in the dexamethasone + lidocaine group, dexamethasone + omnipaque group, lidocaine+omnipaque group and dexamethasone + lidocaine + omnipaque group were significantly lower than that of control group; and simultaneously lower in dexamethasone group, lidocaine group, omnipaque group respectively; P value was also <0.05 or 0.01. Conclusion: Dexamethasone, lidocaine and omnipaque can individually inhibit the activity of collagenase at different degrees, so they shouldn't be used together with collagenase in treating the lumber disc herniation. (authors)

Pupil dilation with intracameral lidocaine during phacoemulsification: Benefits for the patient and surgeon

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Nikeghbali Aminollah

2008-01-01

Full Text Available Topical and/or intracameral administration of anticholinergic and/or sympathomimetic mydriatic agents which are usually used for pupillary dilation during cataract surgery, have some disadvantages such as slow onset of dilation and adverse ocular and systemic effects. We evaluated intracameral injection of preservative-free 1% lidocaine without using any preoperative or intraoperative mydriatics to induce pupil dilation in 31 consecutive eyes scheduled for phacoemulsification cataract extraction and intraocular lens implantation. Pupil diameter was measured before and 90 sec after intracameral lidocaine injection. After intracameral lidocaine injection, the mean pupil diameter was significantly greater than the baseline measurement (P< 0.001. No additional mydriatics were needed up to the end of the operations. Intracameral preservative-free lidocaine 1% has a rapid and effective mydriasis that could be a safe alternative to topical and intracameral mydriatics in phacoemulsification.

Remifentanil vs. Lidocaine on Response to Tracheal Tube during Emergence of General Anesthesia

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Kambiz Sadegi

2014-08-01

Conclusion: we specified Remifentanil reduces cough during the emergence from general anesthesia more effective than Lidocaine in patients undergoing general surgery. In addition, Remifentanil and i.v. lidocaine revealed comparable impact regarding VAS scoring, sedation level and pethidine consumption.

Thermodynamic studies of mixtures for topical anesthesia: Lidocaine-salol binary phase diagram

Energy Technology Data Exchange (ETDEWEB)

Lazerges, Mathieu [Laboratoire de Chimie Physique (EA 4066), Faculte des Sciences Pharmaceutiques et Biologiques, Universite Paris Descartes, 4 Avenue de l' Observatoire, 75270 Paris Cedex 06 (France); Rietveld, Ivo B., E-mail: ivo.rietveld@parisdescartes.fr [Laboratoire de Chimie Physique (EA 4066), Faculte des Sciences Pharmaceutiques et Biologiques, Universite Paris Descartes, 4 Avenue de l' Observatoire, 75270 Paris Cedex 06 (France); Corvis, Yohann; Ceolin, Rene; Espeau, Philippe [Laboratoire de Chimie Physique (EA 4066), Faculte des Sciences Pharmaceutiques et Biologiques, Universite Paris Descartes, 4 Avenue de l' Observatoire, 75270 Paris Cedex 06 (France)

2010-01-10

The lidocaine-salol binary system has been investigated by differential scanning calorimetry, direct visual observations, and X-ray powder diffraction, resulting in a temperature-composition phase diagram with a eutectic equilibrium. The eutectic mixture, found at 0.423 {+-} 0.007 lidocaine mole-fraction, melts at 18.2 {+-} 0.5 {sup o}C with an enthalpy of 17.3 {+-} 0.5 kJ mol{sup -1}. This indicates that the liquid phase around the eutectic composition is stable at room temperature. Moreover, the undercooled liquid mixture does not easily crystallize. The present binary mixture exhibits eutectic behavior similar to the prilocaine-lidocaine mixture in the widely used EMLA topical anesthetic preparation.

Thermodynamic studies of mixtures for topical anesthesia: Lidocaine-salol binary phase diagram

International Nuclear Information System (INIS)

Lazerges, Mathieu; Rietveld, Ivo B.; Corvis, Yohann; Ceolin, Rene; Espeau, Philippe

2010-01-01

The lidocaine-salol binary system has been investigated by differential scanning calorimetry, direct visual observations, and X-ray powder diffraction, resulting in a temperature-composition phase diagram with a eutectic equilibrium. The eutectic mixture, found at 0.423 ± 0.007 lidocaine mole-fraction, melts at 18.2 ± 0.5 o C with an enthalpy of 17.3 ± 0.5 kJ mol -1 . This indicates that the liquid phase around the eutectic composition is stable at room temperature. Moreover, the undercooled liquid mixture does not easily crystallize. The present binary mixture exhibits eutectic behavior similar to the prilocaine-lidocaine mixture in the widely used EMLA topical anesthetic preparation.

Pain and efficacy of local anesthetics for central venous access

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William C Culp Jr

2008-11-01

Full Text Available William C Culp Jr1, Mohammed Yousaf2, Benjamin Lowry1, Timothy C McCowan3, William C Culp21Division of Cardiothoracic Anesthesiology, Scott and White Hospital, The Texas A&M University College of Medicine, Temple, TX, USA; 2Division of Interventional Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA; 3Department of Radiology, University of Mississippi Medical Center, Jackson, MS, USAPurpose: To compare pain during injection and efficacy of analgesia of local anesthetics during central venous line placement.Methods: Sixty-two patients were studied in a randomized, double-blinded prospective fashion. Patients received 1% lidocaine (L, buffered 1% lidocaine (LB, or 2% chloroprocaine (CP injected around the internal jugular vein for procedural analgesia for central venous access. Patients reported pain via a standard linear visual analog scale, with 0 representing no pain and 10 being the worst pain imaginable.Results: Overall patient perception of pain was better with CP and L than LB with mean scores of CP 2.4, L 2.6, LB 4.2. Pain with injection mean scores were CP 2.1, L 2.5, LB 3.2. Pain with catheter placement scores were CP 2.5, L 1.7, LB 3.4. Operator assessment of overall pain values were CP 1.9, L 2.2, LB 3.4. LB consistently scored the worst, though compared with CP, this only reached statistical significance in overall patient pain and pain at catheter insertion compared with L.Conclusion: Though chloroprocaine scored better than lidocaine in 3 of 4 parameters, this trend did not achieve statistical significance. Adding sodium bicarbonate to lidocaine isn’t justified in routine practice, nor is routine replacement of lidocaine with chloroprocaine.Keywords: local anesthesia, analgesia, central venous access, lidocaine, chloroprocaine

Anticonvulsant treatment of asphyxiated newborns under hypothermia with lidocaine : efficacy, safety and dosing

NARCIS (Netherlands)

van den Broek, Marcel P. H.; Rademaker, Carin M. A.; van Straaten, Henrica L. M.; Huitema, Alwin D. R.; Toet, Mona C.; de Vries, Linda S.; Egberts, Antoine C. G.; Groenendaal, Floris

BACKGROUND: Lidocaine is an antiarrythmicum used as an anticonvulsant for neonatal seizures, also during therapeutic hypothermia following (perinatal) asphyxia. Hypothermia may affect the efficacy, safety and dosing of lidocaine in these patients. OBJECTIVE: To study the efficacy and safety of

Epidural analgesia, neonatal care and breastfeeding.

Science.gov (United States)

Zuppa, Antonio Alberto; Alighieri, Giovanni; Riccardi, Riccardo; Cavani, Maria; Iafisco, Alma; Cota, Francesco; Romagnoli, Costantino

2014-11-29

The objective of our study is to evaluate the correlation between epidural analgesia during labor, start of breastfeeding and type of maternal-neonatal care.Two different assistance models were considered: Partial and Full Rooming-in.In this cohort study, 2480 healthy infants were enrolled, 1519 in the Partial Rooming-in group and 1321 in the Full Rooming-in group; 1223 were born to women subjected to epidural analgesia in labor.In case of Partial Rooming-in the rate of exclusive or prevailing breastfeeding is significant more frequent in newborns born to mothers who didn't receive analgesia. Instead, in case of Full Rooming-in the rate of exclusive or prevailing breastfeeding is almost the same and there's no correlation between the use or not of epidural analgesia.The good start of lactation and the success of breastfeeding seems to be guaranteed by the type of care offered to the couple mother-infant, that reverses any possible adverse effects of the use of epidural analgesia in labor.

Comparison of carprofen and tramadol for postoperative analgesia in dogs undergoing enucleation.

Science.gov (United States)

Delgado, Cherlene; Bentley, Ellison; Hetzel, Scott; Smith, Lesley J

2014-12-15

To compare analgesia provided by carprofen and tramadol in dogs after enucleation. Randomized, masked clinical trial. 43 dogs. Client-owned dogs admitted for routine enucleation were randomly assigned to receive either carprofen or tramadol orally 2 hours prior to surgery and 12 hours after the first dose. Dogs were scored for signs of pain at baseline (ie, before carprofen or tramadol administration) and at 0.25, 0.5, 1, 2, 4, 6, 8, 24, and 30 hours after extubation. Dogs received identical premedication and inhalation anesthesia regimens, including premedication with hydromorphone. If the total pain score was ≥ 9 (maximum possible score of 20), there was a score ≥ 3 in any of 5 behavioral categories (highest score possible per category was 3 or 4), or the visual analog scale (VAS) score was ≥ 35 (maximum possible score of 100) combined with a palpation score > 0, rescue analgesia (hydromorphone) was administered and treatment failure was recorded. No differences were found in age, sex, or baseline pain scores between groups. Significantly more dogs receiving tramadol required rescue analgesia (6/21), compared with dogs receiving carprofen (1/22). Pain and VAS scores decreased linearly over time. No significant differences were found in pain or VAS scores between groups at any time point (dogs were excluded from analysis after rescue). Results of this study suggested that carprofen, with opioid premedication, may provide more effective postoperative analgesia than tramadol in dogs undergoing enucleation.

Epidural Analgesia in the Postoperative Period

National Research Council Canada - National Science Library

Mathsen, Curtis

2001-01-01

.... This descriptive study was conducted to determine which surgical patients experienced the most analgesia with the fewest side effects when receiving epidural analgesia in the postoperative period...

Anestesia peridural com lidocaína isolada ou associada à clonidina: efeito cardiorrespiratório e analgésico em cães Epidural anesthesia with lidocaine alone or combinated with clonidine: cardiopulmonary and analgesic effects in dogs

Directory of Open Access Journals (Sweden)

Renata Navarro Cassu

2010-10-01

Full Text Available Analgesia satisfatória tem sido relatada com a administração peridural de agonistas adrenérgicos em associação aos anestésicos locais. Objetivou-se, com este trabalho, avaliar o efeito analgésico e cardiorrespiratório da lidocaína isolada ou associada à clonidina via peridural lombossacra em cães. Seis cães foram submetidos a dois tratamentos, com intervalo mínimo de 15 dias entre cada avaliação. No tratamento L, foi empregada lidocaína 2% com vasoconstrictor (5mg kg-1 e, no tratamento C, a clonidina (10µg kg-1 foi associada à lidocaína, de modo a perfazer um volume final de 0,25ml kg-1. Os animais foram tranquilizados com acepromazina (0,05mg kg-1 IV e mantidos sob anestesia com isofluorano em máscara facial durante a punção do espaço peridural. Foram mensuradas: frequência cardíaca (FC, parâmetros eletrocardiográficos (ECG, frequência respiratória (f, pressão arterial sistólica (PAS, gases sanguíneos, temperatura retal (T, duração e extensão do bloqueio anestésico. A estatística foi realizada com análise de variância, teste de Tukey e teste t pareado (PSatisfactory analgesia has been related with epidural 2 adrenoceptor agonists in combination with local anesthetics. The aim of this study was to compare the analgesic and cardiopulmonary effects of lidocaine or lidocaine-clonidine epidural injections in healthy dogs. Dogs were randomly assigned to two groups of six animals each. The L group received lidocaine (5mg kg-1 L and the C group lidocaine plus clonidine (10µg kg-1 C. Preanaesthetic medication was carried out with acepromazine (0.05mg kg-1 IV. Anaesthesia was induced and maintained with isoflurane by facial mask for epidural injection. Heart rate (HH, electrocardiography (ECG, respiratory rate (RR, systolic arterial blood pressure (SAP, rectal temperature (RT, blood gases, duration of anesthesia and sensitive block level were investigated. Statistical analysis was performed with ANOVA, Tukey test

Labor epidural analgesia: Past, present and future

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Reena

2014-01-01

Full Text Available One of the most severe pains experienced by a woman is that of childbirth. Providing analgesia for labor has always been a challenge more so because of the myths and controversies surrounding labor. It is imperative to understand the pain transmission during various stages of labor in order to select a proper technique for providing labor analgesia. The adverse effects of labor pain are numerous and affect both the mother as well as the fetus. Currently lumbar epidural is considered to be the gold standard technique for labor analgesia. Local anaesthetics like bupivacaine and ropivacaine are commonly used and adjuvants like clonidine, fentanyl and neostigmine have been extensively studied. However, despite being so popular, epidural analgesia is not without complications, with hypotension being the most common. Other complications include accidental dural puncture, infection, intravascular placement, high block and epidural hematoma. Other neuraxial techniques include continuous caudal analgesia, and combined spinal epidural analgesia. The numerous studies investigating the various aspects of this method have also served to dispel various myths surrounding epidural analgesia like increased incidence of cesarean section and instrumental delivery, prolongation of labor and future back pain. The future of labor analgesia lies in the incorporation of ultrasound in identifying the epidural space helping in proper catheter placement. The keywords "labor epidural" in the PUBMED revealed a total of 5018 articles with 574 review articles and 969 clinical trials. The relevant articles along with their references were extensively studied.

HUMAN LIVER SLICES EXPRESS THE SAME LIDOCAINE BIOTRANSFORMATION RATE AS ISOLATED HUMAN HEPATOCYTES

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OLINGA, P; MEIJER, DKF; SLOOFF, MJH; GROOTHUIS, GMM; Merema, M.T.

1993-01-01

In order to investigate whether liver slices are a valuable tool for the assessment of drug metabolism in human liver, we compared the phase I metabolism of lidocaine in human liver slices and hepatocytes prepared from three human livers. Lidocaine is mainly metabolised to monoethylglycinexylidide

Pharmacokinetics of Lidocaine Hydrochloride Administered with or without Adrenaline for the Paravertebral Brachial Plexus Block in Dogs.

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Choquette, Amélie; Troncy, Eric; Guillot, Martin; Varin, France; Del Castillo, Jérôme R E

2017-01-01

Adrenaline is known to prolong the duration of local anesthesia but its effects on the pharmacokinetic processes of local anesthetic drugs are not fully understood. Our objective was to develop a compartmental model for quantification of adrenaline's impact on the pharmacokinetics of perineurally-injected lidocaine in the dog. Dogs were subjected to paravertebral brachial plexus block using lidocaine alone or adrenalinated lidocaine. Data was collected through a prospective, randomised, blinded crossover protocol performed over three periods. Blood samples were collected during 180 minutes following block execution. Compartmental pharmacokinetic models were developed and their goodness-of-fit were compared. The lowering effects of adrenaline on the absorption of lidocaine were statistically determined with one-sided tests. A one-compartment disposition model with two successive zero-order absorption processes best fitted our experimental data. Adrenaline decreased the peak plasma lidocaine concentration by approximately 60% (P Adrenaline decreased the absorption rate of lidocaine and prolonged the duration of its absorption.

Comparison of dural puncture epidural technique versus conventional epidural technique for labor analgesia in primigravida

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Pritam Yadav

2018-01-01

Full Text Available >Background: Dural puncture epidural (DPE is a method in which a dural hole is created prior to epidural injection. This study was planned to evaluate whether dural puncture improves onset and duration of labor analgesia when compared to conventional epidural technique.Methods and Materials: Sixty term primigravida parturients of ASA grade I and II were randomly assigned to two groups of 30 each (Group E for conventional epidural and Group DE for dural puncture epidural. In group E, epidural space was identified and 18-gauge multi-orifice catheter was threaded 5 cm into the epidural space. In group DE, dura was punctured using the combines spinal epidural (CSE spinal needle and epidural catheter threaded as in group E followed by 10 ml of injection of Ropivacaine (0.2% with 20 mcg of Fentanyl (2 mcg/ml in fractions of 2.5 ml. Later, Ropivacaine 10 ml was given as a top-up on patient request. Onset, visual analouge scale (VAS, sensory and motor block, haemodynamic variables, duration of analgesia of initial dose were noted along with mode of delivery and the neonatal outcome.Results: Six parturients in group DE achieved adequate analgesia in 5 minutes while none of those in group E (P 0.05.Conclusions: Both techniques of labor analgesia are efficacious; dural puncture epidural has the potential to fasten onset and improve quality of labor analgesia when compared with conventional epidural technique.

Neuraxial labor analgesia for vaginal delivery and its effects on childhood learning disabilities.

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Flick, Randall P; Lee, Kunmoo; Hofer, Ryan E; Beinborn, Charles W; Hambel, Ellen M; Klein, Melissa K; Gunn, Paul W; Wilder, Robert T; Katusic, Slavica K; Schroeder, Darrell R; Warner, David O; Sprung, Juraj

2011-06-01

In prior work, children born to mothers who received neuraxial anesthesia for cesarean delivery had a lower incidence of subsequent learning disabilities compared with vaginal delivery. The authors speculated that neuraxial anesthesia may reduce stress responses to delivery, which could affect subsequent neurodevelopmental outcomes. To further explore this possibility, we examined the association between the use of neuraxial labor analgesia and development of childhood learning disabilities in a population-based birth cohort of children delivered vaginally. The educational and medical records of all children born to mothers residing in the area of 5 townships of Olmsted County, Minnesota from 1976 to 1982 and remaining in the community at age 5 years were reviewed to identify those with learning disabilities. Cox proportional hazards regression was used to compare the incidence of learning disabilities between children delivered vaginally with and without neuraxial labor analgesia, including analyses adjusted for factors of either potential clinical relevance or that differed between the 2 groups in univariate analysis. Of the study cohort, 4684 mothers delivered children vaginally, with 1495 receiving neuraxial labor analgesia. The presence of childhood learning disabilities in the cohort was not associated with use of labor neuraxial analgesia (adjusted hazard ratio, 1.05; 95%confidence interval, 0.85-1.31; P = 0.63). The use of neuraxial analgesia during labor and vaginal delivery was not independently associated with learning disabilities diagnosed before age 19 years. Future studies are needed to evaluate potential mechanisms of the previous finding indicating that the incidence of learning disabilities is lower in children born to mothers via cesarean delivery under neuraxial anesthesia compared with vaginal delivery.

A New Anaesthetic Protocol for Adult Zebrafish (Danio rerio: Propofol Combined with Lidocaine.

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Ana M Valentim

Full Text Available The increasing use of zebrafish model has not been accompanied by the evolution of proper anaesthesia for this species in research. The most used anaesthetic in fishes, MS222, may induce aversion, reduction of heart rate, and consequently high mortality, especially during long exposures. Therefore, we aim to explore new anaesthetic protocols to be used in zebrafish by studying the quality of anaesthesia and recovery induced by different concentrations of propofol alone and in combination with different concentrations of lidocaine.In experiment A, eighty-three AB zebrafish were randomly assigned to 7 different groups: control, 2.5 (2.5P, 5 (5P or 7.5 μg/ml (7.5P of propofol; and 2.5 μg/ml of propofol combined with 50, (P/50L, 100 (P/100L or 150 μg/ml (P/150L of lidocaine. Zebrafish were placed in an anaesthetic water bath and time to lose the equilibrium, reflex to touch, reflex to a tail pinch, and respiratory rate were measured. Time to gain equilibrium was also assessed in a clean tank. Five and 24 hours after anaesthesia recovery, zebrafish were evaluated concerning activity and reactivity. Afterwards, in a second phase of experiments (experiment B, the best protocol of the experiment A was compared with a new group of 8 fishes treated with 100 mg/L of MS222 (100M.In experiment A, only different concentrations of propofol/lidocaine combination induced full anaesthesia in all animals. Thus only these groups were compared with a standard dose of MS222 in experiment B. Propofol/lidocaine induced a quicker loss of equilibrium, and loss of response to light and painful stimuli compared with MS222. However zebrafish treated with MS222 recovered quickly than the ones treated with propofol/lidocaine.In conclusion, propofol/lidocaine combination and MS222 have advantages in different situations. MS222 is ideal for minor procedures when a quick recovery is important, while propofol/lidocaine is best to induce a quick and complete anaesthesia.

Molecular and functional PET-fMRI measures of placebo analgesia in episodic migraine: Preliminary findings.

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Linnman, Clas; Catana, Ciprian; Petkov, Mike P; Chonde, Daniel Burje; Becerra, Lino; Hooker, Jacob; Borsook, David

2018-01-01

Pain interventions with no active ingredient, placebo, are sometimes effective in treating chronic pain conditions. Prior studies on the neurobiological underpinnings of placebo analgesia indicate endogenous opioid release and changes in brain responses and functional connectivity during pain anticipation and pain experience in healthy subjects. Here, we investigated placebo analgesia in healthy subjects and in interictal migraine patients (n = 9) and matched healthy controls (n = 9) using 11 C-diprenoprhine Positron Emission Tomography (PET) and simultaneous functional Magnetic Resonance Imaging (fMRI). Intravenous saline injections (the placebo) led to lower pain ratings, but we did not find evidence for an altered placebo response in interictal migraine subjects as compared to healthy subjects.

Molecular and functional PET-fMRI measures of placebo analgesia in episodic migraine: Preliminary findings

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Clas Linnman

2018-01-01

Full Text Available Pain interventions with no active ingredient, placebo, are sometimes effective in treating chronic pain conditions. Prior studies on the neurobiological underpinnings of placebo analgesia indicate endogenous opioid release and changes in brain responses and functional connectivity during pain anticipation and pain experience in healthy subjects. Here, we investigated placebo analgesia in healthy subjects and in interictal migraine patients (n = 9 and matched healthy controls (n = 9 using 11C-diprenoprhine Positron Emission Tomography (PET and simultaneous functional Magnetic Resonance Imaging (fMRI. Intravenous saline injections (the placebo led to lower pain ratings, but we did not find evidence for an altered placebo response in interictal migraine subjects as compared to healthy subjects.

Effects of lidocaine and droxicainide on myocardial necrosis: a comparative study

International Nuclear Information System (INIS)

Faria, D.B.; Cheung, W.M.; Ribeiro, L.G.; Maroko, P.R.

1983-01-01

Lidocaine has been shown to protect ischemic myocardium, but the degree of its effectiveness is not yet well established. Therefore, in this study, the effects of this drug on ultimate infarct size were examined quantitatively. Another member of the same class of drugs, droxicainide (ALS1249), DL-N-(2-hydroxyethyl)-pipecolinyl-2,6-dimethylanilide hydrochloride, is a new antiarrhythmic agent that has shown a good therapeutic index in the initial experimental studies. Accordingly, the effects of this drug on ultimate infarct size were examined and compared with those of lidocaine. Coronary artery occlusion was performed on 29 dogs. One minute later, technetium-99m labeled microspheres were injected into the left atrium for assessment of the hypoperfused zone (the zone at risk of infarction). Fifteen minutes after occlusion, the dogs were randomized into three groups: 9 dogs served as a control group, 10 were given lidocaine and 10 were given the same dosage of droxicainide. Six hours after occlusion, the dogs were sacrificed and the hearts cut into 3 mm thick slices and incubated in triphenyltetrazolium chloride to delineate the area of myocardial damage. Autoradiography of the same slices provided images of the areas of myocardial hypoperfusion. Thereafter, in each dog, the percent of hypoperfused area that evolved to necrosis was calculated. In control dogs, it was 85.6 +/- 2.0%; in lidocaine-treated dogs, 68.1 +/- 4.1% (p less than 0.01), a reduction of 20%; and in droxicainide-treated dogs, 50.1 +/- 5.3%, a reduction of 41% (p less than 0.001 versus control and p less than 0.005 versus lidocaine)

Peripheral lidocaine, but not ketamine inhibit capsaicin-induced hyperalgesia in humans

DEFF Research Database (Denmark)

Gottrup, Hanne; Bach, Flemming Winther; Arendt-Nielsen, Lars

2000-01-01

We examined the effect of the subcutaneous infiltration of ketamine, lidocaine and saline before injury on capsaicin-induced pain and hyperalgesia. Twelve healthy volunteers participated in two separate, randomized, double-blind, placebo-controlled crossover experiments. In experiment 1, 100...... micrograms capsaicin was injected intradermally in one volar forearm 10 min after the skin had been pretreated with lidocaine 20.0 mg in 2.0 ml or 0.9% saline 2.0 ml at the capsaicin injection site. In experiment 2, a similar capsaicin test was given 10 min after the skin had been pretreated with ketamine 5...... and brush stimuli, and areas of brush-evoked and punctate-evoked hyperalgesia. Lidocaine reduced all measures compared with placebo (P ketamine failed to change any measures. Pain scores and areas of hyperalgesia were not affected when the contralateral site was infiltrated with ketamine...

Toxicity of topical lidocaine applied to the breasts to reduce discomfort during screening mammography

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Colleen K Lambertz

2012-01-01

Conclusion: Thirty mL of 4% lidocaine gel on the breasts and chest wall covered for 1 h in healthy women resulted in plasma concentrations of lidocaine and MEGX well below therapeutic or toxic levels and no clinically significant adverse events.

The miracle of Lidocaine: Second Look with Cellular and Molecular Perspectives

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Mahnoosh Foroughi

2018-01-01

Full Text Available The pain phenomena as a disabling state but normal fact in human have been noticed to alarm and concern to the tissue injury and damage. Pain management is one the most worldwide clinical challenges in general population that is associated with considerable health care expenses, decreased productive time and impression on the quality of life. Numerous studies have been done to identify its pathophysiology and effective therapeutic agents. Attention to pain etiology, the relationship of inflammatory pathways, the molecular mechanisms and involved transmitters have given insights to novel approaches with more effective pain relief agents. In addition to over the counter analgesic and prescription medicine (NSAIDs, opioids, COX-2 inhibitors, there is no consensus about the analgesic role of herbal medicines. Cochrane library reviewed the place of herbal medicine in low back pain. They showed although the RCTs were not large trials and well-designed but herbal medicine could reduce pain more than placebo in short term without significant side effects (1.Lidocaine as local/regional anesthetic agent has been introduced to reduce acute postoperative pain, the chronic pain conditions, myofascial pain, refractory neuropathic pain and neuralgia. In cancer pain patients with refractory to opioid agents, lidocaine infusion could achieve adequate analgesic state (2. Review of literature shows the recovery improvement by lidocaine infusion depends to the type of surgery. There is strong evidence to decrease pain scores in abdominal surgeries (both open and laparoscopy. In prostate, breast, thoracic and spine operations, the evidence is moderate with small benefit. In cardiac surgery, lidocaine infusion would decrease postoperative cognitive disorder with no analgesic effect (3. Lidocaine acts predominantly through blocking sodium channels. These channels in cell membrane would be upregulated and more excitable in neuropathic pain. Moreover lidocaine

Effect of high-dose lidocaine treatment on superoxide dismutase and malon dialdehyde levels in seven diabetic patients.

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Celebi, H; Bozkirli, F; Günaydin, B; Bilgihan, A

2000-01-01

We report on the use of intravenous (IV) high-dose lidocaine to relieve diabetic neuropathic pain, and the technique's effects on clinical measures of lipid peroxidation. Under continuous electrocardiogram monitoring, IV lidocaine (5 mg kg(-1) in 100 mL saline) was administered over 30 minutes to 7 non-insulin-dependent diabetic patients suffering from neuropathic pain who reported increased pain within the preceding 6 months. This treatment was performed once a week for 1 month. Blood samples were collected from the contralateral limb to determine plasma superoxide dismutase (SOD) and malondialdehyde (MDA) levels on admission and following the final lidocaine administration. Plasma MDA concentrations significantly decreased after the final IV lidocaine treatment (P < .05, paired t-test), whereas SOD levels did not show a statistically significant difference compared with baseline levels. High-dose lidocaine treatment lessens MDA levels, a marker of free-radical-mediated cell damage. This suggests that one of lidocaine's mechanism of action may be its effect on oxygen free radicals, which in turn impacts lipid peroxidation.

Effect of premedication to provide analgesia as a supplement to inferior alveolar nerve block in patients with irreversible pulpitis.

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Lapidus, Daniel; Goldberg, Jack; Hobbs, Edward H; Ram, Saravanan; Clark, Glenn T; Enciso, Reyes

2016-06-01

The authors' objective was to determine whether scientific evidence supports the use of oral premedication to increase the efficacy of inferior alveolar nerve block (IANB) and to decrease endodontic treatment pain in patients with diagnosed irreversible pulpitis. The authors included randomized controlled trials that involved enteral premedication and 2% lidocaine IANB for adults with irreversible pulpitis compared with placebo. In particular, the authors reviewed studies comparing nonsteroidal anti-inflammatory drugs (NSAIDs), benzodiazepines, acetaminophen, and corticosteroids with placebo. The authors searched the following electronic databases: the Cochrane Library, MEDLINE, and Web of Science. The authors analyzed 9 randomized controlled clinical trials. Patients who took the NSAIDs under study, including ibuprofen, ketorolac, diclofenac, indomethacin, and lornoxicam, 1 hour before endodontic treatment showed statistically significant improvement in the outcome of having "little or no pain" during endodontic treatment compared with patients who took a placebo 1 hour before endodontic treatment (risk ratio [RR], 1.989; 95% confidence interval [CI], 1.495-2.646; P < .001). Benzodiazepines were not as well represented in the literature, but the 2 included studies did not show a significant improvement in patients' having "little or no pain" during endodontic treatment over placebo (RR, 0.989; 95% CI, 0.677-1.444; P = .954). There is moderate evidence to support the use of oral NSAIDs-in particular, ibuprofen (600 milligrams)-1 hour before the administration of IANB local anesthetic (1.8-3.6 milliliters of 2% lidocaine) to provide additional analgesia to the patient. Copyright © 2016 American Dental Association. Published by Elsevier Inc. All rights reserved.

Labor analgesia: An update on the effect of epidural analgesia on labor outcome

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Samina Ismail

2013-01-01

Full Text Available Following the introduction of epidural for labor analgesia, debate has centered on the issue of its effect on outcome of labor; in terms of length of labor and increase in the rate of instrumental vaginal delivery and cesarean section (CS. There is no ideal study on the effect of epidural analgesia (EA on the outcome of labor due to logistic problems in randomization, blinding and getting a control group; as a result these queries are partly answered. Despite these problems, it has been established that labor epidural has minimal effect on progress of established labor and maternal request should be a sufficient indication to start an epidural. Although instrumental vaginal delivery is probably increased with epidural but obstetrician practice, pain free patient and teaching opportunity are likely factors increasing the incidence. Maternal-fetal factors and obstetric management and not the use of EA are the most important determinants of the CS rate. The purpose of this review is to summarize data from controlled trials addressing the question of whether neuraxial labor analgesia causes an increased risk of CS or rate of instrumental delivery. In addition, the review discusses whether the timing of initiation of analgesia infl uences the mode of delivery.

Comparison of 2-Chloroprocaine, Bupivacaine, and Lidocaine for Spinal Anesthesia in Patients Undergoing Knee Arthroscopy in an Outpatient Setting: A Double-Blind Randomized Controlled Trial.

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Teunkens, An; Vermeulen, Kristien; Van Gerven, Elke; Fieuws, Steffen; Van de Velde, Marc; Rex, Steffen

2016-01-01

Knee arthroscopy is a well-established procedure in day-case surgery, which is frequently performed under spinal anesthesia. It is, however, controversial whether the choice for a specific local anesthetic translates into relevant outcomes. We hypothesized that the use of 2-chloroprocaine would be associated with a faster recovery from sensorimotor block. Ninety-nine patients were included in this prospective, double-blind, randomized controlled trial and randomly allocated to receive either 40 mg 2-chloroprocaine, 40 mg lidocaine, or 7.5 mg bupivacaine. The primary endpoint was the time until complete recovery of sensory block. Secondary endpoints included time to recovery from motor block, failure rates, incidence of hypotension/bradycardia, postoperative pain, first mobilization, voiding and discharge times, and the incidence of transient neurologic symptoms. This clinical trial was registered prior to patient enrollment (EudraCT 2011-003675-11). Patients in the chloroprocaine group had a significantly shorter time until recovery from sensory block (median, 2.6 hours; interquartile range [IQR], 2.2-2.9 hours) than patients in the lidocaine group (3.1 hours; IQR, 2.7-3.6 hours; P bupivacaine group (6.1 hours; IQR, 5.5 hours to undefined hours; P bupivacaine. Times to first mobilization, voiding, and discharge were significantly shorter for chloroprocaine when compared with bupivacaine, but not with lidocaine. In the bupivacaine group, patients needed significantly less rescue medication for postoperative pain when compared with lidocaine and chloroprocaine. Groups did not differ with respect to patient satisfaction, incidence of bradycardia/hypotension, and transient neurologic symptom rate. For spinal anesthesia in patients undergoing ambulatory knee arthroscopy, chloroprocaine has the shortest time to complete recovery of sensory and motor block compared with bupivacaine and lidocaine.

The pharmacokinetics of morphine and lidocaine in nine severe trauma patients.

Science.gov (United States)

Berkenstadt, H; Mayan, H; Segal, E; Rotenberg, M; Almog, S; Perel, A; Ezra, D

1999-12-01

To study the pharmacokinetic parameters of morphine and lidocaine after a single intravenous (i.v.) bolus in severe trauma patients. Clinical case study. Department of Anesthesiology and Intensive Care of a university hospital. Nine patients, ages 24 to 91 years (mean 54.4 yrs), admitted to the hospital with severe trauma (Injury Severity Score > 20) were included in the study. After initial evaluation and stabilization, a single i.v. dose of morphine 0.025 mg/kg and lidocaine 1.5 mg/kg was given separately, and blood samples were drawn for each drug serum concentration. Morphine pharmacokinetics was studied in eight patients, lidocaine pharmacokinetics in seven patients, and both drugs were studied in six patients. Morphine clearance 2.5 to 10 ml/kg/min (6 +/- 2.6, mean +/- SD) and volume of distribution 0.28 to 3.30 L/kg (1.4 +/- 1.0) were found to be lower than values described previously for healthy volunteers (33.5 +/- 9 ml/kg/min and 5.16 +/- 1.40 L/kg, respectively), and are similar to those described in trauma patients (5 +/- 2.9 ml/kg/min and 0.9 +/- 0.2 L/kg, respectively). In contrast, lidocaine clearance 4.5 to 9.4 ml/kg/min (6.7 +/- 1.7) and volume of distribution 0.39 to 1.20 L/kg (0.72 +/- 0.28) were similar to the value described in healthy volunteers (10 ml/kg/min and 1.32 L/kg, respectively). Changes in pharmacokinetics of drugs eliminated by the liver may occur in patients with severe trauma. The preserved lidocaine clearance indicates an almost normal hepatic blood flow and suggests that other mechanisms may be involved in the lower morphine clearance. The findings may have applications for the treatment of severe trauma patients and suggest that drug monitoring might be needed in some instances so as to avoid toxicity.

Pre-emptive penile ring block with sucrose analgesia reduces pain response to neonatal circumcision.

Science.gov (United States)

Roman-Rodriguez, Christian F; Toussaint, Thomas; Sherlock, Douglas J; Fogel, Joshua; Hsu, Chaur-Dong

2014-04-01

To compare retrospective use of oral sucrose (SUC) vs oral sucrose plus lidocaine ring block (SUC + RB) in the management of pain during neonatal circumcision. A retrospective review of medical records of newborns circumcised using the "Neonatal Infant Pain Scale" was done. With regard to pain, the SUC group had a significantly greater percentage of those with pain than the SUC + RB group at 1 minute (77.7% vs 69.4%; P = .01) and 5 minutes (65.7% vs 55.7%; P = .004). There was no significant pain difference at 30 minutes. In the multivariate logistic regression analyses, those in the SUC group had significantly greater odds for pain at 1 minute than those in the SUC + RB group (odds ratio 1.45, 95% confidence interval 1.04-2.02; P = .03). No significant difference was noted at 5 minutes. Each of the SUC and SUC + RB groups had significant decreases in pain percentages at 5 minutes and 30 minutes (P analgesia. In addition, for post-term neonates, we recommend greater focus on pain levels, including considering higher dosages of pain medications. Copyright © 2014 Elsevier Inc. All rights reserved.

The effect of methyl-lidocaine on the biosynthesis of phospholipids de novo in the isolated hamster heart.

OpenAIRE

Tardi, P G; Man, R Y; Choy, P C

1992-01-01

Methyl-lidocaine is an amphiphilic agent which has been used as an experimental anti-arrhythmic drug. When hamster hearts were perfused with labelled glycerol, the presence of methyl-lidocaine in the perfusate was found to enhance the labelling in phosphatidylserine, phosphatidylinositol, diacylglycerol and triacylglycerol. However, the labelling of phosphatidylcholine and phosphatidylethanolamine was not significantly changed by methyl-lidocaine treatment. Assays in vitro for the enzymes inv...

Seizure threshold to lidocaine is decreased following repeated ECS (electroconvulsive shock)

DEFF Research Database (Denmark)

Kragh, J; Seidelin, J; Bolwig, T G

1993-01-01

Seizure susceptibility to lidocaine was investigated in rats which had received repeated ECS (electroconvulsive shock). In the first experiment three groups of rats received an ECS daily for 18 days, an ECS weekly for 18 weeks, and 18 sham treatments, respectively. Twelve weeks after the last ECS...... all rats received a lidocaine challenge (LC) in the form of an intraperitoneal (IP) injection of lidocaine (65 mg/kg). After the injection the animals were observed for occurrence of motor seizures. A total of 67% (10/15), 47% (7/15), and 0% (0/18) of the daily, weekly, and sham groups, respectively......, had motor seizures in response to the LC. In the second experiment five groups of rats received an ECS daily for 0, 1, 6, 18, and 36 days, respectively. Eighteen weeks after the last ECS all rats received an LC and 0% (0/15), 13% (2/15), 20% (3/15), 53% (8/15), and 58% (7/12), respectively, developed...

Intra-operative lidocaine in the prevention of vomiting after elective tonsillectomy in children: A randomised controlled trial.

Science.gov (United States)

Echevarría, Ghislaine C; Altermatt, Fernando R; Paredes, Sebastian; Puga, Valentina; Auad, Hernán; Veloso, Ana M; Elgueta, María F

2018-05-01

Postoperative vomiting (POV) is a frequent complication of tonsillectomy in children. In adult patients undergoing abdominal surgeries, the use of intravenous lidocaine infusion can prevent POV. To evaluate the anti-emetic effect of an intravenous lidocaine infusion used as an adjuvant to general anaesthesia, in children undergoing elective ear, nose and throat surgery. Double-blind, randomised, controlled study. Hospital-based, single-centre study in Chile. ASA I-II children, aged 2 to 12 years, scheduled for elective tonsillectomy. We standardised the induction and maintenance of anaesthesia. Patients were randomly allocated to lidocaine (1.5 mg kg intravenous lidocaine over 5 min followed by 2 mg kg h) or 0.9% saline (at the same rate and volume). Infusions were continued until the end of the surgery. Presence of at least one episode of vomiting, retching or both in the first 24 h postoperatively (POV). Plasma concentrations of lidocaine and postoperative pain. Ninety-two children were enrolled. Primary outcome data were available for 91. In the Lidocaine group, 28 of 46 patients (60.8%) experienced POV, compared with 37 of 45 patients (82.2%) in the Saline group [difference in proportions 21.3% (95% confidence interval (CI) 2.8 to 38.8), P = 0.024]. The intention-to-treat analysis showed that when we assumed that the patient in the Saline group lost to follow-up did not have POV, the difference in proportions decreased to 19.6% (95% CI, 0.9 to 37.2), with an unadjusted odds ratio of 0.38 (95% CI, 0.15 to 0.97, P = 0.044). The odds of having POV were 62% less likely in those patients receiving lidocaine compared with patients in the Saline group. The mean lidocaine plasma concentration was 3.91 μg ml (range: 0.87 to 4.88). Using an intravenous lidocaine infusion as an adjuvant to general anaesthesia decreased POV in children undergoing elective tonsillectomy. ClinicalTrials.gov Identifier: NCT01986309.

Paraspinous Lidocaine Injection for Chronic Nonspecific Low Back Pain: A Randomized Controlled Clinical Trial.

Science.gov (United States)

Imamura, Marta; Imamura, Satiko Tomikawa; Targino, Rosa Alves; Morales-Quezada, León; Onoda Tomikawa, Luis C; Onoda Tomikawa, Luis G; Alfieri, Fabio M; Filippo, Thais R; da Rocha, Ivan D; Neto, Raul Bolliger; Fregni, Felipe; Battistella, Linamara Rizzo

2016-05-01

In this large, sham-controlled, randomized trial, we examined the efficacy of the combination of standard treatment and paraspinous lidocaine injection compared with standard therapy alone in subjects with chronic low back pain. There is little research-based evidence for the routine clinical use of paraspinous lidocaine injection for low back pain. A total of 378 subjects with nonspecific chronic low back pain were randomized to 3 groups: paraspinous lidocaine injection, analgesics, and exercises (group 1, LID-INJ); sham paraspinous lidocaine injection, analgesics, and exercises (group 2, SH-INJ); and analgesics and exercises (group 3, STD-TTR). A blinded rater assessed the study outcomes at 3 time points: baseline, after treatment, and after 3 months of follow-up. There were increased frequency of pain responses and better low back functional scores in the LID-INJ group compared with the SH-INJ and STD-TTR groups. These effects remained at the 3-month follow-up but differed between all 3 groups. There were significant changes in pain threshold immediately after treatment, supporting the effects of this intervention in reducing central sensitization. Paraspinous lidocaine injection therapy is not associated with a higher risk of adverse effects compared with conventional treatment and sham injection. Its effects on hyperalgesia might correlate with changes in central sensitization. NCT02387567. There are few data to support paraspinous lidocaine injection use in patients with nonspecific chronic low back pain. Our results show that this therapy when combined with standard therapy significantly increases the number of responders versus standard treatment alone. Its effects on hyperalgesia might correlate with a change in central sensitization. Copyright © 2016. Published by Elsevier Inc.

Randomized, double-blind, placebo-controlled trial using lidocaine patch 5% in traumatic rib fractures.

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Ingalls, Nichole K; Horton, Zachary A; Bettendorf, Matthew; Frye, Ira; Rodriguez, Carlos

2010-02-01

The lidocaine patch 5% was developed to treat postherpetic neuralgia. Anecdotal experience at our institution suggests the lidocaine patch 5% decreases narcotic usage in patients with traumatic rib fractures. This trial was developed to define the patch's efficacy. Patients with rib fractures admitted to the trauma service at our Level I trauma center were enrolled and randomized in a 1 to 1 double-blind manner to receive a lidocaine patch 5% or placebo patch. Fifty-eight patients who met the inclusion criteria were enrolled from January 2007 to August 2008. Demographic and clinical information were recorded. The primary outcomes variable was total narcotic use, analyzed using the 1-tailed Mann-Whitney test. The secondary outcomes variables included non-narcotic pain medication, average pain score, pulmonary complications, and length of stay. Significance was defined based on a 1-sided test for the primary outcome and 2-sided tests for other comparisons, at p rib fractures, gender, trauma mechanism, preinjury lung disease, smoking history, percent of current smokers, and need for placement of chest tube between the lidocaine patch 5% and placebo groups. There was no difference between the lidocaine patch 5% and placebo groups, respectively, with regard to total IV narcotic usage: median, 0.23 units versus 0.26 units; total oral narcotics: median, 4 units versus 7 units; pain score: 5.6 +/- 0.4 versus 6.0 +/- 0.3 (mean +/- SEM); length of stay: 7.8 +/- 1.1 versus 6.2 +/- 0.7; or percentage of patients with pulmonary complications: 72.7% versus 72.0%. The lidocaine patch 5% does not significantly improve pain control in polytrauma patients with traumatic rib fractures.

Health economic evidence of 5% lidocaine medicated plaster in post-herpetic neuralgia

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Liedgens H

2013-11-01

Full Text Available Hiltrud Liedgens,1 Marko Obradovic,1 Mark Nuijten2 1Grunenthal GmbH, Aachen, Germany; 2Ars Accessus Medica, Amsterdam, the Netherlands Background: Post-herpetic neuralgia (PHN is the most common and most debilitating complication of herpes zoster, and involves considerable associated costs. Objective: This paper presents results from nine health economic studies undertaken in eight European countries that compared lidocaine medicated plaster with gabapentin and/or pregabalin in PHN. It aims to support the increasing need for published cost-effectiveness data for health care decision-making processes in Europe. Methods: All studies were based on a similar core Markov model with data derived from clinical trials, local Delphi panels, and official national price and tariff lists. The main outcome measure was cost per quality-adjusted life year gained; time without pain or intolerable adverse events was also included as a secondary outcome measure. All studies focused on an elderly population of patients with PHN who had insufficient pain relief with standard analgesics and could not tolerate or had contraindications to tricyclic antidepressants. Results: Despite considerable differences in many of the variables used, the results showed remarkable similarity and suggested that use of lidocaine medicated plaster offered cost-savings in many of the countries studied, where it proved a highly cost-effective alternative to both gabapentin and pregabalin. Conclusion: Lidocaine medicated plaster is a cost-effective alternative to gabapentin and pregabalin in the treatment of PHN. These savings are largely the result of the superior safety profile of the lidocaine medicated plaster. Keywords: post-herpetic neuralgia, zoster, cost-effectiveness, lidocaine, plaster

Pharmacokinetics of lidocaine and bupivacaine and stable isotope labelled analogues : a study in healthy volunteers

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Burm, A.G.D.; de Boer, A G; van Kleef, J.W.; Vermeulen, N P; de Leede, L G; Spierdijk, J; Breimer, D D

1988-01-01

The pharmacokinetics of lidocaine and bupivacaine and tri-deuteromethyl-labelled lidocaine and bupivacaine were investigated in healthy volunteers. The deuterium-labelled and the unlabelled form of the drug to be investigated were simultaneously infused in 10 min. Plasma concentrations were

Anesthesia with topical lidocaine hydrochloride gauzes in acute traumatic wounds in triage, a pilot study

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Ridderikhof, Milan L.; Leenders, Noukje; Goddijn, Helma; Schep, Niels W.; Lirk, Philipp; Goslings, J. Carel; Hollmann, Markus W.

2016-01-01

Topical application of lidocaine in wounds has been studied in combination with vasoconstrictive additives, but the effect without these additives is unknown. The objective was to examine use of lidocaine-soaked gauzes without vasoconstrictive agents, in traumatic wounds in adult patients, applied

Selective REM Sleep Deprivation Improves Expectation-Related Placebo Analgesia.

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Chouchou, Florian; Chauny, Jean-Marc; Rainville, Pierre; Lavigne, Gilles J

2015-01-01

The placebo effect is a neurobiological and psychophysiological process known to influence perceived pain relief. Optimization of placebo analgesia may contribute to the clinical efficacy and effectiveness of medication for acute and chronic pain management. We know that the placebo effect operates through two main mechanisms, expectations and learning, which is also influenced by sleep. Moreover, a recent study suggested that rapid eye movement (REM) sleep is associated with modulation of expectation-mediated placebo analgesia. We examined placebo analgesia following pharmacological REM sleep deprivation and we tested the hypothesis that relief expectations and placebo analgesia would be improved by experimental REM sleep deprivation in healthy volunteers. Following an adaptive night in a sleep laboratory, 26 healthy volunteers underwent classical experimental placebo analgesic conditioning in the evening combined with pharmacological REM sleep deprivation (clonidine: 13 volunteers or inert control pill: 13 volunteers). Medication was administered in a double-blind manner at bedtime, and placebo analgesia was tested in the morning. Results revealed that 1) placebo analgesia improved with REM sleep deprivation; 2) pain relief expectations did not differ between REM sleep deprivation and control groups; and 3) REM sleep moderated the relationship between pain relief expectations and placebo analgesia. These results support the putative role of REM sleep in modulating placebo analgesia. The mechanisms involved in these improvements in placebo analgesia and pain relief following selective REM sleep deprivation should be further investigated.

Epidural Labor Analgesia-Fentanyl Dose and Breastfeeding Success: A Randomized Clinical Trial.

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Lee, Amy I; McCarthy, Robert J; Toledo, Paloma; Jones, Mary Jane; White, Nancy; Wong, Cynthia A

2017-10-01

Breastfeeding is an important public health concern. High cumulative doses of epidural fentanyl administered for labor analgesia have been reported to be associated with early termination of breastfeeding. We tested the hypothesis that breastfeeding success is adversely influenced by the cumulative epidural fentanyl dose administered for labor analgesia. The study was a randomized, double-blind, controlled trial of parous women at greater than 38 weeks gestation who planned to breastfeed, had successfully breastfed a prior infant, and who received neuraxial labor analgesia. Participants were randomized to receive one of three epidural maintenance solutions for labor analgesia (bupivacaine 1 mg/ml, bupivacaine 0.8 mg/ml with fentanyl 1 μg/ml, or bupivacaine 0.625 mg/ml with fentanyl 2 μg/ml). The primary outcome was the proportion of women breastfeeding at 6 weeks postpartum. Maternal and umbilical venous blood fentanyl and bupivacaine concentration at delivery were measured. A total of 345 women were randomized and 305 had complete data for analysis. The frequency of breastfeeding at 6 weeks was 97, 98, and 94% in the groups receiving epidural fentanyl 0, 1, and 2 μg/ml, respectively (P = 0.34). The cumulative fentanyl dose (difference: 37 μg [95% CI of the difference, -58 to 79 μg], P = 0.28) and maternal and umbilical cord venous fentanyl and bupivacaine concentrations did not differ between women who discontinued breastfeeding and those who were still breastfeeding at 6 weeks postpartum. Labor epidural solutions containing fentanyl concentrations as high as 2 μg/ml do not appear to influence breastfeeding rates at 6 weeks postpartum.

Facilitatory effect of AC-iontophoresis of lidocaine hydrochloride on the permeability of human enamel and dentine in extracted teeth.

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Ikeda, Hideharu; Suda, Hideaki

2013-04-01

The objectives of the present study were to quantitatively evaluate chemical permeability through human enamel/dentine using conductometry and to clarify if alternating current (AC) iontophoresis facilitates such permeability. Electrical impedance of different concentrations of lidocaine hydrochloride was measured using a bipolar platinum impedance probe. A quadratic curve closely fitted to the response functions between conductance and lidocaine hydrochloride. For analysis of the passage of lidocaine hydrochloride through human enamel/dentine, eight premolars that were extracted for orthodontic treatment were sectioned at the cemento-enamel junction. The tooth crowns were held between two chambers with a double O-ring. The enamel-side chamber was filled with lidocaine hydrochloride, and the pulp-side chamber was filled with extrapure water. Two platinum plate electrodes were set at the end of each chamber to pass alternating current. A simulated interstitial pulp pressure was applied to the pulp-side chamber. The change in the concentration of lidocaine hydrochloride in the pulp-side chamber was measured every 2min using a platinum recording probe positioned at the centre of the pulp-side chamber. Passive entry without iontophoresis was used as a control. The level of lidocaine hydrochloride that passed through enamel/dentine against the dentinal fluid flow increased with time. Electrical conductance (G, mho) correlated closely to the concentration (x, mmol/L) of lidocaine hydrochloride (G=2.16x(2)+0.0289x+0.000376, r(2)=0.999). Lidocaine hydrochloride can pass through enamel/dentine. Conductometry showed that the level of lidocaine hydrochloride that passed through enamel/dentine was increased by AC iontophoresis. Copyright © 2012 Elsevier Ltd. All rights reserved.

Effect of Intravenous Infusion of Lidocaine on Pain Reduction after Cesarean Section under General Anesthesia

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Anahita Hirmanpour

2018-01-01

Full Text Available Background: The present study was conducted to evaluate the effect of Lidocaine on pain reduction during and ileus and the need for opioids after caesarean section. Methods: For this randomized double-blind controlled clinical trial, 40 ASA I, II pregnant women who were candidates for caesarean section with general anesthesia, were randomly allocated into two groups of Lidocaine receivers and placebo using randomized block design; the Lidocaine group received 1.5 mg/kg of Lidocaine right before the surgery and then its infusion with a dose of 2 mg/kg.h until the end of the surgery and the placebo group received normal saline with the same volume and application. Patients’ pain intensity was measured using numerical rating scale (NRS, 0 (entering the recovery, 0.5, 1, 4, 12 and 24 hours after the surgery. Results: Lidocaine decreased the systolic and diastolic pressures of the patients only during the first minute after intubation, decreased the mean of arterial blood pressure at the 10th minute after intubation and 40th minute after surgery, and also decreased the mean of patients’ pain intensity, Diclofenac and Pethidine consumption, side effects (nausea and vomiting and reduced the time interval before the first time of tolerating oral liquids; but it had effect on infants’ Apgar score 1 and 5 minutes after delivery. Conclusions: Lidocaine was definitely effective on reducing the intensity of pain, opioid and non-steroidal anti-inflammatory drugs consumption and ileus after surgery with the least occurrence of side effects for mothers and infants.

Effect of Intravenous Infusion of Lidocaine on Pain Reduction after Cesarean Section under General Anesthesia

Directory of Open Access Journals (Sweden)

Anahita Hirmanpour

2018-01-01

Full Text Available Background: The present study was conducted to evaluate the effect of Lidocaine on pain reduction during and ileus and the need for opioids after caesarean section.Methods: For this randomized double-blind controlled clinical trial, 40 ASA I, II pregnant women who were candidates for caesarean section with general anesthesia, were randomly allocated into two groups of Lidocaine receivers and placebo using randomized block design; the Lidocaine group received 1.5 mg/kg of Lidocaine right before the surgery and then its infusion with a dose of 2 mg/kg.h until the end of the surgery and the placebo group received normal saline with the same volume and application. Patients’ pain intensity was measured using numerical rating scale (NRS, 0 (entering the recovery, 0.5, 1, 4, 12 and 24 hours after the surgery.Results: Lidocaine decreased the systolic and diastolic pressures of the patients only during the first minute after intubation, decreased the mean of arterial blood pressure at the 10th minute after intubation and 40th minute after surgery, and also decreased the mean of patients’ pain intensity, Diclofenac and Pethidine consumption, side effects (nausea and vomiting and reduced the time interval before the first time of tolerating oral liquids; but it had effect on infants’ Apgar score 1 and 5 minutes after delivery.Conclusions: Lidocaine was definitely effective on reducing the intensity of pain, opioid and non-steroidal anti-inflammatory drugs consumption and ileus after surgery with the least occurrence of side effects for mothers and infants.

Effectiveness of lidocaine Denti patch ® system versus lidocaine gel as topical anesthetic agent in children

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Lara Anwar Shehab

2015-01-01

Full Text Available Background: New methods have been introduced to facilitate dental procedures, but the administration of local anesthesia is still necessary to perform pain control during several dental procedures. Aim: To evaluate the effectiveness of the lidocaine Denti-patch ® system versus the lidocaine topical anesthetic gel in children concerning pain reaction during injection. Materials and Methods: One hundred 9-12-year-old cooperative children weighing more than 29 kg in need of bilateral dental treatment requiring maxillary and mandibular injection and not suffering from acute pain as a result of pulpits on the day of treatment were selected. The children were then divided into two groups: Group 1 comprising of 50 children in need of bilateral maxillary treatment and Group 2 compromising of 50 children requiring bilateral mandibular treatment. These groups were further subdivided into subgroups A and B; those receiving Denti-patch ® on one side and lidocaine gel on the contralateral side, respectively. Pain or comfort was evaluated during injection using sound, eye, motor (SEM scale (objective method while, using faces pain rating scale (FPS scale (subjective method after injection by a trained assistant blinded to the procedure. Statistical Analysis Used: Comparison of the results was performed using Mann-Whitney U-test and Wilcoxon signed-ranks test for SEM and FPS score. Result: There was a statistically significant difference between the patch and the gel group for maxilla (P < 0.0001, as well as mandible (P = 0.01 with respect to SEM score given by the children. Similarly, with FPS scale, there was a statistically significant difference between the patch and the gel groups in both maxilla and mandible (P < 0.0001. However, there was no statistical difference between the patch Groups 1A and IIA or the gel Groups 1B and II B. Conclusion: The Denti-patch ® system can significantly reduce the needle injection pain more than the gel.

Influence of lidocaine forms (salt vs. freebase) on properties of drug-Eudragit® L100-55 extrudates prepared by reactive melt extrusion.

Science.gov (United States)

Liu, Xu; Ma, Xiangyu; Kun, Eucharist; Guo, Xiaodi; Yu, Zhongxue; Zhang, Feng

2018-06-05

This study examines the preparation of sustained-release lidocaine polyelectrolyte complex using reactive melt extrusion. Eudragit L100-55 was selected as the ionic polymer. The influence of drug forms (freebase vs. hydrochloride salt) on lidocaine-Eudragit L100-55 interactions, physical stability, and dissolution properties of extrudates was investigated. It was confirmed by DSC, FT-IR and Raman spectroscopy that polyelectrolyte could only form via the acid-base reaction between Eudragit L100-55 and lidocaine freebase. Due to this ionic interaction, the lidocaine extrudate was physically more stable than the lidocaine hydrochloride extrudate during the storage under stressed condition. Drug release from lidocaine extrudate was a function of drug solubility, polymer solubility, drug-polymer interaction, and drug-induced microenvironment pH. At 30% drug loading, extrudate exhibited sustained release in aqueous media at pH 1.2 and 4.5. Due to the alkaline microenvironment pH induced by dissolved lidocaine, Eudragit L100-55 was solubilized and sustained-release was not achieved in water and aqueous media at pH 5.5. In comparison, lidocaine hydrochloride induced an acidic microenvironment. Drug release of lidocaine hydrochloride extrudate was similar at pH 1.2, 4.5, 5.5 and water with drug being released over 10 hours. The release of lidocaine hydrochloride from the extrudates in these media was primarily controlled by microenvironment pH. It is concluded that different forms of lidocaine resulted in different drug-polymer interactions and distinctive physicochemical properties of extrudates. Copyright © 2018. Published by Elsevier B.V.

Comparison of Transversus Abdominis Plane Infiltration with Liposomal Bupivacaine versus Continuous Epidural Analgesia versus Intravenous Opioid Analgesia.

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Ayad, Sabry; Babazade, Rovnat; Elsharkawy, Hesham; Nadar, Vinayak; Lokhande, Chetan; Makarova, Natalya; Khanna, Rashi; Sessler, Daniel I; Turan, Alparslan

2016-01-01

Epidural analgesia is considered the standard of care but cannot be provided to all patients Liposomal bupivacaine has been approved for field blocks such as transversus abdominis plane (TAP) blocks but has not been clinically compared against other modalities. In this retrospective propensity matched cohort study we thus tested the primary hypothesis that TAP infiltration are noninferior (not worse) to continuous epidural analgesia and superior (better) to intravenous opioid analgesia in patients recovering from major lower abdominal surgery. 318 patients were propensity matched on 18 potential factors among three groups (106 per group): 1) TAP infiltration with bupivacaine liposome; 2) continuous Epidural analgesia with plain bupivacaine; and; 3) intravenous patient-controlled analgesia (IV PCA). We claimed TAP noninferior (not worse) over Epidural if TAP was noninferior (not worse) on total morphine-equivalent opioid and time-weighted average pain score (10-point scale) within first 72 hours after surgery with noninferiority deltas of 1 (10-point scale) for pain and an increase less of 20% in the mean morphine equivalent opioid consumption. We claimed TAP or Epidural groups superior (better) over IV PCA if TAP or Epidural was superior on opioid consumption and at least noninferior on pain outcome. Multivariable linear regressions within the propensity-matched cohorts were used to model total morphine-equivalent opioid dose and time-weighted average pain score within first 72 hours after surgery; joint hypothesis framework was used for formal testing. TAP infiltration were noninferior to Epidural on both primary outcomes (pconsumption (p = 0.37). We did not find noninferiority of Epidural over IV PCA on pain scores (P = 0.13) and nor did we find superiority on opioid consumption (P = 0.98). TAP infiltration with liposomal bupivacaine and continuous epidural analgesia were similar in terms of pain and opioid consumption, and not worse in pain compared with IV PCA

Registered nurses' and midwives' knowledge of epidural analgesia.

Science.gov (United States)

Bird, Annette; Wallis, Marianne; Chaboyer, Wendy

2009-01-01

Despite epidural analgesia increasingly being utilized in hospitals, very little research-based evidence is available about registered nurses' (RNs) and midwives' knowledge of this technique. To describe the current epidural knowledge levels of RNs and midwives in a multi-site setting. RNs and midwives at four, regional teaching facilities completed an epidural knowledge test. The instrument included demographic items and five knowledge subscales relating to epidural analgesia: spinal cord anatomy and physiology; epidural pharmacology; complications of epidural analgesia; assessment of sensory and motor blockade and the general management of patients with epidural analgesia. A total of 408 (99.7% response) RNs and midwives completed the test. Respondents demonstrated good knowledge of sensory and motor blockade assessment and the general management of epidural analgesia subscales with correct responses to 75 and 77% of the questions in these subscales, respectively. Fair knowledge relating to the spinal cord anatomy and physiology subscale was demonstrated with 69% of the questions answered correctly. The knowledge subscales relating to epidural pharmacology (57% correct responses) and the complications of epidural analgesia (56% correct responses) were problematic for the sample. The research results provide generalizable information about what RNs and midwives know about epidural analgesia. These results are an important guide in the development of new and existing dedicated epidural education programs. The results also provide some direction for further research into this important topic.

[Conservative treatment of cervical radiculopathy with 5% lidocaine medicated plaster].

Science.gov (United States)

Mattozzi, I

2015-02-01

Cervical radiculopathy is a mixed pain syndrome characterized by neuropathic, skeletal and myofascial pain. This condition is frequently found in developed countries and is a significant source of disability and a reason for frequent medical consultation. In our Pain Therapy Centre, cervical radiculopathy is initially treated with bi-weekly cycles of mesotherapy coupled, at least 15 days later, with physiotherapy to reach the complete mobilization of cervical spine. Cervical radiculopathy is a localized neuro-pathic pain and in agreement with international guidelines, we checked if patients treated topically with 5% lidocaine medicated plaster may benefit in improving pain management and in reducing the time necessary to start physiotherapy. A retrospective study was carried out on 60 patients, of which 30 were treated with mesotherapy and 30 were treated with 5% lidocaine medicated plaster. Data for a total of 30 days observation were collected from the patient medical records. In particular, besides medical history, intensity of pain, intensity of allodynia and pain were considered. For all analyzed parameters, both treatments were effective, but patients treated with 5% lidocaine medicated plaster showed faster control of the painful symptoms, an essential condition for an earlier rehabilitative treatment.

Does Injection of Lidocaine with 1/100000 Epinephrine Immediately before Lateral Osteotomy Reduce Post-Operative Periorbital Edema and Ecchymosis in Rhinoplasty?

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mansoor zojajy

2014-06-01

Full Text Available Background: Postoperative periorbital edema and ecchymosis are common after rhinoplasty. We studied the effect of local injection of Lidocaine/Adrenaline immediately before osteotomy on prevention of post-operative periorbital edema and ecchymosis in rhinoplasty.Materials and Methods: Thirty healthy candidates for rhinoplasty were enrolled in the self-controlled clinical trial study. Lidocaine/Adrenaline solution injected randomly to one side just prior to the lateral osteotomy. The opposite side used as a control. The degree of edema/ecchymosis on both sides was compared on the 1st, 2nd and 7th day postoperatively.Results: Mean of severity of edema, 24 hours after operation was 3in both sides, (Mann-whitney U; p=0.829. Mean of severity of edema, 48 hours after operation was 2 in both sides (Mann-whitney U; p=0.867 and it was 1 in both sides 7 days after operation (Mann-whitney U; p=0.756.There was no significant difference between two sides. Mean of severity of ecchymosis, 24 hours after operation was 3 in both sides (Mann-whitney U; p=0.692. Mean of severity of ecchymosis, 48 hours after operation was 2 in both sides (Mann-whitney U; p=0.655 and it was 1 in both sides 7 days after operation (Mann-whitney U; p=0.873. There was no significant difference between two sides.Conclusion: local injection of Lidocaine/Adrenaline solution immediately before lateral osteotomy could not reduce postoperative edema and ecchymosis in rhinoplasty.

Influence of prior information on pain involves biased perceptual decision-making.

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Wiech, Katja; Vandekerckhove, Joachim; Zaman, Jonas; Tuerlinckx, Francis; Vlaeyen, Johan W S; Tracey, Irene

2014-08-04

Prior information about features of a stimulus is a strong modulator of perception. For instance, the prospect of more intense pain leads to an increased perception of pain, whereas the expectation of analgesia reduces pain, as shown in placebo analgesia and expectancy modulations during drug administration. This influence is commonly assumed to be rooted in altered sensory processing and expectancy-related modulations in the spinal cord, are often taken as evidence for this notion. Contemporary models of perception, however, suggest that prior information can also modulate perception by biasing perceptual decision-making - the inferential process underlying perception in which prior information is used to interpret sensory information. In this type of bias, the information is already present in the system before the stimulus is observed. Computational models can distinguish between changes in sensory processing and altered decision-making as they result in different response times for incorrect choices in a perceptual decision-making task (Figure S1A,B). Using a drift-diffusion model, we investigated the influence of both processes in two independent experiments. The results of both experiments strongly suggest that these changes in pain perception are predominantly based on altered perceptual decision-making. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Comparative effect of lidocaine and bupivacaine on glucose uptake and lactate production in the perfused working rat heart

International Nuclear Information System (INIS)

Cronau, L.H. Jr.; Merin, R.G.; Aboulish, E.; Steenberg, M.L.; Maljorda, A.

1986-01-01

It has been suggested that at equivalent therapeutic concentrations, lidocaine and bupivacaine may have different cardiotoxic potency. In the isolated working rat heart preparation, the effect of a range of lidocaine and bupivacaine concentrations on glucose uptake and lactate production (LP) were observed. Insulin was added, 10 μ/L, to Ringer's solution containing 3 H-labeled glucose to measure the glycolytic flux (GF). The effect of the local anesthetics on LP at the indicated concentrations were similar. Lidocaine appears to depress the glycolytic flux from exogenous glucose to a lesser degree. Bupivacaine, 10 mg/L, depresses VO 2 to a greater degree than does lidocaine, 40 mg/L

Successful practice of electroacupuncture analgesia in equine surgery.

Science.gov (United States)

Sheta, Eldessouky; Ragab, Safwat; Farghali, Haithem; El-Sherif, Asmaa

2015-02-01

Electroacupuncture analgesia was used for surgery in horses and donkeys. A KWD-808 electrical stimulator was used to incrementally induce a dense, dispersed wave output at frequencies from 20 to 55 Hz, which was maintained at a frequency of 55 Hz, and to change the amplitude of the wave to the best grading number for the suggested operation in each animal. Induction of analgesia lasted for 20-30 minutes, and the effect of analgesia was maintained for 20-45 minutes depending on the type of surgery performed. The exhibited clinical signs, physical examination data, and the responses of all animals were used for evaluating the periods of analgesia. Although the majority of the cases (95%) had no response to strong surgical pain, they experienced significant increases in heart rates and respiratory rates during induction. The lack of pain, relaxed surgical procedures, reduced intraoperative bleeding, and improved healing without complications were all definite benefits of using electroacupuncture analgesia in surgery. Thus, this study has provided surgical evidence supporting the effectiveness of electroacupuncture analgesia, as well as confirming its reliability, in the field of equine anesthesia and surgery. Copyright © 2015. Published by Elsevier B.V.

Muscle-type nicotinic receptor modulation by 2,6-dimethylaniline, a molecule resembling the hydrophobic moiety of lidocaine

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Armando Alberola-Die

2016-11-01

Full Text Available To identify the molecular determinants responsible for lidocaine blockade of muscle-type nAChRs, we have studied the effects on this receptor of 2,6-dimethylaniline (DMA, which resembles lidocaine’s hydrophobic moiety. Torpedo marmorata nAChRs were microtransplanted to Xenopus oocytes and currents elicited by ACh (IACh, either alone or co-applied with DMA, were recorded. DMA reversibly blocked IACh and, similarly to lidocaine, exerted a closed-channel blockade, as evidenced by the enhancement of IACh blockade when DMA was pre-applied before its co-application with ACh, and hastened IACh decay. However, there were marked differences among its mechanisms of nAChR inhibition and those mediated by either the entire lidocaine molecule or diethylamine (DEA, a small amine resembling lidocaine’s hydrophilic moiety. Thereby, the IC50 for DMA, estimated from the dose-inhibition curve, was in the millimolar range, which is one order of magnitude higher than that for either DEA or lidocaine. Besides, nAChR blockade by DMA was voltage-independent in contrast to the increase of IACh inhibition at negative potentials caused by the more polar lidocaine or DEA molecules. Accordingly, virtual docking assays of DMA on nAChRs showed that this molecule binds predominantly at intersubunit crevices of the transmembrane-spanning domain, but also at the extracellular domain. Furthermore, DMA interacted with residues inside the channel pore, although only in the open-channel conformation. Interestingly, co-application of ACh with DEA and DMA, at their IC50s, had additive inhibitory effects on IACh and the extent of blockade was similar to that predicted by the allotopic model of interaction, suggesting that DEA and DMA bind to nAChRs at different loci. These results indicate that DMA mainly mimics the low potency and non-competitive actions of lidocaine on nAChRs, as opposed to the high potency and voltage-dependent block by lidocaine, which is emulated by the

Patient controlled remifentanil and epidural analgesia during labour : satisfaction, costs and safety

NARCIS (Netherlands)

Freeman, Liv

2016-01-01

Epidural analgesia provided superior analgesia to remifentanil PCA. Women randomised to epidural analgesia with a request for pain relief are more satisfied with their analgesia than women randomised to remifentanil PCA. Costs of epidural analgesia and remifentanil PCA are not significantly

Intravenous lidocaine as adjuvant to general anesthesia in renal ...

African Journals Online (AJOL)

Mohamed Said Nakhli

2018-02-13

Feb 13, 2018 ... patients scheduled to undergo elective non-laparoscopic renal surgery under general ..... ambulatory surgery where lidocaine use yielded a 30% ... for laparoscopic cholecystectomy as measured by BIS. ... elderly patients.

Anaesthetic efficacy of articaine versus lidocaine in children's dentistry: a systematic review and meta-analysis.

Science.gov (United States)

Tong, Huei Jinn; Alzahrani, Fatma Salem; Sim, Yu Fan; Tahmassebi, Jinous F; Duggal, Monty

2018-04-10

Over the last few years, numerous reviews and studies have awarded articaine hydrochloride local anaesthetic (LA) a superior reputation, with outcomes of different studies demonstrating a general tendency for articaine hydrochloride to outperform lidocaine hydrochloride for dental treatment. Nevertheless, there seems to be no clear agreement on which LA solution is more efficacious in dental treatment for children. There is no previous publication systematically reviewing and summarising the current best evidence with respect to the success rates of LA solutions in children. To evaluate the available evidence on the efficacy of lidocaine and articaine, used in paediatric dentistry. A systematic search was conducted on Cochrane CENTRAL Register of Controlled Trials, MEDLINE (OVID; 1950 to June 2017), Cumulative Index to Nursing and Allied Health Literature (CINAHL; EBSCOhost; 1982 to June 2017), EMBASE (OVID; 1980 to June 2017), SCI-EXPANDED (ISI Web of Knowledge; 1900 to June 2017), key journals, and previous review bibliographies through June 2017. Original research studies that compared articaine with lidocaine for dental treatment in children were included. Methodological quality assessment and assessment of risk of bias were carried out for each of the included studies. Electronic searching identified 525 publications. Following the primary and secondary assessment process, six randomised controlled trials (RCT) were included in the final analysis. There was no difference between patient self-reported pain between articaine and lidocaine during treatment procedures (SMD = 0.06, P-value = 0.614), and no difference in the occurrence of adverse events between articaine and lidocaine injections following treatment in paediatric patients (RR = 1.10, P-value = 0.863). Yet, patients reported significantly less pain post-procedure following articaine injections (SMD = 0.37, P-value = 0.013). Substantial heterogeneity was noted in the reporting of outcomes among studies

The Effect of Lidocaine Enriched Cardioplegia on Myocardial Ischemia-Reperfusion Injury

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Emin Ata

2016-07-01

Full Text Available Aim: Most of the complications after open heart surgery is usually associated with ischemia reperfusion injury that develops during cardiopulmoner bypass. In ischemia and reperfusion periods lidocaine blocks intracelluler sodium and calcium channels and protect cell membrane against reactive oxygen metabolites. In this study, lidocaine added to cardioplegia solution and its effects on myocardial ischemia-reperfusion injury was examined. Material and Method: 36 patients who underwent elective coronary artery bypass surgery in our clinic between September 2005 and April 2006 was studied. Patients included into two groups. In study group patients (groupe I 2 mg/kg lidocaine was added into cardioplegia solution that is used during aortic cross clamp period; standart cardioplegia solution was used in control group patients (group II. Postoperative 6. and 24. hours cardiac enzyme levels, inotropic support requirement and atrial fibrilation incidence were compared in both groups. Results: In this study, 36 patients (13 women, 23 man whose average age was 63(±5,5, age range 50-70 years and ventriculer functions were not deformed (EF>40% were involved. There were no significantly differences in demographic datas between towo groups. There were no significantly differences in postoperative 6. and 24. hours troponin-I and CK-MB levels, inotropic support or defibrilation requirement and postoperative atrial fibrilation incidence between two groups. Discussion: Addition of 2 mg/kg dosage lidocaine into cardioplegia solution dont effect cardiac enzyme levels, inotropic support requirement and postoperative atrial fibrilation insidence and it doesnt prevent ischemia-reperfusion injury.

Clonidine versus ketamine to prevent tourniquet pain during intravenous regional anesthesia with lidocaine.

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Gorgias, N K; Maidatsi, P G; Kyriakidis, A M; Karakoulas, K A; Alvanos, D N; Giala, M M

2001-01-01

Both clonidine and ketamine have been found to prolong the action of local anesthetics through a peripheral mechanism. Our study compares the efficacy of a low dose of clonidine or ketamine separately added to intravenous regional anesthesia (IVRA) with lidocaine to prevent tourniquet pain. We conducted a prospective randomized double-blinded study in 45 patients undergoing hand or forearm surgery, with anticipated duration exceeding 1 hour under IVRA. Proximal cuff inflation of a double tourniquet was followed by administration of 40 mL of lidocaine 0.5% and either saline, 1 microg/kg clonidine, or 0.1 mg/kg ketamine. When anesthesia was established, the inflation of the proximal and distal cuff was interchanged. Thereafter, tourniquet pain was rated on a visual analog scale (VAS) every 10 minutes. Intraoperatively, boluses of 25 microg fentanyl were provided for tourniquet pain treatment when required, and total fentanyl consumption was recorded. Patients receiving plain lidocaine persistently reported the highest pain scores among groups (P <.001) 20 minutes after distal cuff inflation. Differences between the groups with additional treatment were noted 50 minutes after distal cuff inflation and until the end of the observation, with significantly lower VAS ratings (P <.001 to P <.01) in ketamine-treated patients. Total fentanyl consumption was significantly decreased by ketamine (70.00 +/- 25.35 microg) or clonidine (136.67 +/- 39.94 microg) compared with the plain lidocaine group (215.33 +/- 52.33 microg) (P <.001 between all groups). The addition of clonidine 1 microg/kg or ketamine 0.1 mg/kg to lidocaine for IVRA delays the onset of unbearable tourniquet pain and decreases analgesic consumption for tourniquet pain relief, although ketamine has a more potent effect.

Comparative effect of lidocaine and bupivacaine on glucose uptake and lactate production in the perfused working rat heart

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Cronau, L.H. Jr.; Merin, R.G.; Aboulish, E.; Steenberg, M.L.; Maljorda, A.

1986-03-01

It has been suggested that at equivalent therapeutic concentrations, lidocaine and bupivacaine may have different cardiotoxic potency. In the isolated working rat heart preparation, the effect of a range of lidocaine and bupivacaine concentrations on glucose uptake and lactate production (LP) were observed. Insulin was added, 10 ..mu../L, to Ringer's solution containing /sup 3/H-labeled glucose to measure the glycolytic flux (GF). The effect of the local anesthetics on LP at the indicated concentrations were similar. Lidocaine appears to depress the glycolytic flux from exogenous glucose to a lesser degree. Bupivacaine, 10 mg/L, depresses VO/sub 2/ to a greater degree than does lidocaine, 40 mg/L.

The Onset and Duration of Action of 0.2% Lidocaine in a One-per-Mil Tumescent Solution for Hand Surgery.

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Prasetyono, Theddeus O H; Lestari, Puri A

2016-05-01

One-per-mil tumescent solution, which contains 0.2% lidocaine with 1:1,000,000 epinephrine, has been reported to be clinically effective for hand surgery under local anesthesia. However, it was lacking in its basic pharmacokinetics profile in regard to the onset of action (OOA) and duration of action (DOA). A randomized, double-blind study was conducted on 12 volunteers who met the inclusion criteria from October to November 2014. All volunteers had their right and left ring finger pulps injected with either one-per-mil solution or 2% lidocaine. Semmes-Weinstein and two-point discrimination tests were used to test sensation. Visual analogue scale was recorded at the time when the finger lost its sensation and when it regained normal sensation to measure the OOA and DOA. The data were then analyzed with a paired t-test and a Wilcoxon signed-rank test. The OOA and DOA of 2% plain lidocaine were 1 minute and 99.67 minutes, respectively. Meanwhile, 0.2% lidocaine in a one-per-mil tumescent solution showed an OOA of 5 minutes and a DOA of 186.83 minutes. The OOA of 0.2% lidocaine in a one-per-mil tumescent solution is statistically shorter than 2% plain lidocaine (P=0.04); while its DOA is statistically longer than 2% plain lidocaine (Pmil tumescent solution is statistically and clinically superior to 2% plain lidocaine in achieving longer duration of local anesthesia.

Safety and efficacy of prolonged epidural analgesia after oncologic colorectal surgery

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R. V. Garyaev

2012-01-01

Full Text Available This study demonstrates effective thoracic epidural analgesia by ropivacain 0.2 %, phentanyl 2 mkg/ml, adrenaline 2 mkg/ml in single-use infusion pumps in 124 patients, who underwent surgery for colorectal cancer. Safe, effective and controllable analgesia was observed during surgery and postoperative period. Prolonged analgesia facilitates early rehabilitation and improves gastrointestinal peristaltic activity.  Prolonged epidural analgesia is the recommended method of analgesia in this group of patients.

Spinal anesthesia: a comparison of procaine and lidocaine.

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Le Truong, H H; Girard, M; Drolet, P; Grenier, Y; Boucher, C; Bergeron, L

2001-05-01

To compare spinal procaine to spinal lidocaine with regard to their main clinical characteristics and incidence of transient radicular irritation (TRI). In this randomized, double-blind, prospective study, patients (two groups, n=30 each) received either 100 mg of lidocaine 5% in 7.5% glucose (Group L) or 100 mg of procaine 10% diluted with 1 ml cerebrospinal fluid (Group P). After spinal anesthesia, segmental level of sensory block was assessed by pinprick. Blood pressure and the height of the block were noted each minute for the first ten minutes, then every three minutes for the next 35 min and finally every five minutes until regression of the block to L4. Motor blockade was evaluated using the Bromage scale. To evaluate the presence of TRI, each patient was questioned 48 hr after surgery. Time to highest sensory level and to maximum number of segments blocked showed no difference between groups. Mean time for sensory regression to T10 and for regression of the motor block were shorter in Group P. Eighty minutes following injection, sensory levels were lower in Group P. Five patients had inadequate surgical anesthesia in Group P and only one in Group L. No patient in Group P had TRI (95% CI 10-12%) while eight (27%) in Group L did (95% CI 12-46%). Procaine 10% was associated with a clinical failure rate of 14.2%. This characteristic must be balanced against an absence of TRI, which occurs more frequently with the use of lidocaine 5%.

Sub-Tenon's lidocaine injection improves emergence agitation after ...

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Objective: This study aimed to evaluate the effect of a sub-Tenon's lidocaine injection on emergence agitation in children receiving sevoflurane or halothane anaesthesia for strabismus surgery. Design: A prospective, randomised study. Setting: The study setting included a hospital where a surgical team performed ...

Specifying the non-specific components of acupuncture analgesia

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Vase, Lene; Baram, Sara; Takakura, Nobuari; Yajima, Hiroyoshi; Takayama, Miho; Kaptchuk, Ted J.; Schou, Søren; Jensen, Troels Staehelin; Zachariae, Robert; Svensson, Peter

2014-01-01

It is well known that acupuncture has pain-relieving effects, but the contribution of specific and especially non-specific factors to acupuncture analgesia is less clear. One hundred and one patients who developed pain ≥ 3 on a visual analog scale (VAS, 0-10) following third molar surgery were randomized to receive active acupuncture, placebo acupuncture, or no treatment for 30 min with acupuncture needles with potential for double-blinding. Patients’ perception of the treatment (active or placebo), and expected pain levels (VAS) were assessed prior to and halfway through the treatment. Looking at actual treatment allocation, there was no specific effect of active acupuncture (P = 0.240), but a large and significant non-specific effect of placebo acupuncture (P acupuncture (P acupuncture had significantly lower pain levels than those who believed they received placebo acupuncture. Expected pain levels accounted for significant and progressively larger amounts of the variance in pain ratings following both active and placebo acupuncture (up to 69.8%), This is the first study to show that under optimized blinding conditions non-specific factors such as patients’ perception of and expectations toward treatment are central to the efficacy of acupuncture analgesia and that these factors may contribute to self-reinforcing effects in acupuncture treatment To obtain an effect of acupuncture in clinical practice it may, therefore, be important to incorporate and optimize these factors. PMID:23707680

Pre-emptive analgesia: Recent trends and evidences

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Amiya K Mishra

2013-01-01

Full Text Available Preemptive analgesia, initiated before the surgical procedure to prevent pain in the early postoperative period has the potential to be more effective than a similar analgesic treatment initiated after surgery. This article aims to review all the recent published evidences that assess the efficacy of this enigmatic concept. Materials and Methods: We reviewed original research articles, case-reports, meta-analyses, randomized control trials (RCTs, and reviews based on pain physiology for preemptive analgesia from Medline, Medscape, and PubMed from 1993 to 2013. A broad free-text search in English was undertaken with major keywords "Preemptive analgesia," "postoperative pain," "preoperative," and "preincisional". Results: Review of publications showed that intravenous (IV nonsteroidal anti-inflammatory drugs (NSAIDs are quite effective when used alone, as well as with low dose iv ketamine, preemptively to provide adequate postoperative analgesia. However, ketamine has a doubtful role as a standalone agent. Preemptive administration of LA at the incision site reduces postoperative pain, but achieves an analgesic effect similar to that of postincisional anesthetic infiltration as does intraperitoneal administration. Preemptive epidural analgesia has proved its efficacy in controlling perioperative immune function and pain in comparison to parenteral opioids. Gamma-amino butyric acid (GABA analogues like gabapentin and pregabalin have great potential as preemptive analgesic with the added advantage of its anxiolytic effect. Conclusion: Multimodal approaches that address multiple sites along the pain pathway is necessary to treat pain adequately. However, we need to find an answer to the question of how to obtain the maximal clinical benefits with the use of preemptive analgesia.

Assessment of membrane protection by 31P-NMR effects of lidocaine on calcium-paradox in myocardium

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Sakai, Hirosumi; Yoshiyama, Minoru; Teragaki, Masakazu; Takeuchi, Kazuhide; Takeda, Takeda; Ikata, Mari; Ishikawa, Makoto; Miura, Iwao

1989-01-01

In studying calcium paradox, perfused rat hearts were used to investigate the myocardial protective effects of lidocaine. Intracellular contents of phosphates were measured using the 31 P-NMR method. In hearts reexposed to calcium, following 3 minute calcium-free perfusion, a rapid contracture occurred, followed by rapid and complete disappearance of intracellular phosphates with no resumption of cardiac function. In hearts where lidocaine was administered from the onset of the calcium-free perfusion until 2 minutes following the onset of reexposure to calcium, both intracellular phosphates and cardiac contractility were maintained. Therefore, it can be said that cell membranes were protected by lidocaine

Labour analgesia: Recent advances

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Pandya, Sunil T

2010-01-01

Advances in the field of labour analgesia have tread a long journey from the days of ether and chloroform in 1847 to the present day practice of comprehensive programme of labour pain management using evidence-based medicine. Newer advances include introduction of newer techniques like combined spinal epidurals, low-dose epidurals facilitating ambulation, pharmacological advances like introduction of remifentanil for patient-controlled intravenous analgesia, introduction of newer local anaesthetics and adjuvants like ropivacaine, levobupivacaine, sufentanil, clonidine and neostigmine, use of inhalational agents like sevoflourane for patient-controlled inhalational analgesia using special vaporizers, all have revolutionized the practice of pain management in labouring parturients. Technological advances like use of ultrasound to localize epidural space in difficult cases minimizes failed epidurals and introduction of novel drug delivery modalities like patient-controlled epidural analgesia (PCEA) pumps and computer-integrated drug delivery pumps have improved the overall maternal satisfaction rate and have enabled us to customize a suitable analgesic regimen for each parturient. Recent randomized controlled trials and Cochrane studies have concluded that the association of epidurals with increased caesarean section and long-term backache remains only a myth. Studies have also shown that the newer, low-dose regimes do not have a statistically significant impact on the duration of labour and breast feeding and also that these reduce the instrumental delivery rates thus improving maternal and foetal safety. Advances in medical technology like use of ultrasound for localizing epidural space have helped the clinicians to minimize the failure rates, and many novel drug delivery modalities like PCEA and computer-integrated PCEA have contributed to the overall maternal satisfaction and safety. PMID:21189877

The influence of propofol, remifentanil and lidocaine on the tone of human bronchial smooth muscle.

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Rogliani, Paola; Calzetta, Luigino; Rendina, Erino A; Massullo, Domenico; Dauri, Mario; Rinaldi, Barbara; Capuano, Annalisa; Matera, Maria Gabriella

2013-06-01

Bronchoscopy is generally a safe procedure, but the induction of anaesthesia can induce bronchospasm. Consequently we investigated the influence of propofol, remifentanil and lidocaine on the tone of the human bronchial smooth muscle. The influence of propofol, remifentanil and lidocaine on the contractile response of human bronchial smooth muscle to electrical field stimulation (EFS) has been evaluated. The role of capsaicin-sensitive sensory nerves and of inducible nitric oxide synthase has also been assessed. Furthermore, the interaction between these three dugs has been measured by Bliss Independence (BI) theory. Statistical significance (P < 0.05) was assessed by Student's t test or ANOVA. Propofol (1.3 μg ml(-1)) and lidocaine (1 mg ml(-1)) reduced the baseline tone of bronchial rings (-14.45 ± 4.53% and -33.40 ± 1.07%, respectively, P < 0.05), whereas remifentanil had not such effect. Aminoguanidine prevented the relaxant effect of propofol. Propofol did not alter the bronchial contractile response to EFS following 30 min of treatment, whereas remifentanil enhanced the bronchial tension (133.83 ± 9.38%, control 101.93 ± 6.82%, P < 0.05 P < 0.05) and lidocaine completely abolished the contractility at 1 mg ml(-1) (P < 0.05). The desensitization of capsaicin-sensitive sensory nerves normalized the hyperresponsiveness induced by remifentanil (-26.77 ± 1.68%, P < 0.05). Significant BI antagonism (P < 0.001) was detected for propofol and lidocaine on the bronchial hyperresponsiveness induced by remifentanil. Propofol and remifentanil may be used safely for bronchoscopy, although remifentanil should be associated with propofol or lidocaine to prevent the potential opioid-mediated bronchospasm. Copyright © 2013 Elsevier Ltd. All rights reserved.

Ocular and systemic pharmacokinetics of lidocaine hydrochloride ophthalmic gel in rabbits after topical ocular administration.

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Liu, Bing; Ding, Li; Xu, Xiaowen; Lin, Hongda; Sun, Chenglong; You, Linjun

2015-12-01

Lidocaine hydrochloride ophthalmic gel is a novel ophthalmic preparation for topical ocular anesthesia. The study is aimed at evaluating the ocular and systemic pharmacokinetics of lidocaine hydrochloride 3.5 % ophthalmic gel in rabbits after ocular topical administration. Thirty-six rabbits were randomly placed in 12 groups (3 rabbits per group). The rabbits were quickly killed according to their groups at 0 (predose), 0.0833, 0.167, 0.333, 0.667, 1, 1.5, 2, 3, 4, 6, and 8 h postdose and then the ocular tissue and plasma samples were collected. All the samples were analyzed by a validated LC-MS/MS method. The test result showed that the maximum concentration (C max) of lidocaine in different ocular tissues and plasma were all achieved within 20 min after drug administration, and the data of C max were (2,987 ± 1814) μg/g, (44.67 ± 12.91) μg/g, (26.26 ± 7.19) μg/g, (11,046 ± 2,734) ng/mL, and (160.3 ± 61.0) ng/mL for tear fluid, cornea, conjunctiva, aqueous humor, and plasma, respectively. The data of the elimination half-life in these tissues were 1.5, 3.2, 3.5, 1.9, and 1.7 h for tear fluid, cornea, conjunctiva, aqueous humor, and plasma, respectively. The intraocular lidocaine levels were significantly higher than that in plasma, and the elimination half-life of lidocaine in cornea, conjunctiva, and aqueous humor was relatively longer than that in tear fluid and plasma. The high intraocular penetration, low systemic exposure, and long duration in the ocular tissues suggested lidocaine hydrochloride 3.5 % ophthalmic gel as an effective local anesthetic for ocular anesthesia during ophthalmic procedures.

Diphenylhydantoin and lidocaine modification of A-V conduction in halothane-anesthetized dogs.

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Atlee, J L; Homer, L D; Tobey, R E

1975-07-01

The effect of halothane on A-V conduction was evaluated in gods during atrial pacing using the technique of His-bundle electrocardiography. In addition, the effects of lidocaine and diphenylkydantoin (DPH) on A-V conuction were examined during halothane anesthesia. Effects of these drugs on three subintervals of A-V conduction were compared. These included the -H (stimulus atifact of His-bundle deflection-atrioventricular conduction), H-Q (His-budnle deflection onset of QRS complex-His-Purkinje conduction), and H-S intervals(His-bundle delfection to end of QRS COmplex-total intraventricular conduction). Linear regression best described the relationship between duration of interval (P-H, H-V,and H-S) and heart rate during incremental increases in the atrial paced rate. Data from these experiments were fitted to a multiple lenear regression model that predicted the effect of increasing concentrations of halothan, lidocaine, and DPH on slope and intercept coefficients. In creasing concentrations of halothan ( 30 and 45 mg/100 ml arterial). Both lidocaine and DPH further depressed conduction at all levels of halothan anesthesia. The P-H interval was particularly sensitive todrug effefts. This may represent potentiation of the normal slowing of conduction through the AVnode in response to incremental increases in heart rate (fatigue response.) We conclude thatboth lidocaine and DPH fail to reverse the depressant effect of halothane on A-V conduction. This may explain their ineffectiveness in treating certain types of arrhythmias during halothane anesthesia.

Kidney ischemia and reperfunsion syndrome: effect of lidocaine and local postconditioning.

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Yamaki, Igor Nagai; Pontes, Ruy Victor Simões; Costa, Felipe Lobato DA Silva; Yamaki, Vitor Nagai; Teixeira, Renan Kleber Costa; Yasojima, Edson Yuzur; Brito, Marcus Vinicius Henriques

2016-01-01

to evaluate the effects of blocking the regulation of vascular tone on the ischemia and reperfusion syndrome in rats through the use of lidocaine in the postconditioning technique. we randomized 35 rats into seven groups of five animals: Group 1- Control; Group 2- Ischemia and Reperfusion; Group 3- Ischemia, Reperfusion and Saline; Group 4- Ischemic Postconditioning; Group 5- Ischemic Postconditioning and Saline; Group 6- Lidocaine; Group 7- Ischemic Postconditioning and Lidocaine. Except for the control group, all the others were submitted to renal ischemia for 30 minutes. In postconditioning groups, we performed ischemia and reperfusion cycles of five minutes each, applied right after the main ischemia. In saline and lidocaine groups, we instilled the substances at a rate of two drops per minute. To compare the groups, we measured serum levels of urea and creatinine and also held renal histopathology. The postconditioning and postconditioning + lidocaine groups showed a decrease in urea and creatinine values. The lidocaine group showed only a reduction in creatinine values. In histopathology, only the groups submitted to ischemic postconditioning had decreased degree of tubular necrosis. Lidocaine did not block the effects of postconditioning on renal ischemia reperfusion syndrome, and conferred better glomerular protection when applied in conjunction with ischemic postconditioning. avaliar os efeitos do bloqueio da regulação do tônus vascular por meio do uso da lidocaína na técnica de pós-condicionamento isquêmico na síndrome de isquemia e reperfusão renal em ratos. trinta e cinco ratos foram randomizados em sete grupos de cinco animais: Grupo 1- Controle; Grupo 2- Isquemia e Reperfusão; Grupo 3- Isquemia, Reperfusão e Solução Salina; Grupo 4- Pós-condicionamento Isquêmico; Grupo 5- Pós-condicionamento Isquêmico e Solução Salina; Grupo 6- Lidocaína; Grupo 7- Pós-condicionamento Isquêmico e lidocaína. Com exceção do grupo controle, todos

Combination of Tramadol and Lidocaine for Pain Control During Transrectal Ultrasound-guided Prostate Biopsy: A Randomized Double-blinded Study.

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Sen, Haluk; Seckiner, Ilker; Bayrak, Omer; Sen, Elzem; Erturhan, Sakip; Yagci, Faruk

2015-06-01

To evaluate the efficacy of tramadol, lidocaine, and a combination of tramadol with lidocaine in pain relief using periprostatic nerve block technique by guidance of transrectal ultrasound (TRUS) before the prostate biopsy (PBx). For the indication of TRUS-PBx, the patients with a prostate-specific antigen (PSA) level >4.0 ng/mL or abnormal digital examination findings were selected. The patients were randomized through random method. Group 1: patients were administered 5 mL of 2% lidocaine; group 2: patients were administered 5 mL of 25-mg tramadol; and group 3: patients were administered 5 mL of 2% lidocaine + 25-mg tramadol. The procedures were completed in 10 minutes, and a visual pain scale was administered to the patients to question the pain severity. TRUS-guided PBx was performed in 60 patients with an age range of 57-77 years (mean age, 66.2 ± 7.49 years) and a PSA range of 1-1000 ng/mL. The mean PSA level of the groups was 28.5 (±7.5), 16.1 (±5.0), and 14.9 (±2.9) ng/mL, respectively. The postprocedural pain scores by visual pain scale were 4.6 ± 1.2, 5.4 ± 1.2, and 3.6 ± 0.9 in lidocaine, tramadol, and lidocaine + tramadol groups, respectively. Periprostatic nerve block is the current golden standard method owing to pain management and comfort provided, independent of the patient age and the number of core biopsies. We suggest that tramadol may also be used in this field to achieve better pain management by improving lidocaine's effect or as an alternative to lidocaine. Copyright © 2015 Elsevier Inc. All rights reserved.

Battlefield Medical Research Development Training and Evaluation Priorities

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2012-12-20

are approved by the FDA for the treatment of post-herpetic neuralgia. Lidocaine patches were reported to reduce the pain associated with rib fractures ...2007; 63: 805-813. 20. Zink KA, Mayberry JC, Peck EG, et. al. Lidocaine patches reduce pain in trauma patients with rib fractures . Am Surg 2011; 77...intramuscularly (IM) and the onset of analgesia is delayed, possibly resulting in additional doses to relieve ongoing pain . There are no published

Comparison of cardiovascular responses after injection of lidocaine with either clonidine or adrenaline: a two-year comparative analysis.

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Dandriyal, R; Pachauri, S; Giri, K Y; Rastogi, S; Prasad, N I B; Agarwal, S; Singh, H P

2017-01-01

Our aim was to evaluate the efficacy of clonidine with lidocaine as a local anaesthetic agent for inferior alveolar mandibular nerve blocks for dental extraction. We studied 200 patients who required extraction of mandibular teeth and divided them into two groups of 100 each, the first of which was given lidocaine and adrenaline (12.5μg/ml) and the second lidocaine and clonidine (15μg/ml). Cardiovascular vascular variables (blood pressure, heart rate, and mean arterial pressure) were assessed before, during, and after extraction, and postoperative pain was measured on a visual analogue scale. There was a significant reduction in systolic blood pressure (p=0.0001) and heart rate (p=0.000) after injection of clonidine. However, they both increased after injections of lidocaine plus adrenaline, and there was a significant reduction in pain at four hours postoperatively with clonidine (p=0.000). Our results showed that anaesthesia with lidocaine and clonidine decreases systolic blood pressure and heart rate 10minutes after injection for extraction of lower mandibular teeth. We suggest that patients who have local anaesthetic with lidocaine and clonidine are at minimal cardiovascular risk and there is no difference in the onset of anaesthesia. Copyright © 2016 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Pheniramine Maleate is more effective than Lidocaine on Fentanyl Induced Cough.

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Ozmen, Ozgur; Kara, Duygu; Karaman, Emine Uzlas; Karakoc, Fatma; Karakaya, Muhammet Ahmet; Arslan, Zakir

2016-01-01

Fentanyl is frequently used during anesthesia induction. The use of fentanyl can cause cough through different mechanisms. Here, we aimed to investigate effects of pheniramine maleate (PM), an antihistaminic agent, and compare it with lidocaine on fentanyl induced cough. This is a randomized double-blind prospective clinical study of ASA I-II, 120 patients scheduled for elective abdominal surgery. Patients were administered drugs intravenously and randomly allocated into three groups: Group C (2 ml 0.9 % normal saline), Group L (1mg/kg lidocaine), and Group F (PM 45.5 mg). 90 seconds after administration, 2µ/kg fentanyl was applied in three seconds to all patients. Severity of cough (mild: 1-2, moderate: 3-5, severe> 5), time of the cough and vital parameters were recorded 90 seconds after fentanyl injection. Eight patients (25%) in Group C had fentanyl induced cough whereas three patients (7.5%) in Group L and one patient (2.5%) in Group F experienced this phenomenon. There was statistically significant difference between Group F and Group C (p0.05). Pheniramine Maleate 45.5 mg is better that placebo and as effective as lidocaine to prevent fentanyl induced cough.

Intrathecal analgesia and palliative care: A case study

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Naveen S Salins

2010-01-01

Full Text Available Intrathecal analgesia is an interventional form of pain relief with definite advantages and multiple complications. Administration of intrathecal analgesia needs a good resource setting and expertise. Early complications of intrathecal analgesia can be very distressing and managing these complications will need a high degree of knowledge, technical expertise and level of experience. Pain control alone cannot be the marker of quality in palliative care. A holistic approach may need to be employed that is more person and family oriented.

A Comparison of Equivalent Doses of Lidocaine and Articaine in Maxillary Posterior Tooth Extractions: Case Series

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Christopher C. Friedl

2012-06-01

Full Text Available Objectives: Local anaesthesia is the standard of care during dental extractions. With the advent of newer local anesthetic agents, it is often difficult for the clinician to decide which agent would be most efficacious in a given clinical scenario. This study assessed the efficacy of equal-milligram doses of lidocaine and articaine in achieving surgical anaesthesia of maxillary posterior teeth diagnosed with irreversible pulpitis. Material and Methods: This case-series evaluated a total of 41 patients diagnosed with irreversible pulpitis in a maxillary posterior tooth. Patients randomly received an infiltration of either 3.6 mL (72 mg 2% lidocaine with 1:100,000 epinephrine or 1.8 mL (72 mg 4% articaine with 1:100,000 epinephrine in the buccal fold and palatal soft tissue adjacent to the tooth. After 10 minutes, initial anaesthesia of the tooth was assessed by introducing a sterile 27-gauge needle into the gingival tissue adjacent to the tooth, followed by relief of the gingival cuff. Successful treatment was considered to have occurred when the tooth was extracted with no reported pain. Data was analyzed with the Fisher’s exact test, unpaired t-test and normality test. Results: Twenty-one patients received lidocaine and 20 received articaine. Forty of the 41 patients achieved initial anaesthesia 10 minutes after injection: 21 after lidocaine and 19 after articaine (P = 0.488. Pain-free extraction was accomplished in 33 patients: 19 after lidocaine and 14 after articaine buccal and palatal infiltrations (P = 0.226. Conclusions: There was no significant difference in efficacy between equivalent doses of lidocaine and articaine in the anaesthesia of maxillary posterior teeth with irreversible pulpitis.

Comparing Different Epinephrine Concentrations for Spinal Anesthesia in Cesarean Section: A Double-Blind Randomized Clinical Trial

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Arash Hamzei

2015-07-01

Full Text Available Background: Although various anesthetic techniques can be used in different kinds of surgeries, spinal anesthesia has received considerable attention for the lower abdomen and lower extremities surgeries and cesarean section. This study aimed at comparing the effect of adding epinephrine 1:1000 and 1:10000 to lidocaine and fentanyl in spinal anesthesia on the prolongation of paralysis, analgesia and hemodynamic changes in pregnant women candidate for cesarean section. Methods: A double blind randomized clinical trial was carried out on 66 pregnant women (equally sized control and treatment groups of 33 in 2011. After randomizing the participants into two groups of recipients of epinephrine 1:1000 plus lidocaine 5% and fentanyl (control group and recipients of epinephrine 1:10000 with lidocaine 5% and fentanyl, (treatment group, the participants’ systolic and diastolic blood pressure and heart rate were recorded before and 1, 3, 5, 10, 15 minutes after procedure. Besides the prolongation of paralysis and analgesia, the presence of postoperative nausea and vomiting were evaluated. The outcome of the study was analyzed using SPSS software and via t test, χ2 test and RMANOVA. Results: The mean age (standard deviation of the participants was 29.3 (4.4 and 28.2 (4.5 in the treatment and control groups, respectively. There were no statistical significance between the participants’ prolongation of paralysis, analgesia, the frequency of nausea and vomiting, and the average values of hemodynamic variables between the two groups. Conclusion: The use of epinephrine 1:10000 along with lidocaine and fentanyl is recommended in spinal anesthesia in pregnant women candidate for cesarean section. Trial Registration Number: IRCT201012225445N1.

Comparisons Of The Effects Of Medetomidine, Lidocaine And Their ...

African Journals Online (AJOL)

... with a one-week interval between subsequent injections. Lumbosacral epidural injection of medetomidine and medetomidine-lidocaine combinations induced behavioral changes characterized by ataxia, swaying movements, tail flaccidity, low head carriage, sternal and lateral recumbency posture coupled with salivation.

Posterior paramedian subrhomboidal analgesia versus thoracic epidural analgesia for pain control in patients with multiple rib fractures.

Science.gov (United States)

Shelley, Casey L; Berry, Stepheny; Howard, James; De Ruyter, Martin; Thepthepha, Melissa; Nazir, Niaman; McDonald, Tracy; Dalton, Annemarie; Moncure, Michael

2016-09-01

Rib fractures are common in trauma admissions and are associated with an increased risk of pulmonary complications, intensive care unit admissions, and mortality. Providing adequate pain control in patients with multiple rib fractures decreases the risk of adverse events. Thoracic epidural analgesia is currently the preferred method for pain control. This study compared outcomes in patients with multiple acute rib fractures treated with posterior paramedian subrhomboidal (PoPS) analgesia versus thoracic epidural analgesia (TEA). This prospective study included 30 patients with three or more acute rib fractures admitted to a Level I trauma center. Thoracic epidural analgesia or PoPS catheters were placed, and local anesthesia was infused. Data were collected including patients' pain level, adjunct morphine equivalent use, adverse events, length of stay, lung volumes, and discharge disposition. Nonparametric tests were used and two-sided p Pain rating was lower in the PoPS group (2.5 vs. 5; p = 0.03) after initial placement. Overall, there was no other statistically significant difference in pain control or use of oral morphine adjuncts between the groups. Hypotension occurred in eight patients, 75% with TEA and only 25% with PoPS. No difference was found in adverse events, length of stay, lung volumes, or discharge disposition. In patients with rib fractures, PoPS analgesia may provide pain control equivalent to TEA while being less invasive and more readily placed by a variety of hospital staff. This pilot study is limited by its small sample size, and therefore additional studies are needed to prove equivalence of PoPS compared to TEA. Therapeutic study, level IV.

Differential effect of ketamine and lidocaine on spontaneous and mechanical evoked pain in patients with nerve injury pain

DEFF Research Database (Denmark)

Gottrup, Hanne; Bach, Flemming Winther; Juhl, Gitte Irene

2006-01-01

ketamine, an N-methyl-D-aspartate receptor antagonist and lidocaine, a sodium channel blocker, on spontaneous pain, brush-evoked pain, and pinprick-evoked pain in patients with nerve injury pain. METHODS: Twenty patients participated in two randomized, double-blinded, placebo-controlled, crossover...... experiments in which they, on four different days, received a 30-minute intravenous infusion of ketamine (0.24 mg/kg), lidocaine (5 mg/kg), or saline. Ongoing pain, pain evoked by brush and repetitive pinprick stimuli, and acetone was measured before, during, and after infusion. RESULTS: Ketamine...... significantly reduced ongoing pain and evoked pain to brush and pinprick, whereas lidocaine only reduced evoked pain to repetitive pinprick stimuli. In individual patients, there was no correlation between the pain-relieving effect of lidocaine and ketamine on ongoing or mechanically evoked pains. CONCLUSIONS...

Combined spinal epidural labour analgesia: Complications and their management

OpenAIRE

YILMAZ, Nurullah; KOCAMANOGLU, Ismail Serhat; ABANOZ, Hakan

2016-01-01

Combined spinal-epidural analgesia (CSEA) is an effective and increasingly popular analgesia method used in vaginal delivery. CSEA provides rapid and excellent analgesia, allows mobilization, reduces drug consumption significantly and generally causes negligible maternal and fetal /neonatal adverse effects /complications not requiring treatment. The resulting adverse effects /complications are often associated with technical and /or agent/agents used and cause maternal and fetal /neonatal or,...

Bupivacaine Lozenge Compared with Lidocaine Spray as Topical Pharyngeal Anesthetic before Unsedated Upper Gastrointestinal Endoscopy

DEFF Research Database (Denmark)

Salale, Nesrin; Treldal, Charlotte; Mogensen, Stine

2014-01-01

Unsedated upper gastrointestinal endoscopy (UGE) can induce patient discomfort, mainly due to a strong gag reflex. The aim was to assess the effect of a bupivacaine lozenge as topical pharyngeal anesthetic compared with standard treatment with a lidocaine spray before UGE. Ninety-nine adult...... with a lidocaine spray proved to be a superior option as topical pharyngeal anesthetic before an UGE....

Sucrose ingestion causes opioid analgesia

Directory of Open Access Journals (Sweden)

F.N. Segato

1997-08-01

Full Text Available The intake of saccharin solutions for relatively long periods of time causes analgesia in rats, as measured in the hot-plate test, an experimental procedure involving supraspinal components. In order to investigate the effects of sweet substance intake on pain modulation using a different model, male albino Wistar rats weighing 180-200 g received either tap water or sucrose solutions (250 g/l for 1 day or 14 days as their only source of liquid. Each rat consumed an average of 15.6 g sucrose/day. Their tail withdrawal latencies in the tail-flick test (probably a spinal reflex were measured immediately before and after this treatment. An analgesia index was calculated from the withdrawal latencies before and after treatment. The indexes (mean ± SEM, N = 12 for the groups receiving tap water for 1 day or 14 days, and sucrose solution for 1 day or 14 days were 0.09 ± 0.04, 0.10 ± 0.05, 0.15 ± 0.08 and 0.49 ± 0.07, respectively. One-way ANOVA indicated a significant difference (F(3,47 = 9.521, P<0.001 and the Tukey multiple comparison test (P<0.05 showed that the analgesia index of the 14-day sucrose-treated animals differed from all other groups. Naloxone-treated rats (N = 7 receiving sucrose exhibited an analgesia index of 0.20 ± 0.10 while rats receiving only sucrose (N = 7 had an index of 0.68 ± 0.11 (t = 0.254, 10 degrees of freedom, P<0.03. This result indicates that the analgesic effect of sucrose depends on the time during which the solution is consumed and extends the analgesic effects of sweet substance intake, such as saccharin, to a model other than the hot-plate test, with similar results. Endogenous opioids may be involved in the central regulation of the sweet substance-produced analgesia.

Comparison of the effects of preoperative and intraoperative intravenous application of dexketoprofen on postoperative analgesia in septorhinoplasty patients: randomised double blind clinical trial.

Science.gov (United States)

Ozer, A B; Erhan, O L; Keles, E; Demirel, I; Bestas, A; Gunduz, G

2012-11-01

Postoperative analgesia is important because it prevents the adverse effects of pain. To study the effect of preoperative or intraoperative application of dexketoprofen on postoperative analgesia and patient comfort in patients undergoing septorhinoplasty. A randomized, double-blind, placebo-controlled study. The study included 100 patients randomly assigned to four groups. Patients from group 50/0 got 50 mg dexketoprofen 30 minutes prior to the operation; patients from group 0/50 got 50 mg dexketoprofen 30 minutes after the operation, and patients from group 25/25 got 25 mg dexketoprofen both 30 minutes prior and 30 minutes after the operation. Dexketoprofen was not applied to any of the patients from group C. Once in the recovery room, patient-controlled analgesia was received to all patients. The patients' visual analog scale (VAS), sedation, nausea and vomiting and dyspepsia complaints were recorded at 1, 2, 3, 4, 5, 6, 7, 8, 12 and 24 hours. In addition, patient satisfaction, intraoperative fentanyl and consumption of tramadol in the postoperative 24 hour period were recorded. The VAS, nausea and vomiting, sedation and patient satisfaction scores were lower in patients from all groups that had received dexketoprofen compared to the controls. There was no difference in intraoperative fentanyl consumption between the groups. The consumption of tramadol was significantly higher in group C compared to all other groups. Dexketoprofen provides good postoperative analgesia and patient satisfaction if applied intravenously to septorhinoplasty patients. However, there is no significant difference between preoperative and intraoperative applications of dexketoprofen.

Epidural analgesia practices for labour: results of a 2005 national survey in Ireland.

LENUS (Irish Health Repository)

Fanning, Rebecca A

2012-02-01

BACKGROUND AND OBJECTIVE: The last 25 years have seen changes in the management of epidural analgesia for labour, including the advent of low-dose epidural analgesia, the development of new local anaesthetic agents, various regimes for maintaining epidural analgesia and the practice of combined spinal-epidural analgesia. We conducted a survey of Irish obstetric anaesthetists to obtain information regarding the conduct and management of obstetric epidural analgesia in Ireland in 2005. The specific objective of this survey was to discover whether new developments in obstetric anaesthesia have been incorporated into clinical practice. METHODS: A postal survey was sent to all anaesthetists with a clinical commitment for obstetric anaesthesia in the sites approved for training by the College of Anaesthetists, Ireland. RESULTS: Fifty-three per cent of anaesthetists surveyed responded. The majority of anaesthetists (98%) use low-dose epidural analgesia for the maintenance of analgesia. Only 11% use it for test-dosing and 32% for the induction of analgesia. The combined spinal-epidural analgesia method is used by 49%, but two-thirds of those who use it perform fewer than five per month. Patient-controlled epidural analgesia was in use at only one site. CONCLUSION: It appears that Irish obstetric anaesthetists have adopted the low-dose epidural analgesia trend for the maintenance of labour analgesia. This practice is not as widespread, however, for test dosing, the induction of analgesia dose or in the administration of intermittent epidural boluses to maintain analgesia when higher concentrations are used. Since its introduction in 2000, levobupivacaine has become the most popular local anaesthetic agent.

Epidural analgesia practices for labour: results of a 2005 national survey in Ireland.

Science.gov (United States)

Fanning, Rebecca A; Briggs, Liam P; Carey, Michael F

2009-03-01

The last 25 years have seen changes in the management of epidural analgesia for labour, including the advent of low-dose epidural analgesia, the development of new local anaesthetic agents, various regimes for maintaining epidural analgesia and the practice of combined spinal-epidural analgesia. We conducted a survey of Irish obstetric anaesthetists to obtain information regarding the conduct and management of obstetric epidural analgesia in Ireland in 2005. The specific objective of this survey was to discover whether new developments in obstetric anaesthesia have been incorporated into clinical practice. A postal survey was sent to all anaesthetists with a clinical commitment for obstetric anaesthesia in the sites approved for training by the College of Anaesthetists, Ireland. Fifty-three per cent of anaesthetists surveyed responded. The majority of anaesthetists (98%) use low-dose epidural analgesia for the maintenance of analgesia. Only 11% use it for test-dosing and 32% for the induction of analgesia. The combined spinal-epidural analgesia method is used by 49%, but two-thirds of those who use it perform fewer than five per month. Patient-controlled epidural analgesia was in use at only one site. It appears that Irish obstetric anaesthetists have adopted the low-dose epidural analgesia trend for the maintenance of labour analgesia. This practice is not as widespread, however, for test dosing, the induction of analgesia dose or in the administration of intermittent epidural boluses to maintain analgesia when higher concentrations are used. Since its introduction in 2000, levobupivacaine has become the most popular local anaesthetic agent.

Electroacupuncture analgesia in a rabbit ovariohysterectomy.

Science.gov (United States)

Parmen, Valentin

2014-02-01

This study investigated the effectiveness of electroacupuncture analgesia (EAA) at local and paravertebral acupoints for a rabbit undergoing an ovariohysterectomy. Twelve clinically healthy New Zealand white rabbits were chosen and divided into two groups: the control group (5 rabbits) and the experimental group (7 rabbits). A neuroleptanalgesic (ketamine + xylazine) was administered to the control group (NLA group); the experimental group received EAA treatment (EAA group). The EAA treatment includes one acupuncture formula for local stimulation at the incision site and systemic stimulation. Results of clinical research have shown postoperative analgesia using EAA treatment to be superior to that using NLA. The average postoperative recovery time was 5.2 times longer in the NLA group than in the EAA group. Because consciousness was maintained, EAA presented an advantage in thermoregulation. Animals administered NLA had prolonged thermal homeostasis because of neurovegetative disconnection. For the EAA group, the operative times were characterized as excellent (28%, p = 0.28) or good (72%, p = 0.72). Local stimulation at the incision site provided excellent analgesia of the abdominal wall (100%). In conclusion, EA can provide general analgesia with a considerable analgesic effect for a rabbit undergoing an ovariohysterectomy, resulting in a short postoperative recovery time. Copyright © 2014. Published by Elsevier B.V.

Acupuncture Mechanisms: Anesthesia, Analgesia and Protection on Organ Functions

Directory of Open Access Journals (Sweden)

Jing Wang

2015-01-01

Full Text Available Acupuncture, as a healing art in traditional Chinese medicine, has been widely used to treat various diseases. In the history of acupuncture anesthesia, in the past decades, mechanisms of acupuncture analgesia has been widely investigated, and in recent years, acupuncture protection on organ functions has attracted great interest. This review summarized the research progress on mechanisms of acupuncture for analgesia and its protection against organ function injury in anesthesia, and its perspective of analgesia, immunomodulation, neuroendocrine regulation and multiple organ protection. The current evidence supports that acupuncture analgesia and its organ protection in anesthesia is associated with the integration of neuroendocrine-immune networks in the level of neurotransmitters, cytokines, hormones, neuronal ensembles, lymphocytes, and endocrine cells. Although the mechanisms of acupuncture analgesia and its organ protection are still not completely understood, basic as well as clinic researches on the mechanisms and applications of acupuncture and related techniques are being carried out.

Assisting informed decision making for labour analgesia: a randomised controlled trial of a decision aid for labour analgesia versus a pamphlet

Directory of Open Access Journals (Sweden)

Torvaldsen Siranda

2010-04-01

Full Text Available Abstract Background Most women use some method of pain relief during labour. There is extensive research evidence available of pharmacological pain relief during labour; however this evidence is not readily available to pregnant women. Decision aids are tools that present evidence based information and allow preference elicitation. Methods We developed a labour analgesia decision aid. Using a RCT design women either received a decision aid or a pamphlet. Eligible women were primiparous, ≥ 37 weeks, planning a vaginal birth of a single infant and had sufficient English to complete the trial materials. We used a combination of affective (anxiety, satisfaction and participation in decision-making and behavioural outcomes (intention and analgesia use to assess the impact of the decision aid, which were assessed before labour. Results 596 women were randomised (395 decision aid group, 201 pamphlet group. There were significant differences in knowledge scores between the decision aid group and the pamphlet group (mean difference 8.6, 95% CI 3.70, 13.40. There were no differences between decisional conflict scores (mean difference -0.99 (95% CI -3.07, 1.07, or anxiety (mean difference 0.3, 95% CI -2.15, 1.50. The decision aid group were significantly more likely to consider their care providers opinion (RR 1.28 95%CI 0.64, 0.95. There were no differences in analgesia use and poor follow through between antenatal analgesia intentions and use. Conclusions This decision aid improves women's labour analgesia knowledge without increasing anxiety. Significantly, the decision aid group were more informed of labour analgesia options, and considered the opinion of their care providers more often when making their analgesia decisions, thus improving informed decision making. Trial Registration Trial registration no: ISRCTN52287533

Evaluation of calcium alginate gel as electrode material for alternating current iontophoresis of lidocaine using excised rat skin.

Science.gov (United States)

Ebisawa, Tomoko; Nakajima, Atsushi; Haida, Haruka; Wakita, Ryo; Ando, Shizuka; Yoshioka, Tomohiko; Ikoma, Toshiyuki; Tanaka, Junzo; Fukayama, Haruhisa

2014-06-27

Iontophoresis (IOP) is a noninvasive method of delivering medication transcutaneously through the skin. The electrodes used in this method should tightly fit to rough and irregular surfaces and be biologically safe, easy to handle and prepare, and cost-effective. To satisfy these requirements, calcium alginate gel can be a candidate electrode for IOP. Using calcium alginate gel electrodes, we examined whether lidocaine can be effectively transported across an excised rat skin by squarewave alternating current (AC) application. A squarewave AC with either a 70% or 80% duty cycle was continuously applied to 0.5% calcium alginate gel electrodes containing 10% lidocaine at 10 V and 1 kHz for 60 min. Lidocaine concentration was measured using a spectrophotometer and the temperature of the gel was determined. The lidocaine concentrations for AC-IOP at the 70% and 80% duty cycles were significantly higher than that without AC-IOP. Furthermore, the group with the 80% duty cycle showed higher lidocaine concentrations than the group with the 70% duty cycle. The temperatures of all the groups were lower than 28 °C throughout the procedure. In conclusion, the calcium alginate gel can be used as a possible matrix for IOP electrodes.

Intravenous patient-controlled analgesia for acute postoperative pain

DEFF Research Database (Denmark)

Nikolajsen, Lone; Haroutiunian, Simon

2011-01-01

analgesia in terms of adverse effects and consumption of opioids. Standard orders and nursing procedure protocols are recommended for patients receiving intravenous patient-controlled analgesia to monitor treatment efficacy and development of adverse effects. Some subgroups of patients need special...

Prevention of reperfusion lung injury by lidocaine in isolated rat lung ventilated with higher oxygen levels.

Directory of Open Access Journals (Sweden)

Das K

2003-01-01

Full Text Available BACKGROUND: Lidocaine, an antiarrhythmic drug has been shown to be effective against post-ischaemic reperfusion injury in heart. However, its effect on pulmonary reperfusion injury has not been investigated. AIMS: We investigated the effects of lidocaine on a postischaemic reperfused rat lung model. MATERIALS AND METHODS: Lungs were isolated and perfused at constant flow with Krebs-Henseilet buffer containing 4% bovine serum albumin, and ventilated with 95% oxygen mixed with 5% CO2. Lungs were subjected to ischaemia by stopping perfusion for 60 minutes followed by reperfusion for 10 minutes. Ischaemia was induced in normothermic conditions. RESULTS: Postischaemic reperfusion caused significant (p < 0.0001 higher wet-to-dry lung weight ratio, pulmonary arterial pressure and peak airway pressure compared to control lungs. Lidocaine, at a dose of 5mg/Kg b.w. was found to significantly (p < 0.0001 attenuate the increase in the wet-to-dry lung weight ratio, pulmonary arterial pressure and peak airway pressure observed in post-ischaemic lungs. CONCLUSION: Lidocaine is effective in preventing post-ischaemic reperfusion injury in isolated, perfused rat lung.

Clinically relevant doses of lidocaine and bupivacaine do not impair cutaneous wound healing in mice.

Science.gov (United States)

Waite, A; Gilliver, S C; Masterson, G R; Hardman, M J; Ashcroft, G S

2010-06-01

Lidocaine and bupivacaine are commonly infiltrated into surgical cutaneous wounds to provide local anaesthesia after surgical procedures. However, very little is known about their effects on cutaneous wound healing. If an inhibitory effect is demonstrated, then the balance between the benefits of postoperative local anaesthesia and the negatives of impaired cutaneous wound healing may affect the decision to use local anaesthesia or not. Furthermore, if a difference in the rate of healing of lidocaine- and bupivacaine-treated cutaneous wounds is revealed, or if an inhibitory effect is found to be dose-dependent, then this may well influence the choice of agent and its concentration for clinical use. Immediately before incisional wounding, we administered lidocaine and bupivacaine intradermally to adult female mice, some of which had been ovariectomized to act as a model of post-menopausal women (like post-menopausal women, ovariectomized mice heal wounds poorly, with increased proteolysis and inflammation). Day 3 wound tissue was analysed histologically and tested for expression of inflammatory and proteolytic factors. On day 3 post-wounding, wound areas and extent of re-epithelialization were comparable between the control and local anaesthetic-treated animals, in both intact and ovariectomized groups. Both tested drugs significantly increased wound activity of the degradative enzyme matrix metalloproteinase-2 relative to controls, while lidocaine also increased wound neutrophil numbers. Although lidocaine and bupivacaine influenced local inflammatory and proteolytic factors, they did not impair the rate of healing in either of two well-established models (mimicking normal human wound healing and impaired age-related healing).

Postoperative analgesia after major spine surgery: patient-controlled epidural analgesia versus patient-controlled intravenous analgesia.

Science.gov (United States)

Schenk, Michael R; Putzier, Michael; Kügler, Bjoern; Tohtz, Stephan; Voigt, Kristina; Schink, Tania; Kox, Wolfgang J; Spies, Claudia; Volk, Thomas

2006-11-01

Spinal fusion surgery causes severe postoperative pain, hampering reconvalescense. We investigated the efficacy of patient-controlled epidural analgesia (PCEA) in a prospective, double-blind, randomized, controlled comparison with patient-controlled IV analgesia (PCIA). After lumbar anterior-posterior fusion receiving an epidural catheter intraoperatively, 72 patients were given either PCEA (ropivacaine 0.125% and sufentanil 1.0 microg/mL at 14 mL/h; bolus: 5 mL; lockout time: 15 min) and IV placebo or PCIA (morphine 2.0 mg/mL; bolus: 3 mg; lockout time: 15 min) and epidural placebo. Pain levels (visual analog scale 0-10), functional capabilities (turning in bed, standing, and walking), analgesic consumption, and side effects were evaluated until 72 h after surgery. Fourteen patients were excluded by predetermined criteria, leaving 58 patients for data analysis. Pain levels at rest and during mobilization were significantly lower in the PCEA when compared with that in the PCIA group throughout the study period (P turn in bed was achieved earlier in the PCEA group (P Patients in the PCEA group were significantly more satisfied with pain therapy (P patient satisfaction when compared with PCIA after spinal fusion surgery.

Sustained relief of pain from osteosynthesis surgery of rib fracture by using biodegradable lidocaine-eluting nanofibrous membranes.

Science.gov (United States)

Yu, Yi-Hsun; Hsu, Yung-Heng; Chou, Ying-Chao; Fan, Chin-Lung; Ueng, Steve W N; Kau, Yi-Chuan; Liu, Shih-Jung

2016-10-01

Various effective methods are available for perioperative pain control in osteosynthesis surgery, but they are seldom applied intraoperatively. The aim of this study was to evaluate a biodegradable poly([d,l]-lactide-co-glycolide) (PLGA)/lidocaine nanofibrous membrane for perioperative pain control in rib fracture surgery. Scanning electron microscopy showed high porosity of the membrane, and an ex vivo high-performance liquid chromatography study revealed an excellent release profile for both burst and controlled release of lidocaine within 30days. Additionally, the PLGA/lidocaine nanofibrous membrane was applied in an experimental rabbit rib osteotomy model. Implantation of the membrane around the osteotomized rib during osteosynthesis surgery resulted in a significant increase in weight gain, food and water consumption, and daily activity compared to the study group without the membrane. In addition, all osteotomized ribs were united. Thus, application of the PLGA/lidocaine nanofibrous membrane may be effective for sustained relief of pain in oeteosynthesis surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

Minimum Effective Volume of Lidocaine for Ultrasound-Guided Costoclavicular Block.

Science.gov (United States)

Sotthisopha, Thitipan; Elgueta, Maria Francisca; Samerchua, Artid; Leurcharusmee, Prangmalee; Tiyaprasertkul, Worakamol; Gordon, Aida; Finlayson, Roderick J; Tran, De Q

This dose-finding study aimed to determine the minimum effective volume in 90% of patients (MEV90) of lidocaine 1.5% with epinephrine 5 μg/mL for ultrasound-guided costoclavicular block. Using an in-plane technique and a lateral-to-medial direction, the block needle was positioned in the middle of the 3 cords of the brachial plexus in the costoclavicular space. The entire volume of lidocaine was deposited in this location. Dose assignment was carried out using a biased-coin-design up-and-down sequential method, where the total volume of local anesthetic administered to each patient depended on the response of the previous one. In case of failure, the next subject received a higher volume (defined as the previous volume with an increment of 2.5 mL). If the previous patient had a successful block, the next subject was randomized to a lower volume (defined as the previous volume with a decrement of 2.5 mL), with a probability of b = 0.11, or the same volume, with a probability of 1 - b = 0.89. Success was defined, at 30 minutes, as a minimal score of 14 of 16 points using a sensorimotor composite scale. Patients undergoing surgery of the elbow, forearm, wrist, or hand were prospectively enrolled until 45 successful blocks were obtained. This clinical trial was registered with ClinicalTrials.gov (ID NCT02932670). Fifty-seven patients were included in the study. Using isotonic regression and bootstrap confidence interval, the MEV90 for ultrasound-guided costoclavicular block was estimated to be 34.0 mL (95% confidence interval, 33.4-34.4 mL). All patients with a minimal composite score of 14 points at 30 minutes achieved surgical anesthesia intraoperatively. For ultrasound-guided costoclavicular block, the MEV90 of lidocaine 1.5% with epinephrine 5 μg/mL is 34 mL. Further dose-finding studies are required for other concentrations of lidocaine, other local anesthetic agents, and multiple-injection techniques.

LABOUR ANALGESIA: EPIDURAL DEXMEDITOMIDINE WITH EITHER BUPIVACAINE OR ROPIVACAINE

OpenAIRE

Varaprasad

2015-01-01

BACKGROUND: Pain relief in labour is associated with myths and controversies. Providing effective and safe analgesia has remained a challenge. AIM: The purpose of the study was to compare the effect of analgesia with epidural bupivacain or ropivacain along with dexme ditomidine. METHODS AND MATERIAL: Sixty parturients of ASA grade I and II were randomly selected for the study. Each group consisted of thirty patients. The analgesia, motor loss and level of seda...

Mastoplastia reductora con analgesia acupuntural A mamaplastic reduction using acupunctural analgesia

Directory of Open Access Journals (Sweden)

Javier Cordero Lozano

2004-08-01

Full Text Available Se realizó un ensayo clínico prospectivo y descriptivo con 40 pacientes portadoras de hipertrofia mamaria que acudieron a consulta de Cirugía Plástica en el Hospital Universitario "Abel Santamaría Cuadrado" de Pinar del Río entre septiembre de 2002 y agosto de 2003 a las que se les realizó mastoplastia reductora con analgesia acupuntural (puntos C1, IG4, VC17, VG20 y un punto especial evaluando la calidad de la analgesia acupuntural transoperatoria, el comportamiento hemodinámico transoperatorio y la ocurrencia de complicaciones postoperatorias. Para la validación estadística se utilizó el paquete Systat Con nivel de ajuste µ= 0.05. Se logró con la acupuntura un nivel analgésico transoperatorio satisfactorio en el 50 % de los casos, incluyendo pacientes de todos los grupos de edad, sobre todo en intervenciones que duraran hasta dos horas, independientemente del grado de hipertrofia mamaria. El comportamiento hemodinámico transoperatorio fue satisfactorio en las pacientes operadas con acupuntura; con esta técnica el registro de complicaciones fue inferior al reportado con anestesia general endotraqueal por otros autores, sin que se reportaran reacciones adversas por el uso de la acupuntura.A prospective descriptive clinical trial was carried out in a sample of 40 patients suffering from breast hypertrophy who attended Cosmetic Surgery Office at Abel Santamaría General Hospital between September 2002 and August 2003. A reductive mastoplasia using acupunctural analgesia was carried out (C1, IG4, VC17, VG20 points and special one assessing the quality of transoperative acupunctural analgesia, transoperative hemodynamic behaviour and the occurrence of postoperative complications. Systat pack was used for statistical validation with a fitted level of a = 0.05. a transoperative analgesic level was achieved successfully in 50 % of cases including patients from every age group particularly in up to two hours surgeries irrespective of the

Simultaneous determination of nikethamide and lidocaine in human blood and cerebrospinal fluid by high performance liquid chromatography.

Science.gov (United States)

Chen, Lili; Liao, Linchuan; Zuo, Zhong; Yan, Youyi; Yang, Lin; Fu, Qiang; Chen, Yu; Hou, Junhong

2007-04-11

Nikethamide and lidocaine are often requested to be quantified simultaneously in forensic toxicological analysis. A simple reversed-phase high performance liquid chromatography (RP-HPLC) method has been developed for their simultaneous determination in human blood and cerebrospinal fluid. The method involves simple protein precipitation sample treatment followed by quantification of analytes using HPLC at 263 nm. Analytes were separated on a 5 microm Zorbax Dikema C18 column (150 mm x 4.60 mm, i.d.) with a mobile phase of 22:78 (v/v) mixture of methanol and a diethylamine-acetic acid buffer, pH 4.0. The mean recoveries were between 69.8 and 94.4% for nikethamide and between 78.9 and 97.2% for lidocaine. Limits of detection (LODs) for nikethamide and lidocaine were 0.008 and 0.16 microg/ml in plasma and 0.007 and 0.14 microg/ml in cerebrospinal fluid, respectively. The mean intra-assay and inter-assay coefficients of variation (CVs) for both analytes were less than 9.2 and 10.8%, respectively. The developed method was applied to blood sample analyses in eight forensic cases, where blood concentrations of lidocaine ranged from 0.68 to 34.4 microg/ml and nikethamide ranged from 1.25 to 106.8 microg/ml. In six cases cerebrospinal fluid analysis was requested. The values ranged from 20.3 to 185.6 microg/ml of lidocaine and 8.0 to 72.4 microg/ml of nikethamide. The method is simple and sensitive enough to be used in toxicological analysis for simultaneous determination of nikethamide and lidocaine in blood and cerebrospinal fluid.

Lipid composition and lidocaine effect on immediate and delayed injection pain following propofol administration.

Science.gov (United States)

Zirak, Nahid; Bameshki, Alireza; Yazdani, Mohammadjavad; Gilani, Mehryar Taghavi

2016-01-01

Propofol has been used for the induction and maintenance of anesthesia. However, patients experience vascular pain during its injection. The objective of this study was to compare the effect of the lipid type used in propofol preparations and that of lidocaine on the immediate and delayed vascular pain induced by propofol administration. In this double-blinded clinical study, 150 patients at American Society of Anesthesiologists level I-II were randomly divided into three equally sized groups. A propofol with medium and long-chain triglycerides (propofol-MCT/LCT) was administered to the first group. The second group received propofol containing propofol-LCT, and the third group received propofol-LCT and pretreatment lidocaine 20 mg. The incidence and the intensity of immediate (during injection) and delayed injection pain (after 20 s) were evaluated on a verbal analog scale (1-10) until patients' unconsciousness. Sample size was calculated with SigmaPlot version 12.5 software. Data were analyzed with Statistical Package for the Social Sciences (SPSS) version 16, one-way analysis of variance, and post-hoc Tukey. P < 0.05 was considered statistically significant. The demographic parameters of the three groups were similar. The lidocaine group experienced the least immediate vascular pain. The intensity of pain was highest in the propofol-LCT group (P = 0.04). Additionally, the intensity of delayed pain was lowest in the propofol-MCT/LCT group (P = 0.01). The incidence of pain associated with the propofol administration was 26.5, 44, and 18%, respectively, in propofol-MCT/LCT, propofol-LCT, and lidocaine and propofol-LCT groups. The results indicate an effect of the lipid type on delayed pain reduction, especially propofol-MCT/LCT. On the other hand, the lidocaine decreases immediate propofol-LCT vascular pain.

Preemptive analgesia II: recent advances and current trends.

LENUS (Irish Health Repository)

Kelly, D J

2012-02-03

PURPOSE: This two-part review summarizes the current knowledge of physiological mechanisms, pharmacological modalities and controversial issues surrounding preemptive analgesia. SOURCE: Articles from 1966 to present were obtained from the MEDLINE databases. Search terms included analgesia, preemptive; neurotransmitters; pain, postoperative; hyperalgesia; sensitization, central nervous system; pathways, nociception; anesthetic techniques; analgesics, agents. Principal findings: In Part I of this review article, techniques and agents that attenuate or prevent central and peripheral sensitization were reviewed. In Part II, the conditions required for effective preemptive techniques are evaluated. Specifically, preemptive analgesia may be defined as an antinociceptive treatment that prevents establishment of altered central processing of afferent input from sites of injury. The most important conditions for establishment of effective preemptive analgesia are the establishment of an effective level of antinociception before injury, and the continuation of this effective analgesic level well into the post-injury period to prevent central sensitization during the inflammatory phase. Although single-agent therapy may attenuate the central nociceptive processing, multi-modal therapy is more effective, and may be associated with fewer side effects compared with the high-dose, single-agent therapy. CONCLUSION: The variable patient characteristics and timing of preemptive analgesia in relation to surgical noxious input require individualization of the technique(s) chosen. Multi-modal analgesic techniques appear more effective.

Labour analgesia and the baby: good news is no news.

Science.gov (United States)

Reynolds, Felicity

2011-01-01

When investigating different methods of maternal pain relief in labour, neonatal outcome has not always been at the forefront, or else maternal changes, such as haemodynamics, fever, length of labour, need for oxytocin or type of delivery, are taken as surrogates for neonatal outcome. It is essential to examine the actual baby and to appreciate that labour pain itself has adverse consequences for the baby. For systemic analgesia, pethidine has been most extensively studied and compared with neuraxial analgesia. It depresses fetal muscular activity, aortic blood flow, short-term heart rate variability and oxygen saturation. In the newborn it exacerbates acidosis, depresses Apgar scores, respiration, neurobehavioural score, muscle tone and suckling. Alternatives have few advantages, remifentanil being the most promising. Neuraxial analgesia is associated with better Apgar scores and variable neurobehavioural changes. Neonatal acid-base status is not only better with epidural than with systemic opioid analgesia, it is also better than with no analgesia. The effect on breast feeding has yet to be established, though it is certainly no worse than that of systemic opioid analgesia. Variations in neuraxial technique have little impact on the newborn. Widespread ignorance of the benefit to the newborn of neuraxial labour analgesia in the UK among non-anaesthetists needs to be combated. Copyright © 2010 Elsevier Ltd. All rights reserved.

A comparative evaluation of 4% articaine and 2% lidocaine in mandibular buccal infiltration anesthesia: A clinical study

Science.gov (United States)

Maruthingal, Sunith; Mohan, Dennis; Maroli, Ramesh Kumar; Alahmari, Ali; Alqahtani, Ahmed; Alsadoon, Mohammed

2015-01-01

Background: To compare 4% articaine and 2% lidocaine local anesthetics in achieving pulpal anesthesia of the lower first permanent molar teeth objectively, and to assess and compare lip and lingual mucosa numbness subjectively. Materials and Methods: All subjects received 1.7 ml of any one anesthetic in the mucobuccal fold adjacent to mandibular first molar teeth; the same individuals received the second infiltration at least 1 week after the first. Later, comparisons for pulpal anesthesia, lip and lingual mucosa numbness between these two anesthetics solutions were made. Results: Articaine showed significant results with P = 0.006 in achieving pulpal anesthesia objectively, when compared with lidocaine. Articaine also showed very high significant results subjectively with P = 0.0006 in achieving lip numbness, when compared with lidocaine. But the results in achieving lingual mucosa numbness with articaine subjectively was not significant with P = 0.01, when compared with lidocaine. Conclusion: Endodontic and operative treatments are one of the most common oral non-surgical procedures done under local anesthesia. The diversity of anesthetic substances currently available on the market requires dental professionals to assess the drug both by its pharmacokinetic and also by its clinical characteristics during dental treatments. Our study used 4% articaine, which is available in the market, for comparison with 2% lidocaine. Further studies are required to use an equal concentration of solutions to achieve more accurate results. PMID:26759799

Lidocaine, dexmedetomidine and their combination reduce isoflurane minimum alveolar concentration in dogs.

Directory of Open Access Journals (Sweden)

Carlos M Acevedo-Arcique

Full Text Available The effects of intravenous (i.v. lidocaine, dexmedetomidine and their combination delivered as a bolus followed by a constant rate infusion (CRI on the minimum alveolar concentration of isoflurane (MACISO in dogs were evaluated. Seven healthy adult dogs were included. Anaesthesia was induced with propofol and maintained with isoflurane. For each dog, baseline MAC (MACISO/BASAL was determined after a 90-minute equilibration period. Thereafter, each dog received one of the following treatments (loading dose, CRI: lidocaine 2 mg kg(-1, 100 µg kg(-1 minute(-1; dexmedetomidine 2 µg kg(-1, 2 µg kg(-1 hour(-1; or their combination. MAC was then determined again after 45- minutes of treatment by CRI. At the doses administered, lidocaine, dexmedetomidine and their combination significantly reduced MACISO by 27.3% (range: 12.5-39.2%, 43.4% (33.3-53.3% and 60.9% (46.1-78.1%, respectively, when compared to MACISO/BASAL. The combination resulted in a greater MACISO reduction than the two drugs alone. Their use, at the doses studied, provides a clinically important reduction in the concentration of ISO during anaesthesia in dogs.

A Comparative Study of Ketamine Gargle and Lidocaine Jelly ...

African Journals Online (AJOL)

2017-06-28

Jun 28, 2017 ... How to cite this article: Aigbedia SO, Tobi KU, Amadasun FE. A comparative ... 2017 Nigerian Journal of Clinical Practice | Published by Wolters Kluwer ‑ Medknow ... KEYWORDS: Postoperative throat pain, ketamine gargle, lidocaine, general .... taste from the normal saline placebo of the group L and.

Effects of maternal epidural analgesia on the neonate--a prospective cohort study.

Science.gov (United States)

Shrestha, Bikash; Devgan, Amit; Sharma, Mukti

2014-12-10

Epidural analgesia is one of the most popular modes of analgesia for child birth. There are controversies regarding adverse effects and safety of epidural analgesia. This study was conducted to study the immediate effects of the maternal epidural analgesia on the neonate during early neonatal phase. A prospective cohort study of 100 neonates born to mothers administered epidural analgesia were compared with 100 neonates born to mothers not administered epidural analgesia in terms of passage of urine, initiation of breast feeding, birth asphyxia and incidence of instrumentation. There was significant difference among the two groups in the passage of urine (P value 0.002) and incidence of instrumentation (P value 0.010) but there was no significant difference in regards to initiation of breast feeding and birth asphyxia. Epidural analgesia does not have any effect on the newborns in regards to breast feeding and birth asphyxia but did have effects like delayed passage of urine and increased incidence of instrumentation.

[Observation on analgesia effect of electroacupuncture during gynecologic outpatient operation].

Science.gov (United States)

Wang, Xiao-Hui; Wu, Xue-Lei; Jin, Ping-Lin; Wang, Lu-Dong; Zhao, Zhi-En; Qin, Xue-Yu; Zhang, Zhi-Yan; Hu, Xue-Zhu; Cai, Zhen-Lin

2012-10-01

To verify the feasibility of electroacupuncture analgesia applied to gynecologic outpatient operation. Two hundred patients were randomly divided into an electroacupuncture analgesia group and an intravenous anesthesia group, 100 cases in each group. Operation types included artificial abortion, diagnostic curettage and remove of intrauterine divice. The electroacupuncture analgesia group was treated with electroacupuncture at bilateral Hegu (LI 4) and Neiguan (PC 6), and the routine gynecologic outpatient operation was performed under patients' waking state. The intravenous anesthesia group was treated with routine gynecologic outpatient operation after intravenous injection of fentanyl and propofol. The excellent rate and the effective rate of analgesia were 88.0% (88/100) and 100.0% (100/100) in the electroacupuncture analgesia group, and 94.0% (94/100) and 100.0% (100/100) in the intravenous anesthesia group, with no statistically significant differences between the two groups (all P > 0.05). There was no adverse reaction in the electroacupuncture anesthesia group, but 11 cases of adverse reactions in the intravenous anesthesia group. Electroacupuncture analgesia can effectively alleviate the pain during gynecologic outpatient operation and it is simple and safe without adverse reactions.

Continuous versus patient-controlled epidural analgesia for labour analgesia and their effects on maternal motor function and ambulation.

Science.gov (United States)

Lovach-Chepujnoska, Margarita; Nojkov, Jordan; Joshevska-Jovanovska, Slagjana; Domazetov, Robert

2014-01-01

The advantages of patient-controlled epidural analgesia (PCEA) for delivery compared with continuous epidural analgesia (CEA) have been a point of interest in research obstetric anaesthesia for more than two decades. The aim of this single blind randomized controlled study was to evaluate the incidence of motor block and ability to perform partial knee flexion in women who received CEA or PCEA. Fifty-one healthy nulliparous women were included in this study. After an initial dose and established sensory block at Th 10, parturients were randomized into two groups: group CEA (10 ml/h), and group PCEA (bolus - 5 ml, lockout interval - 15 minutes, basal rate - 0 ml) with bupivacaine 0.08% and fentanyl 2 µg/ml. The motor function of the lower limbs was evaluated by modified Bromage scale at regular hourly intervals until full cervical dilatation. The quality of analgesia was assessed using a visual analogue pain scale (VAPS) and maternal satisfaction. Mode of delivery, the total number of additional rescue boluses, foetal and neonatal outcomes were recorded. Motor block was significantly lower in the third (33.3% vs. 4.35%; p = 0.008), fourth (57.9% vs. 6.3%; p = 0.003) and fifth hour (75.0% vs. 18.2%; p = 0.001) in the PCEA group. Ambulation occurred in 18% in the CEA and 46% in the PCEA group (p = 0.036). VAPS was with borderline significance in the second (p = 0.076) and significantly lower in the fourth hour (p = 0.034). Compared with CEA, PCEA provided less motor block and better first-stage analgesia, which leads to the conclusion that patient-controlled analgesia techniques are the preferred model in obstetric anesthesia.

ANALGESIA AND SEDATION IN THE EMERGENCY ENVIRONMENT

African Journals Online (AJOL)

Enrique

ised pump is the best nasal delivery system, due to good mucosal distribu- tion of the drug. ... teriorly, and asking the child to sniff during and after administering the drug. Onset of action ..... as well as tech- niques using intra-articular lidocaine.

Neuraxial Analgesia In Neonates And Infants: Review of Clinical and Preclinical Strategies for the Development of Safety and Efficacy Data

Science.gov (United States)

Walker, Suellen M.; Yaksh, Tony L.

2015-01-01

Neuraxial agents provide robust pain control, have the potential to improve outcomes, and are an important component of the perioperative care of children. Opioids or clonidine improve analgesia when added to perioperative epidural infusions; analgesia is significantly prolonged by addition of clonidine, ketamine, neostigmine or tramadol to single shot caudal injections of local anesthetic; and neonatal intrathecal anesthesia/analgesia is increasing in some centers. However, it is difficult to determine the relative risk-benefit of different techniques and drugs without detailed and sensitive data related to analgesia requirements, side-effects, and follow-up. Current data related to benefits and complications in neonates and infants are summarized, but variability in current neuraxial drug use reflects the relative lack of high quality evidence. Recent preclinical reports of adverse effects of general anesthetics on the developing brain have increased awareness of the potential benefit of neuraxial anesthesia/analgesia to avoid or reduce general anesthetic dose requirements. However, the developing spinal cord is also vulnerable to drug-related toxicity, and although there are well-established preclinical models and criteria for assessing spinal cord toxicity in adult animals, until recently there had been no systematic evaluation during early life. Therefore, the second half of this review presents preclinical data evaluating age-dependent changes in the pharmacodynamic response to different spinal analgesics, and recent studies evaluating spinal toxicity in specific developmental models. Finally, we advocate use of neuraxial agents with the widest demonstrable safety margin and suggest minimum standards for preclinical evaluation prior to adoption of new analgesics or preparations into routine clinical practice. PMID:22798528

Development of a local anesthetic lidocaine-loaded redox-active injectable gel for postoperative pain management.

Science.gov (United States)

Nagasaki, Yukio; Mizukoshi, Yutaro; Gao, Zhenyu; Feliciano, Chitho P; Chang, Kyungho; Sekiyama, Hiroshi; Kimura, Hiroyuki

2017-07-15

Although local anesthesia is commonly applied for pain relief, there are several issues such as its short duration of action and low effectiveness at the areas of inflammation due to the acidic pH. The presence of excessive amount of reactive oxygen species (ROS) is known to induce inflammation and aggravate pain. To resolve these issues, we developed a redox-active injectable gel (RIG) with ROS-scavenging activity. RIG was prepared by mixing polyamine-b-poly(ethylene glycol)-b-polyamine with nitroxide radical moieties as side chains on the polyamine segments (PMNT-b-PEG-b-PMNT) with a polyanion, which formed a flower-type micelle via electrostatic complexation. Lidocaine could be stably incorporated in its core. When the temperature of the solution was increased to 37°C, the PIC-type flower micelle transformed to gel. The continuous release of lidocaine from the gel was observed for more than three days, without remarkable initial burst, which is probably owing to the stable entrapment of lidocaine in the PIC core of the gel. We evaluated the analgesic effect of RIG in carrageenan-induced arthritis mouse model. Results showed that lidocaine-loaded RIG has stronger and longer analgesic effect when administered in inflamed areas. In contrast, while the use of non-complexed lidocaine did not show analgesic effect one day after its administration. Note that no effect was observed when PIC-type flower micelle without ROS-scavenging ability was used. These findings suggest that local anesthetic-loaded RIG can effectively reduce the number of injection times and limit the side effects associated with the use of anti-inflammatory drugs for postoperative pain management. 1. We have been working on nanomaterials, which effectively eliminate ROS, avoiding dysfunction of mitochondria in healthy cells. 2. We designed redox injectable gel using polyion complexed flower type micelle, which can eliminates ROS locally. 3. We could prepare local anesthesia-loaded redox injectable

Transversus abdominis plane block: A multimodal analgesia technique – Our experience

Directory of Open Access Journals (Sweden)

Deepak Dwivedi

2017-01-01

Full Text Available Context: A retrospective observational study conducted to assess transversus abdominis plane (TAP block as a tool for providing multimodal analgesia postoperatively for abdominal surgeries. Aims: The aim is to compare the visual analog scale (VAS of pain and the requirement of rescue analgesia postoperatively in patients undergoing various abdominal surgeries (open and laparoscopic where TAP block was given for postoperative analgesia and was compared with patients who received pain relief according to the institutional protocol. Settings and Design: Retrospective observational study conducted in a tertiary care hospital. Subjects and Methods: Retrospective data from anesthesia records of patients, who underwent abdominal surgeries from January 2016 to December 2016, were analyzed and were divided into two groups. Group A (n = 250 consisted of patients who received the conventional standard postoperative analgesia protocol of the department of anesthesia. Group B (n = 136 consisted of patients who were administered TAP block postsurgery for the postoperative analgesia by the trained anesthesiologist. Primary outcome considered was (i average VAS at 02, 06, 12, and 24 h and (ii average opioid/nonsteroidal anti-inflammatory drug consumption at 24 h postoperatively. Secondary outcome considered was time to first rescue analgesia. Statistical Analysis: All parametric data were analyzed using unpaired t-test. Data are expressed as the mean ± standard deviation. A SPSS version 17 (SPSS Inc., Chicago, IL, USA was used for statistical analysis. Results: Average pain scores (VAS were lower in Group B as compared to Group A in all subcategories of surgery postoperatively. Patients given TAP block (Group B required less rescue analgesia in the postoperative period with time to first rescue analgesia being prolonged. Conclusions: On the basis of our retrospective study, we suggest that TAP block can be utilized as a part of multimodal analgesia regimen for

Anesthetic efficacy of combinations of 0.5 mol/L mannitol and lidocaine with epinephrine for inferior alveolar nerve blocks in patients with symptomatic irreversible pulpitis.

Science.gov (United States)

Kreimer, Timothy; Kiser, Russell; Reader, Al; Nusstein, John; Drum, Melissa; Beck, Mike

2012-05-01

The purpose of these 2 prospective, randomized, single-blind studies was to determine the anesthetic efficacy of lidocaine with epinephrine compared with a combination lidocaine with epinephrine plus 0.5 mol/L mannitol for inferior alveolar nerve (IAN) blocks in patients experiencing symptomatic irreversible pulpitis. In study one, 55 emergency patients randomly received IAN blocks by using a 3.18-mL formulation containing 63.6 mg of lidocaine with 31.8 μg epinephrine or a 5-mL formulation containing 63.6 mg of lidocaine with 31.8 μg epinephrine (3.18 mL) plus 1.82 mL of 0.5 mol/L mannitol. In study two, 51 emergency patients randomly received IAN blocks by using a 1.9-mL formulation containing 76.4 mg of lidocaine with 36 μg epinephrine or a 3-mL formulation containing 76.4 mg of lidocaine with 36 μg epinephrine (1.9 mL) plus 1.1 mL of 0.5 mol/L mannitol. Endodontic access was begun 15 minutes after the IAN block, and all patients had profound lip numbness. Success was defined as no or mild pain (visual analogue scale recordings) on endodontic access or instrumentation. The 1.9 mL of lidocaine (76.4 mg) with epinephrine plus 0.5 mol/L mannitol had a significantly (P = .04) better success rate of 39% when compared with the lidocaine formulation without mannitol (13% success rate). For mandibular posterior teeth in patients with symptomatic irreversible pulpitis, the addition of 0.5 mol/L mannitol to 1.9 mL of lidocaine (76.4 mg) with epinephrine resulted in a statistically higher success rate. However, the combination lidocaine/mannitol formulation would not result in predictable pulpal anesthesia. Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Evaluation of lidocaine treatment on frequency of cardiac arrhythmias, acute kidney injury, and hospitalization time in dogs with gastric dilatation volvulus.

Science.gov (United States)

Bruchim, Yaron; Itay, Srugo; Shira, Ben-Halevy; Kelmer, Efrat; Sigal, Yudelecitch; Itamar, Aroch; Gilad, Segev

2012-08-01

To assess the efficacy of IV lidocaine in decreasing complication rate and improving the outcome in dogs with gastric dilatation volvulus (GDV). Prospective non-controlled study of 83 lidocaine-treated dogs with GDV compared to 47 untreated historical controls with GDV. University veterinary teaching hospital. One hundred and thirty client-owned dogs with naturally occurring GDV. Study group dogs were treated at presentation with lidocaine (2 mg/kg, IV bolus) followed by constant rate infusion (CRI) of 0.05 mg/kg/min for 24 h. Historical control dogs did not receive any lidocaine. There were no group differences in age, body weight, time lag from onset of clinical signs to presentation, rectal temperature and pulse rate at presentation, and proportion of gastric wall necrosis. The proportions of cardiac arrhythmias and acute kidney injury (AKI) were significantly (Pdogs with GDV compared to untreated historical controls. Due to the nonblinded, placebo-uncontrolled, nonrandomized nature of the current study, further evaluation of the efficacy of lidocaine in dogs with GDV is warranted. © Veterinary Emergency and Critical Care Society 2012.

Effect of cervical epidural blockade with 2% lidocaine plus epinephrine on respiratory function.

Science.gov (United States)

Huang, Chih-Hung

2007-12-01

Cervical epidural anesthesia has been used widely for surgery of upper limbs. Although cervical epidural anesthesia with local anesthetic of 2% lidocaine (plain) has demonstrated the safety in respiratory function in spite of unavoidable phrenic and intercostal palsies to certain extent, the replacement of local anesthetics with 2% lidocaine plus epinephrine has not been investigated yet. I conducted this study to look into the effect of 2% lidocaine plus epinephrine on respiratory function. I collected data from 50 patients with mean age of 24 +/- 3 yrs, mean weight of 65 +/- 10 kg, ASA status: I-II without preoperative pulmonary dysfunction undergoing orthropedic open-reduction with internal fixation because of fractures of upper limbs. Cervical epidural space (C7-T1) was approached by hanging-drop method, using a 17G Tuohy needle. A catheter was inserted craniad to a distance of 12 cm. Pulmonary function measurement and arterial blood gas data were obstained before, 20 min, 50 min and 105 min after injection of 12 mL 2% lidocaine with 1:200,000 epinephrine. The anesthesia levels were between C3-T3 and obtained 15 +/- 2 min after injection. Mean arterial blood gas analysis showed mild respiratory acidosis at 20 min (PaCO2: 48 +/- 3 mmHg) and 50 min (PaCO2: 44 +/- 2 mmHg). The measured values of inspiratory vital capacity (IVC), vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1), peak expiratory flow (PEF) when compaired with control values, were decreased about 18.0% and 12.1% of the control values at 20 min and 50 min respectively. The ratios of FEV1/VC, FEV1/FVC were still within normal limits (> 80%). The results were significantly compatible with the criteria of mild restrictive type of pulmonary function. Cervical epidural anesthesia with 2% lidocaine plus epinephrine could reduce lung volumes and capacities, resulting from partially paralytic intercostal muscles and diaphragm innervated respectively by thoracic

Is urinary drainage necessary during continuous epidural analgesia after colonic resection?

DEFF Research Database (Denmark)

Basse, L; Werner, M; Kehlet, H

2000-01-01

BACKGROUND AND OBJECTIVES: Postoperative urinary retention may occur in between 10% and 60% of patients after major surgery. Continuous lumbar epidural analgesia, in contrast to thoracic epidural analgesia, may inhibit urinary bladder function. Postoperative urinary drainage has been common...... that routine bladder catheterization beyond postoperative day 1 may not be necessary in patients with ongoing continuous low-dose thoracic epidural analgesia....

A Comparison of Intrathecal and Epidural Analgesia and Its Effect on Length of Labor

Science.gov (United States)

1997-09-10

differences were found between agents, lidocaine with epinephrine or bupivacaine with epinephrine, in depression of uterine activity (Willdeck-Lund et al...effects. Also, all parturients except for three reported pain relief lasting throughout labor. Local infiltration of lidocaine was performed for...are not reached. In response to the relative ineffectiveness of epidural morphine and the high incidence of side effects with morphine injected

Use of ropivacain and lidocaine for axillary plexus blockade ...

African Journals Online (AJOL)

Use of ropivacain and lidocaine for axillary plexus blockade. ... of the juvenile anatomy, psychological barriers, time constraints on block ... children in the age group of 2 to 10 years and undergoing short upper limb surgery. ... Browse By Category · Browse Alphabetically · Browse By Country · List All Titles · Free To Read ...

Comparison of Epidural Analgesia with Transversus Abdominis Plane Analgesia for Postoperative Pain Relief in Patients Undergoing Lower Abdominal Surgery: A Prospective Randomized Study.

Science.gov (United States)

Iyer, Sadasivan Shankar; Bavishi, Harshit; Mohan, Chadalavada Venkataram; Kaur, Navdeep

2017-01-01

Anesthesiologists play an important role in postoperative pain management. For analgesia after lower abdominal surgery, epidural analgesia and ultrasound-guided transversus abdominis plane (TAP) block are suitable options. The study aims to compare the analgesic efficacy of both techniques. Seventy-two patients undergoing lower abdominal surgery under spinal anesthesia were randomized to postoperatively receive lumbar epidural catheter (Group E) or ultrasound-guided TAP block (Group T) through intravenous cannulas placed bilaterally. Group E received 10 ml 0.125% bupivacaine stat and 10 ml 8 th hourly for 48 h. Group T received 20 ml 0.125% bupivacaine bilaterally stat and 20 ml bilaterally 8 th hourly for 48 h. Pain at rest and on coughing, total paracetamol and tramadol consumption were recorded. Analgesia at rest was comparable between the groups in the first 16 h. At 24 and 48 h, Group E had significantly better analgesia at rest ( P = 0.001 and 0.004 respectively). Patients in Group E had significantly higher number of patients with nil or mild pain on coughing at all times. Paracetamol consumption was comparable in both groups, but tramadol consumption was significantly higher in Group T at the end of 48 h ( P = 0.001). For lower abdominal surgeries, analgesia provided by intermittent boluses of 0.125% is comparable for first 16 h between epidural and TAP catheters. However, the quality of analgesia provided by the epidural catheter is superior to that provided by TAP catheters beyond that both at rest and on coughing with reduced opioid consumption.

Efficacy of amiodarone and lidocaine for preventing ventricular fibrillation after aortic cross-clamp release in open heart surgery: a meta-analysis of randomized controlled trials.

Science.gov (United States)

Zheng, Yong; Gu, Qiang; Chen, Hong-Wu; Peng, Huai-Ming; Jia, Dong-Yu; Zhou, Yu; Xiang, Mei-Xiang

The relative preventative efficacy of amiodarone and lidocaine for ventricular fibrillation (VF) after release of an aortic cross-clamp (ACC) during open heart surgery has not been determined. This meta-analysis was designed to systematically evaluate the influence of amiodarone, lidocaine, or placebo on the incidence of VF after ACC. Prospective randomized controlled trials (RCTs) that compared the VF-preventative effects of amiodarone with lidocaine, or amiodarone or lidocaine with placebo were included. PubMed, EMBASE, and the Cochrane Library were searched for relevant RCTs. Fixed or randomized effect models were applied according to the heterogeneity of the data from the selected studies. We included eight RCTs in the analysis. Pooled results suggested that the preventative effects of amiodarone and lidocaine were comparable (relative risk (RR)=1.12, 95% confidence interval (CI): 0.70 to 1.80, P=0.63), but both were superior to the placebo (amiodarone, RR=0.71, 95% CI: 0.51 to 1.00, P=0.05; lidocaine, RR=0.63, 95% CI: 0.46 to 0.88, P=0.006). The percentage of patients requiring electric defibrillation counter shocks (DCSs) did not differ significantly among patients administered amiodarone (RR=0.21, 95% CI: 0.04 to 1.19, P=0.08), lidocaine (RR=2.44, 95% CI: 0.13 to 44.02, P=0.55), or the placebo (RR=0.56, 95% CI: 0.25 to 1.25, P=0.16). Amiodarone and lidocaine are comparably effective in preventing VF after ACC, but the percentage of patients who subsequently require DCSs does not differ among those administered amiodarone, lidocaine, or placebo.

Medical Management of Chemical Toxicity in Pediatrics

Science.gov (United States)

2009-01-01

better the outcome. Oxime therapy is rendered ineffective if given after the enzyme aging process has been completed (Dunn and Sidell, 1989). This...bronchospasm: Corticosteroids (prednisone) (also used for PTS with HIO asthma but use unproven) Analgesia and cough: Nebulized lidocaine (4% topical

Activated endothelial interleukin-1beta, -6, and -8 concentrations and intercellular adhesion molecule-1 expression are attenuated by lidocaine.

LENUS (Irish Health Repository)

Lan, Wei

2012-02-03

Endothelial cells play a key role in ischemia reperfusion injury. We investigated the effects of lidocaine on activated human umbilical vein endothelial cell (HUVEC) interleukin (IL)-1beta, IL-6, and IL-8 concentrations and intercellular adhesion molecule-1 (ICAM-1) expression. HUVECs were pretreated with different concentrations of lidocaine (0 to 0.5 mg\\/mL) for 60 min, thereafter tumor necrosis factor-alpha was added at a concentration of 2.5 ng\\/mL and the cells incubated for 4 h. Supernatants were harvested, and cytokine concentrations were analyzed by enzyme-linked immunosorbent assay. Endothelial ICAM-1 expression was analyzed by using flow cytometry. Differences were assessed using analysis of variance and post hoc unpaired Student\\'s t-test where appropriate. Lidocaine (0.5 mg\\/mL) decreased IL-1beta (1.89 +\\/- 0.11 versus 4.16 +\\/- 1.27 pg\\/mL; P = 0.009), IL-6 (65.5 +\\/- 5.14 versus 162 +\\/- 11.5 pg\\/mL; P < 0.001), and IL-8 (3869 +\\/- 785 versus 14,961 +\\/- 406 pg\\/mL; P < 0.001) concentrations compared with the control. IL-1beta, IL-6, and IL-8 concentrations in HUVECs treated with clinically relevant plasma concentrations of lidocaine (0.005 mg\\/mL) were similar to control. ICAM-1 expression on lidocaine-treated (0.05 mg\\/mL) HUVECs was less than on controls (198 +\\/- 52.7 versus 298 +\\/- 50.3; Mean Channel Fluorescence; P < 0.001). Activated endothelial IL-1beta, IL-6, and IL-8 concentrations and ICAM-1 expression are attenuated only by lidocaine at concentrations larger than clinically relevant concentrations.

Efficacy of a Buffered 4% Lidocaine Formulation for Incision and Drainage: A Prospective, Randomized, Double-blind Study.

Science.gov (United States)

Harreld, Taryn Kratz; Fowler, Sara; Drum, Melissa; Reader, Al; Nusstein, John; Beck, Mike

2015-10-01

Incision and drainage of symptomatic emergency patients with facial swelling is painful even after local anesthetics are administered. The purpose of this prospective, randomized, double-blind study was to compare the pain of infiltration and the pain of an incision and drainage procedure of a buffered versus a nonbuffered 4% lidocaine formulation in symptomatic emergency patients presenting with a diagnosis of pulpal necrosis, associated periapical area, and an acute clinical swelling. Eighty-eight emergency patients were randomly divided into 2 groups to receive 2 intraoral infiltration injections (mesial and distal to the swelling) of either 4% lidocaine with 1:100,000 epinephrine buffered with 0.18 mL 8.4% sodium bicarbonate using the Onpharma (Los Gatos, CA) buffering system or 4% lidocaine with 1:100,000 epinephrine. Subjects rated the pain of needle insertion, needle placement, and solution deposition for each injection using a 170-mm visual analog scale. An incision and drainage procedure was performed, and subjects rated the pain of incision, drainage, and dissection on a 170-mm visual analog scale. No significant differences between the buffered and nonbuffered 4% lidocaine formulations were found for needle insertion, placement, and solution deposition of the infiltration injections or for the treatment phases of incision, drainage, and dissection. Buffering a 4% lidocaine formulation did not significantly decrease the pain of infiltrations or significantly decrease the pain of the incision and drainage procedure when compared with a nonbuffered 4% lidocaine formulation in symptomatic patients with a diagnosis of pulpal necrosis and associated acute swelling. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Sucralfate and Lidocain: Antacid 50:50 solution in Post Esophageal Variceal Band Ligation Pain.

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Hafeez, Muhammad; Kadir, Ehsan; Aijaz, Anjum

2016-01-01

To compare the effectiveness of pain relief of Sucralfate and lidocain antacid 50:50 solution in post esophageal variceal band ligation pain. All patients who had under gone Esophageal Variceal Band Ligation (EVBL) were included in the study. Patients un-willing to be included in the study or those who didn't have post EVBL pain were excluded. Patients with post EVBL pains were divided into two groups: one group was given sucralfate and other was given lidocaine: antacid 50:50 solution. Both were inquired about the duration of the pain relief after the medication. The results were analyzed on SPSS 23. Independent samples T-test was performed to find out whether the difference in duration of pain relief was significantly different in the two groups. Out of 110 patients who have EVBL, 66(60.00%) had pain and 44(40.00%) were pain free. In the pain group 46 (69.7%) were given sucralfate and 20 (30.3%) were given lidocain: antacid 50:50 solution. Mean duration of pain relief in two groups was 2.78 (SD ± 2.096) and 2.5 days (SD ±. 0.76) respectively. Independent samples T-test results revealed that there was no statistically significant difference in the duration of pain relief between these two groups with p value 0.426. Both Sucralfate and Lidocain: antacid 50:50 solutions are effective in relieving the post EVBL pain. However, no statistically significant difference in duration of pain relief was detected in separate groups of patients treated with either treatment.

Effectiveness of injection of local anesthetic into the retrobulbar space for postoperative analgesia following eye enucleation in dogs.

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Myrna, Kathern E; Bentley, Ellison; Smith, Lesley J

2010-07-15

To assess the efficacy of a retrobulbar bupivacaine nerve block for postoperative analgesia following eye enucleation in dogs. Randomized controlled trial. 22 dogs. Client-owned dogs admitted to the hospital for routine eye enucleation were enrolled with owner consent and randomly assigned to a treatment (bupivacaine hydrochloride) or control (saline [0.9% NaCl] solution) group. Baseline subjective pain scores were recorded. Anesthesia consisted of hydromorphone and midazolam preoperatively, thiopental or propofol for induction, and isoflurane in oxygen for maintenance. An inferior-temporal palpebral retrobulbar injection of either saline solution or bupivacaine was administered. Transpalpebral eye enucleation was performed. Pain scores were recorded at 0.25, 0.5, 1, 2, 4, 6, 8, and 24 hours after extubation (time 0) by observers masked to treatment groups. Dogs were given hydromorphone (0.2 mg/kg [0.09 mg/lb], IM or IV) as a rescue analgesic if the subjective pain score totaled >or= 9 (out of a maximum total score of 18) or >or= 3 in any 1 category. 9 of 11 control dogs required a rescue dose of hydromorphone, but only 2 of 11 dogs in the bupivacaine treatment group required rescue analgesia. Mean time to treatment failure (ie, administration of rescue analgesia following extubation) was 0.56 hours (95% confidence interval, 0.029 to 1.095 hours) for the 11 dogs that received hydromorphone. Retrobulbar administration of bupivacaine in dogs in conjunction with traditional premedication prior to eye enucleation was an effective form of adjunctive analgesia and reduced the need for additional postoperative analgesics.

Effects of epidural analgesia on labor length, instrumental delivery, and neonatal short-term outcome.

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Hasegawa, Junichi; Farina, Antonio; Turchi, Giovanni; Hasegawa, Yuko; Zanello, Margherita; Baroncini, Simonetta

2013-02-01

We aimed to clarify whether the short-term adverse neonatal outcomes associated with epidural analgesia are due to the epidural analgesia itself or to the instrumental delivery. A retrospective case-control study was conducted to evaluate the relationship between epidural analgesia, labor length, and perinatal outcomes. A total of 350 pregnant women at term who delivered under epidural analgesia (cases) were compared with 1400 patients without epidural analgesia (controls). Vacuum extraction (6.5 vs. 2.9 %) and cesarean section (19.9 vs. 11.1 %) were more frequently performed in the cases than controls (p neonatal variables stratified by mode of delivery were not different in cases and controls, except for a slightly lower umbilical arterial pH in spontaneous delivery for the cases group. However, the Apgar scores and umbilical arterial pH were significantly lower in the neonates delivered by vacuum extraction compared with those in the neonates delivered by spontaneous delivery or cesarean section, regardless of whether epidural analgesia was performed. A multivariable analysis showed that vacuum extraction much more consistently affected the arterial pH than the analgesia itself (the β coefficients were -0.036 for epidural analgesia vs. -0.050 for vacuum extraction). Epidural analgesia was associated with slowly progressing labor, thus resulting in an increased rate of instrumental delivery. This instrumental delivery appears to adversely affect the neonatal outcomes more strongly than the analgesia itself.

Effect of trochar site lidocaine on postoperative pain scoring and patient satisfaction after gynecologic laparoscopies – A randomized clinical trial

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Kamal M. Zahran

2011-06-01

Conclusion: The combined use trochar sites and intraperitoneal lidocaine is superior to intraperitoneal lidocaine alone in managing postoperative pain after laparoscopic gynecological procedures. It leads to lower VAS at day 1 and day 7 postoperatively, less need for additional analgesics and higher patient satisfaction.

Comparison Efficacy of Topical Piroxicam Gel and Lidocaine with Intravenous Pethidine in Reducing Pain during ESWL

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F Mohammad Alibeigi

2011-06-01

Full Text Available Introduction & Objective: ESWL is a non-invasive method of breaking stones, using acoustic shock waves. Shock waves cause temporary deep visceral pain and discomfort in entry therefore, administration of sedatives is necessary. The purpose of this study was to compare the effect of topical lidocaine and piroxicam gel with intravenous pethidine in reducing pain during ESWL. Materials & Methods: This clinical trial study was performed on 159 patients who referred to Ayatollah Kashani Hospital in Shahrkord for ESWL in 2009. Patients were randomly divided into three-groups. For the first group, intravenous pethidine (0.5 mg/kg alone was administered. The second group received topical piroxicam, and the third group received topical lidocaine in the area of flank for half an hour before ESWL. During the operation, those patients who had unbearable pain, received another 0.5 mg/kg of pethidine. Data was collected using MC Gill questionnaires and analyzed using the SPSS software, using parametric, nonparametric methods and Dunn's Multiple Comparisons tests. Results: The mean of pain scores in the first group (pethidine was 6.2 ± 6.9 while these scores were 3.2 ± 2 .7 and 3.9 ± 3.1 for the second (piroxicam gel and third group (lidocaine gel respectively. The differences in the mean score of pain was significant in the pethidine group compared to the other groups (P <0.05. The average pethidin consumption were 24 ± 16 mg for the first group (pethidine, 10 ± 13 mg for the second group (piroxicam gel, and 5 ± 9 mg for the third group (lidocaine gel. The mean difference was significant in pethidine treated group in comparison with other two groups (P < 0.05. Conclusion: The use of topical piroxicam or lidocaine reduces pain in patients after ESWL It also reduces the need for sedative drugs.

Effect of pain and analgesia on compensatory reserve.

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Hinojosa-Laborde, Carmen; Fernandez, Jessie Renee D; Muniz, Gary W; Nawn, Corinne D; Burns, Rebecca K; Le, Thuan H; Porter, Kathy B; Hardy, John T; Convertino, Victor A

2017-07-01

The measurement of the body's capacity to compensate for reduced blood volume can be assessed with a compensatory reserve measurement (CRM). The CRM, which is calculated from changes in features of the arterial waveform, represents the integration of compensatory mechanisms during states of low tissue perfusion and oxygenation, such as hemorrhage. This study was designed to test the hypothesis that pain which activates compensatory mechanisms and analgesia that result in reduced blood pressure are associated with lower compensatory reserve. This study evaluated CRM in obstetric patients during labor as pain intensity increased from no pain to severe pain and compared CRM before and after epidural anesthesia. CRM was calculated from a finger pulse oximeter placed on the patient's index finger and connected to the DataOx monitor in healthy pregnant women (n = 20) before and during the active labor phase of childbirth. As pain intensity, based on an 11-point scale (0, no pain; 10, worst pain), increased from 0 to 8.4 ± 0.9 (mean ± SD), CRM was not affected (81 ± 10% to 82 ± 13%). Before analgesia, CRM was 84 ± 10%. CRM at 10 minutes, 20 minutes, 30 minutes, 40 minutes, 50 minutes, and 60 minutes after analgesia was 82 ± 11%, 83 ± 14%, 83 ± 15%, 86 ± 12%, 89 ± 9%, and 87 ± 10%, respectively. There was a transient 2% reduction followed by a 5% increase in CRM from before to after epidural anesthesia (p = 0.048). Pain scores before and after analgesia were 7 ± 2 and 1 ± 1, respectively (p < 0.001). These results indicate that pain and analgesia contribute minimally, but independently to the reduction in compensatory reserve associated with trauma and hemorrhage. As such, our findings suggest that analgesia can be safely administered on the battlefield while maintaining the maximal capacity of mechanisms to compensate for blood loss. Diagnostic study, level II.

Ovariohysterectomy requires more post-operative analgesia than orchiectomy in dogs and cats.

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Quarterone, Carolina; Luna, Stelio Pacca Loureiro; Crosignani, Nadia; de Oliveira, Flávia Augusta; Lopes, Carlize; da Maia Lima, Alfredo Feio; de Araújo Aguiar, Antonio Jose

2017-11-01

The requirement for post-operative analgesia after ovariohysterectomy (OH) versus orchiectomy in dogs and cats was compared. Twelve male and 12 female cats and 12 male and 12 female dogs received meloxicam, 0.1 mg/kg body weight, PO, 2 h before surgery. Eleven female cats and 3 female dogs received rescue analgesia ( P = 0.002). No male of either species required rescue analgesia. The number of cats receiving rescue analgesia was greater in females than in males ( P dogs or cats. Postoperative pain after OH should be assessed for at least 2 h for cats and 4 h for dogs, using species-specific validated tools, to ensure proper postoperative pain diagnosis and management. Male dogs and cats subjected to orchiectomy required less postoperative analgesia intervention than female dogs and cats submitted to OH.

Simultaneous determination of ethamsylate, tramadol and lidocaine in human urine by capillary electrophoresis with electrochemiluminescence detection.

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Li, Jianguo; Ju, Huangxian

2006-09-01

Ethamsylate, tramadol and lidocaine, partly excreted by the kidney, are generally used as hemostatic, analgesic and local anesthetic in surgery. We developed a simple and sensitive method for their simultaneous monitoring in human urine based on CE coupled with electrochemiluminescence detection by end-column mode. Under optimized conditions the proposed method yielded linear ranges from 5.0 x 10(-8) to 5.0 x 10(-5), 1.0 x 10(-7) to 1.0 x 10(-4) and 1.0 x 10(-7) to 1.0 x 10(-4) M with LODs of 8.0 x 10(-9) M (36 amol), 1.6 x 10(-8) M (72 amol) and 1.0 x 10(-8) M (45 amol) (S/N = 3) for ethamsylate, tramadol and lidocaine, respectively. The RSD for their simultaneous detection at 1.0 x 10(-6) M was 2.1, 2.8 and 3.2% (n = 7), respectively. For practical application an extraction step with ethyl acetate at pH 11 was performed to eliminate the influence of the sample ionic strength. The recoveries of ethamsylate, tramadol and lidocaine at different levels in human urine were between 87 and 95%. This method was used for simultaneous detection of ethamsylate, tramadol and lidocaine in clinic urine samples from two medicated patients. It was valuable in clinical and biochemical laboratories for monitoring these drugs for various purposes.

The Effect of Ketamine and Dexamethasone in Combination with Lidocaine on the Onset and Duration of Axillary Block in Hand and Forearm Soft Tissue Surgery.

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Zaman, Behrooz; Hojjati Ashrafi, Siavash; Seyed Siamdoust, Seyedalireza; Hassani, Valiollah; Mohamad Taheri, Siavash; Noorizad, Samad

2017-10-01

Using peripheral nerve block compared to general anesthesia has gained more popularity due to reduced postoperative pain, less need for post-surgery analgesic drugs, reduced incidence of nausea, shortness of PACU time, and increased patient satisfaction. The aim of this study was to compare the effect of ketamine and dexamethasone as additives to lidocaine on duration and onset of axillary block action. In this clinical trial, all patients who referred to Hazrat-e-Fatemeh hospital for forearm and hand soft tissue surgery with informed consent were randomly divided into three groups in order to examine the onset and duration of axillary block: lidocaine + ketamine, lidocaine + dexamethasone in axillary block, and lidocaine alone (control). Then, the onset and duration of sensory and motor blocks were measured and recorded every three minutes and after the surgery. Quantitative and qualitative variables were analyzed using ANOVA or Kruskal-Wallis test and Chi-square or Fisher exact test in SPSS v.22. Duration of sensory and motor block axillary was significantly higher in lidocaine + dexamethasone group than in lidocaine + ketamine group (P block axillary between the three groups (P > 0.05). According to the results of our study, we can conclude that adding dexamethasone or ketamine to lidocaine could improve duration of sensory and motor axillary block in patients undergoing forearm and hand soft tissue surgery. However, dexamethasone had the highest effect on duration of block axillary. We proved that dexamethasone or ketamine added to lidocaine had no effect on the onset of block axillary.

Electrophysiologic Study of a Method of Euthanasia Using Intrathecal Lidocaine Hydrochloride Administered during Intravenous Anesthesia in Horses.

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Aleman, M; Davis, E; Williams, D C; Madigan, J E; Smith, F; Guedes, A

2015-01-01

An intravenous (IV) overdose of pentobarbital sodium is the most commonly used method of euthanasia in veterinary medicine. However, this compound is not available in many countries or rural areas resulting in usage of alternative methods such as intrathecal lidocaine administration after IV anesthesia. Its safety and efficacy as a method of euthanasia have not been investigated in the horse. To investigate changes in mean arterial blood pressure and electrical activity of the cerebral cortex, brainstem, and heart during intrathecal administration of lidocaine. Our hypothesis was that intrathecal lidocaine affects the cerebral cortex and brainstem before affecting cardiovascular function. Eleven horses requiring euthanasia for medical reasons. Prospective observational study. Horses were anesthetized with xylazine, midazolam, and ketamine; and instrumented for recording of electroencephalogram (EEG), electrooculogram (EOG), brainstem auditory evoked response (BAER), and electrocardiogram (ECG). Physical and neurological (brainstem reflexes) variables were monitored. Mean arterial blood pressure was recorded throughout the study. Loss of cerebro-cortical electrical activity occurred up to 226 seconds after the end of the infusion of lidocaine solution. Cessation of brainstem function as evidenced by a lack of brainstem reflexes and disappearance of BAER occurred subsequently. Undetectable heart sounds, nonpalpable arterial pulse, and extremely low mean arterial blood pressure supported cardiac death; a recordable ECG was the last variable to disappear after the infusion (300-1,279 seconds). Intrathecal administration of lidocaine is an effective alternative method of euthanasia in anesthetized horses, during which brain death occurs before cardiac death. Copyright © 2015 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of American College of Veterinary Internal Medicine.

[Analgesia and sedation in neonatal-pediatric intensive care].

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Schlünder, C; Houben, F; Hartwig, S; Theisohn, M; Roth, B

1991-01-01

In pediatric intensive care, analgesia and sedation has become increasingly important for newborns as well as prematures in recent years. However, its importance is frequently not well recognized and sedation is confounded with analgesia. In our intensive-care unit (ICU), fentanyl and midazolam have proved to be useful. In newborn and premature infants, fentanyl alone has been sufficient because of its analgesic and sedative action. In a study on 20 newborns and prematures suffering from severe respiratory problems as compared with a historical group that did not receive fentanyl, we could show that in subjects receiving fentanyl, considerably less treatment with sedatives and other analgesics was necessary. Cardiopulmonary tolerance was satisfactory. The highest bilirubin values were reached about 1 day earlier and were slightly higher than those measured in the control group, but oral nutrition could be initiated sooner. In small infants, additional midazolam was given after cardiac surgery. During the first 72 h, we found a correlation between serum levels of midazolam and the depth of sedation; however, after 72 h of medication, the dose had to be raised because of an increase in metabolic clearance. During the concomitant administration of midazolam and fentanyl, significantly less midazolam was needed to achieve appropriate analog-sedation. Prior to the administration of analgesics and sedatives, care should be taken to ensure that circulatory conditions are stable and that there is no hypovolemia, and the drugs must be given slowly during several minutes. Especially in a pediatric ICU, light and noise should be diminished and contact between the parents and the child should be encouraged, even when the child is undergoing mechanical ventilation.

Hemodynamic Effect of 2% Lidocaine with 1:80,000 Epinephrine Infiltration in Maxillofacial Surgeries under General Anesthesia

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Baratollah Shaban

2013-12-01

Full Text Available Introduction: Epinephrine-containing lidocaine is the most used anestheic drug in dentistry. The aim of this study was to investigate the hemodynamic changes following local infiltration of 2% lidocaine with 1:80,000 epinephrine in subjects undergoing orthognatic surgery under general anesthesia. Methods: Twenty five patients without any systemic disease participated. After general anesthesia, two cartridges of 2% lidocaine + 1:80,000 epinephrine were infiltrated around the surgery site. Systolic (SBP and diastolic (DBP blood pressure, mean arterial blood pressure (MAP, heart rate (HR, and blood sugar (BS were measured in three stages: before the injection (M1, at the end of injection (M2, and 10 min after injection (M3. Results: No significant difference observed in SBP, DBP, and MAP at the end of injection and 10 min later. HR was increased significantly after injection and remained significantly higher than baseline after 10 min. BS increased slightly at the end of injection and continued to increase after 10 min. However, changes in BS were not significant. Conclusion: Using two cartridges of epinephrine-containing lidocaine have slight systemic changes in healthy subjects; as a result, this dosage could be used in patients with cardiovascular complications undergoing general anesthesia.

Hemodynamic Effect of 2% Lidocaine with 1:80,000 Epinephrine Infiltration in Maxillofacial Surgeries under General Anesthesia

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Baratollah Shaban

2013-01-01

Full Text Available Introduction: Epinephrine-containing lidocaine is the most used anestheic drug in dentistry. The aim of this study was to investigate the hemodynamic changes following local infiltration of 2%lidocaine with 1:80,000 epinephrine in subjects undergoing orthognatic surgery under general anesthesia. Methods: Twenty five patients without any systemic disease participated. After general anesthesia, two cartridges of 2% lidocaine + 1:80,000 epinephrine were infiltrated around the surgery site. Systolic (SBP and diastolic (DBP blood pressure, mean arterial blood pressure (MAP, heart rate (HR, and blood sugar (BS were measured in three stages: before the injection (M1, at the end of injection (M2, and 10 min after injection (M3. Results: No significant difference observed in SBP, DBP, and MAP at the end of injection and 10 min later. HR was increased significantly after injection and remained significantly higher than baseline after 10 min. BS increased slightly at the end of injection and continued to increase after 10 min. However, changes in BS were not significant. Conclusion: Using two cartridges of epinephrine-containing lidocaine have slight systemic changes in healthy subjects; as a result, this dosage could be used in patients with cardiovascular complications undergoing general anesthesia.

Is placebo analgesia mediated by endogenous opioids? A systematic review

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ter Riet, G.; de Craen, A. J.; de Boer, Anthonius; Kessels, A. G.

1998-01-01

This systematic review assesses six experimental studies into the mechanism of placebo analgesia in human subjects suffering from clinical pain or experimentally induced ischaemic arm pain. Due to their sophisticated designs, these studies probably provide the best evidence that placebo analgesia

A 6-month audit of epidural analgesia in a teaching hospital

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Shahla Siddiqui

2016-01-01

Full Text Available Introduction: Major laparotomies generally herald high pain scores postoperatively and have high intraoperative hemodynamic shifts. Traditional analgesic regimens with intravenous opioids were supplanted with the superior epidural analgesia (EA in the mid-1980s. This was based on the perception that EA provided highly effective postoperative analgesia for patients undergoing major abdominal surgery. However, recent literature points to a high failure rate. We aimed to retrospectively audit our EA performance in terms of success and complications and take an in-depth look at factors associated with failure. Methods: We retrospectively reviewed charts and our EA forms over 6 months. Results: Our results show a low rate of mortality and neurological morbidity. However we have a high rate of failure of 37% as judged by high pain scores, use of adjuvant analgesics and also an unacceptably high rate of hypotension from epidural infusions, requiring fluid boluses, inotropes and Intensive Care Unit admission. Registrar level and senior insertion did not show any difference in failure rate. Conclusion: Level of training per se does not equate to experiential skip and prior level of experience with administration of this type of anesthesia. We can conclude that EA in our setting is safe but not effective and requires further and frequent scrutiny in terms of procedures, technical skill, education and perhaps looking at its cost-effectiveness and need for standardization.

Intravenous Remifentanil versus Epidural Ropivacaine with Sufentanil for Labour Analgesia: A Retrospective Study

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Xu, Zhendong; Su, Jing; Liu, Zhiqiang

2014-01-01

Remifentanil with appropriate pharmacological properties seems to be an ideal alternative to epidural analgesia during labour. A retrospective cohort study was undertaken to assess the efficacy and safety of remifentanil intravenous patient-controlled analgesia (IVPCA) compared with epidural analgesia. Medical records of 370 primiparas who received remifentanil IVPCA or epidural analgesia were reviewed. Pain and sedation scores, overall satisfaction, the extent of pain control, maternal side effects and neonatal outcome as primary observational indicators were collected. There was a significant decline of pain scores in both groups. Pain reduction was greater in the epidural group throughout the whole study period (0∼180 min) (Panalgesia. And logistic regression analysis demonstrated that nausea, vomiting were associated with oxytocin usage and instrumental delivery, and dizziness was associated to the type and duration of analgesia. Neonatal outcomes such as Apgar scores and umbilical-cord blood gas analysis were within the normal range, but umbilical pH and base excess of neonatus in the remifentanil group were significantly lower. Remifentanil IVPCA provides poorer efficacy on labor analgesia than epidural analgesia, with more sedation on parturients and a trend of newborn acidosis. Despite these adverse effects, remifentanil IVPCA can still be an alternative option for labor analgesia under the condition of one-to-one bedside care, continuous monitoring, oxygen supply and preparation for neonatal resuscitation. PMID:25386749

Naltrexone-sensitive analgesia following exposure of mice to 2450-MHz radiofrequency radiation (RFR)

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Maillefer, R.H.; Quock, R.M. (Univ. of Illinois, Rockford (United States))

1991-03-11

This study was conducted to determine whether exposure to RFR might induce sufficient thermal stress to activate endogenous opioid mechanisms and induce analgesia. Male Swiss Webster mice, 20-25 g, were exposed to 10, 15 or 20 mV/cm{sup 2} RFR in a 2,450-MHz waveguide system for 10 min, then tested in the abdominal constriction paradigm. Specific absorption rates (SAR) were 23.7 W/kg at 10 mW/cm{sup 2}, 34.6 W/kg at 15 mW/cm{sup 2} and 45.5 W/kg at 20 mW/cm{sup 2}. Confinement in the exposure chamber alone did not appreciably alter body temperature but did appear to induce a stress-associated analgesia that was insensitive to the opioid receptor blocker naltrexone. Exposure of confined mice to RFR elevated body temperature and further increased analgesia in SAR-dependent manner. The high-SAR RFR-induced analgesia, but not the hyperthermia, was reduced by naltrexone. These findings suggest that (1) RFR produces SAR-dependent hyperthermia and analgesia and (2) RFR-induced analgesia is mediated by opioid mechanisms while confinement-induced analgesia involves non-opioid mechanisms.

Anesthetic Efficacy of a Combination of 4% Prilocaine/2% Lidocaine with Epinephrine for the Inferior Alveolar Nerve Block: A Prospective, Randomized, Double-blind Study.

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Cook, Olivia; Nusstein, John; Drum, Melissa; Fowler, Sara; Reader, Al; Draper, John

2018-05-01

Prilocaine plain has a high pH and concentration (4%), which could decrease the pain of injection and increase success. The purpose of this study was to compare pain associated with anesthetic solution deposition and the degree of pulpal anesthesia obtained with the combination of prilocaine and lidocaine versus a lidocaine and lidocaine combination when used for inferior alveolar nerve blocks (IANBs). One hundred eighteen asymptomatic subjects were randomly given a combination of 1 cartridge of 4% prilocaine plain plus 1 cartridge of 2% lidocaine with 1:100,000 epinephrine or a combination of 2 cartridges of 2% lidocaine with 1:100,000 epinephrine for the IANB at 2 separate appointments. Subjects rated the pain associated with anesthetic solution deposition of injection. Mandibular teeth were tested with an electric pulp tester every 4 minutes for 57 minutes. Anesthesia was considered successful when 2 consecutive 80 readings were obtained within 17 minutes and the 80 reading was continuously sustained for 57 minutes. Comparisons for anesthetic success were analyzed using the exact McNemar test, and pain ratings associated with anesthetic solution deposition were analyzed using multiple Wilcoxon matched pairs signed rank tests; both were adjusted using the step-down Bonferroni method of Holm. Four percent prilocaine plain was significantly less painful upon anesthetic solution deposition. Pulpal anesthetic success was not significantly different between the 2 combinations. The combination of 4% prilocaine plain plus 2% lidocaine with 1:100,000 epinephrine did not increase pulpal anesthetic success for IANBs compared with a combination of 2 cartridges of 2% lidocaine with 1:100,000 epinephrine. Pain associated with anesthetic solution deposition from the first cartridge of 4% prilocaine plain was significantly less when compared with the first cartridge of 2% lidocaine with 1:100,000 epinephrine. Copyright © 2018 American Association of Endodontists. Published

Fatores relacionados ao uso de analgesia sistêmica em neonatologia Factors related to use of systemic analgesia in neonatology

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Carmen Lúcia Guimarães de Aymar

2008-12-01

Full Text Available O objetivo desse trabalho foi realizar uma revisão da literatura sobre o histórico e o estágio atual de conhecimento sobre a analgesia sistêmica em neonatologia e os fatores que influenciam a sua utilização. Foi realizada busca de artigos científicos através das bases dados do MEDLINE, SciELO e LILACS com as palavras chave: analgesia, analgésicos sistêmicos, dor, neonatologia, recém-nascido, unidade de terapia intensiva e unidade de terapia intensiva neonatal, além de pesquisa adicional em bancos de dados de dissertações, teses e livros texto. A literatura consultada revela que a analgesia não é uma prática rotineira nas unidades de terapia intensiva neonatal, de uma forma geral, apesar dos inúmeros estudos demonstrando a importância do tema. Apesar de ser o alívio da dor um dos princípios básicos da medicina, de envolver questões éticas e humanitárias, e de estarem disponíveis atualmente vários guias práticos e consensos a respeito do manejo da dor no neonato de risco, os resultados encontrados no presente estudo estão muito aquém das recomendações atuais, tornando-se necessária uma intervenção urgente para reverter a situação observada.The purpose of this paper was to carry out a review of literature on the history and current stage of the knowledge of systemic analgesia in neonatology and the factors influencing its use. A search for scientific articles was made in the MEDLINE, SciELO and LILACS databases using the keywords: analgesia, systemic analgesics, pain, neonatology, newborn, intensive care units and neonatal intensive care units. Additional research was made on dissertations and thesis databanks as well as text books. Literature consulted disclosed that, in general, analgesia is not a routine practice in neonatal intensive care units, despite the numerous studies demonstrating its importance. Although pain relief is a basic principle of medicine, involving ethic and humanitarian issues and despite

Impact of Analgesia on the Course of Spontaneous Labor in Women with Diabetes Mellitus

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M. I. Neimark

2013-01-01

Full Text Available Objective: to improve the results of spontaneous labor in female patients with diabetes mellitus (DM. Subjects and methods. The results of physiological labor analgesia were analyzed in 140 patients. The parturients were divided into 3 groups: 1 40 parturients in whom analgesia was performed by the intravenous administration of promedol; 2 40 parturients in whom analgesia was done by the fractional administration of 0.2% ropivacaine hydrochloride into the epidural space; 3 40 parturients in whom analgesia was carried out with intravenous paracetamol 2000—3000 mg. In all the patients, the investigators estimated central hemodynamic parameters by echocardiography, the efficiency of labor analgesia according to the scale described by N. N. Rasstrigina and B. V. Shnaider, as well as blood glucose levels, fetal status by a cardiotocographic technique, and neonatal status by Apgar scores at 1 and 5 minutes of life. Results. Analgesia quality assessment established that the best analgesic effect was achieved in the patients in Group 2 where 75.0% of the parturients had 8—10 scores. A comparative analysis of carbohydrate metabolic parameters also ascertained that the most steady-state and physiological glycemic level was recorded in Group 2 patients throughout the study. In addition, epidural analgesia versus other analgesic techniques provides the most steady-state hemodynamic parameters during labor, which promotes improved labor and has a beneficial effect on fetal and neonatal states. Conclusion. Glycemic levels during labor and delivery can be optimized in patients with DM only if adequate analgesia is achieved. By ensuring adequate labor analgesia, epidural analgesia normalizes glycemic and central hemodynamic parameters, favors elimination of delivery abnormalities, and has a beneficial effect on fetal and neonatal states. Key words: epidural analgesia, diabetes mellitus, spontaneous labor.

Analgesia and anaesthesia in childbirth: obscurantism and obfuscation.

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Mander, R

1998-07-01

The terms 'analgesia' and 'anaesthesia' have been defined by emphasizing differing aspects of their effects. The distinction between these interventions has not been clarified by their definitions. The historical remedies for pain were similarly unclear. This lack of clarity is apparent in the introduction of chloroform in childbirth, which has much in common with the introduction and effects of epidural analgesia. The reasons for and benefits of this lack of clarity are examined.

Patient-controlled analgesia after coronary bypass: Remifentanil or sufentanil?

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Alavi, Seyed Mostafa; Ghoreishi, Seyed Mohammadmehran; Chitsazan, Mitra; Ghandi, Iman; Fard, Alireza Jahangiri; Hosseini, Seyed Saeed; Mahjoobifard, Maziar; Fani, Kamal

2014-07-01

adequate pain control after cardiac surgery is mandatory to reduce its remarkable morbidity. In this study, we aimed to compare the efficacy of patient-controlled analgesia with remifentanil or sufentanil for pain management after coronary artery bypass grafting. 249 patients who underwent coronary artery bypass were randomly assigned to receive patient-controlled analgesia with remifentanil or sufentanil during the first 24 h postoperatively. Pain intensity during patient-controlled analgesia was assessed using 4 different pain rating scales. patients given remifentanil had lower Visual Analog Scale scores at 24 h compared to those given sufentanil (p = 0.002). The Numeric Rating Scale at 24 h was also significantly lower in patients using remifentanil (p = 0.004). The Faces Pain Scale scores at 4, 18, and 24 h were significantly lower in patients using remifentanil compared to those using sufentanil (p = 0.045, 0.036, and 0.011, respectively). No significant differences between groups were seen in the pain intensity assessed by the Behavior Rating Scale at any time point during the first 24 h postoperatively. our study showed that both remifentanil and sufentanil patient-controlled analgesia can provide acceptable analgesia after coronary artery bypass. The difference between their efficacies was inconspicuous until 24 h postoperatively. Remifentanil seems to result in better pain relief at 24 h postoperatively. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Histological investigation of a 10% metronidazole and 2% lidocaine dressing on wound healing in rats.

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Rodrigues, T S; Poi, W R; Panzarini, S R; Bezerra, C S; Silva, J L

2006-01-01

Alveolitis is considered a disturbance of the alveolar healing process that is characterized by blood clot disintegration, alveolar wall infection and extreme pain. Several substances have been investigated to improve healing and guarantee postoperative comfort to patients. The aim of this study was to evaluate, microscopically, in rats, the healing process in non-infected tooth sockets, after application of a 10% metronidazole and 2% lidocaine dressing, using lanolin as vehicle and mint as flavoring. Forty-five rats (Rattus norvegicus albinus, Wistar) had their right incisor extracted and were randomly assigned to 3 groups (n=15): Group I (control): the sockets were filled with blood clot; Group II: application of adrenaline solution at 1:1 000 with an absorbent paper point during 1 min plus filling of the socket with a 10% metronidazole and 2% lidocaine dressing, with lanolin as vehicle, and mint as flavoring; Group III: filling of the socket with the 10% metronidazole and 2% lidocaine dressing, with lanolin as vehicle and mint as flavoring. After 6, 15 and 28 days postoperatively, 5 animals per group were euthanized with an injectable anesthetic overdose. Histological and statistical analyses were performed. The results showed that the 10% metronidazole and 2% lidocaine dressing with lanolin as vehicle and mint as flavoring yielded similar response as that of the normal repair group and may be used to prevent the onset of alveolitis in those cases in which any predisposing factor is present. The use of this dressing has shown a good postoperative patient's comfort and does not cause a significant delay in the alveolar healing process.

Labor analgesia with ropivacaine added to clonidine: a randomized clinical trial

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Giane Nakamura

Full Text Available CONTEXT AND OBJECTIVE: Previous studies have led to speculation that the association between ropivacaine and clonidine might be more effective than ropivacaine alone. We examined the maternal-fetal effects of two pharmacological approaches: a low dose of ropivacaine or a lower dose of ropivacaine plus clonidine for epidural analgesia during labor. DESIGN AND SETTING: Prospective study at Department of Anesthesiology, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista. METHODS: Thirty-two pregnant women in American Society of Anesthesiologists physical status I and II randomly underwent epidural analgesia using 15 ml of ropivacaine 0.125% (R group or 15 ml of ropivacaine 0.0625% plus 75 µg clonidine (RC group. Pain intensity, sensory block level, latency time, motor block intensity, duration of labor analgesia and duration of epidural analgesia were evaluated. The newborns were evaluated using Apgar scores and the Amiel-Tison method (neurological and adaptive capacity score. RESULTS: There were no statistically significant differences between the groups regarding pain score, sensory block level, duration of epidural analgesia or Apgar score. The latency time, duration of labor analgesia and motor block were R group < RC group. The half-hour and two-hour neurological and adaptive capacity scores were higher in the R group. All of the R group newborns and 75% of the RC group newborns were found to be neurologically healthy at the 24-hour examination. RESULTS: There were no statistically significant differences between the groups regarding pain score, sensory block level, duration of epidural analgesia or Apgar score. The latency time, duration of labor analgesia and motor block were R group < RC group. The half-hour and two-hour neurological and adaptive capacity scores were higher in the R group. All of the R group newborns and 75% of the RC group newborns were found to be neurologically healthy at the 24-hour examination

Transplacental Distribution of Lidocaine and Its Metabolite in Peridural Anesthesia Administered to Patients With Gestational Diabetes Mellitus.

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Moises, Elaine Christine Dantas; Duarte, Luciana de Barros; Cavalli, Ricardo de Carvalho; Carvalho, Daniela Miarelli; Filgueira, Gabriela Campos de Oliveira; Marques, Maria Paula; Lanchote, Vera Lucia; Duarte, Geraldo

2015-07-01

Neonatal effects of drugs administered to mothers before delivery depend on the quantity that crosses the placental barrier, which is determined by the pharmacokinetics of the drug in the mother, fetus, and placenta. Diabetes mellitus can alter the kinetic disposition and the metabolism of drugs. This study investigated the placental transfer of lidocaine and its metabolite monoethylglycinexylidide (MEGX) in pregnant women with gestational diabetes mellitus (GDM) submitted to peridural anesthesia. A total of 10 normal pregnant women (group 1) and 6 pregnant women with GDM (group 2) were studied, all at term. The patients received 200 mg 2% lidocaine hydrochloride by the peridural locoregional route. Maternal blood samples were collected at the time of delivery and, after placental expulsion, blood samples were collected from the intervillous space, umbilical artery, and vein for determination of lidocaine and MEGX concentrations and analysis of the placental transfer of the drug. The following respective lidocaine ratios between the maternal and the fetal compartments were obtained for groups 1 and 2: umbilical vein/maternal peripheral blood, 0.60 and 0.46; intervillous space/maternal blood, 1.01 and 0.88; umbilical artery/umbilical vein, 0.77 and 0.91; and umbilical vein/intervillous space, 0.53 and 0.51. The following MEGX ratios for groups 1 and 2 were, respectively, fetal/maternal, 0.43 and 0.97; intervillous space/maternal blood, 0.64 and 0.90; umbilical artery/umbilical vein, 1.09 and 0.99; and umbilical vein/intervillous space, 0.55 and 0.78. Gestational diabetes mellitus did not affect the transplacental transfer of lidocaine but interfered with the transfer of MEGX, acting as a mechanism facilitating the transport of the metabolite. © The Author(s) 2015.

Intracuff buffered lidocaine versus saline or air – A comparative ...

African Journals Online (AJOL)

... smoking or recently treated upper respiratory tract infections were randomly assigned into three groups (n = 25), based on the type of endotracheal tube cuff inflation, as follows: Group A (air), Group B (6 ml normal saline) and Group C (6 ml 2% lidocaine + 0.5 ml 7.5% sodium bicarbonate). A second, blinded anaesthetist, ...

Enhanced skin penetration of lidocaine through encapsulation into nanoethosomes and nanostructured lipid carriers: a comparative study.

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Babaei, S; Ghanbarzadeh, S; Adib, Z M; Kouhsoltani, M; Davaran, S; Hamishehkar, H

2016-05-01

Lipid based nanoparticles have become a major research object in topical drug delivery to enable drugs to pass the stratum corneum and reach the desired skin layer. The present investigation deals with the encapsulation of lidoacine into nanostructured lipid carriers (NLCs) and nanoethosomes for improving its dermal delivery and consequently local anesthetic efficacy. Concurrently these two topical delivery systems were compared. Lidocaine-loaded NLCs and nanoethosomes were characterized by various techniques and used for an in vitro skin penetration study using excised rat skin and Franz diffusion cells. The nanoparticles were tracked in the skin by following the Rhodamine-labled nanocarriers under fluorescent microscopy. Optimized lidocaine-loaded NLCs (size 96 nm, zeta potential -13.7 mV, encapsulation efficiency (EE) % 69.86% and loading capacity (LC) % 10.47%) and nanoethosomes (size 105.4 nm, zeta potential -33.6 mV, EE 40.14% and LC 8.02%) were chosen for a skin drug delivery study. Higher skin drug deposition of NLCs and nanoethosomal formulations compared to lidocaine hydroalcoholic solution represented a better localization of the drug in the skin. NLC formulation showed the lowest entered drug in the receptor phase of Franz diffusion cell in comparison with nanoethosomes and hydroalcoholic solution confirming the highest skin accumulation of drug. Both colloidal systems showed superiority over the drug solution for dermal delivery of lidocaine, however, NLC exhibited more promising characteristics than nanoethosomes regarding drug loading and skin targeted delivery.

Expectant fathers' experience during labor with or without epidural analgesia.

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Capogna, G; Camorcia, M; Stirparo, S

2007-04-01

For men the worst aspect of childbirth is witnessing their partner in pain. The aim of this study was to investigate fathers' attitudes towards labor and delivery with and without epidural analgesia. The study was performed using a questionnaire that included yes/no, multiple choice or 6-point ordinal scale answers. Expectant fathers whose partners were nullipara between 36 and 38 weeks of gestation were recruited and the questionnaires were administered on the day after the birth. To investigate paternal anxiety during labor, the State part of the State-Trait Anxiety Inventory was used. The questionnaire was completed by 243 fathers. Sixty percent (145) of the parturients received epidural analgesia and 40% (98) did not. Paternal characteristics were comparable. Fathers whose partners did not receive epidural analgesia felt their presence as troublesome and unnecessary (Pinvolvement (Pfathers whose partners did not or did receive epidural analgesia (Pinvolvement, participation and satisfaction with the experience of childbirth.

Obstetric regional analgesia in the Jesenice General hospital in year 2006

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Aleksandra Kern

2007-11-01

Full Text Available Background: The aim of this retrospective analysis of the obstetric regional analgesia (ORA in Jesenice General Hospital in year 2006 was to evaluate our work and present results. We analysed workload, quality of the analgesia and patients’ satisfaction. We also estimated the OR for vacuum extraction (VE in nulliparous labouring women having ORA. We compared quality of analgesia and total local analgesic consumption in nulliparous women having VE or spontaneous delivery.Methods: We performed retrospective analysis of labours with ORA in year 2006. All women received epiduraly mixture of 0.1 % bupivacaine with 2 µg of fentanyl per ml in intermittent boluses.The labour pain was assessed using visual analogue scale (VAS. We used median and interquartile range to describe distribution of these values and mean with standard deviation to describe distribution of other data (local anaesthetic consumption. We considered patient with pain VAS 3 or less adequately treated, VAS 4 and 5 sufficiently and VAS 6 and more insufficiently treated. We used odds ratio as measurement of risk for VE, t-test for differences in local anaesthetic consumption and Mann-Whitney test to evaluate differences in pain between tested groups.Results: 225 labouring women opted for ORA or 38 % of all labouring women in year 2006. We performed 224 ORA, 59 % during regular work, 41 % during turn of duty. 18 % of ORA were performed between 10 p.m. and 7.00 a.m. In 98 % of cases epidural analgesia was used. Anaesthesiologic work took 16 minutes in average (SD 6.06. Analgesia was started at VAS median 5 (IQR 4–6.5 and at average cervical dilatation 4.1 cm (SD 1.4. Average consumption of bupivacaine was 55 mg (SD 23.7 and fentanyl 91.7 µg (SD 46.5. Most common complications were inadequate analgesia, and misplacement of epidural catheter (10/222, dural tap (6/222, and unilateral analgesia (2/222. 70 labours were ended with VE (13 %; n = 532. There were 27 (8.7 %; n = 309 VE in

Intravenous lidocaine suppresses fentanyl-induced cough in Children

OpenAIRE

Gecaj-Gashi, Agreta; Nikolova-Todorova, Zorica; Ismaili-Jaha, Vlora; Gashi, Musli

2013-01-01

Objective Fentanyl-induced cough is usually mild and transitory, but it can be undesirable in patients with increased intracranial pressure, open wounds of the eye, dissecting aortic aneurism, pneumothorax, and reactive airway disease. The aim of this study is to evaluate the efficacy of lidocaine in suppressing fentanyl-induced cough in children during induction in general anesthesia. Methods One hundred and eighty-six children of both sexes, aged between 4?10?years, ASA physical status I an...

Dexmedetomidine Dose Dependently Enhances the Local Anesthetic Action of Lidocaine in Inferior Alveolar Nerve Block: A Randomized Double-Blind Study.

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Ouchi, Kentaro; Sugiyama, Kazuna

2016-01-01

Dexmedetomidine (DEX) dose dependently enhances the local anesthetic action of lidocaine in rats. We hypothesized that the effect might also be dose dependent in humans. We evaluated the effect of various concentrations of DEX with a local anesthetic in humans. Eighteen healthy volunteers were randomly assigned by a computer to receive 1.8 mL of 1 of 4 drug combinations: (1) 1% lidocaine with 2.5 ppm (parts per million) (4.5 μg) DEX, (2) lidocaine with 5.0 ppm (9.0 μg) DEX, (3) lidocaine with 7.5 ppm (13.5μg) DEX, or (4) lidocaine with 1:80,000 (22.5 μg) adrenaline (AD), to produce inferior alveolar nerve block. Pulp latency and lower lip numbness (for assessing onset and duration of anesthesia) were tested, and sedation level, blood pressure, and heart rate were recorded every 5 minutes for 20 minutes, and every 10 minutes from 20 to 60 minutes. Pulp latency of each tooth increased compared with baseline, from 5 to 15 minutes until 60 minutes. There were no significant intergroup differences at any time point. Anesthesia onset was not different between groups. Anesthesia duration was different between groups (that with DEX 7.5 ppm was significantly longer than that with DEX 2.5 ppm and AD; there was no difference between DEX 2.5 ppm and AD). Blood pressure decreased from baseline in the 5.0 and 7.5 ppm DEX groups at 30 to 60 minutes, although there was no hypotension; moreover, heart rate did not change in any group. Sedation score did not indicate deep sedation in any of the groups. Dexmedetomidine dose dependently enhances the local anesthetic action of lidocaine in humans. Dexmedetomidine at 2.5 ppm produces similar enhancement of local anesthesia effect as addition of 1:80,000 AD.

The evaluation of efficacy and safety of paravertebral block for perioperative analgesia in patients undergoing laparoscopic cholecystectomy

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Anil Agarwal

2012-01-01

Full Text Available Background: Paravertebral block is a popular regional anesthetic technique used for perioperative analgesia in multiple surgical procedures. There are very few randomized trials of its use in laparoscopic cholecystectomy in medical literature. This study was aimed at assessing its efficacy and opioid-sparing potential in this surgery. Methods: Fifty patients were included in this prospective randomized study and allocated to two groups: Group A (25 patients receiving general anesthesia alone and Group B (25 patients receiving nerve-stimulator-guided bilateral thoracic Paravertebral Block (PVB at T6 level with 0.3 ml/kg of 0.25% bupivacaine prior to induction of general anesthesia. Intraoperative analgesia was supplemented with fentanyl (0.5 μg/kg based on hemodynamic and clinical parameters. Postoperatively, patients in both the groups received Patient-Controlled Analgesia (PCA morphine for the first 24 hours. The efficacy of PVB was assessed by comparing intraoperative fentanyl requirements, postoperative VAS scores at rest, and on coughing and PCA morphine consumption between the two groups. Results: Intraoperative supplemental fentanyl was significantly less in Group B compared to Group A (17.6 μg and 38.6 μg, respectively, P =0.001. PCA morphine requirement was significantly low in the PVB group at 2, 6, 12, and 24 hours postoperatively compared to that in Group A (4.4 mg vs 6.9 mg, 7.6 mg vs 14.2 mg, 11.6 mg vs 20.0 mg, 16.8 mg vs 27.2 mg, respectively; P <0.0001 at all intervals. Conclusion: Pre-induction PVB resulted in improved analgesia for 24 hours following laparoscopic cholecystectomy in this study, along with a significant reduction in perioperative opioid consumption and opioid-related side effects.

Carprofen provides better post-operative analgesia than tramadol in dogs after enucleation: A randomized, masked clinical trial

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Delgado, Cherlene; Bentley, Ellison; Hetzel, Scott; Smith, Lesley J

2015-01-01

Objective To compare analgesia provided by carprofen or tramadol in dogs after enucleation. Design Randomized, masked trial Animals Forty-three dogs Procedures Client-owned dogs admitted for routine enucleation were randomly assigned to receive either carprofen or tramadol orally 2 hours prior to surgery and 12 hours after the first dose. Dogs were scored for pain at baseline, and postoperatively at 0.25, 0.5, 1, 2, 4, 6, 8, 24, and 30 hours after extubation. Dogs received identical premedication and inhalation anesthesia regimens, including premedication with hydromorphone. If the total pain score was ≥9, if there was a score ≥ 3 in any one category, or if the visual analog scale score (VAS) was ≥35 combined with a palpation score of >0, rescue analgesia (hydromorphone) was administered and treatment failure was recorded. Characteristics between groups were compared with a Student’s t-test and Fisher’s exact test. The incidence of rescue was compared between groups using a log rank test. Pain scores and VAS scores between groups were compared using repeated measures ANOVA. Results There was no difference in age (p=0.493), gender (p=0.366) or baseline pain scores (p=0.288) between groups. Significantly more dogs receiving tramadol required rescue analgesia (6/21) compared to dogs receiving carprofen (1/22; p=0.035). Pain and VAS scores decreased linearly over time (p=0.038, ppain (p=0.915) or VAS scores (p=0.372) between groups at any time point (dogs were excluded from analysis after rescue). Conclusions and Clinical Relevance This study suggests that carprofen, with opioid premedication, provides more effective post-operative analgesia than tramadol in dogs undergoing enucleation. PMID:25459482

Comparison of the anesthetic efficacy between bupivacaine and lidocaine in patients with irreversible pulpitis of mandibular molar.

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Sampaio, Roberta Moura; Carnaval, Talita Girio; Lanfredi, Camila Bernardeli; Horliana, Anna Carolina Ratto Tempestini; Rocha, Rodney Garcia; Tortamano, Isabel Peixoto

2012-05-01

The purpose of this study was to compare the anesthetic efficacy of 0.5% bupivacaine with 1:200,000 epinephrine with that of 2% lidocaine with 1:100,000 epinephrine during pulpectomy in patients with irreversible pulpitis in mandibular posterior teeth. Seventy volunteers, patients with irreversible pulpitis admitted to the Emergency Center of the School of Dentistry at the University of São Paulo, randomly received a conventional inferior alveolar nerve block containing 3.6 mL of either 0.5% bupivacaine with 1:200,000 epinephrine or 2% lidocaine with 1:100,000 epinephrine. During the subsequent pulpectomy, we recorded the patients' subjective assessments of lip anesthesia, the absence/presence of pulpal anesthesia through electric pulp stimulation, and the absence/presence of pain through a verbal analog scale. All patients reported lip anesthesia after the application of either inferior alveolar nerve block. By measuring pulpal anesthesia success with the pulp tester, lidocaine had a higher success rate (42.9%) than bupivacaine (20%). For patients reporting none or mild pain during pulpectomy, the success rate of bupivacaine was 80% and lidocaine was 62.9%. There were only statistically significant differences to the success of pulpal anesthesia. Neither of the solutions resulted in an effective pain control during irreversible pulpitis treatments of mandibular molars. Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Neonatal morphine enhances nociception and decreases analgesia in young rats.

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Zhang, Guo Hua; Sweitzer, Sarah M

2008-03-14

The recognition of the impact of neonatal pain experience on subsequent sensory processing has led to the increased advocacy for the use of opioids for pain relief in infants. However, following long-term opioid exposure in intensive care units more than 48% of infants exhibited behaviors indicative of opioid abstinence syndrome, a developmentally equivalent set of behaviors to opioid withdrawal as seen in adults. Little is known about the long-term influence of repeated neonatal morphine exposure on nociception and analgesia. To investigate this, we examined mechanical and thermal nociception on postnatal days 11, 13, 15, 19, 24, 29, 39 and 48 following subcutaneous administration of morphine (3 mg/kg) once daily on postnatal days 1-9. The cumulative morphine dose-response was assessed on postnatal days 20 and 49, and stress-induced analgesia was assessed on postnatal days 29 and 49. Both basal mechanical and thermal nociception in neonatal, morphine-exposed rats were significantly lower than those in saline-exposed, handled-control rats and naive rats until P29. A rightward-shift of cumulative dose-response curves for morphine analgesia upon chronic neonatal morphine was observed both on P20 and P49. The swim stress-induced analgesia was significantly decreased in neonatal morphine-exposed rats on P29, but not on P49. These data indicate that morphine exposure equivalent to the third trimester of gestation produced prolonged pain hypersensitivity, decreased morphine antinociception, and decreased stress-induced analgesia. The present study illustrates the need to examine the long-term influence of prenatal morphine exposure on pain and analgesia in the human pediatric population.

Technical effects of adding 1 % lidocaine to technetium sulfur colloid for sentinel lymphatic mapping in early breast cancer: analysis of data from a double-blind randomized controlled trial.

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Arciero, Cletus A; Henry, Leonard R; Howard, Robin S; Peoples, George E; Bilchik, Anton J; Avital, Itzhak; Buckenmaier Iii, Chester C; Stojadinovic, Alexander

2013-08-01

A practice standard in sentinel lymph node (SLN) mapping in breast cancer is intradermal injection of technetium-99m sulfur colloid (Tc-99m), resulting in significant patient discomfort and pain. A previous randomized controlled trial showed that adding lidocaine to Tc-99m significantly reduced radioisotope injection-related pain. We tested whether 1 % lidocaine admixed with Tc-99m affects feasibility of SLN mapping. Between January 2006 and April 2009, 140 patients with early breast cancer were randomly assigned (1:1:1:1) to receive standard topical 4 % lidocaine cream and intradermal Tc-99m (control) or to one of three other study groups: topical placebo cream and injection of Tc-99m containing sodium bicarbonate (NaHCO3), 1 % lidocaine, or both. All SLN data were collected prospectively. Study groups were comparable for clinicopathological parameters. As previously reported, the addition of 1 % lidocaine to the radioisotope solution significantly improved patient comfort. Overall SLN identification rate in the trial was 93 %. Technical aspects of SLN biopsy were similar for all groups, including time from injection to operation, first SLN (SLN 1) gamma probe counts, ex vivo counts for SLN 1 and SLN 2, and axillary bed counts. SLN identification rates were comparable statistically: control (96 %), lidocaine (90 %), sodium bicarbonate (97 %), and sodium bicarbonate-lidocaine (90 %). The control group had a significantly higher SLN 2/SLN 1 ex vivo count ratio, and the number of SLNs detected was significantly reduced in the lidocaine versus no-lidocaine groups (p cancer is associated with fewer SLNs detected, but it does not appear to compromise SLN identification.

21 CFR 868.5160 - Gas machine for anesthesia or analgesia.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Gas machine for anesthesia or analgesia. 868.5160... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5160 Gas machine for anesthesia or analgesia. (a) Gas machine for anesthesia—(1) Identification. A gas machine for anesthesia is a...

Remifentanil patient controlled analgesia versus epidural analgesia in labour. A multicentre randomized controlled trial.

NARCIS (Netherlands)

Freeman, L.M.; Bloemenkamp, K.W.; Franssen, M.T.; Papatsonis, D.N.; Hajenius, P.J.; Huizen, M.E. van; Bremer, H.A.; Akker, E.S. van den; Woiski, M.D.; Porath, M.M.; Beek, E. van; Schuitemaker, N.; Salm, P.C. van der; Fong, B.F.; Radder, C.; Bax, C.J.; Sikkema, M.; Akker-van Marle, M.E. van den; Lith, J.M. van; Lopriore, E.; Uildriks, R.J.; Struys, M.M.; Mol, B.W.; Dahan, A; Middeldorp, J.M.

2012-01-01

ABSTRACT: BACKGROUND: Pain relief during labour is a topic of major interest in the Netherlands. Epidural analgesia is considered to be the most effective method of pain relief and recommended as first choice. However its uptake by pregnant women is limited compared to other western countries,

[Eutopic parturition: psychoprophylaxis or extradural analgesia. Influence on the endocrine response].

Science.gov (United States)

Carrasco, M S; Iglesias, J; Freire, J; Martín, M L; Marín Santana, A; Cobo, I; García Rendón, A

1989-01-01

Prolactin, ACTH, cortisol and HGH levels have been studied on 30 pregnant women in three different periods: during the labour, at the delivery and 24 hours later. They were divided into 3 groups depending on the analgesia: I) no analgesia (n = 10); II) psychoprophylaxis (n = 10), and III) extradural analgesia (n = 10). Prolactin levels increased during delivery and 24 hours later. A significant increase of ACTH levels (p less than 0.01) was observed during the delivery in the 3 groups even though they were under hasal values 24 hours later. Cortisol increased 38% (p less than 0.01) and 52% (p less than 0.02) in II and III groups, respectively during the delivery. No difference was found with HGH. Our results suggest that endocrine response modified by labour and delivery doesn't change with different analgesia techniques.

Does Articaine Provide an Advantage over Lidocaine in Patients with Symptomatic Irreversible Pulpitis? A Systematic Review and Meta-analysis.

Science.gov (United States)

Kung, Jason; McDonagh, Marian; Sedgley, Christine M

2015-11-01

Achieving profound pulpal anesthesia can be difficult in patients with symptomatic irreversible pulpitis. This study provides a systematic review and meta-analysis to address the population, intervention, comparison, outcome (PICO) question: in adults with symptomatic irreversible pulpitis who are undergoing endodontic treatment, what is the comparative efficacy of articaine compared with lidocaine in reducing pain and incidence of adverse events? A protocol was prepared and registered on PROSPERO. Electronic searches were conducted in MEDLINE, Scopus, Cochrane Library, and ClinicalTrials.gov by using strict inclusion and exclusion criteria. Two independent reviewers assessed eligibility for inclusion and quality. Weighted anesthesia success rates and 95% confidence intervals (CIs) were estimated and compared by using a random-effects model. Two hundred seventy-five studies were initially identified from the search; 10 double-blind, randomized clinical trials met the inclusion criteria. For combined studies, articaine was more likely than lidocaine to achieve successful anesthesia (odds ratio [OR], 2.21; 95% CI, 1.41-3.47; P = .0006; I(2) = 40%). Maxillary infiltration subgroup analysis showed no significant difference between articaine and lidocaine (OR, 3.99; 95% CI, 0.50-31.62; P = .19; I(2) = 59%). For combined mandibular anesthesia studies articaine was superior to lidocaine (OR, 2.20; 95% CI, 1.40-3.44; P = .0006; I(2) = 30%), with further subgroup analysis showing no difference for mandibular block anesthesia (OR, 1.44; 95% CI, 0.87-2.38; P = .16; I(2) = 0%). When used for supplemental infiltration after successful mandibular block anesthesia, articaine was significantly more effective than lidocaine (OR, 3.55; 95% CI, 1.97-6.39; P pulpitis. There is a significant advantage to using articaine over lidocaine for supplementary infiltration after mandibular block anesthesia but no advantage when used for mandibular block anesthesia alone or for maxillary

A Comparison of Combined Suprascapular and Axillary Nerve Blocks to Interscalene Nerve Block for Analgesia in Arthroscopic Shoulder Surgery: An Equivalence Study.

Science.gov (United States)

Dhir, Shalini; Sondekoppam, Rakesh V; Sharma, Ranjita; Ganapathy, Sugantha; Athwal, George S

2016-01-01

The primary objective of this study was to compare the analgesic efficacy of combined suprascapular and axillary nerve block (SSAX) with interscalene block (ISB) after arthroscopic shoulder surgery. Our hypothesis was that ultrasound-guided SSAX would provide postoperative analgesia equivalent to ISB. Sixty adult patients undergoing arthroscopic shoulder surgery received either SSAX or ISB prior to general anesthesia, in a randomized fashion. Pain scores, satisfaction, and adverse effects were recorded in the recovery room, 6 hours, 24 hours, and 7 days after surgery. Combined suprascapular and axillary nerve block provided nonequivalent analgesia when compared with ISB at different time points postoperatively, except on postoperative day 7. Interscalene block had better mean static pain score in the recovery room (ISB 1.80 [95% confidence interval [CI], 1.10-2.50] vs SSAX 5.45 [95% CI, 4.40-6.49; P shoulder surgery. While SSAX provides better quality pain relief at rest and fewer adverse effects at 24 hours, ISB provides better analgesia in the immediate postoperative period. For arthroscopic shoulder surgery, SSAX can be a clinically acceptable analgesic option with different analgesic profile compared with ISB.

Lidocaine self-sacrificially improves the skin permeation of the acidic and poorly water-soluble drug etodolac via its transformation into an ionic liquid.

Science.gov (United States)

Miwa, Yasushi; Hamamoto, Hidetoshi; Ishida, Tatsuhiro

2016-05-01

Poor transdermal penetration of active pharmaceutical ingredients (APIs) impairs both bioavailability and therapeutic benefits and is a major challenge in the development of transdermal drug delivery systems. Here, we transformed a poorly water-soluble drug, etodolac, into an ionic liquid in order to improve its hydrophobicity, hydrophilicity and skin permeability. The ionic liquid was prepared by mixing etodolac with lidocaine (1:1, mol/mol). Both the free drug and the transformed ionic liquid were characterized by differential scanning colorimetry (DSC), infrared spectroscopy (IR), and saturation concentration measurements. In addition, in vitro skin-permeation testing was carried out via an ionic liquid-containing patch (Etoreat patch). The lidocaine and etodolac in ionic liquid form led to a relatively lower melting point than either lidocaine or etodolac alone, and this improved the lipophilicity/hydrophilicity of etodolac. In vitro skin-permeation testing demonstrated that the Etoreat patch significantly increased the skin permeation of etodolac (9.3-fold) compared with an etodolac alone patch, although an Etoreat patch did not increase the skin permeation of lidocaine, which was consistent with the results when using a lidocaine alone patch. Lidocaine appeared to self-sacrificially improve the skin permeation of etodolac via its transformation into an ionic liquid. The data suggest that ionic liquids composed of approved drugs may substantially expand the formulation preparation method to meet the challenges of drugs which are characterized by poor rates of transdermal absorption. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

Unpredictability of regression of analgesia during the continuous postoperative extradural infusion of bupivacaine

DEFF Research Database (Denmark)

Mogensen, T; Hjortsø, N C; Bigler, D

1988-01-01

Twenty-four otherwise healthy patients scheduled for elective major abdominal surgery received general anaesthesia plus lumbar extradural analgesia. A loading dose of 0.5% plain bupivacaine was given to produce sensory analgesia (pin prick) from T4 to S5 and followed by a continuous infusion of 0.......5% plain bupivacaine 8 ml h-1. Pain, scored on a 5-point scale, and sensory analgesia were assessed hourly for 16 h after skin incision. If sensory analgesia decreased by more than 5 segments from its preoperative level, or if the pain score reached 2 (moderate pain), the patients were removed from...

Comparison of granisetron and lidocaine on reducing injection pain of etomidate: a controlled randomized study

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Alireza Saliminia

Full Text Available Abstract Background and objectives Reducing pain on injection of anesthetic drugs is of importance to every anesthesiologist. In this study we pursued to define if pretreatment by granisetron reduces the pain on injection of etomidate similar to lidocaine. Methods Thirty patients aged between 18 and 50 years of American Society of Anesthesiologists physical status class I or II, whom were candidates for elective laparoscopic cholecystectomy surgery were enrolled in this study. Two 20 gauge cannulas were inserted into the veins on the dorsum of both hands and 100 mL of normal saline was administered during a 10 min period from each cannula. Using an elastic band as a tourniquet, venous drainage of both hands was occluded. 2 mL of granisetron was administered into one hand and 2 mL of lidocaine 2% at the same time into the other hand. One minute later the elastic band was opened and 2 mL of etomidate was administered to each hand with equal rates. The patients were asked to give a score from 0 to 10 (0 = no pain, 10 = severe pain to each the pain sensed in each hand. Results Two patients were deeply sedated after injection of etomidate and unable to answer any questions. The mean numerical rating score for injection pain of intravenously administered etomidate after intravenous granisetron was 2.3 ± 1.7, which was lower when compared with pain sensed due to intravenously administered etomidate after administration of lidocaine 2% (4.6 ± 1.8, p < 0.05. Conclusion The result of this study demonstrated that, granisetron reduces pain on injection of etomidate more efficiently than lidocaine.

Conditions sufficient for the production of oral cocaine or lidocaine self-administration in preference to water.

Science.gov (United States)

Falk, J L; Siris, A; Lau, C E

1996-03-01

Groups of rats were given a chronic history of drinking cocaine solutions of different concentrations in daily, 3-h schedule induced polydipsia sessions. Animals failed to develop a preference for cocaine solution to concurrently presented water. Schedule-induction conditions were maintained, and the animals were divided into separate groups, drinking either cocaine or lidocaine placed in a highly acceptable vehicle (glucose-saccharin solution). Animals preferred their respective drug solutions to concurrently presented water, and these preferences remained stable after the glucose-saccharin vehicle was gradually faded to water, leaving only cocaine or lidocaine, respectively, in the solution. Thus a stable preference for drug solution to water could be instituted in rats for either cocaine or lidocaine solution (putative reinforcing and nonreinforcing agents, respectively) given an appropriate associative history, with high intakes maintained by schedule-induction. Conditions sufficient for the initiation of an oral preference and high intake for a putatively reinforcing drug cannot be assumed to occur owing to the drug's reinforcing property in the absence of demonstrating the ineffectiveness of an appropriate negative control substance.

Perinatal and neonatal use of sedation and analgesia.

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McPherson, Christopher; Inder, Terrie

2017-10-01

Optimal obstetric and neonatal care requires the provision of adequate analgesia for painful procedures. However, anesthetic and analgesic agents have the potential to adversely impact the developing fetal/neonatal brain. In this setting, clinicians must assess the risks and benefits of pharmacologic anesthesia and analgesia for specific indications in this population. General anesthesia is required for non-obstetric surgery and cesarean section in the absence of neuraxial anesthesia for the health of the mother and fetus. Although experimental data raise concerns, human data are reassuring and future research may focus on neuroprotective adjuncts in the setting of repeated or prolonged anesthetic exposures. Opioid analgesia is standard of care for preterm infants undergoing major procedures including invasive surgery and endotracheal intubation. The use of opioids for agitation resulting from mechanical ventilation is controversial, but prevalent. Randomized and retrospective studies detect short-term toxicity with inconclusive long-term impact, suggesting the need to explore alternative therapies. Copyright © 2017 Elsevier Ltd. All rights reserved.

Epidural Analgesia and Fever at Labor

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Ye. M. Shifman

2008-01-01

Full Text Available Objective: to study the incidence of labor fever under epidural analgesia (EA and to evaluate its impact on the courses of puerperium and early neonatality. Subjects and methods. The paper presents the data of a prospective study of the course of labor, puerperium, and early neonatality in 397 women in whom labors occurred at the Republican Peritoneal Center in 2006. A study group included 324 parturients in whom labor pain was relieved by EA. A comparison group comprised 55 parturients in whom no analgesics were used at labor. Results. There were no significant statistical differences between the groups in the incidence of labor fever and complicated puerperium and in that of neonatal pyoseptic diseases. Key words: labor hyperthermia, epidural analgesia, labor pain relief.

[Epidural anaesthesia: Simulated intravascular test dose with S(+) ketamine, lidocaine and adrenaline. A prospective, randomized, double blind and placebo controlled study].

Science.gov (United States)

Higueras, R; Errando, C L; Soriano-Bru, J L

2015-02-01

The use of a test dose in epidural anaesthesia is a safety recommendation. However specificity and sensitivity of the drugs used with this indication have been not conclusive. The main objective of this study was to compare the effectiveness and the adverse effects of a simulated intravascular test dose of adrenaline, lidocaine and S(+)-ketamine. A prospective, randomized, double blinded, placebo controlled study was designed. ASA I patients scheduled for elective surgery were included. These were randomized to the following study groups: S(+)-ketamine 0.5 mg.kg-1 (S+K group), 5% lidocaine 1.5 mg.kg-1 (L5% group), adrenaline 15μg (ADR group), and physiological saline 3 ml (SF group; control group). An evaluation was made during the first 15 minutes after the study drug was administered. Variables including heart rate (HR) systolic and diastolic blood pressure (sBP and dBP), mean arterial pressure (MAP), and SpO2 were recorded at 0 min (baseline) and at 2, 5, 8, 10 and 15 minutes after drug injection. An increase of at least 20 beats per minute (bpm) in relation to the baseline measurement was considered a positive result, as was an increase sBP >15 mmHg. The clinical effects described as related to iv injection of the study drugs recorded were: sedation-hypnosis, dizziness, nystagmus, metallic taste perception, perioral or facial paresthesias, tinnitus, as well as any other effect the patients mentioned. Sensitivity and specificity were calculated as was the percent increase in the parameters in order to see if these were clinically useful. A total of 80 patients, 20 per group, were included. The sBP, dBP, and MAP were significantly raised at the 2, 5, 8 and 10 minutes measurements in the S(+)K group compared to the rest of the groups (Padrenaline at the scheduled doses showed low sensitivity and specificity as a simulated iv epidural test dose. S(+)-ketamine could be a feasible marker after accidental iv injection during epidural anaesthesia or analgesia

Remifentanil patient controlled analgesia versus epidural analgesia in labour. A multicentre randomized controlled trial

NARCIS (Netherlands)

Freeman, Liv M.; Bloemenkamp, Kitty W. M.; Franssen, Maureen T. M.; Papatsonis, Dimitri N. M.; Hajenius, Petra J.; van Huizen, Marloes E.; Bremer, Henk A.; van den Akker, Eline S. A.; Woiski, Mallory D.; Porath, Martina M.; van Beek, Erik; Schuitemaker, Nico; van der Salm, Paulien C. M.; Fong, Bianca F.; Radder, Celine; Bax, Caroline J.; Sikkema, Marko; van den Akker-van Marle, M. Elske; van Lith, Jan M. M.; Lopriore, Enrico; Uildriks, Renske J.; Struys, Michel M. R. F.; Mol, Ben Willem J.; Dahan, Albert; Middeldorp, Johanna M.

2012-01-01

Background: Pain relief during labour is a topic of major interest in the Netherlands. Epidural analgesia is considered to be the most effective method of pain relief and recommended as first choice. However its uptake by pregnant women is limited compared to other western countries, partly as a

Analgesia and sedation practices for incarcerated inguinal hernias in children.

Science.gov (United States)

Al-Ansari, Khalid; Sulowski, Christopher; Ratnapalan, Savithiri

2008-10-01

In this study, the use of medications for analgesia and/or sedation for incarcerated inguinal hernia reductions in the emergency department was analyzed. A retrospective chart review was conducted for all patients presenting to a pediatric emergency department with incarcerated inguinal hernia from 2002 to 2005. A total of 99 children presented with incarcerated hernias during the study period. The median age was 11 months. Forty-four percent of children received medication for the procedure, of them 75% received parenteral and 25% oral or intranasal medications. Forty-five percent of children who received medication went through at least 1 hernia reduction attempt initially without medications. More than half the children with incarcerated inguinal hernias did not receive any medication for pain and/or sedation prior to hernia reduction. Guidelines for medication use for children with incarcerated inguinal hernias need to be developed.

Synthesis of ¹³C-lidocaine as a probe of breath test for the evaluation of cytochrome P450 activity.

Science.gov (United States)

Mitome, Hidemichi; Sugiyama, Erika; Sato, Hitoshi; Akira, Kazuki

2014-01-01

(13)C-Labeled lidocaine, 2-di[1-(13)C]ethylamino-N-(2,6-dimethylphenyl)acetamide (1), was synthesized from [1-(13)C]acetic acid in six steps, as a probe for a breath test to evaluate in vivo cytochrome P450 activity. The measurement of (13)CO2 in breath was successfully performed following oral administration of (13)C-lidocaine 1 to mice.

Sex-dependent components of the analgesia produced by athletic competition.

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Sternberg, W F; Bokat, C; Kass, L; Alboyadjian, A; Gracely, R H

2001-02-01

Competing in various athletic events (track meet, basketball game, or fencing match) can produce analgesia to cold pressor stimuli in male and female college athletes compared with baseline assessments. This competition-induced analgesia has been attributed to the stress associated with competition, which has components related to both physical exercise and the cognitive aspects of competing. This study evaluated the analgesic effect of exercise-related stress, and that caused by the cognitively stressful components of competing independent of exercise. Cold pressor pain ratings were assessed after competition in a track meet and after treadmill exercise or sedentary video game competition in both athletes and nonathletes. As expected, competing in athletics resulted in a decrease in cold pressor ratings in both male and female athletes. Independent of athletic status, treadmill running induced analgesia in women, but not in males, whereas sedentary video game competition produced analgesia in men, but not in women. These findings suggest that different components of the competitive athletic experience might be responsible for the analgesic effects in a sex-dependent manner.

Effects of Fentanyl-lidocaine-propofol and Dexmedetomidine-lidocaine-propofol on Tracheal Intubation Without Use of Muscle Relaxants

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Volkan Hancı

2010-05-01

Full Text Available The aim of this study was to compare the effects of fentanyl or dexmedetomidine when used in combination with propofol and lidocaine for tracheal intubation without using muscle relaxants. Sixty patients with American Society of Anesthesiologists stage I risk were randomized to receive 1 mg/kg dexmedetomidine (Group D, n = 30 or 2 mg/kg fentanyl (Group F, n = 30, both in combination with 1.5 mg/kg lidocaine and 3 mg/kg propofol. The requirement for intubation was determined based on mask ventilation capability, jaw motility, position of the vocal cords and the patient's response to intubation and inflation of the endotracheal tube cuff. Systolic arterial pressure, mean arterial pressure, heart rate and peripheral oxygen saturation values were also recorded. Rate pressure products were calculated. Jaw relaxation, position of the vocal cords and patient's response to intubation and inflation of the endotracheal tube cuff were significantly better in Group D than in Group F (p < 0.05. The intubation conditions were significantly more satisfactory in Group D than in Group F (p = 0.01. Heart rate was significantly lower in Group D than in Group F after the administration of the study drugs and intubation (p < 0.05. Mean arterial pressure was significantly lower in Group F than in Group D after propofol injection and at 3 and 5 minutes after intubation (p < 0.05. After intubation, the rate pressure product values were significantly lower in Group D than in Group F (p < 0.05. We conclude that endotracheal intubation was better with the dexmedetomidine–lidocaine–propofol combination than with the fentanyl–lidocaine–propofol combination. However, side effects such as bradycardia should be considered when using dexmedetomidine.

Intrathecal opioids versus epidural local anesthetics for labor analgesia: a meta-analysis.

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Bucklin, Brenda A; Chestnut, David H; Hawkins, Joy L

2002-01-01

Some anesthesiologists contend that intrathecal opioid administration has advantages over conventional epidural techniques during labor. Randomized clinical trials comparing analgesia and obstetric outcome using single-injection intrathecal opioids versus epidural local anesthetics suggest that intrathecal opioids provide comparable analgesia with few serious side effects. This meta-analysis compared the analgesic efficacy, side effects, and obstetric outcome of single-injection intrathecal opioid techniques versus epidural local anesthetics in laboring women. Relevant clinical studies were identified using electronic and manual searches of the literature covering the period from 1989 to 2000. Searches used the following descriptors: intrathecal analgesia, spinal opioids, epidural analgesia, epidural local anesthetics, and analgesia for labor. Data were extracted from 7 randomized clinical trials comparing analgesic measures, incidence of motor block, pruritus, nausea, hypotension, mode of delivery, and/or Apgar scores. Combined test results indicated comparable analgesic efficacy 15 to 20 minutes after injection with single-injection intrathecal opioid administration. Intrathecal opioid injections were associated with a greater incidence of pruritus (odds ratio, 14.01; 99% confidence interval, 6.9 to 28.3), but there was no difference in the incidence of nausea or in the method of delivery. Published studies suggest that intrathecal opioids provide comparable early labor analgesia when compared with epidural local anesthetics. Intrathecal opioid administration results in a greater incidence of pruritus. The choice of technique does not appear to affect the method of delivery.

Information Models of Acupuncture Analgesia and Meridian Channels

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Chang Hua Zou

2010-12-01

Full Text Available Acupuncture and meridian channels have been major components of Chinese and Eastern Asian medicine—especially for analgesia—for over 2000 years. In recent decades, electroacupuncture (EA analgesia has been applied clinically and experimentally. However, there were controversial results between different treatment frequencies, or between the active and the placebo treatments; and the mechanisms of the treatments and the related meridian channels are still unknown. In this study, we propose a new term of infophysics therapy and develop information models of acupuncture (or EA analgesia and meridian channels, to understand the mechanisms and to explain the controversial results, based on Western theories of information, trigonometry and Fourier series, and physics, as well as published biomedical data. We are trying to build a bridge between Chinese medicine and Western medicine by investigating the Eastern acupuncture analgesia and meridian channels with Western sciences; we model the meridians as a physiological system that is mostly constructed with interstices in or between other physiological systems; we consider frequencies, amplitudes and wave numbers of electric field intensity (EFI as information data. Our modeling results demonstrate that information regulated with acupuncture (or EA is different from pain information, we provide answers to explain the controversial published results, and suggest that mechanisms of acupuncture (or EA analgesia could be mostly involved in information regulation of frequencies and amplitudes of EFI as well as neuronal transmitters such as endorphins.

Systemic Lidocaine Does Not Attenuate Hepatic Dysfunction After Liver Surgery in Rats

NARCIS (Netherlands)

de Graaf, Wilmar; Diepenhorst, Gwen M. P.; Herroeder, Susanne; Erdogan, Deha; Hollmann, Markus W.; van Gulik, Thomas M.

2012-01-01

BACKGROUND: Lidocaine has been shown to attenuate ischemia-reperfusion (I/R) injury in the heart, lung, and brain, potentially due to modulation of inflammatory responses and apoptotic signaling pathways. Because hepatic I/R injury after liver surgery still poses a significant risk for postoperative

Perioperative intravenous lidocaine decreases the incidence of persistent pain after breast surgery.

LENUS (Irish Health Repository)

Grigoras, Anca

2012-09-01

Breast cancer surgery is associated with a high incidence of persistent postsurgical pain (PPSP). The aim of this study was to evaluate the impact of intravenous (IV) lidocaine on acute and PPSP, analgesic requirements, and sensation abnormalities in patients undergoing surgery for breast cancer.

Intravenous remifentanil versus epidural ropivacaine with sufentanil for labour analgesia: a retrospective study.

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Rong Lin

Full Text Available Remifentanil with appropriate pharmacological properties seems to be an ideal alternative to epidural analgesia during labour. A retrospective cohort study was undertaken to assess the efficacy and safety of remifentanil intravenous patient-controlled analgesia (IVPCA compared with epidural analgesia. Medical records of 370 primiparas who received remifentanil IVPCA or epidural analgesia were reviewed. Pain and sedation scores, overall satisfaction, the extent of pain control, maternal side effects and neonatal outcome as primary observational indicators were collected. There was a significant decline of pain scores in both groups. Pain reduction was greater in the epidural group throughout the whole study period (0 ∼ 180 min (P < 0.0001, and pain scores in the remifentanil group showed an increasing trend one hour later. The remifentanil group had a lower SpO2 (P < 0.0001 and a higher sedation score (P < 0.0001 within 30 min after treatment. The epidural group had a higher overall satisfaction score (3.8 ± 0.4 vs. 3.7 ± 0.6, P = 0.007 and pain relief score (2.9 ± 0.3 vs. 2.8 ± 0.4, P < 0.0001 compared with the remifentanil group. There was no significant difference on side effects between the two groups, except that a higher rate of dizziness (1% vs. 21.8%, P < 0.0001 was observed during remifentanil analgesia. And logistic regression analysis demonstrated that nausea, vomiting were associated with oxytocin usage and instrumental delivery, and dizziness was associated to the type and duration of analgesia. Neonatal outcomes such as Apgar scores and umbilical-cord blood gas analysis were within the normal range, but umbilical pH and base excess of neonatus in the remifentanil group were significantly lower. Remifentanil IVPCA provides poorer efficacy on labor analgesia than epidural analgesia, with more sedation on parturients and a trend of newborn acidosis. Despite these adverse effects, remifentanil IVPCA can still be an alternative

MULTIMODAL ANALGESIA AFTER TOTAL HIP ARTHROPLASTY

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I. G. Mukutsa

2012-01-01

Full Text Available Purpose - to assess the effect of multimodal analgesia in the early rehabilitation of patients after hip replacement. Materials and methods. A prospective single-centre randomized research, which included 32 patients. Patients of the 1st group received paracetamol, ketorolac and tramadol, the 2nd group of patients - ketorolac intravenously and the 3rd group of patients - etoricoxib and gabapentin. Patients of the 2nd and the 3rd groups underwent epidural analgesia with ropivacaine. Multimodal analgesia was carried out for 48 hours after the surgery. Assessment of pain intensity was performed by the VAS (visual analogue scale, a neuropathic pain component - on the DN4 questionnaire . Time was recorded during the first and second verticalization of patients, using the distance walkers and by fixing the distance covered with in 2 minutes. Results. The intensity of pain for more than 50 mm on VAS at movement at least once every 48 hours after the surgery was occurred among 9% of the 1st group, 22% of patients from the 2nd group and 8% of patients of the 3rd group. Number of patients with neuropathic pain component decreased from 25% to 3% (p ≤ 0.05. The first verticalization was performed 10 ± 8 hours after the surgery, the second - 21 ± 8 hours later. Two-minute walk distance was 5 ± 3 and 8 ± 4 m, respectively. It is noted more frequent adverse events in patients of the 1st group was noted compared to patients of the 2nd and the 3rd groups during first (91%, 33% and 25%, p ≤ 0.05 and the second verticalization (70%, 25% and 17%, p ≤ 0.05. Multimodal analgesia allows to proceed with the successful activation of patients after hip replacement with in the first day after the surgery. The 3rd group patients are noted with a tendency for the optimal combination of efficient and safe of analgetic therapy.

Differential effects of systemically administered ketamine and lidocaine on dynamic and static hyperalgesia induced by intradermal capsaicin in humans

DEFF Research Database (Denmark)

Gottrup, Hanne; Hansen, Peter Orm; Arendt-Nielsen, Lars

2000-01-01

We have examined the effect of systemic administration of ketamine and lidocaine on brush-evoked (dynamic) pain and punctate-evoked (static) hyperalgesia induced by capsaicin. In a randomized, double-blind, placebo-controlled, crossover study, we studied 12 volunteers in three experiments....... Capsaicin 100 micrograms was injected intradermally on the volar forearm followed by an i.v. infusion of ketamine (bolus 0.1 mg kg-1 over 10 min followed by infusion of 7 micrograms kg-1 min-1), lidocaine 5 mg kg-1 or saline for 50 min. Infusion started 15 min after injection of capsaicin. The following...... were measured: spontaneous pain, pain evoked by punctate and brush stimuli (VAS), and areas of brush-evoked and punctate-evoked hyperalgesia. Ketamine reduced both the area of brush-evoked and punctate-evoked hyperalgesia significantly and it tended to reduce brush-evoked pain. Lidocaine reduced...

Intranasal sufentanil/ketamine analgesia in children

DEFF Research Database (Denmark)

Nielsen, Bettina Nygaard; Friis, Susanne M; Rømsing, Janne

2014-01-01

The management of procedural pain in children ranges from physical restraint to pharmacological interventions. Pediatric formulations that permit accurate dosing, are accepted by children and a have a rapid onset of analgesia are lacking....

A randomised double-blinded crossover study comparing pain during anaesthetising the eyelids in upper blepharoplasty : First versus second eyelid and lidocaine versus prilocaine

NARCIS (Netherlands)

Pool, Shariselle M. W.; Struys, Michel M. R. F.; van der Lei, Berend

Aim: The aim of this study was to investigate whether infiltration of the upper eyelid skin is less painful with prilocaine than with lidocaine. Methods: In 40 consecutive patients scheduled for bilateral upper blepharoplasty, one upper eyelid was anaesthetised with lidocaine with epinephrine and

Hyaluron Filler Containing Lidocaine on a CPM Basis for Lip Augmentation: Reports from Practical Experience.

Science.gov (United States)

Fischer, Tanja C; Sattler, Gerhard; Gauglitz, Gerd G

2016-06-01

Lip augmentation with hyaluronic acid fillers is established. As monophasic polydensified hyaluronic acid products with variable density, CPM-HAL1 (Belotero Balance Lidocaine, Merz Aesthetics, Raleigh, NC) and CPM-HAL2 (Belotero Intense Lidocaine, Merz Aesthetics, Raleigh, NC) are qualified for beautification and particularly natural-looking rejuvenation, respectively. The aim of this article was to assess the handling and outcome of lip augmentation using the lidocaine-containing hyaluronic acid fillers, CPM-HAL1 and CPM-HAL2. Data were documented from patients who received lip augmentation by means of beautification and/or rejuvenation using CPM-HAL1 and/or CPM-HAL2. Observation period was 4 months, with assessment of natural outcome, evenness, distribution, fluidity, handling, malleability, tolerability, as well as patient satisfaction and pain. A total of 146 patients from 21 German centers participated. Physicians rated natural outcome and evenness as good or very good for more than 95% of patients. Distribution, fluidity, handling, and malleability were assessed for both fillers as good or very good in more than 91% of patients. At every evaluation point, more than 93% of patients were very or very much satisfied with the product. A total of 125 patients (85.6%) experienced transient injection-related side effects. Pain intensity during the procedure was mild (2.72 ± 1.72 on the 0-10 pain assessment scale) and abated markedly within 30 minutes (0.42 ± 0.57). Lip augmentation with hyaluronic acid fillers produced a long-term cosmetic result. Due to the lidocaine content, procedural pain was low and transient. Accordingly, a high degree of patient satisfaction was achieved that was maintained throughout the observation period. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

[PERIOPERATIVE ANALGESIA INFLUENCE ON MOTHER REHABILITATION PERIOD AFTER CESAREAN SECTION].

Science.gov (United States)

Sedykh, S V

2015-01-01

Early breast-feeding is a standard of perinatal care currently. After cesarean section it can be possible in case of early mother activation (verticalization). Assessment of perioperative analgesia influence on activation timing was the aim of our research. We included 120 parturient women. It was proved, that local analgesia using in postoperative period promotes early mother verticaliration, and optimal breast-feeding starting.

Staff education, regular sedation and analgesia quality feedback, and a sedation monitoring technology for improving sedation and analgesia quality for critically ill, mechanically ventilated patients: a cluster randomised trial.

Science.gov (United States)

Walsh, Timothy S; Kydonaki, Kalliopi; Antonelli, Jean; Stephen, Jacqueline; Lee, Robert J; Everingham, Kirsty; Hanley, Janet; Phillips, Emma C; Uutela, Kimmo; Peltola, Petra; Cole, Stephen; Quasim, Tara; Ruddy, James; McDougall, Marcia; Davidson, Alan; Rutherford, John; Richards, Jonathan; Weir, Christopher J

2016-10-01

Optimal sedation of patients in intensive care units (ICUs) requires the avoidance of pain, agitation, and unnecessary deep sedation, but these outcomes are challenging to achieve. Excessive sedation can prolong ICU stay, whereas light sedation can increase pain and frightening memories, which are commonly recalled by ICU survivors. We aimed to assess the effectiveness of three interventions to improve sedation and analgesia quality: an online education programme; regular feedback of sedation-analgesia quality data; and use of a novel sedation-monitoring technology (the Responsiveness Index [RI]). We did a cluster randomised trial in eight ICUs, which were randomly allocated to receive education alone (two ICUs), education plus sedation-analgesia quality feedback (two ICUs), education plus RI monitoring technology (two ICUs), or all three interventions (two ICUs). Randomisation was done with computer-generated random permuted blocks, stratified according to recruitment start date. A 45 week baseline period was followed by a 45 week intervention period, separated by an 8 week implementation period in which the interventions were introduced. ICU and research staff were not masked to study group assignment during the intervention period. All mechanically ventilated patients were potentially eligible. We assessed patients' sedation-analgesia quality for each 12 h period of nursing care, and sedation-related adverse events daily. Our primary outcome was the proportion of care periods with optimal sedation-analgesia, defined as being free from excessive sedation, agitation, poor limb relaxation, and poor ventilator synchronisation. Analysis used multilevel generalised linear mixed modelling to explore intervention effects in a single model taking clustering and patient-level factors into account. A concurrent mixed-methods process evaluation was undertaken to help understand the trial findings. The trial is registered with ClinicalTrials.gov, number NCT01634451. Between

EFFECT OF EPIDURAL ANALGESIA ON LABOR AND ITS OUTCOMES.

Science.gov (United States)

Anwar, Sadia; Anwar, Muhannad Waseem; Ahmad, Sajjad

2015-01-01

Epidural analgesia is an effective and popular way to relieve labour pain but it may interfere with normal mechanism of labour. The objective of this study was to evaluate the outcome of labour in women with effective epidural analgesia in terms of duration of labour, mode of delivery and neonatal outcome. This was a quasi-experimental study conducted in the Department of Obstetrics and Gynaecology, Shaikh Zayed Federal Postgraduate Medical Institute and Hospital, Lahore. One hundred pregnant women were selected by non-probability convenient sampling method. Subjects were divided into two groups of. 50 each as per convenience. Patients of any gravidity at term from 37-41 weeks were included in the sample. Epidural analgesia was applied to group B and distilled water to group A at the lumber region and the progress of labour, mode of delivery and effects on Apgar scores of neonates were evaluated. Out of hundred patients, 77 had normal duration of second stage while 23 had prolonged second stage. Among them, 18 patients (36%) were in epidural group and 5 patients (10%) in non-epidural group, while 4 patients (8%) in epidural group developed intra-partum complications; whereas among non-epidural group had such complications. 65 patients had spontaneous vaginal delivery while 35 patients had instrumental delivery. Among them 29 patients (58%) were in epidural group while only 6 patients (12%) were in non-epidural group. Babies born had Apgar score 5/10 (21.8%), 6/10 (59.4%) and 7/10 (17.8%) at 1 minute and 8/10 (74.3%) and 9/10 (24.8%) at 5 minutes in both groups and none of them needed bag and mask resuscitation. Epidural analgesia does prolong the duration of second stage of labour and increases the instrumental delivery rate. Neonatal outcome is satisfactory while only a few intra-partum complications are found with epidural analgesia.

[Lidocaine-containing hyaluronic acid filler on a CPM® basis for lip augmentation : Experience from clinical practice].

Science.gov (United States)

Fischer, T; Sattler, G; Gauglitz, G

2016-06-01

Lip augmentation with hyaluronic acid fillers is an established procedure. As monophasic polydensified hyaluronic acid products with variable density CPM-HAL1 (Belotero® Balance Lidocaine) and CPM-HAL2 (Belotero® Intense Lidocaine) are qualified for beautification and particularly natural-looking rejuvenation, respectively. Assessment of handling and outcome of lip augmentation using the lidocaine-containing hyaluronic acid fillers CPM-HAL1 and CPM-HAL2. Data from patients who received lip augmentation by means of bautification and/or rejuvenation using CPM-HAL1 and/or CPM-HAL2 were documented. Observation period was 4 months, with assessment of natural outcome, evenness, handling, fluidity, distribution, malleability, tolerability, as well as patient satisfaction and pain. In total, 146 patients from 21 German centres participated. Physicians rated natural outcome and evenness as good or very good for > 95 % of patients. Handling, fluidity, distribution and malleability were assessed for both fillers as good or very good in > 91 % of patients. At every evaluation point, more than 93 % of patients were very or very much satisfied with the product. A total of 125 patients (85.6 %) experienced transient injection-related side effects. Pain intensity during the procedure was mild (2.72 ± 1.72 on the 0-10 pain assessment scale) and abated markedly within 30 min (0.42 ± 0.57). Lip augmentation with hyaluronic acid fillers produced a long-term cosmetic result. Due to the lidocaine content, procedural pain was low and transient. Accordingly, a high degree of patient satisfaction was achieved that was maintained throughout the observation period.

Effect of irradiation on analgesia induced by morphine and endorphin

International Nuclear Information System (INIS)

Kim, Jin Kyu; Lee, Byoung Hun; Hyun, Soung Hee; Chung, Ki Myung

2003-01-01

Morphine and endorphin administered intracerebroventricularly (i.c.v.) produce analgesia by activating different descending pain inhibitory systems. Gamma irradiation attenuates the acute analgesic action of i.c.v. injected morphine in mice. This study was done to investigate the effect of-irradiation on the analgesia produced by i.c.v. injected morphine and endorphin in male ICR mice. In one group, mice were exposed to whole-body irradiation at a dose of 5 Gy from a 60 Co source and the analgesic effects were tested 5, 30, 60, 90 and 180 min after irradiation using the acetic acid-induced writhing test. The analgesic effect was produced time-dependently and reached its maximum at 90 min after irradiation. Thus, time was fixed in the following studies. In another group, mice were irradiated with 5 Gy and tested 90 minutes later for analgesia produced by i.c.v. administration of morphine or endorphin. Irradiation significantly potentiated the analgesia produced by endorphin. However, the antinociception produced by morphine was not affected by irradiation. These results support the hypothesis that morphine and endorphin administered supraspinally produce antinocieception by different neuronal mechanisms

Effect of irradiation on analgesia induced by morphine and endorphin

Energy Technology Data Exchange (ETDEWEB)

Kim, Jin Kyu; Lee, Byoung Hun; Hyun, Soung Hee; Chung, Ki Myung [KAERI, Daejeon (Korea, Republic of)

2003-07-01

Morphine and endorphin administered intracerebroventricularly (i.c.v.) produce analgesia by activating different descending pain inhibitory systems. Gamma irradiation attenuates the acute analgesic action of i.c.v. injected morphine in mice. This study was done to investigate the effect of-irradiation on the analgesia produced by i.c.v. injected morphine and endorphin in male ICR mice. In one group, mice were exposed to whole-body irradiation at a dose of 5 Gy from a {sup 60}Co source and the analgesic effects were tested 5, 30, 60, 90 and 180 min after irradiation using the acetic acid-induced writhing test. The analgesic effect was produced time-dependently and reached its maximum at 90 min after irradiation. Thus, time was fixed in the following studies. In another group, mice were irradiated with 5 Gy and tested 90 minutes later for analgesia produced by i.c.v. administration of morphine or endorphin. Irradiation significantly potentiated the analgesia produced by endorphin. However, the antinociception produced by morphine was not affected by irradiation. These results support the hypothesis that morphine and endorphin administered supraspinally produce antinocieception by different neuronal mechanisms.

Intravenous Lidocaine Infusion to Treat Chemotherapy-Induced Peripheral Neuropathy.

Science.gov (United States)

Papapetrou, Peter; Kumar, Aashish J; Muppuri, Rudram; Chakrabortty, Shushovan

2015-11-01

Chemotherapy-induced peripheral neuropathy is a debilitating side effect of chemotherapy, which manifests as paresthesias, dysesthesias, and numbness in the hands and feet. Numerous chemoprotective agents and treatments have been used with limited success to treat chemotherapy-induced peripheral neuropathy. We report a case in which a patient presenting with chemotherapy-induced peripheral neuropathy received an IV lidocaine infusion over the course of 60 minutes with complete symptomatic pain relief for a prolonged period of 2 weeks.

Impact of Sodium Bicarbonate-Buffered Lidocaine on Patient Pain During Image-Guided Breast Biopsy.

Science.gov (United States)

Vasan, Alison; Baker, Jay A; Shelby, Rebecca A; Soo, Mary Scott C

2017-09-01

This randomized, double-blind controlled study evaluated the effectiveness of sodium bicarbonate-buffered lidocaine on reducing pain during imaging-guided breast biopsies. This prospective, HIPAA-compliant study randomly assigned 85 women undergoing ultrasound- or stereotactic-guided core-needle breast biopsies to receive intradermally and intraparenchymally either 1% lidocaine buffered with sodium bicarbonate (9:1 ratio) (bicarbonate study group) or 1% lidocaine alone (control group). Pain was evaluated using a 0-to-10 Likert pain scale during both intradermal and intraparenchymal anesthesia injections and during tissue sampling. Prebiopsy breast pain, anxiety, medical history, demographics, biopsy type, radiologist level of training, breast density, and lesion histology were recorded. Data were analyzed using analysis of variance and analysis of covariance. Unadjusted mean pain scores were 1.47 and 2.07 (study and control groups, respectively; P = .15) during intradermal injections, and 1.84 and 2.98 (study and control groups, respectively; P = .03) during intraparenchymal injections. Tissue sampling mean pain scores were .81 and 1.71 (study and control groups, respectively; P = .07). Moderator analyses found (1) among patients with preprocedural pain, those in the bicarbonate group experienced less intradermal injection pain (0.85 ± 1.23) than patients in the control group (2.50 ± 2.09); (2) among patients with fatty or scattered fibroglandular tissue, those in the bicarbonate group (1.35 ± 1.95) experienced less intraparenchymal injection pain than the control group (3.52 ± 3.13); and (3) during ultrasound-guided biopsies, patients in the bicarbonate group experienced less tissue-sampling pain (0.23 ± 0.63) than the control group (1.79 ± 3.05). Overall, buffering lidocaine with sodium bicarbonate significantly reduced pain during intraparenchymal injections, and additional pain reduction was found in certain patient subgroups during intradermal

Prevention of propofol injection pain in children: a comparison of pretreatment with tramadol and propofol-lidocaine mixture.

Science.gov (United States)

Borazan, Hale; Sahin, Osman; Kececioglu, Ahmet; Uluer, M Selcuk; Et, Tayfun; Otelcioglu, Seref

2012-01-01

The pain on propofol injection is considered to be a common and difficult to eliminate problem in children. In this study, we aimed to compare the efficacy of pretreatment with tramadol 1 mg.kg(-1)and propofol-lidocaine 20 mg mixture for prevention of propofol induced pain in children. One hundred and twenty ASA I-II patients undergoing orthopedic and otolaryngological surgery were included in this study and were divided into three groups with random table numbers. Group C (n=39) received normal saline placebo and Group T (n=40) received 1 mg.kg(-1) tramadol 60 sec before propofol (180 mg 1% propofol with 2 ml normal saline) whereas Group L (n=40) received normal saline placebo before propofol-lidocaine mixture (180 mg 1% propofol with 2 ml %1 lidocaine). One patient in Group C was dropped out from the study because of difficulty in inserting an iv cannula. Thus, one hundred and nineteen patients were analyzed for the study. After given the calculated dose of propofol, a blinded observer assessed the pain with a four-point behavioral scale. There were no significant differences in patient characteristics and intraoperative variables (p>0.05) except intraoperative fentanyl consumption and analgesic requirement one hr after surgery among the groups (ppain when compared with control group. Moderate and severe pain were found higher in control group (ppain was 79.4% in the control group, 35% in tramadol group, 25% in lidocaine group respectively (ppain when compared to placebo in children.

Dexamethasone prolongs local analgesia after subcutaneous infiltration of bupivacaine microcapsules in human volunteers

DEFF Research Database (Denmark)

Holte, Kathrine; Werner, Mads U; Lacouture, Peter G

2002-01-01

BACKGROUND: The addition of small amounts of dexamethasone to extended-release formulations of bupivacaine in microcapsules has been found to prolong local analgesia in experimental studies, but no clinical data are available. METHODS: In a double-blinded study, 12 healthy male volunteers were...... randomized to receive simultaneous subcutaneous injections of bupivacaine microcapsules with dexamethasone and bupivacaine microcapsules without dexamethasone in each calf. Local analgesia was assessed with a validated human pain model; main parameters evaluated were thermal, mechanical, and pain detection...... curve [AUC]) were considered best estimate of analgesia. Safety evaluations were performed daily for the first week and at 2 weeks, 6 weeks, and 6 months after injection. RESULTS: The addition of dexamethasone significantly prolonged local analgesia of bupivacaine microcapsules without influence...

Reported provision of analgesia to patients with acute abdominal pain in Canadian paediatric emergency departments.

Science.gov (United States)

Poonai, Naveen; Cowie, Allyson; Davidson, Chloe; Benidir, Andréanne; Thompson, Graham C; Boisclair, Philippe; Harman, Stuart; Miller, Michael; Butter, Andreana; Lim, Rod; Ali, Samina

2016-09-01

Evidence exists that analgesics are underutilized, delayed, and insufficiently dosed for emergency department (ED) patients with acute abdominal pain. For physicians practicing in a Canadian paediatric ED setting, we (1) explored theoretical practice variation in the provision of analgesia to children with acute abdominal pain; (2) identified reasons for withholding analgesia; and (3) evaluated the relationship between providing analgesia and surgical consultation. Physician members of Paediatric Emergency Research Canada (PERC) were prospectively surveyed and presented with three scenarios of undifferentiated acute abdominal pain to assess management. A modified Dillman's Tailored Design method was used to distribute the survey from June to July 2014. Overall response rate was 74.5% (149/200); 51.7% of respondents were female and mean age was 44 (SD 8.4) years. The reported rates of providing analgesia for case scenarios representative of renal colic, appendicitis, and intussusception, were 100%, 92.1%, and 83.4%, respectively, while rates of providing intravenous opioids were 85.2%, 58.6%, and 12.4%, respectively. In all 60 responses where the respondent indicated they would obtain a surgical consultation, analgesia would be provided. In the 35 responses where analgesia would be withheld, 21 (60%) believed pain was not severe enough, while 5 (14.3%) indicated it would obscure a surgical condition. Pediatric emergency physicians self-reported rates of providing analgesia for acute abdominal pain scenarios were higher than previously reported, and appeared unrelated to request for surgical consultation. However, an unwillingness to provide opioid analgesia, belief that analgesia can obscure a surgical condition, and failure to take self-reported pain at face value remain, suggesting that the need exists for further knowledge translation efforts.

Stereotactic core biopsy of an impalpable screen-detected breast lesion using acupuncture-analgesia

OpenAIRE

English, R E; Chen, J H

2010-01-01

Chinese acupuncture-analgesia is used for pain management during various surgical procedures. Over the past 40 years this approach has been introduced in many countries and has been particularly helpful in the investigation and treatment of patients who are unable to tolerate conventional analgesia. We report here the case of a woman with a 17-year history of myalgic encephalitis who underwent a stereotactic core biopsy of the breast under acupuncture-analgesia. A planning session was needed ...

Treatment of complex regional pain syndrome type 1 in a pediatric patient using the lidocaine patch 5%: a case report

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Steven G Frost, MD

2003-09-01

Full Text Available Background: Successful treatment of complex regional pain syndrome type 1 (CRPS-1 requires a coordinated, multidisciplinary approach. Physical rehabilitation is an important component of long-term treatment. Unfortunately, patients with significant allodynia or hyperalgesia characteristic of CRPS-1 often have difficulty progressing through a physical therapy (PT regimen. In most adults with CRPS-1, the treatment of choice is PO opioids. Objective: This article presents a case report of the use of the lidocaine patch 5%, a targeted peripheral analgesic, in a pediatric patient and its effects on reducing pain, improving the patient's overall attitude, and facilitating compliance with ongoing PT. Results: A 10-year-old girl developed CRPS-1 after arthroscopic surgery for a sprained ankle. Attempts at PT were unsuccessful due to inadequate pain relief from various treatment modalities. Therapy with the lidocaine patch 5% was initiated and resulted in significant pain relief, improvements in the patient's attitude, and progress with PT. Conclusion: This case report of a child with CRPS-1 showed that therapy with lidocaine patch 5% may be efficacious in treating children with pain resulting from CRPS-1, thereby increasing the success of PT. Keywords: complex regional pain syndrome, lidocaine patch 5%, targeted peripheral analgesic, pediatrics

Transient neurologic symptoms (TNS) following spinal anaesthesia with lidocaine versus other local anaesthetics

DEFF Research Database (Denmark)

Zaric, Dusanka; Pace, Nathan Leon

2009-01-01

(bupivacaine, prilocaine, procaine, levobupivacaine, ropivacaine, and 2-chloroprocaine) was 7.31 (95% confidence interval (CI) 4.16 to 12.86). Mepivacaine was found to give similar results as lidocaine and was therefor omitted from the overall comparison to diminish the heterogeneity. AUTHORS' CONCLUSIONS...

Labor induction just after external cephalic version with epidural analgesia at term.

Science.gov (United States)

Cuerva, Marcos J; Piñel, Carlos S; Caceres, Javier; Espinosa, Jose A

2017-06-01

To analyze the benefits of external cephalic version (ECV) with epidural analgesia at term and labor induction just after the procedure. This is a retrospective observational study with patients who did not want trying a breech vaginal delivery and decided trying an ECV with epidural analgesia at term and wanted labor induction or cesarean section after the procedure. We present the results of 40 ECV with epidural analgesia at term and labor induction or cesarean section just after the ECV. ECV succeeded in 26 out of 40 (65%) patients. Among the 26 successful ECV, 6 delivered by cesarean (23.1%). 20 patients delivered vaginally (76.9%; 50% of all patients). Considering that a high number of cesarean deliveries can be avoided, induction of labor after ECV with epidural analgesia at term can be considered after being discussed in selected patient. Copyright © 2017. Published by Elsevier B.V.

Cutaneous synergistic analgesia of bupivacaine in combination with dopamine in rats.

Science.gov (United States)

Tzeng, Jann-Inn; Wang, Jieh-Neng; Wang, Jhi-Joung; Chen, Yu-Wen; Hung, Ching-Hsia

2016-05-04

The main goal of the study was to investigate the interaction between bupivacaine and dopamine on local analgesia. After the blockade of the cutaneous trunci muscle reflex (CTMR) responses, which occurred following the drugs were subcutaneously injected in rats, the cutaneous analgesic effect of dopamine in a dosage-dependent fashion was compared to that of bupivacaine. Drug-drug interactions were evaluated by isobolographic methods. We showed the dose-dependent effects of dopamine on infiltrative cutaneous analgesia. On the 50% effective dose (ED50) basis, the rank of drug potency was bupivacaine (1.99 [1.92-2.09] μmol/kg) greater than dopamine (190 [181-203] μmol/kg) (Pbupivacaine. The addition of dopamine to the bupivacaine solution exhibited a synergistic effect. Our pre-clinical data showed that dopamine produced a dose-dependent effect in producing cutaneous analgesia. When compared with bupivacaine, dopamine produced a lesser potency with a similar duration of cutaneous analgesia. Dopamine added to the bupivacaine preparation resulted in a synergistic analgesic effect. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Comparison of the anesthetic efficacy of articaine infiltration versus lidocaine inferior alveolar nerve block in pulp therapy of lower primary molars

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Maryam Sharifi

2017-12-01

Full Text Available Introduction: Pain control is essential to the behavioral management of children in pediatric dentistry. Effective anesthesia plays a key role in this regard, especially in pulp therapy. In order to achieve successful anesthesia, the type of analgesics and injection techniques should be considered. The present study aimed to compare the anesthetic efficacy of articaine infiltration and lidocaine inferior alveolar nerve block in the pulp therapy of lower primary molars. Materials and Methods: This randomized, crossover, triple-blind clinical trial was conducted on 64 children aged 4-10 years, who required the bilateral pulp therapy of the lower primary molars. Subjects were randomly divided into two groups. Treatment was performed for two sessions, and one lower primary molar was treated in each session. In the first treatment session, subjects in group A were injected with lidocaine inferior alveolar nerve block, and in the second session, they were injected with articaine infiltration. In group B, all the procedures were similar to group A. In the first treatment session, subjects in group B were injected with articaine infiltration, and in the second session, they were injected with lidocaine inferior alveolar nerve block. Pain intensity was measured upon the initiation of the pulp exposure using the visual analogue scale (VAS. Data analysis was performed by crossover analysis, paired t-test, and independent two-sample t-test. Results: During the study period, mean pain intensity in the children treated by lidocaine inferior alveolar nerve block was significantly lower compared to those treated by articaine infiltration. However, the two techniques had no statistically significant difference in the children aged 4-6 years and the treatment of the first primary molars. Conclusion: According to the results, lidocaine inferior alveolar nerve block has higher anesthetic efficacy in the pulp therapy of the lower primary molars compared to articaine

Tourniquet Deflation Prior to 20 Minutes in Upper Extremity Intravenous Regional Anesthesia.

Science.gov (United States)

Gurich, Richard W; Langan, Justin W; Teasdall, Robert J; Tanner, Stephanie L; Sanders, John L

2018-03-01

Bier blocks, or intravenous regional anesthesia (IVRA), are a method of anesthesia for upper extremity surgeries. This study reports our experience with tourniquet deflation prior to 20 minutes with upper extremity IVRA. This study was designed as a retrospective cohort analysis. Records, including intraoperative and immediate postoperative anesthesia notes, of 430 patients who underwent IVRA with an upper extremity Bier block and a corresponding tourniquet time of less than 20 minutes were reviewed. Patient demographics, procedure(s) performed, American Society of Anesthesiologists scores, volume of lidocaine used in Bier block, tourniquet time, and any complications were recorded. This cohort consisted of 127 males and 303 females. The 3 most common procedures performed were carpal tunnel release (315), trigger finger release (47), and excision of masses (34). The average tourniquet time for this cohort was 16 minutes (range, 9-19 minutes), and the average volume of lidocaine (0.5% plain) injected was 44 mL (range, 30-70 mL). A tourniquet time of 17 minutes or less was observed in 339 patients, and 170 patients had tourniquet times of 15 minutes or less. Five complications were recorded: intraoperative vomiting, mild postoperative nausea/vomiting, severe postoperative nausea and vomiting, and transient postoperative hypotension that responded to a fluid bolus. No major complications were observed in our cohort of upper extremity IVRA and tourniquet times of less than 20 minutes. Several variables play a role in the safety of upper extremity IVRA.

Epidural analgesia in labour and neonatal respiratory distress: a case-control study.

Science.gov (United States)

Kumar, Manoj; Chandra, Sue; Ijaz, Zainab; Senthilselvan, Ambikaipakan

2014-03-01

Epidural analgesia is the commonest mode for providing pain relief in labour, with a combination of bupivacaine and fentanyl most often used in practice. To test whether late-preterm and term neonates exposed to opioids in epidural analgesia in labour are more likely to develop respiratory distress in the immediate neonatal period. A case-control study was conducted of singleton infants born during January 2006 to December 2010. Cases were neonates ≥34 weeks gestation, who developed respiratory distress within 24 h of life requiring supplemental oxygen ≥2 h and/or positive pressure ventilation in the neonatal intensive care unit. Controls were gestation and site-matched neonates who did not develop any respiratory distress within the same period. The information on exposure to epidural analgesia and on potential confounding variables was obtained from the standardised delivery record, routinely filled out on all women admitted to the labour wards. In our study, 206 cases and 206 matched controls were enrolled. Exposure to epidural analgesia was present in 146 (70.9%) cases as compared with 131 (63.6%) of the controls. The association between exposure to epidural analgesia and respiratory distress in neonates was statistically significant upon adjustment for all potential confounders (adjusted OR: 1.75, 95% CI 1.03 to 2.99; p = 0.04). When data was separately analysed for term and late-preterm infants, the results were consistent across these subpopulations, showing no interaction effect. Late-preterm and term infants exposed to maternal epidural analgesia in labour are more likely to develop respiratory distress in the immediate neonatal period.

Patient Controlled Epidural Analgesia during Labour: Effect of Addition of Background Infusion on Quality of Analgesia & Maternal Satisfaction

Directory of Open Access Journals (Sweden)

Uma Srivastava

2009-01-01

Full Text Available Patient controlled epidural analgesia (PCEA is a well established technique for pain relief during labor. But the inclusion of continuous background infusion to PCEA is controversial. The aim of this study was to assess whether the use of continuous infusion along with PCEA was beneficial for laboring women with regards to quality of analgesia, maternal satisfaction and neonatal outcome in comparison to PCEA alone. Fifty five parturients received epidural bolus of 10ml solution containing 0.125% bupivacaine +2 ìg.ml-1 of fentanyl. For maintenance of analgesia the patients of Group PCEA self administered 8 ml bolus with lockout interval of 20 minutes of above solution on demand with no basal infusion. While the patients of Group PCEA + CI received continuous epidural infusion at the rate of 10 ml.hr-1 along with self administered boluses of 3 ml with lockout interval of 10 minutes of similar epidural solution. Patients of both groups were given rescue boluses by the anaesthetists for distressing pain. Verbal analogue pain scores, incidence of distressing pain, need of supplementary/rescue boluses, dose of bupivacaine consumed, maternal satisfaction and neonatal Apgar scores were recorded. No significant difference was observed between mean VAS pain scores during labor, maternal satisfaction, mode of delivery or neonatal Apgar scores. But more patients (n=8 required rescue boluses in PCEA group for distressing pain. The total volume consumed of bupivacaine and opioid was slightly more in PCEA + CI group. In both the techniques the highest sensory level, degree of motor block were comparable& prolongation of labor was not seen. It was concluded that both the techniques provided equivalent labor analgesia, maternal satisfaction and neonatal Apgar scores. PCEA along with continuous infusion at the rate of 10 ml/ hr resulted in lesser incidence of distressing pain and need for rescue analgesic. Although this group consumed higher dose of bupivacaine

Patient-Controlled Oral Analgesia for Postoperative Pain Management Following Total Knee Replacement

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Patti Kastanias

2010-01-01

Full Text Available PURPOSE: To investigate whether patient-controlled oral analgesia (PCOA used by individuals receiving a total knee replacement could reduce pain, increase patient satisfaction, reduce opioid use and/or reduce opioid side effects when compared with traditional nurse (RN-administered oral analgesia.

Inhalation analgesia with nitrous oxide versus other analgesic techniques in hysteroscopic polypectomy: a pilot study.

Science.gov (United States)

Del Valle Rubido, Cristina; Solano Calvo, Juan Antonio; Rodríguez Miguel, Antonio; Delgado Espeja, Juan José; González Hinojosa, Jerónimo; Zapico Goñi, Álvaro

2015-01-01

To show the decrease in pain and better tolerance to inhalation analgesia with a 50% equimolar mixture of nitrogen protoxide and oxygen in hysteroscopic polypectomy compared with paracervical anesthesia and a control group. One hundred six patients scheduled for office hysteroscopy and polypectomy were divided into the following 3 groups: the control group, the nitrous oxide group, and the paracervical infiltration group. Patients were assigned sequentially (Canadian Task Force classification II-1). The study took place in a hysteroscopy outpatient clinic under the supervision of a gynecologist and 2 nurses trained to cooperate in the trial. One hundred six women from Area III of Madrid Community, Spain, who had been diagnosed with endometrial polyps at a gynecology office and were scheduled for office hysteroscopy and polypectomy agreed to participate in the study. Patients in group 1 (control group) received no treatment. Group 2 received inhaled nitrous oxide and group 3 paracervical infiltration with 1% lidocaine. Pain was assessed using the visual analog scale (0-10). Pain perceived by patients was lower in the nitrous Oxide group (mean: 3.55 ± 0.60, median: 3) versus the control group (mean: 5.49 ± 1.88, median: 6, p nitrous oxide group, and good for the paracervical infiltration group (p nitrous oxide group, whereas in the paracervical infiltration group, there were complications in more than 50% of the patients. No severe complications occurred. Nitrous oxide is a safe and effective analgesic technique for polipectomy office hysteroscopy compared with the paracervical infiltration and control groups. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

Neuraxial analgesia effects on labor progression: facts, fallacies, uncertainties, and the future

Science.gov (United States)

Grant, Erica N.; Tao, Weike; Craig, Margaret; McIntire, Donald; Leveno, Kenneth

2014-01-01

Approximately 60% of women who labor receive some form of neuraxial analgesia, but concerns have been raised regarding whether it negatively impacts the labor and delivery process. In this review, we attempt to clarify what has been established as truths, falsities, and uncertainties regarding the effects of this form of pain relief on labor progression, negative and/or positive. Additionally, although the term “epidural” has become synonymous with neuraxial analgesia, we discuss two other techniques, combined spinal-epidural and continuous spinal analgesia, that are gaining popularity, as well as their effects on labor progression. PMID:25088476

Effects of Multimodal Analgesia on the Success of Mouse Embryo Transfer Surgery

Science.gov (United States)

Parker, John M.; Austin, Jamie; Wilkerson, James; Carbone, Larry

2011-01-01

Multimodal analgesia is promoted as the best practice pain management for invasive animal research procedures. Universal acceptance and incorporation of multimodal analgesia requires assessing potential effects on study outcome. The focus of this study was to assess effects on embryo survival after multimodal analgesia comprising an opioid and nonsteroidal antiinflammatory drug (NSAID) compared with opioid-only analgesia during embryo transfer procedures in transgenic mouse production. Mice were assigned to receive either carprofen (5 mg/kg) with buprenorphine (0.1 mg/kg; CB) or vehicle with buprenorphine (0.1 mg/kg; VB) in a prospective, double-blinded placebo controlled clinical trial. Data were analyzed in surgical sets of 1 to 3 female mice receiving embryos chimeric for a shared targeted embryonic stem-cell clone and host blastocyst cells. A total of 99 surgical sets were analyzed, comprising 199 Crl:CD1 female mice and their 996 offspring. Neither yield (pups weaned per embryo implanted in the surgical set) nor birth rate (average number of pups weaned per dam in the set) differed significantly between the CB and VB conditions. Multimodal opioid–NSAID analgesia appears to have no significant positive or negative effect on the success of producing novel lines of transgenic mice by blastocyst transfer. PMID:21838973

The analgesic effect of dexketoprofen when added to lidocaine for intravenous regional anaesthesia: a prospective, randomized, placebo-controlled study.

Science.gov (United States)

Yurtlu, S; Hanci, V; Kargi, E; Erdoğan, G; Köksal, B G; Gül, Ş; Okyay, R D; Ayoğlu, H; Turan, I Ö

2011-01-01

This prospective, randomized, placebo-controlled study evaluated the effects of dexketoprofen as an adjunct to lidocaine in intravenous regional anaesthesia (IVRA) or as a supplemental intravenous (i.v.) analgesic. Patients scheduled for elective hand or forearm soft-tissue surgery were randomly divided into three groups. All 45 patients received 0.5% lidocaine as IVRA. Dexketoprofen was given either i.v. or added into the IVRA solution and the control group received an equal volume of saline both i.v. and as part of the IVRA. The times of sensory and motor block onset, recovery time and postoperative analgesic consumption were recorded. Compared with controls, the addition of dexketoprofen to the IVRA solution resulted in more rapid onset of sensory and motor block, longer recovery time, decreased intra- and postoperative pain scores and decreased paracetamol use. It is concluded that coadministration of dexketoprofen with lidocaine in IVRA improves anaesthetic block and decreases postoperative analgesic requirements.

Assessing patient satisfaction with cataract surgery under topical anesthesia supplemented by intracameral lidocaine combined with sedation

Directory of Open Access Journals (Sweden)

Manuela Bezerril Cipião Fernandes

2013-12-01

Full Text Available PURPOSE: Ocular akinesia, the use of anticoagulants, and patient collaboration are some of the factors that must be taken into consideration when choosing the appropriate anesthesia for phacoemulsification cataract surgery. The satisfaction of patients with the use of topical anesthesia and conscious sedation for this procedure has not been enough described in Brazil. Conscious sedation allows patient walk and answer a voice command. To assess the satisfaction, pain, and perioperative hemodynamic alterations of patients subjected to phacoemulsification under conscious sedation and topical anesthesia supplemented with intracameral lidocaine. METHODS: Prospective cohort non-controlled study that included patients treated by the same surgical team over a 70-day period. Sedation was performed with midazolam at a total dose of 3 mg and topical anesthesia with 0.5% proxymetacaine chlorhydrate and 2% lidocaine gel combined with 2% lidocaine by intracameral route. The intraoperative vital parameters, scores based on the Iowa Satisfaction with Anesthesia Scale (ISAS, and the pain visual analog scale (VAS were recorded at several time points after surgery. RESULTS: A total of 106 patients were enroled in study (73.6% female, the mean age was 65.9 years. The surgical procedures lasted 11.2 minutes on average. The hemodynamic parameters did not exhibit significant changes at any of the investigated time points. The average ISAS score was 2.67 immediately after surgery and 2.99 eight hours after the surgery; this increase was statistically significant (p<0.0001. More than two-thirds (68.9% of the participants (73 patients did not report any pain in the transoperative period, and 98.1% of patients denied the occurrence of pain after surgery. CONCLUSIONS: Patients that received topical anesthesia supplemented by intracameral lidocaine combined with sedation for phacoemulsification cataract surgery reported adequate level of satisfaction with the anesthetic

Neuraxial block and postoperative epidural analgesia

DEFF Research Database (Denmark)

Leslie, K; McIlroy, D; Kasza, J

2016-01-01

BACKGROUND: We assessed associations between intraoperative neuraxial block and postoperative epidural analgesia, and a composite primary outcome of death or non-fatal myocardial infarction, at 30 days post-randomization in POISE-2 Trial subjects. METHODS: 10 010 high-risk noncardiac surgical pat...

The effect of lidocaine on in vitro neutrophil and endothelial adhesion molecule expression induced by plasma obtained during tourniquet-induced ischaemia and reperfusion.

LENUS (Irish Health Repository)

Lan, W

2012-02-03

BACKGROUND: Changes in neutrophil and endothelial adhesion molecule expression occur during perioperative ischaemia and reperfusion (I\\/R) injury. We investigated the effects of lidocaine on neutrophil-independent changes in neutrophil and endothelial adhesion molecule expression associated with tourniquet-induced I\\/R. METHODS: Plasma was obtained from venous blood samples (tourniquet arm) taken before (baseline), during, 15 min, 2 and 24 h following tourniquet release in seven patients undergoing elective upper limb surgery with tourniquet application. Isolated neutrophils from healthy volunteers (n = 7) were pretreated in the presence or absence of lidocaine (0.005, 0.05 and 0.5 mg mL(-1) for 1 h, and then incubated with I\\/R plasma for 2 h. Human umbilical vein endothelial cells (HUVECs) were pretreated in the presence or absence of lidocaine (0.005, 0.05 and 0.5 mg mL(-1)) for 1 h, and then incubated with the plasma for 4 h. Adhesion molecule expression was estimated using flow cytometry. Data were analysed using ANOVA and post hoc Student-Newman-Keuls tests. RESULTS: I\\/R plasma (withdrawn 15 min following tourniquet release) increased isolated neutrophil CD11b (P = 0.03), CD18 (P = 0.01) and endothelial intercellular adhesion molecule-1 (ICAM-1) (P = 0.008) expression compared to baseline. CD11b, CD18 and ICAM-1 expression on lidocaine (0.005 mg mL(-1)) treated neutrophils was similar to control. CD11b (P < 0.001), CD18 (P = 0.03) and ICAM-1 (P = 0.002) expression on lidocaine (0.05 mg mL(-1)) treated neutrophils and HUVECs was less than that on controls. CONCLUSION: Increased in vitro neutrophil and endothelial cell adhesion molecule expression on exposure to plasma obtained during the early reperfusion phase is diminished by lidocaine at greater than clinically relevant plasma concentrations.

Effect of Duration and Amplitude of Direct Current when Lidocaine Is Delivered by Iontophoresis

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Ethan N. Saliba

2011-12-01

Full Text Available Dosage for the galvanic stimulation for iontophoresis varies. Clinicians manipulate the duration or the amplitude of the current, but it is not known which is more effective. We compared the anesthetic effect of lidocaine HCL (2% by manipulating the current parameters on 21 healthy volunteers (age: 21.2 ± 4.2, height 170.7 ± 10.2 cm, mass 82.1 ± 19.2 kg. Three conditions were administered in a random order using a Phoresor II® with 2 mL, 2% lidocaine HCL in an iontophoresis electrode. (1 HASD (40 mA*min: High amplitude (4 mA, short duration (10 min; (2 LALD (40 mA.min: Low amplitude (2 mA, long duration (20 min; (3 Sham condition (0 mA, 20 min. Semmes-Weinstein monofilament (SWM scores were taken pre and post intervention to measure sensation changes. Two-way ANOVA with repeated measures was used to compare sensation. Both iontophoresis treatments: LALD (4.2 ± 0.32 mm and HASD (4.2 ± 0.52 mm significantly increased SWM scores, indicating an increase in anesthesia, compared to the sham condition (3.6 ± 0.06 mm p < 0.05. Neither LALD nor HASD was more effective and there was no difference in anesthesia with the sham. Lidocaine delivered via iontophoresis reduces cutaneous sensation. However, there was no benefit in either a HASD or LALD treatment.

Considerações sobre analgesia controlada pelo paciente em hospital universitário Consideraciones sobre analgesia controlada por el paciente en hospital universitario Patient controlled analgesia in a university hospital

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Guilherme Antônio Moreira de Barros

2003-02-01

Full Text Available JUSTIFICATIVA E OBJETIVOS: O rápido progresso obtido nas técnicas cirúrgicas e anestésicas nos últimos anos proporcionou extraordinário aumento das indicações de procedimentos invasivos. Por outro lado, com o envelhecimento da população, o período de recuperação pós-operatória passou a ser motivo de maior preocupação da equipe de saúde. Para tanto, novas técnicas de analgesia foram criadas e desenvolvidas e, dentre elas, destaca-se a Analgesia Controlada pelo Paciente (ACP. Em nosso país, o Serviço de Dor Aguda (SEDA da Disciplina de Terapia Antálgica e Cuidados Paliativos, do Departamento de Anestesiologia da Faculdade de Medicina de Botucatu - UNESP, utiliza há muitos anos esta técnica de analgesia. Com a finalidade de atestar a qualidade do serviço prestado, a pesquisa objetiva verificar a eficácia e segurança do método, assim como identificar e caracterizar a população atendida. MÉTODO: De modo retrospectivo, foram avaliados 679 pacientes tratados pelo SEDA, exclusivamente com o método de ACP, durante três anos. Os pacientes foram incluídos na análise aleatoriamente, sem restrições quanto à idade, ao sexo, ao tipo de cirurgia e considerando-se unicamente a possibilidade de indicação da ACP. Foram estudados os seguintes atributos: sexo, idade, tipo de cirurgia, intensidade da dor, dias de acompanhamento, analgésicos utilizados, vias de administração, ocorrência de efeitos colaterais e complicações da técnica. RESULTADOS: 3,96% dos pacientes submetidos a cirurgias e 1,64% dos internados no período observado foram acompanhados com técnica ACP. A cirurgia torácica foi a mais freqüentemente atendida, com 25% dos pacientes. A morfina foi o medicamento mais utilizado (54,2%, sendo a via peridural a preferencial (49,5%. A escala numérica verbal média foi de 0,8 (0-10. Os efeitos colaterais ocorreram em 22,4% dos doentes tratados. CONCLUSÕES: Os resultados foram considerados excelentes quanto �

Intravenously administered lidocaine in therapeutic doses increases the intraspinal release of acetylcholine in rats

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Abelson, Klas S P; Höglund, A Urban

2002-01-01

The local anesthetic lidocaine suppresses different pain conditions when administered systemically. Part of the antinociceptive effect appears to be mediated via receptor mechanisms. We have previously shown that muscarinic and nicotinic agonists that produce antinociception increase the intraspi...

Bronchospasm and anaphylactic shock following lidocaine aerosol inhalation in a patient with butane inhalation lung injury.

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Lee, Min-Young; Park, Kyong Ah; Yeo, So-Jeong; Kim, Shin-Hee; Goong, Hyeun-Jeong; Jang, An-Soo; Park, Choon-Sik

2011-10-01

Allergic reactions to local anesthetics are very rare and represent inhalation lung injury due to butane gas fuel. On the fifth day, he developed an asthmatic attack and anaphylactic shock immediately after lidocaine aerosol administration to prepare for bronchoscopy to confirm an acute inhalational lung injury diagnosis. Cardiopulmonary resuscitation was performed immediately after respiratory arrest, and the patient was admitted to the intensive care unit intubated and on a ventilator. He was extubated safely on the third post-cardiopulmonary resuscitation day. These observations suggest that aerosol lidocaine anesthesia may cause airway narrowing and anaphylactic shock. Practitioners should be aware of this potential complication. We report on this case with a brief review of the literature.

Acupuntura e analgesia: aplicações clínicas e principais acupontos Acupuncture and analgesia: clinical applications and main acupoints

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Marilda Onghero Taffarel

2009-12-01

Full Text Available A dor é uma resposta protetora do organismo a estímulos nocivos, que resulta em efeitos indesejáveis quando não controlada. A analgesia pode ser promovida mediante a utilização de vários tipos de fármacos. No entanto, estes podem causar efeitos adversos de acordo com a espécie e condição física do paciente. A acupuntura tem se mostrado eficaz como coanalgésico pela capacidade de diminuir a quantidade de fármacos utilizados para o controle da dor e raramente ser contraindicada. Objetivou-se com este trabalho fazer uma breve revisão sobre as aplicações clínicas e os efeitos fisiológicos da acupuntura nos mecanismos da dor, bem como demonstrar os principais pontos de acupuntura utilizados para analgesia em animais. A pesquisa foi realizada em bases de dados eletrônicas por palavra-chave, durante o período de março a dezembro de 2008.Pain is a protective response of the body to harmful stimulus, which results in undesirable effects if not controlled. Analgesia can be achieved with the use of different types of drugs. However, these drugs can cause adverse effects according to species and patient physical condition. Acupuncture has been proved to be an effective analgesic adjuvant, by the capacity to decrease the amount of drug used for pain control, rarely contra-indicated. The aim of this paper was to review the physiological effects of acupuncture on pain mechanisms, and demonstrate the main acupoints used for animal analgesia. The search was done in electronic search database using key words, in 2008.

Morphine- and buprenorphine-induced analgesia and antihyperalgesia in a human inflammatory pain model

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Ravn, Pernille; Secher, EL; Skram, U

2013-01-01

Opioid therapy is associated with the development of tolerance and paradoxically increased sensitivity to pain. It has been suggested that buprenorphine is associated with a higher antihyperalgesia/analgesia ratio than μ-opioid receptor agonists. The primary outcome of this study was therefore...... to investigate relative differences in antihyperalgesia and analgesia effects between morphine and buprenorphine in an inflammatory pain model in volunteers. The secondary outcome was to examine the relationship between pain sensitivity and opioid-induced effects on analgesia, antihyperalgesia, and descending...... pain modulation....

Comparison of hemodynamic effects of lidocaine, prilocaine and mepivacaine solutions without vasoconstrictor in hypertensive patients

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Bahadir Ezmek

2010-08-01

Full Text Available OBJECTIVE: Local anesthetic solutions with vasoconstrictors are not contraindicated in hypertensive patients, but due to their hemodynamic effects, local anesthetics without vasoconstrictors are mainly preferred by the clinicians. The aim of this study was to compare hemodynamic effects of three different local anesthetics without vasoconstrictors during tooth extraction in hypertensive patients. MATERIAL AND METHODS: Sixty-five mandibular molars and premolars were extracted in 60 hypertensive patients (29 females and 31 males; mean age: 66.95 ± 10.87 years; range: 38 to 86 years old. Inferior alveolar and buccal nerve blocks were performed with 2% lidocaine hydrochloride (HCl, 2% prilocaine HCl or 3% mepivacaine HCl without vasoconstrictor. Hemodynamic parameters namely systolic blood pressure (SBP, diastolic blood pressure (DBP, mean arterial pressure (MAP, heart rate (HR, saturation rate (SR, rate pressure product (RPP and pressure rate quotient (PRQ were investigated before and at different intervals after anesthetic injection. RESULTS: The hemodynamic effects of the three agents were similar to each other, although some significance was observed for DBP, MAP, RPP and PRQ values in the lidocaine, prilocaine and mepivacaine groups. CONCLUSION: Lidocaine, prilocaine and mepivacaine solutions without vasoconstrictor can be safely used in hypertensive patients. It is advisable that dental practitioners select anesthetic solutions for hypertensive patients considering their cardiovascular effects in order to provide patient comfort and safety.

Remifentanil for labour analgesia: a double-blinded, randomised controlled trial of maternal and neonatal effects of patient-controlled analgesia versus continuous infusion.

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Shen, M K; Wu, Z F; Zhu, A B; He, L L; Shen, X F; Yang, J J; Feng, S W

2013-03-01

This trial aimed to compare the maternal and neonatal effects of remifentanil given by patient-controlled analgesia (PCA) or continuous infusion for labour analgesia. Patient controlled analgesia was administered using increasing stepwise boluses from 0.1 to 0.4 μg.kg(-1) (0.1 μg.kg(-1) increment, 2 min lockout, n = 30). Continuous infusion used rates from 0.05 to 0.2 μg.kg(-1) .min(-1) (0.05 μg.kg(-1) .min(-1) increment, n = 30). Dose increments were given on request. Women reported lowest pain scores (median (IQR [range]) of 3 (2-4 [2-5]) for PCA and 4 (3-5.25 [3-7]) for continuous infusion (p = 0.004) at 60 min after the beginning of analgesia. The mean (SD) remifentanil umbilical vein/maternal artery ratio in the PCA and infusion groups were 0.74 (0.45) vs 0.70 (0.52), respectively (p = 0.776). The mean (SD) umbilical artery/umbilical vein ratios were 0.31 (0.12) vs 0.26 (0.07), respectively (p = 0.088). Maternal and neonatal adverse reactions of remifentanil were similar between the two groups. The total remifentanil consumption (median (IQR [range]) during PCA administration was lower than continuous infusion, 1.34 (1.22-1.48 [0.89-1.69]) mg vs 1.49 (1.35-1.61 [1.12-1.70] mg; p = 0.011). The results suggest that remifentanil PCA provides better pain relief and similar placental transfer compared with continuous infusion. Anaesthesia © 2013 The Association of Anaesthetists of Great Britain and Ireland.

Comparing Transcervical Intrauterine Lidocaine Instillation with Rectal Diclofenac for Pain Relief During Outpatient Hysteroscopy: A Randomized Controlled Trial

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Sussan S. Mohammadi

2015-05-01

Full Text Available Objectives: There are a number of potential advantages to performing hysteroscopy in an outpatient setting. However, the ideal approach, using local uterine anesthesia or rectal non-steroidal anti-inflammatory drugs, has not been determined. Our objective was to compare the efficacy of intrauterine lidocaine instillation with rectal diclofenac for pain relief during diagnostic hysteroscopy. Methods: We conducted a double-blind randomized controlled trial on 70 nulliparous women with primary infertility undergoing diagnostic hysteroscopy. Subjects were assigned into one of two groups to receive either 100mg of rectal diclofenac or 5mL of 2% intrauterine lidocaine. The intensity of pain was measured by a numeric rating scale 0–10. Pain scoring was performed during insertion of the hysteroscope, during visualization of the intrauterine cavity, and during extrusion of the hysteroscope. Results: There were no statistically significant differences between the groups with regard to the mean pain score during intrauterine visualization (p=0.500. The mean pain score was significantly lower during insertion and extrusion of the hysteroscope in the diclofenac group (p=0.001 and p=0.030, respectively. Nine patients in the lidocaine group and five patients in diclofenac group needed supplementary intravenous propofol injection for sedation (p=0.060. Conclusions: Rectal diclofenac appears to be more effective than intrauterine lidocaine in reducing pain during insertion and extrusion of hysteroscope, but there are no significant statistical and clinical differences between the two methods with regard to the mean pain score during intrauterine inspection.

Effect of epidural analgesia on labor and its outcomes

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Fawad, A.; Naz, H.; Nelofar, T.; Abbasi, A.U.N.

2015-01-01

Epidural analgesia is an effective and popular way to relieve labour pain but it may interfere with normal mechanism of labour. The objective of this study was to evaluate the outcome of labour in women with effective epidural analgesia in terms of duration of labour, mode of delivery and neonatal outcome. Methods: This was a quasi-experimental study conducted in the Department of Obstetrics and Gynaecology, Shaikh Zayed Federal Postgraduate Medical Institute and Hospital, Lahore. One hundred pregnant women were selected by non-probability convenient sampling method. Subjects were divided into two groups of 50 each as per convenience. Patients of any gravidity at term from 37-41 weeks were included in the sample. Epidural analgesia was applied to group B and distilled water to group A at the lumber region and the progress of labour, mode of delivery and effects on Apgar scores of neonates were evaluated. Out of hundred patients, 77 had normal duration of second stage while 23 had prolonged second stage. Among them, 18 patients (36%) were in epidural group and 5 patients (10%) in non-epidural group, while 4 patients (8%) in epidural group developed intra-partum complications; whereas among non-epidural group had such complications. 65 patients had spontaneous vaginal delivery while 35 patients had instrumental delivery. Among them 29 patients (58%) were in epidural group while only 6 patients (12%) were in non-epidural group. Babies born had Apgar score 5/10 (21.8%), 6/10 (59.4%) and 7/10 (17.8%) at 1 minute and 8/10 (74.3%) and 9/10 (24.8%) at 5 minutes in both groups and none of them needed bag and mask resuscitation. Conclusion: Epidural analgesia does prolong the duration of second stage of labour and increases the instrumental delivery rate. Neonatal outcome is satisfactory while only a few intra-partum complications are found with epidural analgesia. (author)

Effect of paracetamol, dexketoprofen trometamol, lidocaine spray, pethidine & diclofenac sodium application for pain relief during fractional curettage: A randomized controlled trial.

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Acmaz, Gökhan; Bayraktar, Evrim; Aksoy, Hüseyin; Başer, Mürvet; Yilmaz, Mustafa Oğuz; Müderris, İptisam İpek

2015-10-01

Patients frequently experience pain of moderate to severe degree during gynaecologic procedures. This prospective, randomized, placebo-controlled trial was aimed to investigate the analgesic efficacy of preoperative oral dexketoprofen trometamol, intravenous paracetamol, lidocaine spray, pethidine and diclofenac sodium on fractional curettage procedure. A total of 144 multiparous women were randomly allocated to one of the six groups. The first group (control group) consisted of 22 participants and they did not receive any treatment. The second group had 26 participants receiving oral 25 mg dexketoprofen trometamol. The 23 participants of the third group received two puff lidocaine sprays on cervical mucosa. t0 he forth group consisted of 25 participants receiving 100 mg pethidine. In the fifth group, the 23 participants received 1000 mg intravenous paracetamol and the sixth group consisted of 25 participants receiving diclofenac sodium. Pethidine was the best choice for reducing pain score during curettage procedure (t2:intra-operative). All analgesic procedures were significantly effective in reducing pain during postoperative period (t3). Significant pain reduction was achieved for both intra- and postoperative period by using analgesics. The results of our study showed that lidocaine puffs provided the best pain relief than the other analgesics used. Therefore, lidocaine may be considered as the first choice analgesic in fractional curettage (NCT ID: 01993589).

Sustained Release of Lidocaine from Solvent-Free Biodegradable Poly[(d,l)-Lactide-co-Glycolide] (PLGA): In Vitro and In Vivo Study.

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Kau, Yi-Chuan; Liao, Chia-Chih; Chen, Ying-Chi; Liu, Shih-Jung

2014-09-16

Local anesthetics are commonly used for pain relief by regional nerve blocking. In this study, we fabricated solvent-free biodegradable pellets to extend the duration of lidocaine release without any significant local or systemic toxicity levels. To manufacture the pellets, poly[(d,l)-lactide-co-glycolide] (PLGA) was first pre-mixed with lidocaine powder into different ratios. The powder mixture was then compressed with a mold (diameter of 1, 5, 8 or 10 mm) and sintered at 65 °C to form pellets. The in vitro release study showed that the lidocaine/PLGA pellets exhibited a tri-phase release behavior (a burst, a diffusion-controlled release and a degradation-dominated release) and reached completion around day 28. Scanning electron microscope (SEM) photos show that small channels could be found on the surfaces of the pellets on day 2. Furthermore, the polymer matrix swelled and fell apart on day 7, while the pellets became viscous after 10 days of in vitro elution. Perineural administration of the lidocaine/PLGA pellets produced anti-hypersensitivity effects lasting for at least 24 h in rats, significant when compared to the control group (a pure PLGA was pellet administered). In addition, no inflammation was detected within the nerve and in the neighboring muscle by histopathology.

Sustained Release of Lidocaine from Solvent-Free Biodegradable Poly[(d,l-Lactide-co-Glycolide] (PLGA: In Vitro and In Vivo Study

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Yi-Chuan Kau

2014-09-01

Full Text Available Local anesthetics are commonly used for pain relief by regional nerve blocking. In this study, we fabricated solvent-free biodegradable pellets to extend the duration of lidocaine release without any significant local or systemic toxicity levels. To manufacture the pellets, poly[(d,l-lactide-co-glycolide] (PLGA was first pre-mixed with lidocaine powder into different ratios. The powder mixture was then compressed with a mold (diameter of 1, 5, 8 or 10 mm and sintered at 65 °C to form pellets. The in vitro release study showed that the lidocaine/PLGA pellets exhibited a tri-phase release behavior (a burst, a diffusion-controlled release and a degradation-dominated release and reached completion around day 28. Scanning electron microscope (SEM photos show that small channels could be found on the surfaces of the pellets on day 2. Furthermore, the polymer matrix swelled and fell apart on day 7, while the pellets became viscous after 10 days of in vitro elution. Perineural administration of the lidocaine/PLGA pellets produced anti-hypersensitivity effects lasting for at least 24 h in rats, significant when compared to the control group (a pure PLGA was pellet administered. In addition, no inflammation was detected within the nerve and in the neighboring muscle by histopathology.

Effects of Addition of Systemic Tramadol or Adjunct Tramadol to Lidocaine Used for Intravenous Regional Anesthesia in Patients Undergoing Hand Surgery

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Abdulkadir Yektaş

2016-01-01

Full Text Available Intravenous regional anesthesia (IVRA is used in outpatient hand surgery as an easily applicable and cost-effective technique with clinical advantages. The present study aimed to investigate the effects of addition of systemic tramadol or adjunct tramadol to lidocaine for IVRA in patients undergoing hand surgery. American Society of Anesthesiologists (ASA I-II patients (n=60 who underwent hand surgery were included. For this purpose, only lidocaine (LDC, lidocaine+adjunct tramadol (LDC+TRA group, or lidocaine+systemic tramadol (LDC+SysTRA group was administered to the patients for IVRA and the groups were compared in terms of onset and recovery time of sensory and motor blocks, quality of anesthesia, and the degree of intraoperative and postoperative pain. The onset time of sensorial block was significantly shorter in the LDC+TRA group than that in the LDC+SysTRA group. The motor block recovery time was significantly shorter in the LDC+SysTRA group than that in the LDC+TRA and LDC groups. Administration of tramadol as an adjunct showed some clinical benefits by providing a shorter onset time of sensory and motor block, decreasing pain and analgesic requirement, and improving intraoperative conditions during IVRA. It was determined that systemic tramadol administration had no superiority.

Efficacy and Safety of a Lidocaine and Ropivacaine Mixture for Scalp Nerve Block and Local Infiltration Anesthesia in Patients Undergoing Awake Craniotomy.

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Chaki, Tomohiro; Sugino, Shigekazu; Janicki, Piotr K; Ishioka, Yoshiya; Hatakeyama, Yosuke; Hayase, Tomo; Kaneuchi-Yamashita, Miki; Kohri, Naonori; Yamakage, Michiaki

2016-01-01

Mixtures of various local anesthetics, such as lidocaine and ropivacaine, have been widely used. However, their efficacy and safety for scalp nerve blocks and local infiltration during awake craniotomy have not been fully elucidated. We prospectively investigated 53 patients who underwent awake craniotomy. Scalp block was performed for the blockade of the supraorbital, supratrochlear, zygomaticotemporal, auriculotemporal, greater occipital, and lesser occipital nerves with a mixture containing equal volumes of 2% lidocaine and 0.75% ropivacaine, including 5 μg/mL of epinephrine. Infiltration anesthesia was applied at the site of skin incision using the same mixture. The study outcomes included changes in heart rate and blood pressure after head pinning and skin incision, and incidence of severe pain on emergence from anesthesia. Total doses and plasma concentrations of lidocaine and ropivacaine were measured at different time points after performing the block. The heart rate and blood pressure after head pinning were marginally, but significantly, increased when compared with baseline values. There were no significant differences in heart rate and blood pressure before and after the skin incision. Nineteen percent of the patients (10/53) complained of incisional pain at emergence from anesthesia. The highest observed blood concentrations of lidocaine and ropivacaine were 1.9±0.9 and 1.1±0.4 μg/mL, respectively. No acute anesthetic toxicity symptom was observed. Scalp block with a mixture of lidocaine and ropivacaine seems to provide effective and safe anesthetic management in patients undergoing awake craniotomy.

Comparison of the Anesthetic Efficacy of Mepivacaine and Lidocaine in Patients with Irreversible Pulpitis: A Double-blind Randomized Clinical Trial.

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Visconti, Renata Pieroni; Tortamano, Isabel Peixoto; Buscariolo, Inês Aparecida

2016-09-01

The objective of this study was to compare the anesthetic efficacy of 2% mepivacaine combined with 1:100,000 epinephrine with 2% lidocaine combined with 1:100,000 epinephrine during pulpectomy of mandibular posterior teeth in patients with irreversible pulpitis. Forty-two patients with irreversible pulpitis who were admitted to the Emergency Center at the University of São Paulo School of Dentistry volunteered to take part in the study and were randomized to receive conventional inferior alveolar nerve block containing 1.8 or 3.6 mL of either 2% mepivacaine with 1:100,000 epinephrine or 2% lidocaine with 1:100,000 epinephrine. We recorded patients' subjective assessments of lip anesthesia, absence/presence of pulpal anesthesia tested by using electric pulp stimulation, and absence/presence of pain during the subsequent pulpectomy by using a verbal analogue scale. All patients tested reported lip anesthesia after application of either type of inferior alveolar nerve block. Pulpal anesthesia success rates measured by using the pulp tester were satisfactory for both solutions (86% for mepivacaine and 67% for lidocaine). Success rates according to patient report of no pain or mild pain during pulpectomy were higher for mepivacaine solution (55%) than for lidocaine solution (14%). The differences between mepivacaine and lidocaine were statistically significant. Mepivacaine resulted in effective pain control during irreversible pulpitis treatments. The success rates with either solution were not high enough to ensure complete pulpal anesthesia. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Associação entre a analgesia epidural e o trauma perineal no parto vaginal Asociación entre la analgesia epidural y el trauma perineal en el parto vaginal Association between epidural analgesia and perineal laceration in vaginal delivery

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Juliana Cristina dos Santos Monteiro

2009-03-01

Full Text Available O objetivo deste estudo foi analisar a associação entre a analgesia epidural e a laceração perineal em mulheres submetidas ao parto vaginal. Foi realizado um estudo descritivo e transversal, para o qual foram pesquisados 109 prontuários de mulheres assistidas durante o processo de parturição, em uma maternidade em Ribeirão Preto. Os dados foram coletados nos meses de março e abril de 2003. Para analisar a correlação entre as variáveis foi aplicado o teste qui-quadrado. Foi realizado parto normal em 91,7% (100 das parturientes e fórceps em 8,2% (9. Na análise dos dados, 74,3% da amostra receberam analgesia epidural; destas, 26,5% tiveram algum grau de laceração perineal e 9,1%, períneo íntegro, não sendo possível verificar a associação entre as variáveis mencionadas. Não foi verificada, neste estudo, significância estatística para afirmar que as condições do períneo após o parto vaginal e a utilização da analgesia epidural estão associadas (valor x²4GL= 3,1.El objetivo de esto estudio fue analizar la asociación entre la analgesia epidural y la laceración perineal en mujeres sometidas al parto vaginal. Fue realizado un estudio descriptivo y transversal, para lo cual fueron investigados 109 prontuarios de mujeres asistidas durante el proceso de parturición en una maternidad en Ribeirão Preto. Los datos fueron colectados en marzo y abril de 2003. Para analizar la correlación entre las variables fue aplicado el Teste Chi-Cuadrado. Fue realizado parto normal en 91,7% (100 de las parturientes y en 8,2% (09 parto fórceps. En el análisis de los datos, 74,3% de la muestra recibieron analgesia epidural, y de estas 26,5% tuvieron algún nivel de laceración perineal y 9,1% perineo íntegro. No fue posible verificar la asociación entre las variables aludidas. No fue verificado en esto estudio, significancia estadística para afirmar que las condiciones del perineo después del parto vaginal y el uso de analgesia

Nerve injury caused by mandibular block analgesia

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Hillerup, S; Jensen, Rigmor H

2006-01-01

Fifty-four injection injuries in 52 patients were caused by mandibular block analgesia affecting the lingual nerve (n=42) and/or the inferior alveolar nerve (n=12). All patients were examined with a standardized test of neurosensory functions. The perception of the following stimuli was assessed......: feather light touch, pinprick, sharp/dull discrimination, warm, cold, point location, brush stroke direction, 2-point discrimination and pain perception. Gustation was tested for recognition of sweet, salt, sour and bitter. Mandibular block analgesia causes lingual nerve injury more frequently than...... inferior alveolar nerve injury. All grades of loss of neurosensory and gustatory functions were found, and a range of persisting neurogenic malfunctions was reported. Subjective complaints and neurosensory function tests indicate that lingual nerve lesions are more incapacitating than inferior alveolar...

Perioperative epidural analgesia reduces cancer recurrence after gastro-oesophageal surgery.

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Hiller, J G; Hacking, M B; Link, E K; Wessels, K L; Riedel, B J

2014-03-01

Recent interest has focused on the role of perioperative epidural analgesia in improving cancer outcomes. The heterogeneity of studies (tumour type, stage and outcome endpoints) has produced inconsistent results. Clinical practice also highlights the variability in epidural effectiveness. We considered the novel hypothesis that effective epidural analgesia improves cancer outcomes following gastro-oesophageal cancer surgery in patients with grouped pathological staging. Following institutional approval, a database analysis identified 140 patients, with 2-year minimum follow-up after gastro-oesophageal cancer surgery. All patients were operated on by a single surgeon (2005-2010). Information pertaining to cancer and survival outcomes was extracted. Univariate analysis demonstrated a 1-year 14% vs. 33% (P = 0.01) and 2-year 27% vs. 40% [hazard ratio (HR)=0.59; 95% CI, 0.32-1.09, P = 0.087] incidence of cancer recurrence in patients with (vs. without) effective (> 36 h duration) epidural analgesia, respectively. Multivariate analysis demonstrated increased time to cancer recurrence (HR = 0.33; 95% CI: 0.17-0.63, P benefit (HR = 0.42; 95% CI: 0.21-0.83, P benefit in patients with oesophageal cancer (HR = 0.34; 95% CI: 0.16-0.75, P = 0.005) and in patients with tumour lymphovascular space infiltration (LVSI), (HR = 0.49; 95% CI: 0.26-0.94, P = 0.03). Effective epidural analgesia improved estimated median time to death (2.9 vs. 1.8 years, P = 0.029) in patients with tumour LVSI. This study found an association between effective post-operative epidural analgesia and medium-term benefit on cancer recurrence and survival following oesophageal surgery. A prospective study that controls for disease type, stage and epidural effectiveness is warranted. © 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Standard versus pH-adjusted and lidocaine supplemented radiocolloid for patients undergoing sentinel-lymph-node mapping and biopsy for early breast cancer (PASSION-P trial): a double-blind, randomised controlled trial.

Science.gov (United States)

Stojadinovic, Alexander; Peoples, George E; Jurgens, Jennifer S; Howard, Robin S; Schuyler, Brandi; Kwon, Kyung H; Henry, Leonard R; Shriver, Craig D; Buckenmaier, Chester C

2009-09-01

Sentinel-lymph-node (SLN) mapping and biopsy maintains staging accuracy in early breast cancer and identifies patients for selective lymphadenectomy. SLN mapping requires injection of technetium-99m-sulfur colloid-an effective but sometimes painful method, for which better pain-management strategies are needed. In this randomised, double-blind trial, we compared degree of pain between standard radiocolloid injection and pH-adjusted and lidocaine-supplemented formulations for patients undergoing SLN mapping for breast cancer. Between Jan 13, 2006, and April 30, 2009, 140 patients with early breast cancer were randomly assigned in a 1:1:1:1 fashion to receive the standard topical 4% lidocaine cream and injection of [(99m)Tc]Tc-sulfur colloid (n=35), or to one of three other study groups: topical placebo cream and injection of Tc-sulfur colloid containing either sodium bicarbonate (n=35), 1% lidocaine (n=35), or sodium bicarbonate and 1% lidocaine (n=35). The randomisation sequence was computer generated, and all patients and investigators were masked to treatment allocation. The primary endpoint was patient-reported breast pain immediately after radioisotope injection, using the Wong-Baker FACES pain rating scale and McGill pain questionnaire, analysed in the per-protocol population. This study is registered with ClinicalTrials.gov, number NCT00940199. 19 of the 140 patients enrolled were excluded from analysis: nine declined study participation or sought care elsewhere, nine did not undergo SLN mapping because of disease extent or a technical problem, and one had unreliable data. There were no adverse events. Mean pain scores on the Wong-Baker scale (0-10) were: 6.0 (SD 2.6) for those who received standard of practice, 4.7 (3.0) for those who received radiocolloid plus bicarbonate, 1.6 (1.4) for those who received radiocolloid plus 1% lidocaine, and 1.6 (1.3) for those who received radiocolloid plus bicarbonate and 1% lidocaine (psodium bicarbonate group, 4.6 (4

Transient impairment of the axolemma following regional anaesthesia by lidocaine in humans

DEFF Research Database (Denmark)

Moldovan, Mihai; Lange, Kai Henrik Wiborg; Aachmann-Andersen, Niels Jacob

2014-01-01

The local anaesthetic lidocaine is known to block voltage-gated Na(+) channels (VGSCs), although at high concentration it was also reported to block other ion channel currents as well as to alter lipid membranes. The aim of this study was to investigate whether the clinical regional anaesthetic...... reflect, at least in part, a reversible structural impairment of the axolemma....

Combined spinal-epidural analgesia in labour: its effects on delivery outcome

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Suneet Kaur Sra Charanjit Singh

2016-06-01

Full Text Available ABSTRACT BACKGROUND AND OBJECTIVES: Combined spinal-epidural (CSE has become an increasingly popular alternative to traditional labour epidural due to its rapid onset and reliable analgesia provided. This was a prospective, convenient sampling study to determine the effects of CSE analgesia on labour outcome. METHODS: One hundred and ten healthy primigravida parturients with a singleton pregnancy of ≥37 weeks gestation and in the active phase of labour were studied. They were enrolled to the CSE (n = 55 or Non-CSE (n = 55 group based on whether they consented to CSE analgesia. Non-CSE parturients were offered other methods of labour analgesia. The duration of the first and second stage of labour, rate of instrumental vaginal delivery and emergency cesarean section, and Apgar scores were compared. RESULTS: The mean duration of the first and second stage of labour was not significantly different between both groups. Instrumental delivery rates between the groups were not significantly different (CSE group, 11% versus Non-CSE group, 16%. The slightly higher incidence of cesarean section in the CSE group (16% versus 15% in the Non-CSE group was not statistically significant. Neonatal outcome in terms of Apgar score of less than 7 at 1 and 5 min was similar in both groups. CONCLUSION: There were no significant differences in the duration of labour, rate of instrumental vaginal delivery and emergency cesarean section, and neonatal outcome in parturients who received compared to those who did not receive CSE for labour analgesia.

Regional analgesia for video-assisted thoracic surgery – a systematic review

DEFF Research Database (Denmark)

Julia Steinthorsdottir, Kristin; Wildgaard, Lorna; Jessen Hansen, Henrik

2013-01-01

there is no gold standard for regional analgesia for VATS. This systematic review aimed to assess different regional techniques in regards to effect on acute post-operative pain following VATS, with emphasis on VATS lobectomy. The systematic review of the PubMed, Cochrane Library and Embase databases yielded...... be demonstrated, but a guide of factors to include in future studies on regional analgesia for VATS is presented....

The protective effect of lidocaine on lipopolysaccharide-induced acute lung injury in rats through NF-κB and p38 MAPK signaling pathway and excessive inflammatory responses.

Science.gov (United States)

Chen, L-J; Ding, Y-B; Ma, P-L; Jiang, S-H; Li, K-Z; Li, A-Z; Li, M-C; Shi, C-X; Du, J; Zhou, H-D

2018-04-01

Acute lung injury is a severe disease with a high rate of mortality, leading to more important illness. We aimed at exploring the protective role and potential mechanisms of lidocaine on lipopolysaccharide (LPS)-induced acute lung injury (ALI). Sprague Dawley (SD) rats were randomly assigned to control group receiving 0.9% saline solution, LPS group treated with 4 mg/kg LPS i.p., LPS + lidocaine(treated with 4 mg/kg LPS i.p. followed by giving 1 mg/kg, 3 mg/kg, 5 mg/kg of lidocaine i.v.). Lung specimens and the bronchoalveolar lavage fluid (BALF) were collected for histopathological examination and biochemical analyze 12 h after LPS induction. The cytokines expression of TNF-α, IL-6 and MCP-1 was measured by ELISA. In addition, the malondialdehyde (MDA) content, the activities of total antioxidant capacity (T-AOC) and superoxide dismutase (SOD) in lung tissues were also detected using ELISA. The protein expressions of p38, p-p38, p65, p-p65 and IκB were analyzed by Western blot. The results indicated that after lidocaine treatment was able to decrease significantly wet-to-dry (W/D) ratio and ameliorate the histopathologic damage. Additionally, total protein content and the number of leukocytes in BALF significantly decreased. ELISA result indicated that the levels of TNF-α, IL-6 and MCP-1 in BALF were markedly suppressed. Meanwhile, the activities of T-AOC and SOD in lung tissues significantly increased, while the content of MDA significantly decreased after treatment with lidocaine. Moreover, Western blot suggested that lidocaine inhibited phosphorylation of NF-κB p65 and p38 MAPK. Therefore, lidocaine could ameliorate the LPS-induced lung injury via NF-κB/p38 MAPK signaling and excessive inflammatory responses, providing a potential for becoming the anti-inflammatory agent against lung injury.

Lumbosacral epidural magnesium prolongs ketamine analgesia in conscious sheep Sulfato de magnésio prolonga a analgesia epidural lombosacral induzida pela quetamina em carneiros

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Rafael DeRossi

2012-02-01

Full Text Available PURPOSE: To determine the analgesic, motor, sedation and systemic effects of lumbosacral epidural magnesium sulphate added to ketamine in the sheep. METHODS: Six healthy adult male mixed-breed sheep; weighing 43 ± 5 kg and aged 20-36 months. Each sheep underwent three treatments, at least 2 weeks apart, via epidural injection: (1 ketamine (KE; 2.5 mg/kg, (2 magnesium sulphate (MG; 100 mg, and (3 KE + MG (KEMG; 2.5 mg/kg + 100 mg, respectively. Epidural injections were administered through the lumbosacral space. Analgesia, motor block, sedation, cardiovascular effects, respiratory rate, skin temperature, and rectal temperature were evaluated before (baseline and after drug administration as needed. RESULTS: The duration of analgesia with the lumbosacral epidural KEMG combination was 115 ± 17 min (mean ± SD, that is, more than twice that obtained with KE (41 ± 7 min or MG (29 ± 5 min alone. KE and KEMG used in this experiment induced severe ataxia. The heart rate and arterial blood pressures changes were no statistical difference in these clinically health sheep. CONCLUSION: The dose of magnesium sulphate to lumbosacral epidural ketamine in sheep is feasible, and can be used in procedures analgesics in sheep.OBJETIVO: Determinar os efeitos analgésicos, motores, sedativos e sistêmicos da adição de sulfato de magnésio na analgesia epidural com quetamina em carneiros. MÉTODOS: Foram utilizados seis carneiros machos sadios, pesando 43 ± 5 kg, com idade entre 20 a 36 meses. Cada animal recebeu três tratamentos, com duas semanas entre experimentos via administração epidural: (1 quetamina (KE; 2,5 mg/kg, (2 sulfato de magnésio (MG; 100 mg e (3 KE + MG (KEMG; 2,5 mg/kg + 100 mg, respectivamente. As administrações epidurais foram administradas no espaço lombosacral. Analgesia, bloqueio motor, sedação, efeitos cardiovasculares, freqüência respiratória, temperatura retal e de pele foram avaliados antes (basal e depois da administra

Comparative evaluation of the efficacy of 2% lidocaine containing 1:200,000 epinephrine with and without hyaluronidase (75 IU) in patients with irreversible pulpitis.

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Satish, Sarvepalli Venkata; Shetty, Krishna Prasad; Kilaru, Krishnarao; Bhargavi, Puridi; Reddy, E Srinivas; Bellutgi, Aditya

2013-09-01

The purpose of this study was to determine the anesthetic efficacy of lidocaine containing epinephrine compared with lidocaine containing epinephrine plus hyaluronidase (75 IU) when performing an inferior alveolar nerve block. Patients complaining of pain in the mandibular posterior teeth were selected. Based on their chief complaint, proper clinical and radiographic examinations were performed. Among them, 40 subjects diagnosed with irreversible pulpitis were selected. The inferior alveolar nerve block was induced using 3 mL 2% lidocaine with epinephrine. Hyaluronidase (75 IU) or a placebo was injected 30 minutes after the beginning of pulpal anesthesia (randomized and double-blind trial). The duration of the effect in the pulpal and gingival tissues was evaluated by the response to painful electrical stimuli applied to the adjacent premolar and by mechanical stimuli (pinprick) to the buccal gingiva, respectively. In both pulpal and gingival tissues, the duration of the anesthetic effects with hyaluronidase was longer than with placebo. Hyaluronidase increased the duration of the effects of lidocaine in inferior alveolar nerve blocks. Copyright © 2013. Published by Elsevier Inc.

Preparation and biological profile of 99mTc-lidocaine as a cardioselective imaging agent using 99mTc eluted from 99Mo/99mTc generator based on Al-Mo gel

International Nuclear Information System (INIS)

Sakr, T.M.; October University of Modern Sciences and Arts; Ibrahim, A.B.; Rashed, H.M.; Fasih, T.W.

2017-01-01

The current study is aimed to prepare 99m Tc-lidocaine as a new myocardial perfusion-imaging agent. The used 99m Tc was obtained from Al- 99 Mo-molybdate(VI) gel matrix. 99m Tc-lidocaine showed higher (15.4 ± 0.11% ID/g) and faster (15 min post injection) cardiac uptake than the recently studied 99m Tc-valsartan and 99m Tc-procainamide. Consequently, 99m Tc-lidocaine will be a valuable myocardial SPECT agent for diagnosis of emergency patients. Besides, the receptor affinity study confirmed the selectivity of 99m Tc-lidocaine for sodium channels in the heart. (author)

Stellate ganglion blockade for analgesia following upper limb surgery.

LENUS (Irish Health Repository)

McDonnell, J G

2012-01-31

We report the successful use of a stellate ganglion block as part of a multi-modal postoperative analgesic regimen. Four patients scheduled for orthopaedic surgery following upper limb trauma underwent blockade of the stellate ganglion pre-operatively under ultrasound guidance. Patients reported excellent postoperative analgesia, with postoperative VAS pain scores between 0 and 2, and consumption of morphine in the first 24 h ranging from 0 to 14 mg. While these are preliminary findings, and must be confirmed in a clinical trial, they highlight the potential for stellate ganglion blockade to provide analgesia following major upper limb surgery.

Effect of dexamethasone added to lidocaine in supraclavicular brachial plexus block: A prospective, randomised, double-blind study

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Prashant A Biradar

2013-01-01

Full Text Available Background: Different additives have been used to prolong brachial plexus block. We performed a prospective, randomised, double-blind study to evaluate the effect of dexamethasone added to lidocaine on the onset and duration of supraclavicular brachial plexus block as this is the most common type of brachial block performed in our institute. Methods: Sixty American Society of Anaesthesiologist′s physical status I and II patients undergoing elective hand, forearm and elbow surgery under brachial plexus block were randomly allocated to receive either 1.5% lidocaine (7 mg/kg with adrenaline (1:200,000 and 2 ml of normal saline (group C, n=30 or 1.5% lidocaine (7 mg/kg with adrenaline (1:200,000 and 2 ml of dexamethasone (8 mg (group D, n=30. The block was performed using a nerve stimulator. Onset and duration of sensory and motor blockade were assessed. The sensory and motor blockade of radial, median, ulnar and musculocutaneous nerves were evaluated and recorded at 5, 10, 20, 120 min, and at every 30 min thereafter. Results: Two patients were excluded from the study because of block failure. The onset of sensory and motor blockade (13.4±2.8 vs. 16.0±2.3 min and 16.0±2.7 vs. 18.7±2.8 min, respectively were significantly more rapid in the dexamethasone group than in the control group ( P=0.001. The duration of sensory and motor blockade (326±58.6 vs. 159±20.1 and 290.6±52.7 vs. 135.5±20.3 min, respectively were significantly longer in the dexamethasone group than in the control group ( P=0.001. Conclusion: Addition of dexamethasone to 1.5% lidocaine with adrenaline in supraclavicular brachial plexus block speeds the onset and prolongs the duration of sensory and motor blockade.

Comparison of Anaesthetic Efficacy of 4% Articaine Primary Buccal Infiltration Versus 2% Lidocaine Inferior Alveolar Nerve Block in Symptomatic Mandibular First Molar Teeth.

Science.gov (United States)

Zain, Muhammad; Rehman Khattak, Shakeel Ur; Sikandar, Huma; Shah, Shafqat Ali; Fayyaz

2016-01-01

To evaluate success of pulpal anaesthesia of mandibular 1st molar by using 4% articaine in buccal infiltration versus 2% lidocaine in inferior alveolar nerve block. Randomized control trial. Department of Operative Dentistry, Sardar Begum Dental College, Gandhara University, Peshawar, from March to August 2014. One hundred and fifty-six emergency patients, who had 1st molar diagnosed with irreversible pulpitis, participated in the study. Subjects were divided into two groups by random allocation. One group received 4% articaine buccal infiltration and the other group received inferior alveolar nerve block of 2% lidocaine. Subjects’self-reported pain response was recorded on Heft Parker Visual Analogue Scale after local anaesthetic administration during access cavity preparation and pulp extirpation. Mean age of subjects was 31.46 ±10.994 years. The success rate of 4% buccal infiltration was 76.9%; whereas the success rate of 2% lidocaine inferior alveolar nerve block was 62.8%. There was no statistically significant difference between the two groups. 4% articaine buccal infiltration can be considered a viable alternative to 2% lidocaine inferior alveolar nerve block in securing successful pulpal anaesthesia for endodontic therapy.

Orthogonal polarization spectral imaging of the microcirculation during acute hypervolemic hemodilution and epidural lidocaine injection

NARCIS (Netherlands)

van den Oever, Huub L. A.; Dzoljic, Misa; Ince, Can; Hollmann, Markus W.; Mokken, Fleur C.

2006-01-01

We used Orthogonal Polarization Spectral Imaging to examine the microcirculation of the vaginal mucosa in nine anesthetized patients during two consecutive anesthetic interventions: hypervolemic hemodilution using hydroxyethyl starch followed by thoracic epidural lidocaine. Images taken before and

Efficacy of clonidine as an adjuvant to bupivacaine for caudal analgesia in children undergoing sub-umbilical surgery

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Aruna Parameswari

2010-01-01

Full Text Available Caudal epidural analgesia with bupivacaine is very popular in paediatric anaesthesia for providing intra- and postoperative analgesia. Several adjuvants have been used to prolong the action of bupivacaine. We evaluated the efficacy of clonidine added to bupivacaine in prolonging the analgesia produced by caudal bupivacaine in children undergoing sub-umbilical surgery. One hundred children, age one to three years, undergoing sub-umbilical surgery, were prospectively randomized to one of two groups: caudal analgesia with 1 ml/kg of 0.25% bupivacaine in normal saline (Group A or caudal analgesia with 1 ml/kg of 0.25% bupivacaine with 1 μg/kg of clonidine in normal saline (Group B. Post-operative pain was assessed for 24 hours using the FLACC scale. The mean duration of analgesia was significantly longer in Group B (593.4 ± 423.3 min than in Group A (288.7 ± 259.1 min; P < 0.05. The pain score assessed using FLACC scale was compared between the two groups, and children in Group B had lower pain scores, which was statistically significant. The requirement of rescue medicine was lesser in Group B. Clonidine in a dose of 1 μg/kg added to 0.25% bupivacaine for caudal analgesia, during sub-umbilical surgeries, prolongs the duration of analgesia of bupivacaine, without any side effects.

Lumbar segmental nerve blocks with local anesthetics, pain relief, and motor function: a prospective double-blind study between lidocaine and ropivacaine.

Science.gov (United States)

Wolff, André P; Wilder Smith, Oliver H G; Crul, Ben J P; van de Heijden, Marc P; Groen, Gerbrand J

2004-08-01

Selective segmental nerve blocks with local anesthetics are applied for diagnostic purposes in patients with chronic back pain to determine the segmental level of the pain. We performed this study to establish myotomal motor effects after L4 spinal nerve blocks by lidocaine and ropivacaine and to evaluate the relationship with pain. Therefore, 20 patients, of which 19 finished the complete protocol, with chronic lumbosacral radicular pain without neurological deficits underwent segmental nerve blocks at L4 with both lidocaine and ropivacaine. Pain intensity scores (verbal numeric rating scale; VNRS) and the maximum voluntary muscle force (MVMF; using a dynamometer expressed in newtons) of the tibialis anterior and quadriceps femoris muscles were measured on the painful side and on the control side. The median VNRS decrease was 4.0 (P segmental nerve (L4) block is associated with increased quadriceps femoris and tibialis anterior MVMF, without differences for lidocaine and ropivacaine.

Obstetrical and perinatal outcomes in patients with or without obstetric analgesia during labor

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Piedrahíta-Gutiérrez, Dany Leandro

2016-07-01

Full Text Available Objective: To describe and compare the obstetric and perinatal outcomes in patients with or without obstetric analgesia during labor, and to determine whether such analgesia is associated with adverse maternal or perinatal outcomes. Methodology: Comparative, retrospective, descriptive study, between January and November 2014, that included 502 healthy patients with normal pregnancies, out of which 250 received obstetric analgesia. The groups were compared as to maternal and perinatal outcomes. Results: Young, single and nulliparous mothers predominated; delivery was vaginal in 86 % of the cases, and by caesarean section in 14 %. Obstetric analgesia was associated with longer duration of the second stage of labor, instrumental delivery and cesarean section due to arrest of dilatation or fetal bradycardia; however, it was not related with higher incidence of postpartum hemorrhage or adverse perinatal outcomes such as meconium-stained amniotic fluid, Apgar under 5 at one minute or under 7 at 5 minutes, the need for neonatal resuscitation or for admission to NICU. Conclusion: Obstetric analgesia increases the duration of the second stage of labor and can increase the rate of caesarean sections and instrumental delivery, but it is not associated with adverse maternal or perinatal outcomes. Therefore, its use in labor is justified.

Pharmacokinetics of lidocaine and bupivacaine following subarachnoid administration in surgical patients: simultaneous investigation of absorption and disposition kinetics using stable isotopes

International Nuclear Information System (INIS)

Burm, A.G.; Van Kleef, J.W.; Vermeulen, N.P.; Olthof, G.; Breimer, D.D.; Spierdijk, J.

1988-01-01

The pharmacokinetics of lidocaine and bupivacaine following subarachnoid administration were studied in 12 surgical patients using a stable isotope method. After subarachnoid administration of the agent to be evaluated, a deuterium-labelled analogue was administered intravenously. Blood samples were collected for 24 h. Plasma concentrations of the unlabelled and the deuterium-labelled local anesthetics were determined using a combination of capillary gas chromatography and mass fragmentography. Bi-exponential functions were fitted to the plasma concentration-time data of the deuterium-labelled local anesthetics. The progression of the absorption was evaluated using deconvolution. Mono- and bi-exponential functions were then fitted to the fraction absorbed versus time data. The distribution and elimination half-lives of the deuterium-labelled analogues were 25 +/- 13 min (mean +/- SD) and 121 +/- 31 min for lidocaine and 19 +/- 10 min and 131 +/- 33 min for bupivacaine. The volumes of the central compartment and steady-state volumes of distribution were: lidocaine 57 +/- 10 l and 105 +/- 25 l, bupivacaine 25 +/- 6 l and 63 +/- 22 l. Total plasma clearance values averaged 0.97 +/- 0.21 l/min for lidocaine and 0.56 +/- 0.14 l/min for bupivacaine. The absorption of lidocaine could be described by a single first order absorption process, characterized by a half-life of 71 +/- 17 min in five out of six patients. The absorption of bupivacaine could be described adequately assuming two parallel first order absorption processes in all six patients. The half-lives, characterizing the fast and slow absorption processes of bupivacaine, were 50 +/- 27 min and 408 +/- 275 min, respectively. The fractions of the dose, absorbed in the fast and slow processes, were 0.35 +/- 0.17 and 0.61 +/- 0.16, respectively

Pharmacokinetics of lidocaine and bupivacaine following subarachnoid administration in surgical patients: simultaneous investigation of absorption and disposition kinetics using stable isotopes

Energy Technology Data Exchange (ETDEWEB)

Burm, A.G.; Van Kleef, J.W.; Vermeulen, N.P.; Olthof, G.; Breimer, D.D.; Spierdijk, J.

1988-10-01

The pharmacokinetics of lidocaine and bupivacaine following subarachnoid administration were studied in 12 surgical patients using a stable isotope method. After subarachnoid administration of the agent to be evaluated, a deuterium-labelled analogue was administered intravenously. Blood samples were collected for 24 h. Plasma concentrations of the unlabelled and the deuterium-labelled local anesthetics were determined using a combination of capillary gas chromatography and mass fragmentography. Bi-exponential functions were fitted to the plasma concentration-time data of the deuterium-labelled local anesthetics. The progression of the absorption was evaluated using deconvolution. Mono- and bi-exponential functions were then fitted to the fraction absorbed versus time data. The distribution and elimination half-lives of the deuterium-labelled analogues were 25 +/- 13 min (mean +/- SD) and 121 +/- 31 min for lidocaine and 19 +/- 10 min and 131 +/- 33 min for bupivacaine. The volumes of the central compartment and steady-state volumes of distribution were: lidocaine 57 +/- 10 l and 105 +/- 25 l, bupivacaine 25 +/- 6 l and 63 +/- 22 l. Total plasma clearance values averaged 0.97 +/- 0.21 l/min for lidocaine and 0.56 +/- 0.14 l/min for bupivacaine. The absorption of lidocaine could be described by a single first order absorption process, characterized by a half-life of 71 +/- 17 min in five out of six patients. The absorption of bupivacaine could be described adequately assuming two parallel first order absorption processes in all six patients. The half-lives, characterizing the fast and slow absorption processes of bupivacaine, were 50 +/- 27 min and 408 +/- 275 min, respectively. The fractions of the dose, absorbed in the fast and slow processes, were 0.35 +/- 0.17 and 0.61 +/- 0.16, respectively.

Age-related postoperative morphine requirements in children following major surgery--an assessment using patient-controlled analgesia (PCA)

DEFF Research Database (Denmark)

Hansen, Tom Giedsing; Henneberg, Steen Winther; Hole, P

1996-01-01

To investigate if small children require less morphine for postoperative analgesia than do older children and adolescents we analysed the morphine consumption pattern of 28 consecutive children on intravenous patient-controlled analgesia (PCA) following major surgery. The median age-specific morp......To investigate if small children require less morphine for postoperative analgesia than do older children and adolescents we analysed the morphine consumption pattern of 28 consecutive children on intravenous patient-controlled analgesia (PCA) following major surgery. The median age...

Intravenous Lidocaine for Effective Pain Relief After a Laparoscopic Colectomy: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study

Science.gov (United States)

Ahn, EunJin; Kang, Hyun; Choi, Geun Joo; Park, Yong Hee; Yang, So Young; Kim, Beom Gyu; Choi, Seung Won

2015-01-01

A perioperative intravenous lidocaine infusion has been reported to decrease postoperative pain. The goal of this study was to evaluate the effectiveness of intravenous lidocaine in reducing postoperative pain for laparoscopic colectomy patients. Fifty-five patients scheduled for an elective laparoscopic colectomy were randomly assigned to 2 groups. Group L received an intravenous bolus injection of lidocaine 1.5 mg/kg before intubation, followed by 2 mg/kg/h continuous infusion during the operation. Group C received the same dosage of saline at the same time. Postoperative pain was assessed at 2, 4, 8, 12, 24, and 48 hours after surgery by using the visual analog scale (VAS). Fentanyl consumption by patient-controlled plus investigator-controlled rescue administration and the total number of button pushes were measured at 2, 4, 8, 12, 24, and 48 hours after surgery. In addition, C-reactive protein (CRP) levels were checked on the operation day and postoperative days 1, 2, 3, and 5. VAS scores were significantly lower in group L than group C until 24 hours after surgery. Fentanyl consumption was lower in group L than group C until 12 hours after surgery. Moreover, additional fentanyl injections and the total number of button pushes appeared to be lower in group L than group C (P < 0.05). The CRP level tended to be lower in group L than group C, especially on postoperative day1 and 2 and appeared to be statistically significant. The satisfaction score was higher in group L than group C (P = 0.024). Intravenous lidocaine infusion during an operation reduces pain after a laparoscopic colectomy. PMID:25785316

Postoperative opioid analgesia: time for a reconsideration?

DEFF Research Database (Denmark)

Kehlet, H; Rung, G W; Callesen, T

1996-01-01

Postoperative pain relief has improved in recent years with the development of new analgesics, additional routes of administration and the appearance of the hypothesis of preemptive as well as balanced analgesia (Kehlet H; Postoperative pain relief-what is the issue? Br J Anaesth 1994;72:375-8). ......Postoperative pain relief has improved in recent years with the development of new analgesics, additional routes of administration and the appearance of the hypothesis of preemptive as well as balanced analgesia (Kehlet H; Postoperative pain relief-what is the issue? Br J Anaesth 1994......;72:375-8). Many initial improvements simply involved the administration of opioid analgesics in new ways, such as continuous or on demand intravenous (i.v.) or epidural infusion. These methods allow lower total opioid dosages, provide a more stable concentration of opioid at the receptor and correspondingly...

Intravenous regional block is similar to sympathetic ganglion block for pain management in patients with complex regional pain syndrome type I

Directory of Open Access Journals (Sweden)

M.S.A. Nascimento

2010-12-01

Full Text Available Sympathetic ganglion block (SGB or intravenous regional block (IVRB has been recommended for pain management in patients with complex regional pain syndrome type I (CRPS-I. Forty-five patients were initially selected but only 43 were accepted for the study. The present study evaluated the efficacy of IVRB produced by combining 70 mg lidocaine with 30 µg clonidine (14 patients, 1 male/13 females, age range: 27-50 years versus SGB produced by the injection of 70 mg lidocaine alone (14 patients, 1 male/13 females, age range: 27-54 years or combined with 30 µg clonidine (15 patients, 1 male/14 females, age range: 25-50 years into the stellate ganglion for pain management in patients with upper extremity CRPS-I. Each procedure was repeated five times at 7-day intervals, and pain intensity and duration were measured using a visual analog scale immediately before each procedure. A progressive and significant reduction in pain scores and a significant increase in the duration of analgesia were observed in all groups following the first three blocks, but no further improvement was obtained following the last two blocks. Drowsiness, the most frequent side effect, and dry mouth occurred only in patients submitted to SGB with lidocaine combined with clonidine. The three methods were similar regarding changes in pain intensity and duration of analgesia. However, IVRB seems to be preferable to SGB due to its easier execution and lower risk of undesirable effects.

Infiltration with lidocaine and adrenaline instead of normal saline does not improve the septoplasty procedure.

Science.gov (United States)

Gungor, Volkan; Baklaci, Deniz; Kum, Rauf Oguzhan; Yilmaz, Yavuz Fuat; Ozcan, Muge; Unal, Adnan

2016-08-01

The aim of this study was to determine whether infiltration of local anesthetics with adrenaline improved septoplasty procedure when compared to normal saline. Eight-two patients undergoing septoplasty were randomized into two groups. In group 1, septal mucoperichondrium was infiltrated with lidocaine with adrenaline, and normal saline was used in group 2. Presence of intra-operative septal mucosal injuries, the amount of bleeding, arterial blood pressure, operation time as well as the quality of the surgical field and the convenience of finding the correct surgical plane as determined by the surgeon using a 5-point scale were compared between two groups. There were no significant differences for the amount of blood loss, mean arterial pressure, operation time, or scores for convenience of finding the correct surgical plane between the two groups. There was no significant difference for intra-operative simple (P = 0.631) and total (simple+severe) (P = 0.649) septal mucoperichondrial injuries between groups 1 and 2, either. However, severe mucoperichondrial injury rate was higher in the patients infiltrated with lidocaine and adrenaline (P = 0.026), and the quality of the surgical field was worse in the patients injected with normal saline (P = 0.0179). Infiltration of septal mucoperichondrium with lidocaine and adrenaline instead of normal saline was not advantageous in terms of objective parameters tested, including bleeding amount and duration of surgery as well as the of the total mucosal injury rate in septoplasty procedure.

Use of Lidocaine Patches for Neuropathic Pain in a Comprehensive Cancer Centre

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Julia Ann Fleming

2009-01-01

Full Text Available BACKGROUND: There are few reports of the use of the lidocaine 5% patch (L5%P for neuropathic pain (NP in the cancer patient. Within a comprehensive cancer centre, L5%P has been prescribed by the Pain and Palliative Care Service (Peter McCallum Cancer Centre, East Melbourne, Victoria, Australia for selected patients with NP since 2001.

Development of an ANN optimized mucoadhesive buccal tablet containing flurbiprofen and lidocaine for dental pain.

Science.gov (United States)

Hussain, Amjad; Syed, Muhammad Ali; Abbas, Nasir; Hanif, Sana; Arshad, Muhammad Sohail; Bukhari, Nadeem Irfan; Hussain, Khalid; Akhlaq, Muhammad; Ahmad, Zeeshan

2016-06-01

A novel mucoadhesive buccal tablet containing flurbiprofen (FLB) and lidocaine HCl (LID) was prepared to relieve dental pain. Tablet formulations (F1-F9) were prepared using variable quantities of mucoadhesive agents, hydroxypropyl methyl cellulose (HPMC) and sodium alginate (SA). The formulations were evaluated for their physicochemical properties, mucoadhesive strength and mucoadhesion time, swellability index and in vitro release of active agents. Release of both drugs depended on the relative ratio of HPMC:SA. However, mucoadhesive strength and mucoadhesion time were better in formulations, containing higher proportions of HPMC compared to SA. An artificial neural network (ANN) approach was applied to optimise formulations based on known effective parameters (i.e., mucoadhesive strength, mucoadhesion time and drug release), which proved valuable. This study indicates that an effective buccal tablet formulation of flurbiprofen and lidocaine can be prepared via an optimized ANN approach.

Effects of two newly synthesized analogues of lidocaine on rat arterial blood pressure and heart rate.

Science.gov (United States)

Al Rasheed, N M; Al Sayed, M I; Al Zuhair, H H; Al Obaid, A R; Fatani, A J

2001-04-01

Two new analogues of lidocaine were synthesized at the College of Pharmacy, King Saud University: compound I (Methyl-2-[2-(N,N-diethylamino) acetamido]-3-cyano-4,5-dimethylbenzoate) and compound II (Methyl-2-[2-(piperidino) acetamido]-3-cyano-4,5-dimethylbenzoate). Their influence on the arterial blood pressure and the heart rate of urethane-anaesthetized rats was studied and compared with the actions of lidocaine. Compounds I, II and lidocaine induced significant dose-dependent decreases in the arterial blood pressure and heart rate, which usually returned to basal values within 3-5 min. There were significant differences in the potency of the three compounds in producing their effects on blood pressure and heart rate (Plidocaine and compound I, respectively. The results of this study also indicated the ineffectiveness of antagonists of autonomic, histaminergic and 5-HT receptor, and various vasodilators in blocking the actions of the three compounds on blood pressure and heart rate. Pretreatment with CaCl(2)significantly reduced the hypotension and bradycardia induced by the three compounds, suggesting the involvement of calcium channels, probably of the L type. Several possible mechanisms are postulated. In conclusion, the results direct attention to the capability of the two new compounds to decrease blood pressure and heart rate; affects that may have clinical potential. Copyright 2001 Academic Press.

Subcostal transversus abdominis plane block can improve analgesia after laparoscopic cholecystectomy

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Vladimir Vrsajkov

Full Text Available Abstract Background and goal of study: After laparoscopic cholecystectomy, patients have moderate pain in the early postoperative period. Some studies shown beneficial effects of subcostal transversus abdominis plane block on reducing this pain. Our goal was to investigate influence of subcostal transversus abdominis plane block on postoperative pain scores and opioid consumption. Materials and methods: We have randomized 76 patients undergoing laparoscopic cholecystectomy to receive either subcostal transversus abdominis plane block (n = 38 or standard postoperative analgesia (n = 38. First group received bilateral ultrasound guided subcostal transversus abdominis plane block with 20 mL of 0.33% bupivacaine per side before operation and tramadol 1 mg.kg−1 IV for pain breakthrough (≥6. Second group received after operation tramadol 1 mg.kg−1/6 h as standard hospital analgesia protocol. Both groups received acetaminophen 1 g/8 h IV and metamizole 2.5 g/12 h. Pain at rest was recorded for each patient using NR scale (0–10 in period of 10 min, 30 min, 2 h, 4 h, 8 h, 12 h and 16 h after the surgery. Results and discussion: We obtained no difference between groups according age, weight, intraoperative fentanyl consumption and duration of surgery. Subcostal transversus abdominis plane block significantly reduced postoperative pain scores compared to standard analgesia in all periods after surgery. Tramadol consumption was significantly lower in the subcostal transversus abdominis plane (24.29 ± 47.54 g than in the standard analgesia group (270.2 ± 81.9 g (p = 0.000. Conclusion: Our results show that subcostal transversus abdominis plane block can provide superior postoperative analgesia and reduction in opioid requirements after laparoscopic cholecystectomy.

[Subcostal transversus abdominis plane block can improve analgesia after laparoscopic cholecystectomy].

Science.gov (United States)

Vrsajkov, Vladimir; Mančić, Nedjica; Mihajlović, Dunja; Milićević, Suzana Tonković; Uvelin, Arsen; Vrsajkov, Jelena Pantić

After laparoscopic cholecystectomy, patients have moderate pain in the early postoperative period. Some studies shown beneficial effects of subcostal transversus abdominis plane block on reducing this pain. Our goal was to investigate influence of subcostal transversus abdominis plane block on postoperative pain scores and opioid consumption. We have randomized 76 patients undergoing laparoscopic cholecystectomy to receive either subcostal transversus abdominis plane block (n=38) or standard postoperative analgesia (n=38). First group received bilateral ultrasound guided subcostal transversus abdominis plane block with 20mL of 0.33% bupivacaine per side before operation and tramadol 1mg.kg -1 IV for pain breakthrough (≥6). Second group received after operation tramadol 1mg.kg -1 /6h as standard hospital analgesia protocol. Both groups received acetaminophen 1g/8h IV and metamizole 2.5g/12h. Pain at rest was recorded for each patient using NR scale (0-10) in period of 10min, 30min, 2h, 4h, 8h, 12h and 16h after the surgery. We obtained no difference between groups according age, weight, intraoperative fentanyl consumption and duration of surgery. Subcostal transversus abdominis plane block significantly reduced postoperative pain scores compared to standard analgesia in all periods after surgery. Tramadol consumption was significantly lower in the subcostal transversus abdominis plane (24.29±47.54g) than in the standard analgesia group (270.2±81.9g) (p=0.000). Our results show that subcostal transversus abdominis plane block can provide superior postoperative analgesia and reduction in opioid requirements after laparoscopic cholecystectomy. Copyright © 2017 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

Epidural Analgesia Versus Patient-Controlled Analgesia for Pain Relief in Uterine Artery Embolization for Uterine Fibroids: A Decision Analysis

International Nuclear Information System (INIS)

Kooij, Sanne M. van der; Moolenaar, Lobke M.; Ankum, Willem M.; Reekers, Jim A.; Mol, Ben Willem J.; Hehenkamp, Wouter J. K.

2013-01-01

Purpose: This study was designed to compare the costs and effects of epidural analgesia (EDA) to those of patient-controlled intravenous analgesia (PCA) for postintervention pain relief in women having uterine artery embolization (UAE) for systematic uterine fibroids. Methods: Cost-effectiveness analysis (CEA) based on data from the literature by constructing a decision tree to model the clinical pathways for estimating the effects and costs of treatment with EDA and PCA. Literature on EDA for pain-relief after UAE was missing, and therefore, data on EDA for abdominal surgery were used. Outcome measures were compared costs to reduce one point in visual analogue score (VAS) or numeric rating scale (NRS) for pain 6 and 24 h after UAE and risk for complications. Results: Six hours after the intervention, the VAS was 3.56 when using PCA and 2.0 when using EDA. The costs for pain relief in women undergoing UAE with PCA and EDA were €191 and €355, respectively. The costs for EDA to reduce the VAS score 6 h after the intervention with one point compared with PCA were €105 and €179 after 24 h. The risk of having a complication was 2.45 times higher when using EDA. Conclusions: The results of this indirect comparison of EDA for abdominal surgery with PCA for UAE show that EDA would provide superior analgesia for post UAE pain at 6 and 24 h but with higher costs and an increased risk of complications

Juvéderm Volbella with Lidocaine for Lip and Perioral Enhancement: A Prospective, Randomized, Controlled Trial

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Hervé Raspaldo, MD

2015-03-01

Conclusions: Juvéderm Volbella with Lidocaine is effective for lip enhancement, improves perioral lines and oral commissures, and results in less short-term swelling and disruption in daily activities than Restylane-L.

Functional network architecture predicts psychologically mediated analgesia related to treatment in chronic knee pain patients.

Science.gov (United States)

Hashmi, Javeria Ali; Kong, Jian; Spaeth, Rosa; Khan, Sheraz; Kaptchuk, Ted J; Gollub, Randy L

2014-03-12

Placebo analgesia is an indicator of how efficiently the brain translates psychological signals conveyed by a treatment procedure into pain relief. It has been demonstrated that functional connectivity between distributed brain regions predicts placebo analgesia in chronic back pain patients. Greater network efficiency in baseline brain networks may allow better information transfer and facilitate adaptive physiological responses to psychological aspects of treatment. Here, we theorized that topological network alignments in resting state scans predict psychologically conditioned analgesic responses to acupuncture treatment in chronic knee osteoarthritis pain patients (n = 45). Analgesia was induced by building positive expectations toward acupuncture treatment with verbal suggestion and heat pain conditioning on a test site of the arm. This procedure induced significantly more analgesia after sham or real acupuncture on the test site than in a control site. The psychologically conditioned analgesia was invariant to sham versus real treatment. Efficiency of information transfer within local networks calculated with graph-theoretic measures (local efficiency and clustering coefficients) significantly predicted conditioned analgesia. Clustering coefficients in regions associated with memory, motivation, and pain modulation were closely involved in predicting analgesia. Moreover, women showed higher clustering coefficients and marginally greater pain reduction than men. Overall, analgesic response to placebo cues can be predicted from a priori resting state data by observing local network topology. Such low-cost synchronizations may represent preparatory resources that facilitate subsequent performance of brain circuits in responding to adaptive environmental cues. This suggests a potential utility of network measures in predicting placebo response for clinical use.

Can oxytocin augmentation modify the risk of epidural analgesia by maternal age in cesarean sections?

Science.gov (United States)

Rossen, Janne; Klungsøyr, Kari; Albrechtsen, Susanne; Løkkegård, Ellen; Rasmussen, Steen; Bergholt, Thomas; Skjeldestad, Finn E

2018-03-07

Maternal age is an established risk factor for cesarean section; epidural analgesia and oxytocin augmentation may modify this association. We investigated the effects and interactions of oxytocin augmentation, epidural analgesia and maternal age on the risk of cesarean section. In all, 416 386 nulliparous women with spontaneous onset of labor, ≥37 weeks of gestation and singleton infants with a cephalic presentation during 2000-2011 from Norway and Denmark were included [Ten-group classification system (Robson) group 1]. In this case-control study the main exposure was maternal age; epidural analgesia, oxytocin augmentation, birthweight and time period were explanatory variables. Chi-square test and logistic regression were used to estimate associations and interactions. The cesarean section rate increased consistently with advancing maternal age, both overall and in strata of epidural analgesia and oxytocin augmentation. We observed strong interactions between maternal age, oxytocin augmentation and epidural analgesia for the risk of cesarean section. Women with epidural analgesia generally had a reduced adjusted odds ratio when oxytocin was used compared with when it was not used. In Norway, this applied to all maternal age groups but in Denmark only for women ≥30 years. Among women without epidural, oxytocin augmentation was associated with an increased odds ratio for cesarean section in Denmark, whereas no difference was observed in Norway. Oxytocin augmentation in nulliparous women with epidural analgesia is associated with a reduced risk of cesarean section in labor with spontaneous onset. © 2018 Nordic Federation of Societies of Obstetrics and Gynecology.

The effect of lidocaine on neutrophil CD11b/CD18 and endothelial ICAM-1 expression and IL-1beta concentrations induced by hypoxia-reoxygenation.

LENUS (Irish Health Repository)

Lan, W

2012-02-03

BACKGROUND: Lidocaine has actions potentially of benefit during ischaemia-reperfusion. Neutrophils and endothelial cells have an important role in ischaemia-reperfusion injury. METHODS: Isolated human neutrophil CD11b and CD18, and human umbilical vein endothelial cell (HUVEC) ICAM-1 expression and supernatant IL-1beta concentrations in response to hypoxia-reoxygenation were studied in the presence or absence of different concentrations of lidocaine (0.005, 0.05 and 0.5 mg mL(-1)). Adhesion molecule expression was quantified by flow cytometry and IL- 1beta concentrations by ELISA. Differences were assessed with analysis of variance and Student-Newman-Keuls as appropriate. Data are presented as mean+\\/-SD. RESULTS: Exposure to hypoxia-reoxygenation increased neutrophil CD11b (94.33+\\/-40.65 vs. 34.32+\\/-6.83 mean channel fluorescence (MCF), P = 0.02), CD18 (109.84+\\/-35.44 vs. 59.05+\\/-6.71 MCF, P = 0.03) and endothelial ICAM-1 (146.62+\\/-16.78 vs. 47.29+\\/-9.85 MCF, P < 0.001) expression compared to normoxia. Neutrophil CD18 expression on exposure to hypoxia-reoxygenation was less in lidocaine (0.005 mg mL(-1)) treated cells compared to control (71.07+\\/-10.14 vs. 109.84+\\/-35.44 MCF, P = 0.03). Endothelial ICAM-1 expression on exposure to hypoxia-reoxygenation was less in lidocaine (0.005 mg mL(-1)) treated cells compared to control (133.25+\\/-16.05 vs. 146.62+\\/-16.78 MCF, P = 0.03). Hypoxia-reoxygenation increased HUVEC supernatant IL-1beta concentrations compared to normoxia (3.41+\\/-0.36 vs. 2.65+\\/-0.21 pg mL(-1), P = 0.02). Endothelial supernatant IL-1beta concentrations in lidocaine-treated HUVECs were similar to controls. CONCLUSIONS: Lidocaine at clinically relevant concentrations decreased neutrophil CD18 and endothelial ICAM-1 expression but not endothelial IL-1beta concentrations.

Unpredictability of regression of analgesia during the continuous postoperative extradural infusion of bupivacaine

DEFF Research Database (Denmark)

Mogensen, T; Hjortsø, N C; Bigler, D

1988-01-01

Twenty-four otherwise healthy patients scheduled for elective major abdominal surgery received general anaesthesia plus lumbar extradural analgesia. A loading dose of 0.5% plain bupivacaine was given to produce sensory analgesia (pin prick) from T4 to S5 and followed by a continuous infusion of 0...

The addition of lidocaine to bupivacaine does not shorten the duration of spinal anesthesia

DEFF Research Database (Denmark)

Jacobsen, Jon; Husum, Bent; Staffeldt, Henrik

2011-01-01

The duration of spinal anesthesia with bupivacaine is often too long for day surgery. A recent study of patients presenting for transurethral surgery suggested that the addition of a small amount of lidocaine to intrathecal hyperbaric bupivacaine could shorten the duration of the sensory and motor...

Early versus late initiation of epidural analgesia for labour.

Science.gov (United States)

Sng, Ban Leong; Leong, Wan Ling; Zeng, Yanzhi; Siddiqui, Fahad Javaid; Assam, Pryseley N; Lim, Yvonne; Chan, Edwin S Y; Sia, Alex T

2014-10-09

Pain during childbirth is arguably the most severe pain some women may experience in their lifetime. Epidural analgesia is an effective form of pain relief during labour. Many women have concerns regarding its safety. Furthermore, epidural services and anaesthetic support may not be available consistently across all centres. Observational data suggest that early initiation of epidural may be associated with an increased risk of caesarean section, but the same findings were not seen in recent randomised controlled trials. More recent guidelines suggest that in the absence of a medical contraindication, maternal request is a sufficient medical indication for pain relief during labour. The choice of analgesic technique, agent, and dosage is based on many factors, including patient preference, medical status, and contraindications. There is no systematically reviewed evidence on the maternal and foetal outcomes and safety of this practice. This systematic review aimed to summarise the effectiveness and safety of early initiation versus late initiation of epidural analgesia in women. We considered the obstetric and fetal outcomes relevant to women and side effects of the treatments, including risk of caesarean section, instrumental birth and time to birth. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (12 February 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 1), MEDLINE (January 1966 to February 2014), Embase (January 1980 to February 2014) and reference lists of retrieved studies. We included all randomised controlled trials involving women undergoing epidural labour analgesia that compared early initiation versus late initiation of epidural labour analgesia. Two review authors independently assessed trials for inclusion, extracted the data and assessed the trial quality. Data were checked for accuracy. We included nine studies with a total of 15,752 women.The overall risk of bias of

Subcostal transversus abdominis plane block can improve analgesia after laparoscopic cholecystectomy

Directory of Open Access Journals (Sweden)

Vladimir Vrsajkov

2018-03-01

Full Text Available Background and goal of study: After laparoscopic cholecystectomy, patients have moderate pain in the early postoperative period. Some studies shown beneficial effects of subcostal transversus abdominis plane block on reducing this pain. Our goal was to investigate influence of subcostal transversus abdominis plane block on postoperative pain scores and opioid consumption. Materials and methods: We have randomized 76 patients undergoing laparoscopic cholecystectomy to receive either subcostal transversus abdominis plane block (n = 38 or standard postoperative analgesia (n = 38. First group received bilateral ultrasound guided subcostal transversus abdominis plane block with 20 mL of 0.33% bupivacaine per side before operation and tramadol 1 mg.kg−1 IV for pain breakthrough (≥6. Second group received after operation tramadol 1 mg.kg−1/6 h as standard hospital analgesia protocol. Both groups received acetaminophen 1 g/8 h IV and metamizole 2.5 g/12 h. Pain at rest was recorded for each patient using NR scale (0–10 in period of 10 min, 30 min, 2 h, 4 h, 8 h, 12 h and 16 h after the surgery. Results and discussion: We obtained no difference between groups according age, weight, intraoperative fentanyl consumption and duration of surgery. Subcostal transversus abdominis plane block significantly reduced postoperative pain scores compared to standard analgesia in all periods after surgery. Tramadol consumption was significantly lower in the subcostal transversus abdominis plane (24.29 ± 47.54 g than in the standard analgesia group (270.2 ± 81.9 g (p = 0.000. Conclusion: Our results show that subcostal transversus abdominis plane block can provide superior postoperative analgesia and reduction in opioid requirements after laparoscopic cholecystectomy. Resumo: Justificativa e objetivo: Após a colecistectomia laparoscópica, os pacientes apresentam dor moderada no pós-operatório imediato. Alguns estudos mostraram

High-volume infiltration analgesia in bilateral hip arthroplasty

DEFF Research Database (Denmark)

Andersen, Lasse Ø; Otte, Niels Kristian Stahl; Husted, Henrik

2011-01-01

Background and purpose High-volume infiltration analgesia may be effective in postoperative pain management after hip arthroplasty but methodological problems prevent exact interpretation of previous studies. Methods In a randomized, double-blind placebo-controlled trial in 12 patients undergoing...... bilateral total hip arthroplasty (THA) in a fast-track setting, saline or high-volume (170 mL) ropivacaine (0.2%) with epinephrine (1:100,000) was administered to the wound intraoperatively along with supplementary postoperative injections via an intraarticular epidural catheter. Oral analgesia...... was instituted preoperatively with a multimodal regimen (gabapentin, celecoxib, and acetaminophen). Pain was assessed repeatedly for 48 hours postoperatively, at rest and with 45° hip flexion. Results Pain scores were low and similar between ropivacaine and saline administration. Median hospital stay was 4...

[Obstetric analgesia and anesthesia in Switzerland in 1999].

Science.gov (United States)

Zwetsch-Rast, G; Schneider, M C; Siegemund, M

2002-02-01

This survey investigated the common practice of obstetric analgesia and anaesthesia in Swiss hospitals and evaluated the influence of the Swiss interest group for obstetric anaesthesia. In March 1999 we submitted 145 questionnaires to all Swiss hospitals providing an obstetric service. The rate of epidural analgesia (EA) was higher in large hospitals (> 1,000 births/year) than in small services. EA was maintained by continuous infusion techniques in 53% of the responding hospitals. For elective caesarean section, spinal anaesthesia (SA) and EA were performed in 77% and 16% of the patients, respectively. General anaesthesia (5%) was only used in small hospitals (interest group for obstetric anaesthesia, as well as the expectations of pregnant women, increased the numbers of regional anaesthesia compared with the first survey in 1992.

Cytotoxic effects of local anesthesia through lidocaine/ropivacaine on human melanoma cell lines

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Ding-Kun Kang

Full Text Available Abstract Background: Local anesthetics (LAs are generally considered as safe, but cytotoxicity has been reported for several local anesthetics used in humans, which is not well investigated. In the present study, the cytotoxicity of lidocaine, ropivacaine and the combination of lidocaine and ropivacaine were evaluated on human melanoma cell lines. Melphalan, a nitrogen mustard alkylating agent, was used as a control agent for comparison of cytotoxic activity. Methods: Melanoma cell lines, A375 and Hs294T, were exposed to 1 h to different concentrations of above agents. Cell-viability after exposure was determined by flow cytometry. Results: Investigated LAs showed detrimental cytotoxicity on studied melanoma cell lines in time- (p < 0.001, concentration- (p < 0.001, and agent dependant. In both A375 and Hs294T cell lines, minimum cell viability rates were found after 72 h of exposure to these agents. Lidocaine 2% caused a reduction of vital cells to 10% ± 2% and 14% ± 2% in A375 and Hs294T, respectively after 72 h of exposure. Ropivacaine 0.75% after 72 h reduced viable cells to 15% ± 3% and 25% ± 3% in A375 and Hs294T, respectively. Minimum cell viability after 72 h exposure to the combination was 10% ± 2% and 18% ± 2% in A375 and Hs294T, respectively. Minimum cell viability after 72 h exposure to melphalan was 8% ± 1% and 12% ± 2%, in A375 and Hs294T, respectively. Conclusion: LAs have cytotoxic activity on human melanoma cell lines in a time-, concentration- and agent-dependant manner. Apoptosis in the cell lines was mediated through activity of caspases-3 and caspases-8.

Lidocaine and ropivacaine, but not bupivacaine, demethylate deoxyribonucleic acid in breast cancer cells in vitro

NARCIS (Netherlands)

Lirk, P.; Hollmann, M. W.; Fleischer, M.; Weber, N. C.; Fiegl, H.

2014-01-01

Lidocaine demethylates deoxyribonucleic acid (DNA) in breast cancer cells. This modification of epigenetic information may be of therapeutic relevance in the perioperative period, because a decrease in methylation can reactivate tumour suppressor genes and inhibit tumour growth. The objectives of

Mechanism of aromatic hydroxylation of lidocaine at a Pt electrode under acidic conditions

International Nuclear Information System (INIS)

Gul, Turan; Bischoff, Rainer; Permentier, Hjalmar P.

2017-01-01

Aromatic hydroxylation reactions, which are mainly catalyzed by cytochrome P450 (CYP) enzymes in vivo, are some of the most important reactions of Phase I metabolism, because insertion of a hydroxyl group into a lipophilic drug compound increases its hydrophilicity and prepares it for subsequent Phase II metabolic conjugation reactions as a prerequisite to excretion. Aromatic hydroxylation metabolites of pharmaceuticals may be obtained through various synthetic and enzymatic methods Electrochemical oxidation is an alternative with advantages in terms of mild reaction conditions and less hazardous chemicals. In the present study, we report that aromatic hydroxylation metabolites of lidocaine can be readily obtained electrochemically under aqueous acidic conditions at platinum electrodes. Our results show that the dominant N-dealkylation reaction can be suppressed by decreasing the solution pH below 0.5 resulting in selective 3-hydroxylidocaine, which is an in vivo metabolite of lidocaine. Experiments in 18 O labelled water indicated that water is the primary source of oxygen, while dissolved molecular oxygen contributes to a minor extent to the hydroxylation reaction.

Neonatal respiratory depression associated with epidural analgesia

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Alberto Gálvez Toro

2013-06-01

Full Text Available Background: Epidural analgesia is the most effective analgesics used during childbirth but is not without its problems.In the Hospital San Juan de la Cruz of Ubeda from November 2011 we have detected 3 cases of newborn infants with signs of respiratory depression. Appeared in them: normal cardiotocographic records during childbirth, use of epidural associated with fentanyl, termination by vacuum and elevated temperature in one case.ObjectivesKnow if the neonatal adaptation to extrauterine life may be influenced by the use of epidural analgesia in childbirth. Review what role can have the rise in maternal temperature and the use of epidural fentanyl with the appearance of newborn respiratory distress.MethodsLiterature Review conducted in February of 2012 in Pubmed and the Cochrane Library, using the key words: childbirth, epidural analgesia, neonatal respiratory depression.ResultsOn the respiratory depression associated with fentanyl, a Cochrane review found indicating that newborns of mothers with an epidural, had a lower pH and were less need for administration of naloxone.On PubMed we find a review study that indicates that the respiratory depression caused by the administration of opioids via neuroaxial is rare, placing it below 1 per 1000, and a clinical case that concluded that doses of fentanyl exceeding 300 µg (approx. 5 µg/kg for 4 hours previous to childbirth, have a high risk of neonatal respiratory depression at birth.The same Cochrane review indicates that the women with epidural analgesia had increased risk of maternal fever of at least 38 ° C and a recent cohort study relates this increase in temperature with a greater likelihood of neonatal adverse events (from 37.5 ° C.ConclusionsThe studies found considered safe epidurals to the neonate and the mother, except when certain conditions are met. The literature and our clinical experience have been reports linking neonatal respiratory depression with increasing temperature (37

Post-radiation analgesia at rats and function of endogenous opiates

International Nuclear Information System (INIS)

Slivkova, E.; Smajda, B.; Paulikova, E.; Lackova, M.

2002-01-01

In this work post-radiation analgesia at rats as well as the function of endogenous opiates were tested. Males of rats were irradiated all-body dose 6 Gy. Hot-plate test was used. Dose of 8 mg of naloxone per kg of animal blocked perception of ache. This dose blocked analgetic effect of ionising radiation. Activity of phagocyte activity and phagocyte index were enhanced at rats which obtained naloxone. Authors stated that opiate system play a significant role at analgesia induced by radiation at rats and can modify response of immunity system on the stress

Placebo analgesia: understanding the mechanisms

OpenAIRE

Medoff, Zev M; Colloca, Luana

2015-01-01

Expectations of pain relief drive placebo analgesia. Understanding how expectations of improvement trigger distinct biological systems to shape therapeutic analgesic outcomes has been the focus of recent pharmacologic and neuroimaging studies in the field of pain. Recent findings indicate that placebo effects can imitate the actions of real painkillers and promote the endogenous release of opioids and nonopioids in humans. Social support and observational learning also contribute to placebo a...

Analgesia peridural contínua: análise da eficácia, efeitos adversos e fatores de risco para ocorrência de complicações Analgesia peridural continua: análisis de la eficacia, efectos adversos y factores de riesgo para ocurrencia de complicaciones Continuous epidural analgesia: analysis of efficacy, side effects and risk factors

Directory of Open Access Journals (Sweden)

Leonardo Teixeira Domingues Duarte

2004-06-01

Full Text Available JUSTIFICATIVA E OBJETIVOS: A analgesia promovida pela infusão peridural de anestésico local com analgésicos opióides é reconhecidamente de boa qualidade e com poucos efeitos adversos. O objetivo deste estudo foi determinar o número, formas e gravidade das complicações pós-operatórias relacionadas à analgesia peridural e à inserção do cateter peridural. MÉTODO: Foram avaliados, retrospectivamente, 469 pacientes submetidos à analgesia peridural pós-operatória entre 18/10/1999 e 18/10/2001. A analgesia peridural foi conduzida usando-se solução de bupivacaína a 0,1% com fentanil (1 a 5 µg.ml-1, iniciando-se a infusão de 3 ml.h-1. A velocidade de infusão era ajustada de acordo com a queixa álgica do paciente. Foram analisadas as seguintes variáveis: a duração da infusão peridural; a ocorrência de efeitos adversos e complicações, relacionando-os aos dados demográficos, tipo de cirurgia e posição do cateter peridural; e a qualidade da analgesia obtida com a técnica (escala analógico-visual de dor e índice de satisfação do paciente. RESULTADOS: Os cateteres peridurais permaneceram implantados uma média de 2,2 dias, variando de 6 horas a 10 dias, e o índice global de complicações relacionadas à técnica foi de 46,3%, sendo que a maioria foi de pequena magnitude, sem repercussão clínica. Destas, 13,9% estavam relacionadas diretamente ao cateter peridural (desconexão, exteriorização, dor lombar, inflamação e infecção local. Outras complicações mais comumente encontradas foram vômitos e retenção urinária. A analgesia pós-operatória foi efetiva com 97,2% dos pacientes referindo satisfação com a técnica. Pacientes sem dor ou com dor leve, no primeiro, segundo e terceiro dias de pós-operatório, constituíram, respectivamente, 80,1%, 92,8% e 93,3% da população estudada. CONCLUSÕES: A analgesia peridural contínua é efetiva e segura. As complicações ocorridas não foram consideradas graves

Fentanyl supplement expedites the onset time of sensory and motor blocking in interscalene lidocaine anesthesia

Directory of Open Access Journals (Sweden)

RS Moharari

2010-12-01

Full Text Available Background and the purpose of the study: Opioids are usually used in regional anesthesia, with or without local anesthetics to improve the regional block or postoperative pain control. Since no data are available on fentanyl's effect on the onset time of lidocaine interscalene anesthesia, the purpose of this study was to examine its effect on the onset time of sensory and motor blockade during interscalene anesthesia.  Methods: In a prospective, randomized, double-blind study, ninety patients scheduled for elective shoulder, arm and forearm surgeries under an  interscalene brachial plexus block .They were randomly allocated to receive either 30 ml of  1.5 % lidocaine with 1.5 ml of isotonic saline  (control group, n = 39 or 30 ml of 1.5%  lidocaine with 1.5 ml (75µg of  fentanyl (fentanyl group,n=41. Then the onset time of sensory and motor blockades of the shoulder, arm and forearm were evaluated every 60 sec. The onset time of the sensory and motor blockades was defined as the time between the last injection and the total abolition of the pinprick response and complete paralysis. The duration of sensory blocks were considered as the time interval between the administration of the local anesthetic and the first postoperative pain sensation. Results: Ten patients were excluded because of unsuccessful blockade or unbearable pain during the surgery. The onset time of the sensory block was significantly faster in the fentanyl group (186.54± 62.71sec compared with the control group (289.51± 81.22, P < 0.01. The onset times of the motor block up to complete paralysis in forearm flexion was significantly faster in the fentanyl group (260.61± 119.91sec than the control group (367.08± 162.43sec, P < 0.01 There was no difference in the duration of the sensory block between two groups. Conclusion: Results of the study showed that the combination of 75 µg fentanyl and 1.5% lidocaine solution accelerated the onset of sensory and motor

Analgesia de parto: estudo comparativo entre anestesia combinada raquiperidural versus anestesia peridural contínua Analgesia de parto: estudio comparativo entre anestesia combinada raqui-peridural versus anestesia peridural continua Labor analgesia: a comparative study between combined spinal-epidural anesthesia versus continuous epidural anesthesia

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Carlos Alberto de Figueiredo Côrtes

2007-02-01

Full Text Available JUSTIFICATIVA E OBJETIVOS: O alívio da dor no trabalho de parto tem recebido atenção constante visando ao bem-estar materno, diminuindo o estresse causado pela dor e reduzindo as conseqüências deste sobre o concepto. Inúmeras técnicas podem ser utilizadas para analgesia de parto. Este trabalho teve como objetivo comparar a técnica peridural contínua com a combinada, ambas com o uso de bupivacaína a 0,25% em excesso enantiomérico 50% e fentanil como agentes. MÉTODO: Participaram do estudo 40 parturientes em trabalho de parto com dilatação cervical entre 4 e 5 cm que foram distribuídas em dois grupos iguais de forma aleatória. O Grupo I recebeu anestesia peridural contínua. O Grupo II recebeu anestesia combinada. Foram avaliados: medidas antropométricas, idade gestacional, dilatação cervical, tempo entre o bloqueio e a ausência de dor por meio da escala analógica visual, possibilidade de deambulação, tempo entre o início da analgesia e a dilatação cervical completa, duração do período expulsivo, parâmetros hemodinâmicos maternos e vitalidade do recém-nascido. Possíveis complicações, como depressão respiratória, hipotensão arterial materna, prurido, náuseas e vômitos, também foram observadas. Para a comparação das médias utilizou-se o teste t de Student e para a paridade e tipo de parto utilizou-se o teste do Qui-quadrado. RESULTADOS: Não houve diferença estatística significativa entre os dois grupos em relação ao tempo entre o início da analgesia e a dilatação cervical completa, bem como em relação ao tempo da duração do período expulsivo, incidência de cesariana relacionada com a analgesia, parâmetros hemodinâmicos maternos e vitalidade do recém-nascido. CONCLUSÕES: Ambas as técnicas se mostraram eficazes e seguras para a analgesia do trabalho de parto, embora a técnica combinada tenha proporcionado um rápido e imediato alívio da dor. Estudos clínicos com maior número de casos s

Development of an ANN optimized mucoadhesive buccal tablet containing flurbiprofen and lidocaine for dental pain

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Hussain Amjad

2016-06-01

Full Text Available A novel mucoadhesive buccal tablet containing flurbiprofen (FLB and lidocaine HCl (LID was prepared to relieve dental pain. Tablet formulations (F1-F9 were prepared using variable quantities of mucoadhesive agents, hydroxypropyl methyl cellulose (HPMC and sodium alginate (SA. The formulations were evaluated for their physicochemical properties, mucoadhesive strength and mucoadhesion time, swellability index and in vitro release of active agents. Release of both drugs depended on the relative ratio of HPMC:SA. However, mucoadhesive strength and mucoadhesion time were better in formulations, containing higher proportions of HPMC compared to SA. An artificial neural network (ANN approach was applied to optimise formulations based on known effective parameters (i.e., mucoadhesive strength, mucoadhesion time and drug release, which proved valuable. This study indicates that an effective buccal tablet formulation of flurbiprofen and lidocaine can be prepared via an optimized ANN approach.

Fetal effects of combined spinal-epidural vs epidural labour analgesia: a prospective, randomised double-blind study.

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Patel, N P; El-Wahab, N; Fernando, R; Wilson, S; Robson, S C; Columb, M O; Lyons, G R

2014-05-01

We have compared fetal heart rate patterns, Apgar scores and umbilical cord gas values following initiation of labour analgesia using either combined spinal-epidural or epidural. One hundred and fifteen healthy women requesting neuraxial analgesia in the first stage of labour were randomly assigned to receive either combined spinal-epidural (n = 62) or epidural analgesia (n = 53). Fetal heart rate traces, recorded for 30 min before and 60 min after neuraxial block, were categorised as normal, suspicious or pathological according to national guidelines. Sixty-one fetal heart rate tracings were analysed in the combined spinal-epidural group and 52 in the epidural group. No significant differences were found in fetal heart rate patterns, Apgar scores or umbilical artery and vein acid-base status between groups. However, in both combined spinal-epidural and epidural groups, there was a significant increase in the incidence of abnormal fetal heart rate patterns following neuraxial analgesia (p analgesia in the combined spinal-epidural group and zero before compared with 11 after in the epidural group. These changes comprised increased decelerations (p = 0.0045) (combined spinal-epidural group nine before and 14 after analgesia, epidural group four before and 16 after), increased late decelerations (p analgesia, epidural group zero before and eight after), and a reduction in acceleration rate (p = 0.034) (combined spinal-epidural group mean (SD) 12.2 (6.7) h(-1) before and 9.9 (6.1) h(-1) after analgesia, epidural group 11.0 (7.3) h(-1) before and 8.4 (5.9) h(-1) after). These fetal heart rate changes did not affect neonatal outcome in this healthy population. © 2014 The Association of Anaesthetists of Great Britain and Ireland.

Effect of postoperative epidural analgesia on rehabilitation and pain after hip fracture surgery

DEFF Research Database (Denmark)

Foss, Nicolai Bang; Kristensen, Morten Tange; Kristensen, Billy Bjarne

2005-01-01

Hip fracture surgery usually carries a high demand for rehabilitation and a significant risk of perioperative morbidity and mortality. Postoperative epidural analgesia may reduce morbidity and has been shown to facilitate rehabilitation in elective orthopedic procedures. No studies exist...... on the effect of postoperative epidural analgesia on pain and rehabilitation after hip fracture surgery....

Transretroperitoneal CT-guided Embolization of Growing Internal Iliac Artery Aneurysm after Repair of Abdominal Aortic Aneurysm: A Transretroperitoneal Approach with Intramuscular Lidocaine Injection Technique

Energy Technology Data Exchange (ETDEWEB)

Park, Joon Young, E-mail: pjy1331@hanmail.net; Kim, Shin Jung, E-mail: witdd2@hanmail.net; Kim, Hyoung Ook, E-mail: chaos821209@hanmail.net [Chonnam National University Hospital, Department of Radiology (Korea, Republic of); Kim, Yong Tae, E-mail: mono-111@hanmail.net [Chonnam National University Hwasun Hospital, Department of Radiology (Korea, Republic of); Lim, Nam Yeol, E-mail: apleseed@hanmail.net; Kim, Jae Kyu, E-mail: kjkrad@jnu.ac.kr [Chonnam National University Hospital, Department of Radiology (Korea, Republic of); Chung, Sang Young, E-mail: sycpvts@jnu.ac.kr; Choi, Soo Jin Na, E-mail: choisjn@jnu.ac.kr; Lee, Ho Kyun, E-mail: mhaha@hanmail.net [Chonnam National University Hospital, Department of Surgery (Korea, Republic of)

2015-02-15

This study was designed to evaluate the efficacy and safety of CT-guided embolization of internal iliac artery aneurysm (IIAA) after repair of abdominal aortic aneurysm by transretroperitoneal approach using the lidocaine injection technique to iliacus muscle, making window for safe needle path for three patients for whom CT-guided embolization of IIAA was performed by transretroperitoneal approach with intramuscular lidocaine injection technique. Transretroperitoneal access to the IIAA was successful in all three patients. In all three patients, the IIAA was first embolized using microcoils. The aneurysmal sac was then embolized with glue and coils without complication. With a mean follow-up of 7 months, the volume of the IIAAs remained stable without residual endoleaks. Transretroperitoneal CT-guided embolization of IIAA using intramuscular lidocaine injection technique is effective, safe, and results in good outcome.

ELA-max: A new topical lidocaine formulation.

Science.gov (United States)

Goldman, Ran D

2004-05-01

To evaluate the role of a new formulation of lidocaine (ELA-max) in local anesthesia in children and compare it with the eutectic mixture of local anesthetics (EMLA). Relevant literature was identified by a MEDLINE search (1966-November 2003) using the search terms ELA-max and EMLA. Bibliographies of selected articles were also examined to include all relevant investigations. The product manufacturer was contacted for inclusion of the most recent data available. Topical anesthesia in children is clinically challenging. ELA-max has been shown to be as effective as EMLA for venipuncture in children, but with faster onset. Adverse effects, such as transient blanching with redness and erythema, have been reported. Further investigation is needed to determine the effectiveness of ELA-max on other painful procedures in children, as well as its safety.

Epidural Analgesia Versus Patient-Controlled Analgesia for Pain Relief in Uterine Artery Embolization for Uterine Fibroids: A Decision Analysis

Energy Technology Data Exchange (ETDEWEB)

Kooij, Sanne M. van der, E-mail: s.m.vanderkooij@amc.uva.nl; Moolenaar, Lobke M.; Ankum, Willem M. [Academic Medical Centre, Department of Gynaecology (Netherlands); Reekers, Jim A. [Academic Medical Centre, Department of Radiology (Netherlands); Mol, Ben Willem J. [Academic Medical Centre, Department of Gynaecology (Netherlands); Hehenkamp, Wouter J. K. [VU University Medical Centre, Department of Gynaecology (Netherlands)

2013-12-15

Purpose: This study was designed to compare the costs and effects of epidural analgesia (EDA) to those of patient-controlled intravenous analgesia (PCA) for postintervention pain relief in women having uterine artery embolization (UAE) for systematic uterine fibroids. Methods: Cost-effectiveness analysis (CEA) based on data from the literature by constructing a decision tree to model the clinical pathways for estimating the effects and costs of treatment with EDA and PCA. Literature on EDA for pain-relief after UAE was missing, and therefore, data on EDA for abdominal surgery were used. Outcome measures were compared costs to reduce one point in visual analogue score (VAS) or numeric rating scale (NRS) for pain 6 and 24 h after UAE and risk for complications. Results: Six hours after the intervention, the VAS was 3.56 when using PCA and 2.0 when using EDA. The costs for pain relief in women undergoing UAE with PCA and EDA were Euro-Sign 191 and Euro-Sign 355, respectively. The costs for EDA to reduce the VAS score 6 h after the intervention with one point compared with PCA were Euro-Sign 105 and Euro-Sign 179 after 24 h. The risk of having a complication was 2.45 times higher when using EDA. Conclusions: The results of this indirect comparison of EDA for abdominal surgery with PCA for UAE show that EDA would provide superior analgesia for post UAE pain at 6 and 24 h but with higher costs and an increased risk of complications.

The Efficacy of Buccal Infiltration of 4% Articaine and PSA Injection of 2% Lidocaine on Anesthesia of Maxillary Second Molars.

Science.gov (United States)

Maljaei, Ensiyeh; Pourkazemi, Maryam; Ghanizadeh, Milad; Ranjbar, Rana

2017-01-01

During the early mixed dentition period, the location of the deciduous maxillary second molar results in ineffectiveness of the infiltration technique in this area. In such cases, administration of posterior superior alveolar (PSA) nerve block is recommended; however, such a technique has some complications. The present study was undertaken to compare the effects of buccal infiltration of 4% Articaine and PSA technique with 2% Lidocaine on the success of anesthesia of maxillary deciduous second molars in 6 to 9-year old children. In the present double-blind randomized clinical trial, 56 children aged 6-9 years requiring vital pulp therapy of deciduous maxillary second molar were included. In group 1, 4% Articaine was injected using a buccal infiltration technique. In group 2, 2% Lidocaine was injected using the PSA nerve block technique. After 10 min, the caries was removed and access cavity preparation was instituted. The patients were asked to report the presence or absence of pain during the procedure. Therefore, the existence of pain was measured by the patient's self-report. Data were analyzed with descriptive statistical methods and the chi -squared test. Pain was reported by 6 (21.4%) and 9 (32.1%) subjects in the Articaine and Lidocaine groups, respectively. Chi -squared test did not reveal any significant differences between the two groups ( P =0.54). Under the limitations of the present study, there was no significant differences between the results of Articaine buccal infiltration and Lidocaine PSA technique, so Articaine buccal infiltration can be used as a substitute for the PSA technique.

Comparison of ropivacaine (0.2%) with or without clonidine 1 μg/kg for epidural labor analgesia: A randomized controlled study

OpenAIRE

Indira Kumari; Kapil Sharma; Vikram Bedi; Madhan Mohan; Hemraj Tungaria; Manish Kumar Modi

2018-01-01

Background and Aims: The aim is to determine the effect of addition of clonidine to ropivacaine for epidural labor analgesia with regard to onset of analgesia, duration of analgesia, neonatal outcome, and quality of analgesia. Material and Methods: A total of 60 term parturients of the American Society of Anesthesiologists Grade I and II with uncomplicated pregnancy, vertex presentation, posted for on-demand epidural labor analgesia after informed consent were divided in two groups. Group ...

Intrapartum analgesia as a condition of human satisfaction at hospital

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Concetta Polizzi

2013-06-01

Full Text Available The study investigates parturients’ satisfaction with intrapartum analgesia. It aims to assess their opinions about hospital and health staff involved in delivery, besides investigating emotional control, locus control and bond between mothers and their newborn infants. A multidimensional approach has been used to investigate the variable of woman as a person, the variable of context and the variable of bond with the newborn infant. The study was conducted according to a quasi-experimental design, with a control group. The study was performed within the Analgesia and Intensive Care Operational Unit of the Maternal-Infant Department of the P. Giaccone University General Hospital of Palermo. It involved 60 women subdivided into two groups of 30 women each, the experimental group (women who requested intrapartum analgesia called the A group, and the control group (women who refused it called the B group. The following tools were administered: the STAI-Y (State-Trait Anxiety Inventory, form Y scale; the Depression Questionnaire of CBA (Cognitive Behavioural Assessment scale; the Locus of Control questionnaire; and an interview designed for the purpose. The experimental A group women exhibited lower levels of state anxiety and depression post-partum than those of the control B group; moreover, the women in the A group exhibited higher levels of external locus of control and evaluated delivery more positively than those of the B group. There were no significant differences with regard to the relationship with their newborn infants. The study shows that intrapartum analgesia provides hospitals with the possibility to satisfy women’s needs for safety and well-being.

The stability and microbial contamination of bupivacaine, lidocaine and mepivacaine used for lameness diagnostics in horses

DEFF Research Database (Denmark)

Adler, D. M. T.; Cornett, C.; Damborg, P.

2016-01-01

Local anaesthetics (LAs) are frequently used for diagnostic procedures in equine veterinary practice. The objective of this study was to investigate the physico-chemical stability and bacterial contamination of bupivacaine, lidocaine and mepivacaine used for lameness examinations in horses. The LAs...... serially in both new and repeatedly punctured (RP) vials. Mepivacaine remained chemically stable. A 1.9% increase in bupivacaine concentration was evident in one group, whereas a 1.9–3.7% decrease was noted in six groups. Risk factors associated with a change in concentration were light and RP vials...... in practice vehicles were risk factors for degradation. No contamination was present in any of the LAs and pH remained stable. Commercially available solutions of lidocaine, mepivacaine and bupivacaine stored under common veterinary field conditions are extremely stable and sterile for extended periods...

Does the combination of 3% mepivacaine plain plus 2% lidocaine with epinephrine improve anesthesia and reduce the pain of anesthetic injection for the inferior alveolar nerve block? A prospective, randomized, double-blind study.

Science.gov (United States)

Lammers, Emily; Nusstein, John; Reader, Al; Drum, Melissa; Beck, Mike; Fowler, Sara

2014-09-01

In theory, using 3% mepivacaine initially for an inferior alveolar nerve (IAN) block would decrease the pain of injection, provide faster onset, and increase anesthetic success. The purpose of this prospective, randomized, double-blind study was to compare the degree of pulpal anesthesia obtained with a combination of 3% mepivacaine/2% lidocaine (1:100,000 epinephrine) versus a combination of 2% lidocaine (1:100,000 epinephrine)/2% lidocaine (1:100,000 epinephrine) in IAN blocks. Injection pain was also studied. One hundred asymptomatic subjects were randomly given a combination of a 1-cartridge volume of 3% mepivacaine plus a 1-cartridge volume of 2% lidocaine with 1:100,000 epinephrine and a combination of a 1-cartridge volume of 2% lidocaine with 1:100,000 epinephrine plus a 1-cartridge volume of 2% lidocaine with 1:100,000 epinephrine for the IAN block at 2 separate appointments. Subjects rated the pain of injection. The molars, premolars, and incisors were tested with an electric pulp tester in 4-minute cycles for 60 minutes. Anesthetic success was defined as the subject achieving 2 consecutive 80 readings within 15 minutes after completion of the IAN blocks and sustaining the 80 reading for 60 minutes. Success was not significantly different (P > .05) between the 2 combinations. No statistical differences in injection pain or onset times were found. The combination of 3% mepivacaine plus 2% lidocaine with 1:100,000 epinephrine was equivalent to the combination of 2 cartridges of 2% lidocaine with 1:100,000 epinephrine in terms of injection pain, onset time, and pulpal anesthetic success for the IAN block. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

How first time mothers experience the use of epidural analgesia

DEFF Research Database (Denmark)

Jepsen, Ingrid

2010-01-01

How first time mothers experience the use of epidural analgesia during birth Ingrid Jepsen, Midwife, SD, MPH, Kurt Dauer Keller cand.psych, PhD Contact email irj@ucn.dk Aim: to investigate the experiences of epidural analgesia as to the choice of epidurals, the changes in pain, the period from...... and two months later. The midwives were interviewed two hours after the birth. Method of analysis: The “Idealtype-” method, the “importance-” method and the “process-” method described by Bo Eneroth. Results: Two ideal-types were discovered: the worried and the unworried mother. Important and common...

Analgesia de parto em paciente com tetralogia de Fallot não corrigida: relato de caso Analgesia de parto en paciente con tetralogía de Fallot no corregida: relato de caso Labour analgesia in parturient with uncorrected tetralogy of Fallot: case report

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Florentino Fernandes Mendes

2005-02-01

Full Text Available JUSTIFICATIVA E OBJETIVOS: Embora a tetralogia de Fallot seja a mais comum das cardiopatias congênitas cianóticas, as publicações nacionais, relacionando essa doença com a prática anestésica são escassas. O objetivo deste relato é apresentar um caso de analgesia de parto em paciente portadora de tetralogia de Fallot não corrigida e diagnosticada durante a gestação. RELATO DO CASO: Paciente com 26 anos, 56 kg, 1,56 m, idade gestacional 32 semanas e 5 dias, com diagnóstico de tetralogia de Fallot realizado durante a gestação. Internou em trabalho de parto. A conduta obstétrica foi a de parto via baixa, sendo realizada analgesia através de bloqueio peridural com bupivacaína a 0,125% e fentanil (100 µg e colocação de cateter peridural. Após 1h30 minutos do início da analgesia, ocorreu o nascimento. O peso do recém-nascido foi 1485 g e o índice de Apgar 6 e 8 no primeiro e no quinto minutos, respectivamente. A paciente permaneceu estável e sem alterações hemodinâmicas e/ou eletrocardiográficas. CONCLUSÕES: A escolha da técnica anestésica é de fundamental importância no manuseio das pacientes com tetralogia de Fallot não corrigidas. Condições favoráveis do colo e boa dinâmica uterina, particularmente naquelas pacientes sem história de síncope, tornam-se imprescindíveis para uma boa indicação da analgesia de parto.JUSTIFICATIVA Y OBJETIVOS: Aunque la tetralogía de Fallot sea la más común de las cardiopatías congénitas cianóticas, las publicaciones nacionales, relacionando esa enfermedad con la práctica anestésica son escasas. El objetivo de este relato es presentar un caso de analgesia de parto en paciente portadora de tetralogía de Fallot no corregida y diagnosticada durante la gestación. RELATO DEL CASO: Paciente con 26 años, 56 kg, 1,56 m, edad gestacional 32 semanas y 5 días, con diagnóstico de tetralogía de Fallot realizado durante la gestación. Internó en trabajo de parto. La conducta

Hospitalization for partial nephrectomy was not associated with intrathecal opioid analgesia: Retrospective analysis.

Science.gov (United States)

Weingarten, Toby N; Del Mundo, Serena B; Yeoh, Tze Yeng; Scavonetto, Federica; Leibovich, Bradley C; Sprung, Juraj

2014-10-01

The aim of this retrospective study is to test the hypothesis that the use of spinal analgesia shortens the length of hospital stay after partial nephrectomy. We reviewed all patients undergoing partial nephrectomy for malignancy through flank incision between January 1, 2008, and June 30, 2011. We excluded patients who underwent tumor thrombectomy, used sustained-release opioids, or had general anesthesia supplemented by epidural analgesia. Patients were grouped into "spinal" (intrathecal opioid injection for postoperative analgesia) versus "general anesthetic" group, and "early" discharge group (within 3 postoperative days) versus "late" group. Association between demographics, patient physical status, anesthetic techniques, and surgical complexity and hospital stay were analyzed using multivariable logistic regression analysis. Of 380 patients, 158 (41.6%) were discharged "early" and 151 (39.7%) were "spinal" cases. Both spinal and early discharge groups had better postoperative pain control and used less postoperative systemic opioids. Spinal analgesia was associated with early hospital discharge, odds ratio 1.52, (95% confidence interval 1.00-2.30), P = 0.05, but in adjusted analysis was no longer associated with early discharge, 1.16 (0.73-1.86), P = 0.52. Early discharge was associated with calendar year, with more recent years being associated with early discharge. Spinal analgesia combined with general anesthesia was associated with improved postoperative pain control during the 1(st) postoperative day, but not with shorter hospital stay following partial nephrectomy. Therefore, unaccounted practice changes that occurred during more recent times affected hospital stay.

Immediate reaction to lidocaine with periorbital edema during upper blepharoplasty

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Benjamin Presman

2016-01-01

Conclusion: In clinical practice, we recommend that patient should be informed about the possibility of recurrence of an adverse reaction in case of re-exposure to lidocaine, even in the vast majority of cases where true allergy could not be proven. In case of further need for local anesthesia with history of an adverse event, a different agent may be chosen even from the same class (another amide as cross-reactions in the amide group are rare. Otherwise, an anesthetic from the ester group can also be safely used.

A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty

DEFF Research Database (Denmark)

Andersen, Karen Vestergaard; Bak, Marie; Christensen, Birgitte Viebæk

2010-01-01

There have been few studies describing wound infiltration with additional intraarticular administration of multimodal analgesia for total knee arthroplasty (TKA). In this study, we assessed the efficacy of wound infiltration combined with intraarticular regional analgesia with epidural infusion...

Analgesia after total hip replacement: epidural versus psoas ...

African Journals Online (AJOL)

tive analgesia following total hip replacement surgery. The research design was a ... matoma, intra-abdominal injury and pain due to spasm of the lumbar paravertebral ..... 2. Brown DL. Spinal, epidural, and caudal anesthesia In: Miller RD, ed.

Comparative Analysis of Different Types of Analgesia in Patients after Surgical Correction of Scoliotic Spinal Deformity

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M.A. Georgiyants

2013-03-01

Full Text Available A comparative study of epidural analgesia and anesthesia using opiates after surgical interventions for spinal scoliosis in children has beem carried out. Patients were divided into 2 groups. In the first one postoperative analgesia was carried out by intramuscular injection of promedol, in second one epidural analgesia was used with the constant introduction of ropivacaine. The authors studied the effect of these techniques on hemodynamics, the analysis of the subjective perception of pain by patients.

Intrapleural analgesia after endoscopic thoracic sympathectomy Analgesia intrapleural após simpatectomia videotoracoscópica

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Patrícia Gomes da Silva

2011-12-01

Full Text Available PURPOSE: To compare analgesia traditionally used for thoracic sympathectomy to intrapleural ropivacaine injection in two different doses. METHODS: Twenty-four patients were divided into three similar groups, and all of them received intravenous dipyrone. Group A received intravenous tramadol and intrapleural injection of saline solution. Group B received intrapleural injection of 0.33% ropivacaine, and Group C 0.5% ropivacaine. The following aspects were analyzed: inspiratory capacity, respiratory rate and pain. Pain was evaluated in the immediate postoperative period by means of the visual analog scale and over a one-week period. RESULTS: In Groups A and B, reduced inspiratory capacity was observed in the postoperative period. In the first postoperative 12 hours, only 12.5% of the patients in Groups B and C showed intense pain as compared to 25% in Group A. In the subsequent week, only one patient in Group A showed mild pain while the remainder reported intense pain. In Group B, half of the patients showed intense pain, and in Group C, only one presented intense pain. CONCLUSION: Intrapleural analgesia with ropivacaine resulted in less pain in the late postoperative period with better analgesic outcomes in higher doses, providing a better ventilatory pattern.OBJETIVO: Comparar a analgesia tradicionalmente utilizada para simpatectomia videotoracoscópica à injeção intrapleural de ropivacaína em duas doses diferentes. MÉTODOS: Vinte e quatro pacientes foram distribuídos em três grupos semelhantes, e todos eles receberam dipirona endovenosa. O grupo A recebeu tramadol endovenoso e injeção intrapleural de solução salina. O grupo B recebeu injeção intrapleural de ropivacaína a 0,33%, e Grupo C ropivacaína a 0,5%. Os aspectos analisados foram: capacidade inspiratória, freqüência respiratória e dor. A dor foi avaliada no período pós-operatório por meio da escala visual analógica e durante o período de uma semana. RESULTADOS

Modafinil reduces patient-reported tiredness after sedation/analgesia but does not improve patient psychomotor skills.

NARCIS (Netherlands)

Galvin, E.; Boesjes, H.; Hol, J.; Ubben, J.F.; Klein-Nulend, J.; Verbrugge, S.J.

2010-01-01

BACKGROUND: Early recovery of patients following sedation/analgesia and anesthesia is important in ambulatory practice. The aim of this study was to assess whether modafinil, used for the treatment of narcolepsy, improves recovery following sedation/analgesia. METHODS: Patients scheduled for

Comparison of analgesic efficacy of four-quadrant transversus abdominis plane (TAP) block and continuous posterior TAP analgesia with epidural analgesia in patients undergoing laparoscopic colorectal surgery: an open-label, randomised, non-inferiority trial.

Science.gov (United States)

Niraj, G; Kelkar, A; Hart, E; Horst, C; Malik, D; Yeow, C; Singh, B; Chaudhri, S

2014-04-01

Posterior transversus abdominis plane blocks have been reported to be an effective method of providing analgesia after lower abdominal surgery. We compared the efficacy of a novel technique of providing continuous transversus abdominis plane analgesia with epidural analgesia in patients on an enhanced recovery programme following laparoscopic colorectal surgery. A non-inferiority comparison was used. Adult patients undergoing elective laparoscopic colorectal surgery were randomly assigned to receive continuous transversus abdominis plane analgesia (n = 35) vs epidural analgesia (n = 35), in addition to a postoperative analgesic regimen comprising regular paracetamol, regular diclofenac and tramadol as required. Sixty-one patients completed the study. The transversus group received four-quadrant transversus abdominis plane blocks and bilateral posterior transversus abdominis plane catheters that were infused with levobupivacaine 0.25% for 48 h. The epidural group received an infusion of bupivacaine and fentanyl. The primary outcome measure was visual analogue scale pain score on coughing at 24 h after surgery. We found no significant difference in median (IQR [range]) visual analogue scores during coughing at 24 h between the transversus group 2.5 (1.0-3.0 [0-5.5]) and the epidural group 2.5 (1.0-5.0 [0-6.0]). The one-sided 97.5% CI was a 0.0 (∞-1.0) difference in means, establishing non-inferiority. There were no significant differences between the groups for tramadol consumption. Success rate was 28/30 (93%) in the transversus group vs 27/31 (87%) in the epidural group. Continuous transversus abdominis plane infusion was non-inferior to epidural infusion in providing analgesia after laparoscopic colorectal surgery. © 2013 The Association of Anaesthetists of Great Britain and Ireland.

Analgesia peridural para o trabalho de parto e para o parto: efeitos da adição de um opióide Effects of the association of an opioid with epidural analgesia for labor and delivery

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José Guilherme Cecatti

1998-07-01

Full Text Available O objetivo deste estudo foi avaliar a eficácia e segurança da associação bupivacaína com sufentanil para a analgesia no trabalho de parto e do parto por meio de um bloqueio peridural contínuo. Realizou-se um ensaio clínico duplo-cego, prospectivo e aleatório, incluindo sessenta mulheres nulíparas da Maternidade do CAISM/UNICAMP. No momento da analgesia, as mulheres foram aleatoriamente alocadas em dois grupos: BS, recebendo 12,5 mg de bupivacaína com adrenalina mais 30 µg de sufentanil e BP, recebendo 12,5 mg de bupivacaína com adrenalina mais placebo. Foram avaliados os parâmetros relativos à qualidade e duração da analgesia, duração do trabalho de parto e também possíveis efeitos sobre o recém-nascido. Os resultados mostraram a superioridade da adição do sufentanil sobre o grau de analgesia durante o tempo de ação da primeira dose de anestésico local. Não houve aumento na duração do trabalho de parto depois do início da analgesia quando se compararam ambos os grupos, nem qualquer diferença quanto à via de parto. Não houve também diferenças entre os grupos com relação à avaliação dos recém-nascidos. Conclui-se que a associação de 30 µg de sufentanil à primeira dose de bupivacaína é segura e eficaz, melhorando a qualidade da analgesia, sua duração e não afetando a progressão do trabalho de parto e o resultado neonatal.The purpose of the present study was to evaluate the efficacy and safety of the association bupivacaine with sufentanil for labor and delivery analgesia through a continuous epidural blockade, for both mother and the neonate. A randomized double blind prospective clinical trial was performed including sixty nulliparous women at the Maternity of CAISM/UNICAMP. When requesting analgesia, the women were randomly allocated to two groups: BS, receiving 12.5 mg of bupivacaine with adrenaline plus 30 µg of sufentanil and BP, receiving 12.5 mg of bupivacaine with adrenaline plus placebo

Autoradiographic visualization on the role of central 3H-5-hydroxytryptamine in acupuncture analgesia

International Nuclear Information System (INIS)

Zhu Shoupeng; Shi Fuxi; Liu Zhonghao; Jiang Ji

1990-10-01

The role played by central 5-hydroxytryptamine (5-HT) in electroacupuncture analgesia has been studied in rats by means of autoradiography with isotopic tracers 3 H-5-HT. The purpose of the study is to determine the localization of 3 H-5-HT in the midbrain raphe nuclei and in the mesencephalon aquaeduct as well as periaquaeductal gray matter. Parallel experiments were studied by freezing microautoradiographic method and histo-fixative microautoradiographic method. The analgesic effect of acupuncture can be enhanced or lowered by the increment or the decrement of the 5-HT level in the midbrain raphe nuclei and in the mesencephalon aquaeduct as well as periaquaeductal gray matter. The results show that when the rats were subjected to electro-acupuncture analgesia, the microautoradiographic intensities of 3 H-5-HT both in the midbrain raphe nuclei and in the areas of mesencephalon aqueduct were significantly increased. It may be observed that the release of 5-HT in these regions of the brain is accelerated during acupuncture analgesia. From this it can be concluded that the midbrain raphe nuclei and the mesencephalon aquaeduct as well as the periaquaeductal gray matter are closely related to acupuncture analgesia. The results imply that 5-HT in these areas may be one of the most important neurochemical agents mediating acupuncture analgesia

Mechanochemical Synthesis and Crystal Structure of the Lidocaine-Phloroglucinol Hydrate 1:1:1 Complex

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Nancy Evelyn Magaña-Vergara

2018-03-01

Full Text Available Molecular complexation is a strategy used to modify the physicochemical or biopharmaceutical properties of an active pharmaceutical ingredient. Solvent assisted grinding is a common method used to obtain solid complexes in the form of cocrystals. Lidocaine is a drug used as an anesthetic and for the treatment of chronic pain, which bears in its chemical structure an amide functional group able to form hydrogen bonds. Polyphenols are used as cocrystal coformers due to their ability to form O–H···X (X = O, N hydrogen bond interactions. The objective of this study was to exploit the ability of phloroglucinol to form molecular complexes with lidocaine by liquid assisted grinding. The formation of the complex was confirmed by the shift of the O–H and C=O stretching bands in the IR spectra of the polycrystalline ground powders, suggesting the formation of O–H···O=C hydrogen bonds. Hydration of the complexes also was confirmed by IR spectroscopy and by powder X-ray diffraction. The molecular structure was determined by single crystal X-ray diffraction.

Thalamic VPM nucleus in the behaving monkey. III. Effects of reversible inactivation by lidocaine on thermal and mechanical discrimination.

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Duncan, G H; Bushnell, M C; Oliveras, J L; Bastrash, N; Tremblay, N

1993-11-01

1. The present study evaluates the necessity of the ventroposterior medial thalamic nucleus (VPM) for discrimination of the intensity of noxious heating, innocuous cooling, and innocuous tactile (airpuff) stimulation of the maxillary skin. 2. Two rhesus monkeys were trained to detect small differences (Lidocaine hydrochloride (2%) was microinjected into regions of thalamus where single-unit recordings had identified neuronal responses to the noxious heating and/or cooling stimuli. The effectiveness of the anesthetic blockade was monitored by multiunit recordings using microelectrodes positioned 1-3 mm from the orifice of the injection cannula. The monkey's ability to detect near-threshold changes in stimulus intensity was compared before and after each injection. 3. During six experimental sessions, single injections of 1-4 microliters lidocaine near the dorsomedial border of VPM did not significantly alter the monkey's ability to detect small changes in the intensity of noxious heat, cool, airpuff, or visual stimuli despite neurophysiological evidence that spontaneous neuronal activity was blocked within parts of VPM. 4. During three experiments, dual simultaneous microinjections of lidocaine (delivered through 2 microcannulae separated by approximately 1 mm) resulted in profound deficits in noxious heat discrimination, with lesser deficits in cool and airpuff discrimination; visual discrimination was never altered. Monitoring of adjacent microelectrodes revealed that although activity ventral to the injection sites was blocked, activity in medial thalamic nuclei, implicated in nociceptive processing, was probably not altered by these injections. 5. These data suggest that VPM is important for the perception of noxious and innocuous thermal stimuli as well as for the perception of tactile stimuli. However, considering the ineffectiveness of small single microinjections of lidocaine, it appears that some critical proportion of VPM must be inactivated to disrupt

Perceived levels of pain associated with bone marrow aspirates and biopsies.

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Talamo, Giampaolo; Liao, Jason; Joudeh, Jamal; Lamparella, Nicholas E; Dinh, Hoang; Malysz, Jozef; Ehmann, W Christopher

2012-01-01

Little is known about the degree of pain experienced by patients undergoing a bone marrow aspiration and biopsy (BMAB). To evaluate the effectiveness of several strategies aimed at reducing the pain score. We conducted a retrospective analysis of 258 consecutive adult patients who underwent BMAB via 6 different approaches, the first 5 of which were performed by one physician. Group A received local anesthesia with 1% lidocaine hydrochloride (5 mL) and a 5-minute wait time before the procedure; group B received local anesthesia with a double dose (10 mL) of lidocaine; group C received 5 mL of local anesthesia with a 10-minute wait; group D received 5 mL of local anesthesia plus a topical spray with ethyl chloride; group E received oral analgesia and anxiolysis 30 minutes before the procedure in addition to the group A dosage of lidocaine; and group F received the same anesthesia as did group A, but the BMAD was performed by a less experienced practitioner. On a 0 to 10 scale, the mean pain level among the 258 patients was 3.2 (standard deviation = 2.6). Rate of complications was low (<1%). Several strategies failed to improve the pain level, including the administration of a double dose of local anesthesia, waiting longer for the anesthesia effect, and the additional use of a topical anesthetic spray or oral analgesia and anxiolysis. Pain levels were not increased when the procedure was done by a less experienced practitioner. Younger age and female gender were associated with higher pain levels. Given that the average level of perceived pain during BMAB is low to moderate (approximately 3 on a 0-10 scale), the routine use of conscious sedation for this procedure may not be indicated. Several strategies aimed at reducing the pain level, including doubling the dose of anesthesia and using an oral prophylactic regimen of analgesia and anxiolysis, failed to improve pain scores. Copyright © 2012 Elsevier Inc. All rights reserved.

Reduction in radiation-induced brain injury by use of pentobarbital or lidocaine protection

International Nuclear Information System (INIS)

Oldfield, E.H.; Friedman, R.; Kinsella, T.; Moquin, R.; Olson, J.J.; Orr, K.; DeLuca, A.M.

1990-01-01

To determine if barbiturates would protect brain at high doses of radiation, survival rates in rats that received whole-brain x-irradiation during pentobarbital- or lidocaine-induced anesthesia were compared with those of control animals that received no medication and of animals anesthetized with ketamine. The animals were shielded so that respiratory and digestive tissues would not be damaged by the radiation. Survival rates in rats that received whole-brain irradiation as a single 7500-rad dose under pentobarbital- or lidocaine-induced anesthesia was increased from between from 0% and 20% to between 45% and 69% over the 40 days of observation compared with the other two groups (p less than 0.007). Ketamine anesthesia provided no protection. There were no notable differential effects upon non-neural tissues, suggesting that pentobarbital afforded protection through modulation of ambient neural activity during radiation exposure. Neural suppression during high-dose cranial irradiation protects brain from acute and early delayed radiation injury. Further development and application of this knowledge may reduce the incidence of radiation toxicity of the central nervous system (CNS) and may permit the safe use of otherwise unsafe doses of radiation in patients with CNS neoplasms

Efficacy and safety of articaine versus lidocaine for irreversible pulpitis treatment: A systematic review and meta-analysis of randomised controlled trials.

Science.gov (United States)

Su, Naichuan; Li, Chunjie; Wang, Hang; Shen, Jiefei; Liu, Wenjia; Kou, Liang

2016-04-01

The aim was to assess the efficacy and safety of articaine compared with lidocaine for irreversible pulpitis (IP) treatment. Databases were explored electronically and relevant journals as well as the references of the included studies were hand-searched for randomised clinical trials comparing the efficacy and safety of articaine with lidocaine in treatment of IP. Twenty studies were included, of which eight had low risk of bias, 10 had moderate risk of bias and two had high risk of bias. In comparison with 2% lidocaine with 1:100,000 epinephrine, 4% articaine with 1:100,000 epinephrine showed a higher success rate in anaesthesia of IP at either person (risk ratio (RR) 1.15; 95% confidence intervals (CI) 1.10 1.20; P < 0.00001) or tooth unit (RR 1.10; 95% CI 1.10 1.19, P < 0.00001), lower VAS scores during injection phase (mean difference (MD) -0.67; 95% CI -1.26 -0.08, P = 0.02) and treatment phase (MD -3.35; 95% CI -3.78 -2.91, P < 0.00001), shorter onset time of pulpal anaesthesia (MD -0.94; 95% CI -1.13 -0.74, P < 0.00001) and lower percentage of patients undergoing adverse events (RR 0.17; 95% CI 0.03 0.92, P = 0.04). Given the efficacy and safety of the two solutions, 4% articaine with 1:100,000 epinephrine was superior to 2% lidocaine with 1:100,000 epinephrine in dental treatments in IP. © 2016 Australian Society of Endodontology Inc.

A comparison of intrathecal dexmedetomidine verses intrathecal fentanyl with epidural bupivacaine for combined spinal epidural labor analgesia

OpenAIRE

P K Dilesh; S Eapen; S Kiran; Vivek Chopra

2014-01-01

Context: Combined spinal epidural (CSE) analgesia technique is effective for labor analgesia and various concentrations of bupivacaine and lipophilic opioids like fentanyl have been studied. Dexmedetomidine is a highly selective alpha 2 adrenoreceptor agonist with analgesic properties and has been used intrathecally with bupivacaine for prolonged postoperative analgesia. Recent reviews have shown that it is highly lipophilic and does not cross placenta significantly. Aim: The aim of this s...

External cephalic version for breech presentation with or without spinal analgesia in nulliparous women at term: a randomized controlled trial.

Science.gov (United States)