Dermatoscope for the diagnosis of erythema with purpura induced by lidocaine/prilocaine cream:A case report

BACKGROUND Lidocaine/prilocaine(EMLA)cream is a local anesthetic that is applied to the skin or mucosa during painful therapeutic procedures with few reported side effects.CASE SUMMARY Here,we report the use of dermatoscopy to identify a case of erythema with purpura,a rare side effect,after the application of 5%EMLA cream.CONCLUSION We conclude that erythema with purpura is caused by irritation and toxicity associated with EMLA,but the specific mechanism by which the toxic substance affects skin blood vessels is unclear.In response to this situation and for cosmetic needs,we recommend tranexamic acid,in addition to routine therapy,to prevent changes in pigmentation in patients with dermatitis.

Analysis of the Effects of Local Injection of Epinephrine and Lidocaine on Postoperative Pain and Bleeding in Children Undergoing Tonsillectomy

Objective:To explore the effects of local injection of epinephrine and lidocaine on postoperative pain and bleeding in children undergoing tonsillectomy.Methods:Sixty-eight children who underwent a tonsillectomy in our hospital from March 2019 to October 2020 were selected.The children were randomly divided into two groups of 34 cases each.The observation group received local anesthetic injections of lidocaine and the control group received local anesthetic injections of epinephrine.The postoperative pain,operation time,blood pressure changes,and intraoperative blood loss of the two groups of children were observed and analyzed.Results:The postoperative pain,operation time,and intraoperative blood loss scores of the children in the observation group were 4.36±0.69,0.36±0.09,and 39.36±1.78 respectively,which were significantly better than those of the children in the control group(P<0.05)at 5.36±0.77,0.79±0.05,and 45.36±1.56,respectively.The systolic blood pressure and diastolic blood pressure of the observation group 3 minutes before surgery and 180 minutes after surgery were no different from those of the control group(P>0.05).Conclusion:Local injection of epinephrine and lidocaine effectively relieved postoperative pain and reduced bleeding in children undergoing tonsillectomy as compared to epinephrine alone.

Efficacy of lidocaine wet compress combined with red-light irradiation for chronic wounds

BACKGROUND Chronic wounds that fail to progress through normal phases of healing present a significant healthcare burden owing to prolonged treatment and associated costs.Traditional wound care typically involves regular dressing changes,which can be painful.Recent approaches have explored the use of lidocaine to manage pain and red-light irradiation(RLI),known for its anti-inflammatory and cell proliferation effects,to potentially enhance wound healing.AIM To investigate the therapeutic efficacy of lidocaine wet compression(LWC)combined with RLI for chronic wounds.METHODS We enrolled 150 patients with chronic wounds from the Wound and Ostomy Outpatient Clinic of the Second Hospital of Anhui Medical University from April to September 2022.The wounds were treated with dressing changes.The patients were randomly assigned to the control and experimental groups using a random number table and given the same first dressing change(2%LWC for 5 min and routine dressing change).From the second dressing change,in addition to 2%LWC for 5 min and routine dressing change,the experimental group received RLI,whereas the control group continued to receive the same LWC and dressing change.The first and second dressing changes were performed on days 1 and 2,respectively.The third dressing change was performed 3 d after the second change.The frequency of subsequent dressing changes was determined based on wound exudation and pain.Pain during the first three dressing changes was evaluated in both groups.The average number of dressing changes within 28 d and the degree of wound healing on day 28 were also recorded.RESULTS During the initial dressing change,no noticeable differences were observed in the pain levels experienced by the two groups,indicating similar pain tolerance.However,during the second and third dressing changes,the experimental group reported significantly less pain than the control group.Furthermore,over 28 d,the experimental group required fewer dressing changes than the control group.CONCLUSION Notably,the effectiveness of wound healing on the 28th day was significantly higher in the experimental group than that of in the control group.The combination of LWC and RLI was effective in reducing early-stage pain,promoting wound healing,decreasing the frequency of dressing changes,and enhancing patients’overall quality of life with chronic wounds.

Malignant hyperthermia as a rare complication of local lidocaine injection:A case report

BACKGROUND Malignant hyperthermia(MH)is a hypermetabolic disorder of skeletal muscles triggered by exposure to volatile anesthetics and depolarizing muscular relaxants.It manifests with clinical presentations such as tachycardia,muscle rigidity,hyperpyrexia,and rhabdomyolysis in genetically predisposed individuals with ryanodine receptor or calcium voltage-gated channel subunit alpha1 S mutations.Local anesthetics,such as lidocaine,are generally considered safe;however,complications can arise,albeit rarely.Lidocaine administration has been reported to induce hypermetabolic reactions resembling MH in susceptible individuals.The exact mechanism by which lidocaine might trigger MH is not fully understood.Although some mechanisms are postulated,further research is needed for a better understanding of this.CASE SUMMARY We present the case of MH in a 43-year-old male patient with an unknown genetic predisposition following a lidocaine injection during a dental procedure.This case serves as a reminder that while the occurrence of lidocaine-induced MH is rare,lidocaine can still trigger this life-threatening condition.Therefore,caution should be exercised when administering lidocaine to individuals who may be susceptible to MH.It is important to note that prompt intervention played a crucial role in managing the patient’s symptoms.Upon recognizing the early signs of MH,aggressive measures were initiated,including vigorous intravenous normal saline administration and lorazepam.Due to the effectiveness of these interventions,the administration of dantrolene sodium,a specific antidote for MH,was deferred.CONCLUSION This case highlighted the significance of vigilant monitoring and swift action in mitigating the detrimental effects of lidocaine-induced MH.Caution should be exercised when administering lidocaine to individuals who may be predisposed to MH.It is very important to be aware and vigilant of the signs and symptoms of MH as early recognition and treatment intervention are important to prevent serious complications to decrease mortality.

Effect of TRPV1 combined with lidocaine on cell state and apoptosis of U87-MG glioma cell lines

Objective:To study the effects of Transient receptor potential cation channel,subfamily V,member 1(TRPV1) combined with lidocaine on status and apoptosis of U87-MG glioma cell line,and explore whether local anesthetic produces neurotoxicity by TRPVI.Methods:U87-MG cells were divided into control group,gene silencing group,empty vector group and TRPV gene up-rcgulation group.For cells in each group,flow cytometry was employed to detect the intracellular calcium ion concentration and mitochondrial membrane potential at different lime point from cellular perspective.Cell apoptosis of U87-MG was assayed by flow cytometry and MTT from a holistic perspective.Results:Calcium ion concentration increased along with time.The concentration in TRPV1 gene up-regulation group was significantly higher than those in other groups at each time point(P<0.05).After adding lidocaine.mitochondrial membrane potential in U87-MG significantly increased(P<0.05).This increasing trend in TRPV1 gene up-regulation group was more significant than other groups(P<0.05).while in TRPV1 gene silencing group,the trend significantly decreased(P<0.05).Flow cytometry result and MTT result both showed that cell apoptosis in each group significantly increased after lidocaine was added(P<0.05).This increasing trend in TRPV1 gene up-regulation group was more significant than other groups(P<0.05),while in TRPV1 gene silencing group,the trend significandy decreased(P<0.05).Moreover,apoptosis was more severe along with the increasing concentration of lidocaine(P<0.05).Conclusions:In this study,it was proved that lidocaine could dose-dependently induce the increase of intracellular calcium ion concentration,mitochondrial membrane potential and apoptosis in U87-MG glioma cell line.The up-regulation of TRPV1 enhanced cytotoxicity of lidocaine,which revealed the correlations between mem.Lidocaine might have increased intracellular calcium ion concentration by activating TRPVI gene and induced apoptosis of U87-GM glioma cell line by up-regulating mitochondrial membrane potential.

Effect of Lidocaine and Amiodarone on Transmural Heterogeneity of Ventricular Repolarization in Isolated Rabbit Hearts Model of Sustained Global Ischemia

Summary： To study the effect of of lidocaine and amiodarone on the transmural heterogeneity of ventricular repolarization in isolated rabbit hearts model of sustained global ischemia and to explore the mechanisms underlying the antiarrhythmic activity of lidocaine and amiodarone, rabbits were randomly divided into 4 groups： control group, ischemia group, lidocaine group and amiodarone group. By the monophasic action potential （MAP） recording technique, MAPs of epicardium, midmyocardium and endocardium were simultaneously recorded across the left ventricular free wall in rabbit hearts perfused by low-flow ischemia （2. 5 mL/min） in Langendorff method to study the transmural dispcrsion of repolarization （TDR） and arrhythmic induced by ischemia.Our results showed that TDR of three myocardial layers in ischemia group were significantly lengthened after ischemia. TDR was increased from 17.5±3.9 ms to 31.2±4.6 ms at the time that concided with the onset of sustained ventricle arrhythmic. Amiodarone could decrease TDR, but lidocaine could increase TDR at initial ischemia, and no significant difference was found at other ischemia time points. 5 cases had ventriclar arrhythmia in ischemia group （62. 5%）, but no case in lidocaine group （P〈0.01） and only 1 case in amiodarone group had ventrilar arrhythmia （P〈 0.01）. No significant difference was found between amiodarone group and lidocaine group. It is concluded that TDR of of three myocardial layers increases significantly at ischemia and it is closely associated with development of ventricular arrhythmia, and amiodarone could decrease TDR, but lidocaine could increase TDR at initial ischemia and has no effects at other ischemia time points.

Local anesthetic lidocaine induces apoptosis in human corneal stromal cells in vitro

AIM:To demonstrate the apoptosis-inducing effect of iidocalne on human corneal stromal(HCS)cells fn vitm,and provide experimental basis for safety anesthetic usage In clinic of ophthalmology.METHODS:In vitro cultured HCS cells were treated with lidocaine at different doses and times,and their morphology was monitored successively with inverted phase contrast microscopy.The membrane permeability of them was detected by acridine orange/ethidium bromide(AO/EB)double staining.The DNA fragmentation of them was examined by agarose gel electrophoresis,and their ultrastructure was observed by transmission electron microscopy(TEM),respectively.RESULTS:Exposure to lidocaine at doses from0.3125g/L to 20g/L induced morphological changes of HCS cells such as cytoplasmic vacuolation,cellular shrinkage,and turning round,and elevated membrane permeability of these cells in AO/EB staining.The change of morphology and membrane permeability was doseand time-dependent,while lidocaine at dose below0.15625g/L could not induce these changes.Furthermore,lidocaine induced DNA fragmentation and ultrastructural changes such as cytoplasmic vacuolation,structural disorganization,chromatin condensation,and apoptotic body appearance of the cells.CONCLUSION:Lidocaine has significant cytotoxicity on human corneal stromal cells in vitro in a dose-and time-dependent manner by inducing apoptosis of these cells.The established experimental model and findingsbased on this model here help provide new insight into the apoptosis-inducing effect of local anesthetics in eye clinic.

Intracameral lidocaine as supplement to classic topical anesthesia for relieving ocular pain in cataract surgery

AIM: To evaluate safety, efficacy, and patient adherence of intracameral lidocaine as supplement of classic topical anesthetic drops in cataract surgery.METHODS: A prospective and controlled trial including a large cohort of 1650 individuals suffering with bilateral cataract not complicated, in program by phacoemulsification surgery, were randomly assigned to 2 different groups for the type of anesthesia received, 0.4% oxybuprocaine hydrochloride(INN) drops, and INN drops associated to intracameral 1% lidocaine hydrochloride monohydrate. At the end of surgery, tables were assigned to each patient indicating the degree of pain(0-3) felt during the operation.RESULTS: Thirty-two percent of patients in group 1 declared to have not felt any pain against the 77% of patients in group 2. Fifty-nine percent of patients in group 1 complained about only a slight discomfort against 20% of group 2 patients. Only a small percentage of patients in group 1(5%) admitted severe pain, while no patient in group 2 admitted severe pain. Four patients of group 2 reported an episode of transient amaurosis, lasting several hours after surgery.CONCLUSION: Intracameral administration of lidocaine is a simple and secure method able to increase the analgesia during the cataract surgery, eliminating the discomfort and increasing also the cooperation of the patients during the steps of manipulation.

在 esophagogastroduodenoscopy 使用 lidocaine 的实用性与 propofol 表现在镇静下面

AIM:To determine whether topical lidocaine benefits esophagogastroduoduenoscopy(EGD) by decreasing propofol dose necessary for sedation or procedurerelated complications.METHODS:The study was designed as a prospective,single centre,double blind,randomised clinical trial and was conducted in 2012 between January and May(NCT01489891).Consecutive patients undergoing EGD were randomly assigned to receive supplemental topical lidocaine(L;50 mg in an excipient solution which was applied as a spray to the oropharynx) or placebo(P;taste excipients solution without active substance,similarly delivered) prior to the standard propofol sedation procedure.The propofol was administered as a bolus intravenous(iv) dose,with patients in the L and P groups receiving initial doses based on the patient’s American Society of Anaesthesiologists(ASA) classification(ASAⅠ-Ⅱ:0.50-0.60 mg/kg;ASA Ⅲ-Ⅳ:0.25-0.35 mg/kg),followed by 10-20 mg iv dose every 30-60 s at the anaesthetist’s discretion.Vital signs,anthropometric measurements,amount of propofol administered,sedation level reached,examination time,and the subjective assessments of the endoscopist’s and anaesthetist’s satisfaction(based upon a four point Likert scale) were recorded.All statistical tests were performed by the Stata statistical software suite(Release 11,2009;StataCorp,LP,College Station,TX,United States).RESULTS:No significant differences were found between the groups treated with lidocaine or placebo in terms of total propofol dose(310.7 ± 139.2 mg/kg per minute vs 280.1 ± 87.7 mg/kg per minute,P = 0.15) or intraprocedural propofol dose(135.3 ± 151.7 mg/kg per minute vs 122.7 ± 96.5 mg/kg per minute,P = 0.58).Only when the L and P groups were analysed with the particular subgroups of female,【 65-year-old,and lower anaesthetic risk level(ASA Ⅰ-Ⅱ) was a statistically significant difference found(L:336.5 ± 141.2 mg/kg per minute vs P:284.6 ± 91.2 mg/kg per minute,P = 0.03) for greater total propofol requirements).The total incidence of complications was also similar between the two groups,with the L group showing a complication rate of 32.2%(95%CI:21.6-45.0) and the P group showing a complication rate of 26.7%(95%CI:17.0-39.0).In addition,the use of lidocaine had no effect on the anaesthetist’s or endoscopist’s satisfaction with the procedure.Thus,the endoscopist’s satisfaction Likert assessments were equally distributed among the L and P groups:unsatisfactory,[L:6.8%(95%CI:2.2-15.5) vs P:0%(95%CI:0-4.8);neutral,L:10.1%(95%CI:4.2-19.9) vs P:15%(95%CI:7.6-25.7)];satisfactory,[L:25.4%(95%CI:10-29.6) vs P:18.3%(95%CI:15.5-37.6);and very satisfactory,L:57.6%(95%CI:54-77.7) vs P:66.6%(95%CI:44.8-69.7)].Likewise,the anaesthetist’s satisfaction Likert assessments regarding the ease of maintaining a patient at an optimum sedation level without agitation or modification of the projected sedation protocol were not affected by the application of lidocaine,as evidenced by the lack of significant differences between the scores for the placebo group:unsatisfactory,L:5.8%(95%CI:1.3-13.2) vs P:0%(95%CI:0-4.8);neutral,L:16.9%(95%CI:8.9-28.4) vs P:16.7%(95%CI:8.8-27.7);satisfactory,L:15.2%(95%CI:7.7-26.1) vs P:20.3%(95%CI:11.3-31.6);and very satisfactory,L:62.7%(95%CI:49.9-74.3) vs P:63.3%(95%CI:50.6-74.7).CONCLUSION:Topical pharyngeal anaesthesia is safe in EGD but does not reduce the necessary dose of propofol or improve the anaesthetist’s or endoscopist’s satisfaction with the procedure.

Inhibitory effects of lidocaine on cerebral vasospasm in a rabbit model of subarachnoid hemorrhage

Following subarachnoid hemorrhage, vasoconstrictor substances, cellular apoptosis, blood coagulation, and vascular cell proliferation affect the onset of cerebral vasospasm. Previous studies from our laboratory have revealed that injection of lidocaine （2 mg） into the cisterna magna reduces cerebral vasospasm and nerve functional impairment in an animal model of subarachnoid hemorrhage. The present study determined the optimal lidocaine dose for vasospasm and brain injury by injecting different doses of lidocaine into the cisterna magna in a rabbit model of subarachnoid hemorrhage. Results showed that endothelin, tumor necrosis factor-a, and interleukin-6 levels significantly increased in plasma, and calcitonin gene-related peptide levels significantly decreased in plasma （P 〈 0.05）. The number of neurons was decreased, the number of cells expressing c-Fos increased in the hippocampus, and cross-sections and diameters of basilar arteries were reduced （P 〈 0.05）. These changes significantly improved following injection of lidocaine （1,2, 4, and 6 mg） into the cisterna magna. A dose of 6 mg lidocaine into the cisterna magna resulted in optimal effects on cerebral vasospasm and brain injury following subarachnoid hemorrhage.

Posterior lingual lidocaine: A novel method to improve tolerance in upper gastrointestinal endoscopy

AIM: To evaluate the effect of posterior lingual lidocaine swab on patient tolerance to esophagogastro-duodenoscopy, the ease of performance of the procedure, and to determine if such use will reduce the need for intravenous sedation. METHODS: Eighty patients undergoing diagnostic esophagogastroduodenoscopy in a tertiary care medical center were randomized to either lidocaine swab or spray. Intravenous meperidine and midazolam were given as needed during the procedure. RESULTS: Patients in the lidocaine swab group (SWG) tolerated the procedure better than those in the spray group (SPG) with a median tolerability score of 2 (1, 4) compared to 4 (2, 5) (P < 0.01). The endoscopists encountered less diffi culty performing the proceduresin the SWG with lower median difficulty scores of 1 (1, 5) compared to 4 (1, 5) in the SPG (P < 0.01). In addition, the need for intravenous sedation was also lower in the SWG compared to the SPG with fewer patients requiring intravenous sedation (13/40 patients vs 38/40 patients, respectively, P < 0.01). The patients in the SWG were more satisfi ed with the mode of local anesthesia they received as compared to the SPG. In addition, the endoscopists were happier with the use of lidocaine swab. CONCLUSION: The use of a posterior lingual lidocaine swab in esophagogastroduodenoscopy improves patient comfort and tolerance and endoscopist satisfaction and decreases the need for intravenous sedation.

Why Labor Epidural Causes Fever and Why Lidocaine Burns on Injection? Role of TRPV 1 Receptor in Hyperthermia: Possible Explanation of Mechanism of Hyperthermia during Labor Epidural and Burning Sensation on Injection of Local Anesthetics

The mechanisms of epidural-associated fever remain incompletely understood [1-3]. We propose that action of local anesthetic on TPRV1. The transient receptor potential cation channel subfamily V member 1 (TRPV1), also known as the capsaicin receptor and the vanilloid receptor can explain this effect and explain mechanism of burning sensation on local anesthetic injected subcutaneously or intramuscular. Role of TRPV1 receptor was not discussed previously in Obstetric Anesthesia literature. Based on available data, we propose that Local Anesthetics work as agonist/antagonist on TPRV1 receptors. Antagonist action may cause hyperthermia through modifying thermoregulation [4], agonist action may cause hyperthermia thru release of IL-6 and other mediators of inflammation [5-10]. Agonist action may explain burning sensation on injection of Local Anesthetics. Burning sensation can be diminished by increasing pH of Local Anesthetic solution, because vanillin receptors are stimulated by acidification through lower pH [11,12].

Intracuff alkalinized lidocaine to prevent postoperative airway complications:A meta-analysis

BACKGROUND Post-extubation cough is a common phenomenon in surgical patients undergoing general anesthesia,which can lead to potentially dangerous complications.In this meta-analysis,we evaluated the efficacy and safety of intracuff alkalinized lidocaine in patients with tracheal intubation to prevent cough and other airway complications during the perioperative period.AIM To perform a systematic review and meta-analysis of intracuff alkalinized lidocaine for the prevention of postoperative airway complications.METHODS PubMed,Embase,Cochrane,and Web of Science were searched for randomized controlled trials(RCTs)that compared intracuff alkalinized lidocaine to placebo.We used risk-of-bias assessment to assess the RCTs,and the quality of evidence was assessed using the grading of recommendations,assessment,development,and evaluations.RESULTS Twelve randomized trials(1175 patients)were analyzed.Meta-analysis showed that intracuff alkalinized lidocaine was associated with less cough compared to that produced by placebo[risk ratio(RR):0.38;95%confidence interval(CI):0.23-0.63].Similarly,intracuff alkalinized lidocaine was more effective than the control in reducing postoperative sore throat at 24 h(RR:0.19;95%CI:0.09-0.41)and postoperative hoarseness(RR:0.38;95%CI:0.21-0.69).CONCLUSION Intracuff alkalinized lidocaine is an effective adjuvant that can decrease airway complications,such as coughing,hoarseness,and sore throat.

Comparative efficacy of ketamine,lidocaine,acetaminophen,and dexmedetomidine combined with morphine patient-controlled analgesia in treating opium-addicted patients undergoing tibia fracture surgery:A randomized clinical trial

Objective:To compare the effect of ketamine,lidocaine,acetaminophen,and dexmedetomidine combined with morphine patient-controlled analgesia for opium addicts after tibial fracture surgery.Methods:This double-blind clinical trial included opium-addicted patients undergoing tibia fracture surgery.Patients were recruited and randomized to four different groups including the ketamine group,the lidocaine group,the acetaminophen group,and the dexmedetomidine group.The hemodynamic parameters such as heart rate(HR),mean arterial pressure,and arterial SaO2,alongside visual analog scale pain scores,sedation assessed by Ramsay score,nausea and vomiting,and opioid use were recorded and compared among the four groups.Results:This study included 140 patients,aged 37(32,41)years,with 92 males and 48 females,and each group had 35 patients.Dexmedetomidine-sedated subjects had the lowest blood pressure from 1 to 24 h after surgery,decreased HR at 12 and 24 h after surgery,and more satisfactory sedation(P<0.05).Notwithstanding no significant difference was noted in the pain scores,or nausea and vomiting among the groups(P>0.05).Conclusions:Dexmedetomidine has a better sedation effect compared to ketamine,lidocaine,and acetaminophen for pain control,but the final choice hinges on the patients’physical condition and the anesthesiologist's preference.Clinical registration:It is registered in Iranian Registry Clinical Trial by code IRCT20141209020258N146.

Effects of propofol combined with lidocaine on hemodynamics, serum adrenocorticotropic hormone, interleukin-6, and cortisol in children

BACKGROUND Children are a unique patient population.Anesthesia for pediatric abdominal surgery has long been achieved mainly with intravenous amiodarone and propofol alone or combined with other anesthetics.The incidence of complications and postoperative adverse reactions is relatively high owing to the imperfect development of various protocols for children.Choosing the most appropriate anesthesia program is an important means of reducing adverse reactions.AIM To explore the clinical value of propofol combined with lidocaine-assisted anesthesia in pediatric surgery.METHODS A total of 120 children who underwent abdominal surgery at our hospital from January 2016 to March 2018 were selected and divided into groups A and B using the random number table method,with 60 patients in each group.Group B received ketamine for anesthesia,while group A received ketamine,propofol,and lidocaine.The pre-and postoperative heart rate(HR);mean arterial pressure(MAP);arterial oxygen saturation(SpO_(2));serum adrenocorticotropic hormone(ACTH),interleukin-6(IL-6),and cortisol(Cor)levels;restlessness score during the recovery period[Paediatric Anesthesia Emergence Delirium Scale(PAED)];and adverse reactions were compared between the two groups.RESULTS The HR,MAP,and SpO_(2) Level at five minutes before initiating anesthesia were compared between groups A and B,and the difference was not statistically significant(P>0.05).At 10 and 20 minutes after anesthesia initiation,the HR and MAP were lower in group A compared with group B(P<0.05).The differences in preoperative serum ACTH,IL-6,and Cor levels between groups A and B were not statistically significant(P>0.05);however,the postoperative serum ACTH,IL-6,and Cor levels in group A were lower compared with group B(P<0.05).Furthermore,the visual analog scale scores of group A at 2 h and 8 h postoperative were lower than those in group B,and the differences were statistically significant(P<0.05).The mean PAED score in group A was lower than that in group B(P<0.05),and the incidence of restlessness in group A was 23.33%lower than that in group B(36.67%)(P<0.05).The incidence of adverse reactions was lower in group A than in group B(6.25%vs 16.25%).CONCLUSION The anesthetic effect of propofol combined with lidocaine and ketamine in pediatric surgery was better than that of ketamine alone,and had less influence on hemodynamics and pediatric stress response indices,lower incidence of restlessness in the recovery period,and lower incidence of adverse reactions.

A Comparative Study of Effect of Intravenous Lidocaine Infusion, Gabapentin and Their Combination on Postoperative Analgesia after Thyroid Surgery

Objective: This prospective randomized study aimed to evaluate the effect of IV lidocaine infusion or gabapentin and their combination in providing efficient analgesia after thyroid surgery. Methods: Eighty-eight patients scheduled for thyroidectomy were randomized into four equal groups (n = 22). Group P (placebo) patients received placebo capsules 1 h preoperatively and intravenous (IV) saline infusion. Group L (Lidocaine): patients received placebo capsules 1 h preoperatively and IV bolus lidocaine 1.0 mg/kg followed by infusion 2 mg/kg/h. Group G (Gabapentin) patients received 600 mg gabapentin capsules 1 h preoperatively and IV saline infusion. Group LG (Lidocaine-Gabapentin) patients received 600 mg gabapentin capsules 1 h preoperatively and IV bolus of 1.0 mg/kg lidocaine followed by infusion 2 mg/kg/h. (lidocaine or saline infusion started before induction of anesthesia and continued until the end of surgery). Intraoperative fentanyl consumption and hemodynamic changes were recorded. Postoperative total tramadol consumption, time to first analgesic request, visual analog scale (VAS) of pain, sedation level, and side effects were assessed for 24 hours. Results: (LG) group had significant lower intraoperative fentanyl and lower postoperative tramadol consumption (p < 0.001) compared to (P), (L) and (G) groups, with prolonged time of first analgesic request (p < 0.001) compared to (P) and (L) groups, and lower VAS compared to other groups (p < 0.001 or p < 0.01). There was significantly lower postoperative nausea and vomiting (PONV) in G & LG groups compared to (P) group (p < 0.01). Conclusion: The combination of preoperative gabapentin and intraoperative lidocaine infusion provided more analgesic effect than either drug alone with lower and more delayed postoperative analgesic requirements and lower VAS. (PONV) was lower in groups received gabapentin.

Intravesical Non-Alkalinized Lidocaine Instillation for Interstitial Cystitis/Bladder Pain Syndrome Patients

Purpose: The effectiveness of daily or weekly instillation of non-alkalinized lidocaine for patients suffering interstitial cystitis and/or bladder pain syndrome was evaluated retrospectively. Patients and methods: Five female patients (40 - 71 years old) diagnosed as interstitial cystitis by cystoscopic findings and a 68 year-old bladder pain syndrome patient were enrolled. All patients, having interstitial cystitis, had undergone hydrodistention therapy previously and had not improved their symptoms by empirical therapies. Daily or weekly (upon their severity of symptoms) intravesical instillation of 20 ml of 4% non-alkalinized (pH 6.0 - 7.0) lidocaine solution was performed for several times, and patients were asked to keep them in the bladder as long as two hours each time. Previous medications such as anti-cholinergic drugs and analgesics were continued according to patient's requirements and symptoms. The treatment effect was evaluated comparing O'Leary-Sant Symptom Index for interstitial cystitis patients and visual analog pain scale before and after the series of lidocaine therapies. Results: Instillation was made 6 to 16 times. Patients with interstitial cystitis improved their symptoms from O'Leary-Sant Symptom Index 17.5 to 10, Problem Index from 14.8 to 6 in an average. Crouching pain disappeared in all these patients after the instillation therapy. Severe interstitial cystitis findings on cystoscopy disappeared completely in one patient after the therapy. One patient having bladder pain syndrome reduced her analgesics use, and bladder-filling pain decreased from 7 to 3 as a visual analog scale score. One patient complained palpitation at 11th instillation and abandoned treatment thereafter, otherwise, none of these patients showed side effect concerning lidocaine toxicity. Conclusions: Intravesical non-alkalinized lidocaine instillation therapy for interstitial cystitis/bladder pain syndrome patients were an easy, safe and effective treatment.

Pain on Injection of Propofol: Efficacy of Paracetamol and Lidocaine

Background and Objectives: Propofol remains the most common drug for induction of general anaesthesia, although it causes considerable pain on injection. None of the commonly used methods completely attenuate this discomfort. We aimed to investigate the effect of i.v. paracetamol pretreatment on the propofol injection pain. Materials and Methods: A prospective randomized double-blind study was conducted on 180 patients, ASA I or II status, scheduled to undergo elective surgery. They were randomly assigned to one of the three groups of 60 each. Groups I, II, III were pretreated with 40 mg of lidocaine in saline, 100 mg of paracetamol and 10 ml of saline, respectively. All patients had an 18-gauge catheter inserted into a superficial radial vein. After 2 min of venous occlusion, one-fourth of the total propofol dose was injected into the vein over a period of 20 seconds. During the injection of both pretreatment solution and propofol, a blinded researcher assessed the patient’s pain level using a four-point verbal rating scale (VRS) (none = 0, mild = 1, moderate = 2, and severe = 3). X2 test and Kruskal-Wallis tests were used for the statistical analysis. For all analyses, differences were considered to be significant at P < 0.05. Results: The three groups were comparable in respect to patient’s characteristics. The incidence of pain on injection of propofol in placebo, i.v. paracetamol and lidocaine groups were 85%, 36%, 21% respectively (p < 0.05). Intensity and severity of propofol induced pain were comparable between paracetamol and lidocaine groups. Conclusion: Pretreatment using i.v. paracetamol was found to be effective in reducing propofol injection-induced pain.

A Comparative Study between Dexmedetomidine Alone versus Combined Low Dose of Dexmedetomidine and Lidocaine for the Hemodynamic Response to Endotracheal Extubation in Patient Undergoing Abdominal Surgery—A Prospective Randomized Controlled Study

Background: Tracheal extubation is related to many side effects of hemodynamic, especially for patients with comorbid states. The study compared the validity of dexmedetomidine 1 μg/kg and low combination dose of dexmedetomidine 0.5 μg/kg plus Lidocaine 1 mg/kg in softening hemodynamic stress response and estimated quality of extubation in study groups. Materials and Methods: The patients in our study, one hundred and fifty of both gender, ASA class I &II patients, aged 20 - 50 years old subject to elective abdominal operations under general anesthesia were allocated into three equal groups. Anesthetic technique was standardized. Before extubation by 10 minutes, the patients in Group N, D, and DL have given 0.9% normal Saline intravenous bolus infusion, dexmedetomidine 1 μg/kg and Dexmedetomidine 0.5 μg/kg, respectively within a 10-minute period. Before complete extubation by 90 seconds, in the three groups by syringe ten cc volumes and at time of extubation, Group N and D patients received 0.9% normal Saline intravenous bolus infusion, but in Group DL received Lidocaine 1 mg/kg then extubation completed. Heart rate (HR), Diastolic BP (DBP), Systolic BP (SBP), and Mean Arterial Pressure (MAP) were noted at baseline, at the reverse, extubation, 2, 4, 6, 8, 10 min and at the regular times after that for two hours. Extubation quality was assessed by extubation quality scale. Aldrete’s recovery score and Ramsay sedation score were also recorded and also any complications were noted and recorded. Results: All the hemodynamic parameters significantly elevated extubation and numerous periods of observation in the normal saline group than dexmedetomidine and dexmedetomidine plus Lidocaine group (p-value = 0.001). Response of tachycardia was seen in 41 (82%) in patients of N group, compared to 18 (36%) and 20 (40%) in D & DL group respectively (p = 0.001). Hypertensive response statistically significant noticed in 40 (80%) patients of N group, 9 (18%) of D group and 12 (24%) of DL group (p = 0.001). Tachycardia duration and the response of hypertension were significantly prolonged in the control group. As regards extubation quality, the three groups differed in D Groups (1.93 ± 0.57) and DL (1.51 ± 0.57) had decreased scores compared to group N (2.67 ± 0.48) modulating smoother extubation (p Conclusion: Low combined dose of (Dexmedetomidine 0.5 μg/kg plus Lidocaine 1 mg/kg) IV was useful as much as Dexmedetomidine 1 μg/kg IV in softening hemodynamic stress responses during emergence.

Comparation of the eutectic mixture of lidocaine/prilocain versus benzocaine gel in children

Objective: To compare the anesthetic effect of a non commercial eutectic mixture of 4% lidocaine/ prilocaine (PLO 4%) and 20% benzocaine gel (Hurricaine?), as topical anesthetic, prior to inferior alveolar nerve block and buccal infiltration anesthe-sia in 5-12 year old children. Study design: Infiltrative anesthesia was applied in 50 children, divided in two groups (n = 25) using PLO 4% and Hurricaine? as topical anesthesia prior to infiltration. Physical reac-tions were registered using the Sound-Eyes- Motor Scale. Physiological changes expressed by ar-terial pressure and heart rate. Subjective pain re-sponse was scored on a Facial Image Scale. Physical physiological and subjective response was related to the type of topical anesthetic, age and sex using χ2 and Mann-Whitney U test. Results: Physical responses to puncture were similar and localized in the state of comfort with both anesthetics. Girls showed more ocular response than boys. Subjective pain perception and physiological reactions showed no anesthetic- or sex-related differences, except for heart rate before and after the procedure which was significantly higher in girls. Conclusions: PLO 4% showed the same capacity as Hurricaine? in reducing pain response to needle puncture. Girls expressed more needle puncture-related pain than boys. The young children showed most prior comfort and less discomfort to the puncture than older children.