Pharmacokinetics and pharmacodynamics of lignocaine: A review

Lignocaine is an essential drug on World Health Organisation essential drug list, considered efficacious, safe and cost-effective for any health-care system. Despite its ubiquitous use in medicine and surgery, there are few detailed reviews of its pharmacokinetics and pharmacodynamics. Being an amide-type local anesthetic and Class 1b antiarrhythmic, lignocaine is most frequently used clinically for its anesthetic and antiarrhythmic benefits. However, lignocaine has important antinociceptive, immuno-modulating, and antiinflammatory properties. Information pertaining to the pharmacokinetics and pharmacodynamics of lignocaine was examined by performing a literature search of Pub Med, Embase and MEDLINE(via Ovid), pharmacology textbooks and online sources. We present a focused synopsis of lignocaine's pharmacological composition, indications for use and mechanisms of action, focusing on its anti-inflammatory, immuno-modulating and analgesia effects. In addition we review the dosing regimes and infusion kinetics of lignocaine in the clinical setting. Finally, we review the evidence for ligocaine's modulation of the inflammatory response during major surgery and its specific effects on cancer recurrence. These indirect effects of local anesthetics in tumor development may stem from the reduction of neuroendocrine responses to the stress response elicited by major surgery and tissue damage, enhanced preservation of immune-competence, in addition to opioid-sparing effects of modulating tumor growth.

Comparing lignocaine-adrenaline-tetracaine gel with lignocaine infiltration for anesthesia during repair of lacerations:A randomized trial

BACKGROUND:This study aimed to compare the topical anesthetic lignocaine,adrenaline,and tetracaine(LAT)(4%lignocaine,1:2 000 adrenaline,1%tetracaine) with the conventional lignocaine infiltration(LI) for repair of minor lacerations,for the comfort of anesthetic administration,efficacy,adverse effects and cost.METHODS:This was a prospective randomized clinical trial.Forty Asian patients who required toilet and suture for minor lacerations in the emergency department of the Singapore General Hospital over a 4-month period.The patients were assigned randomly to 2 arms of treatment.The first was the LAT gel group who had LAT gel applied to the laceration prior to suturing.The second was the control group in whom the anesthetic administered was lignocaine infiltration(LI) via a syringe.The pain of the process of administering anesthetic and efficacy of anesthesia were scored using the visual pain scale included within.The efficacy of LAT vs.lignocaine infiltration as an anesthetic prior to the toilet and suture of minor lacerations and complications of therapy.RESULTS:Twenty patients were randomized to LAT gel and 16 to LI on an intention to treat analysis.The mean pain score by patients in the LAT gel group was 2.5(0.52 SE),and 2.5(0.58 SE)in the LI group.The pain score for pain during application of the anesthetic was 1.5(0.40) in the LAT gel group,and 3.5(0.46) in the LI group.There was no difference in complications between the LAT and LI groups.CONCLUSION:LAT gel prior to the toilet and suture of minor lacerations is proven to be as efficacious as LI in terms of patient comfort and effectiveness of anesthesia.The complications are also comparable to those treated with LI.