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1.
Med Sci Monit ; 26: e919971, 2020 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-32198342

RESUMO

BACKGROUND Intravenous lidocaine administered during surgery improves postoperative outcomes; however, few studies have evaluated the relationship between intravenous lidocaine and volatile anesthetics requirements. This study assessed the effects of lidocaine treatment on sevoflurane consumption and postoperative consciousness disorders in children undergoing major spine surgery. MATERIAL AND METHODS Patients were randomly divided into 2 treatment groups: lidocaine and placebo (control). The lidocaine group received lidocaine as a bolus of 1.5 mg/kg over 30 min, followed by a continuous infusion at 1 mg/kg/h to 6 h after surgery. The following data were assessed: end-tidal sevoflurane concentration required to maintain a bispectral index BIS between 40 and 60, intraoperative blood pressure, heart rate, demand for fentanyl, and consciousness level assessed after surgery using the Richmond Agitation-Sedation Scale. Any treatment-related adverse events were recorded. RESULTS Compared to the control group, lidocaine treatment reduced by 15% the end-tidal sevoflurane concentration required to maintain the intraoperative hemodynamic stability and appropriate level of anesthesia (P=0.0003). There were no intergroup differences in total dose of fentanyl used, average mean arterial pressure, or heart rate measured intraoperatively. The postoperative level of patient consciousness did not differ during the first 6 h between groups. After 9 h, more patients in the control group were still sleepy (P=0.032), and there were fewer perioperative complications in the lidocaine group. CONCLUSIONS Lidocaine treatment decreases sevoflurane consumption and improves recovery profiles in children undergoing major spine surgery.


Assuntos
Período de Recuperação da Anestesia , Lidocaína/administração & dosagem , Sevoflurano/administração & dosagem , Coluna Vertebral/cirurgia , Adolescente , Anestesia Geral , Anestésicos Combinados/administração & dosagem , Criança , Relação Dose-Resposta a Droga , Feminino , Hemodinâmica/efeitos dos fármacos , Humanos , Infusões Intravenosas , Período Intraoperatório , Lidocaína/efeitos adversos , Lidocaína/sangue , Masculino , Monitorização Intraoperatória , Sevoflurano/sangue
2.
Br J Anaesth ; 124(3): 314-323, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32000978

RESUMO

BACKGROUND: In surgical patients undergoing general anaesthesia, coughing at the time of extubation is common and can result in potentially dangerous complications. We performed a systematic review and meta-analysis to assess the efficacy and safety of i.v. lidocaine administration during the perioperative period to prevent cough and other airway complications. METHODS: We searched Medical Literature Analysis and Retrieval System, Excerpta Medica database, and Cochrane Central Register of Controlled Trials for RCTs comparing the perioperative use of i.v. lidocaine with a control group in adult patients undergoing surgery under general anaesthesia. The RCTs were assessed using risk-of-bias assessment, and the quality of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluations (GRADE). RESULTS: In 16 trials (n=1516), the administration of i.v. lidocaine compared with placebo or no treatment led to large reductions in post-extubation cough (risk ratio [RR]: 0.64; 95% confidence interval [CI]: 0.48-0.86) and in postoperative sore throat at 1 h (RR: 0.46; 95% CI: 0.32-0.67). There was no difference in incidence of laryngospasm (risk difference [RD]: 0.02; 95% CI: -0.07 to 0.03) or incidence of adverse events related to the use of lidocaine. CONCLUSIONS: The use of i.v. lidocaine perioperatively decreased airway complications, including coughing and sore throat. There was no associated increased risk of harm.


Assuntos
Anestesia Geral/efeitos adversos , Anestésicos Locais/administração & dosagem , Tosse/prevenção & controle , Lidocaína/administração & dosagem , Complicações Pós-Operatórias/prevenção & controle , Anestésicos Locais/uso terapêutico , Tosse/etiologia , Remoção de Dispositivo/efeitos adversos , Humanos , Injeções Intravenosas , Intubação Intratraqueal/efeitos adversos , Lidocaína/uso terapêutico , Assistência Perioperatória/métodos , Faringite/etiologia , Faringite/prevenção & controle
3.
Postgrad Med ; 132(1): 28-36, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31900074

RESUMO

Interest in and use of topical analgesics has been increasing, presumably due to their potential utility for relief of acute and chronic pain. Topically applied agents with analgesic properties can target peripheral nociceptive pathways while minimizing absorption into the plasma that leads to potential systemic adverse effects.Clinical trials have found 5% lidocaine patches to be effective and well tolerated for the treatment of post-herpetic neuralgia (PHN) with a minimal risk of toxicity or drug-drug interactions. With this patch formulation, the penetration of lidocaine into the skin produces an analgesic effect without producing a complete sensory block. Use of topical lidocaine is supported by clinical practice guidelines, including first-line treatment by the American Academy of Neurology (guidelines retired 2018), the European Federation of Neurological Societies and second-line by the Canadian Pain Society.FDA approved 5% lidocaine patches in 1999, and a 1.8% topical lidocaine system in 2018 - both indicated for the treatment of pain secondary to PHN. The 1.8% system offers a more efficient delivery of lidocaine that is bioequivalent to 5% lidocaine patches, but with a 19-fold decrease in drug load (i.e., 36 mg versus 700 mg) as well as superior adhesion that allows the patch to maintain contact with the skin during the 12-h administration period.Although topical lidocaine formulations have advanced over time and play an important role in the treatment of PHN, a variety of other conditions that respond to topical lidocaine have been reported in the literature including PHN, lower back pain, carpal tunnel syndrome, diabetic peripheral neuropathy, and osteoarthritis joint pain. Other neuropathic or nociceptive pain syndromes may respond to topical lidocaine in select cases and warrant further study. Clinicians should consider local anesthetics and other topical agents as part of their multimodal treatments of acute and chronic pain.


Assuntos
Analgésicos/administração & dosagem , Lidocaína/administração & dosagem , Administração Cutânea , Analgésicos/uso terapêutico , Humanos , Lidocaína/uso terapêutico , Neuralgia/tratamento farmacológico , Adesivo Transdérmico
4.
Artigo em Inglês | MEDLINE | ID: mdl-31918305

RESUMO

A simple, sensitive HPLC-MS/MS method was developed and validated for the determination of lidocaine in skin and plasma of rats. The methods were established and validated assessing lower limit of quantitation (LLOQ), linearity, intra and inter-day precision and accuracy, selectivity, recovery and matrix effect. Chromatography was done on a Gemini column embedded with C18 stationary phase (50 mm × 2.0 mm, 5 µm particle size), using a gradient with mobile phases consisting of 0.1% HCOOH in bidistilled water and 0.1% HCOOH in acetonitrile. The mass spectrometer worked with electrospray ionization in positive ion mode and selected reaction monitoring, using target ions m/z 235.10 for lidocaine and m/z 245.10 for lidocaine-d10, used as internal standard. RESULTS: The linearity of the method was in the ranges of lidocaine concentrations 10.0-200.0 ng/mL for skin homogenate (accuracy 94.1-105.5%; R2 ≥ 0.998) and 0.025-2 ng/mL for plasma (accuracy 96.2-104.8%; R2 ≥ 0.996). The intra- and inter-day precision and accuracy determined on three quality control samples (20, 75 and 170 ng/mL for skin and 0.075, 0.4 and 1.5 ng/mL for plasma) were ≤4.2% and 103.8-108.2% for skin and ≤12.4% and 95.5-101.4% for plasma. The LLOQ was 10 ng/mL in skin homogenate and 0.025 ng/mL in plasma. The applicability of the method was demonstrated by measuring lidocaine in skin and plasma after exposure to medicated patches containing 5% lidocaine.


Assuntos
Cromatografia Líquida de Alta Pressão/métodos , Lidocaína/análise , Espectrometria de Massas em Tandem/métodos , Adesivo Transdérmico , Animais , Estabilidade de Medicamentos , Lidocaína/administração & dosagem , Lidocaína/farmacocinética , Limite de Detecção , Modelos Lineares , Masculino , Ratos , Reprodutibilidade dos Testes , Pele/química
5.
J Appl Oral Sci ; 28: e20190025, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31778442

RESUMO

INTRODUCTION: Periodontal therapy usually requires local anesthesia. If effective, a non-invasive, liposomal anesthetic gel could increase the levels of acceptance of patients in relation to periodontal therapy. OBJECTIVE: This study investigated the efficacy of liposomal anesthetic gel for pain control during periodontal therapy. METHODOLOGY: Forty volunteers with moderate to severe chronic periodontitis were recruited, of which at least three sextants required periodontal therapy. At least one of the selected teeth had one site with a probing depth of ≥4 mm. The volunteers received the following three gels: a placebo, lidocaine/prilocaine (Oraqix®), or a liposomal lidocaine/prilocaine, which were applied to different sextants. Pain frequency was registered during treatment and the volunteers received a digital counter to register any painful or uncomfortable experiences. At the end of each session, the volunteers indicated their pain intensity using rating scales (NRS-101 and VRS-4). The volunteers had their hemodynamic parameters measured by a non-invasive digital monitor. RESULTS: Pain frequency/intensity did not show statistical difference between intervention groups. The tested gels did not interfere with the hemodynamic indices. Dental anxiety, suppuration and probing depth could influence pain during periodontal therapy. CONCLUSION: Our results suggest limited indications for the use of non-invasive anesthesia when used for scaling and root planing. Intra-pocket anesthetic gel could be a good option for anxious patients, or those who have a fear of needles.


Assuntos
Anestesia Dentária/métodos , Anestésicos Locais/administração & dosagem , Raspagem Dentária/efeitos adversos , Géis/administração & dosagem , Dor/prevenção & controle , Aplainamento Radicular/efeitos adversos , Adulto , Idoso , Periodontite Crônica/complicações , Periodontite Crônica/terapia , Método Duplo-Cego , Feminino , Humanos , Lidocaína/administração & dosagem , Combinação Lidocaína e Prilocaína , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Bolsa Periodontal , Placebos , Prilocaína/administração & dosagem , Adulto Jovem
6.
Ann Otol Rhinol Laryngol ; 129(3): 256-264, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31658815

RESUMO

BACKGROUND: Surgery with hypnosis avoids the use of general anesthesia (GA). It also shortens hospitalization and promotes outpatient surgery. The objective of this study has been to assess the satisfaction of operated patients. No previous study has focused on patient satisfaction in a prospective design. METHODS: In this prospective, non-randomized, observational study, all patients operated with hypnosis between 2009 and 2017 in the Ear, Nose, and Throat department of a tertiary care hospital were selected. All patients were asked to fill a questionnaire based on a previously validated questionnaire incremented with complementary questions. Questionnaires were completed immediately after surgery for 31 patients and after 6 months for 20 patients. Global Satisfaction Index (GSI) was self-assessed on a scale ranging from 1 to 10. Patients were asked; whether they felt comfortable during the operation, whether hypnosis helped them, whether the experience matched their expectations, whether they would revisit or recommend it to someone else and whether they considered to have been sufficiently informed before the procedure. The data was analyzed using a linear regression model with P < .05 considered as statistically significant. RESULTS: During the inclusion period, no patient required conversion to GA. A total of 48 questionnaires were evaluated. The median of the GSI was 8/10. GSI significantly correlated with patient comfort (P < 0.0001) and quality of preoperative information (P = .002). The percentage of patients who found hypnosis helpful correlated with the duration of surgery (P = .04). The probability for a patient to consider hypnosis as an experience matching their expectation increased with surgical team experience OR 0.55 (0.3-0.9). CONCLUSION: This study reveals that patients' global satisfaction after hypnosis is high. This is significantly related to the quality of preoperative information and to the experience of the surgical team. It also suggests that patients are more likely to benefit from hypnosis if the surgery is longer.


Assuntos
Hipnose , Procedimentos Cirúrgicos Otorrinolaringológicos , Satisfação do Paciente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/administração & dosagem , Feminino , Humanos , Lidocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Educação de Pacientes como Assunto , Estudos Prospectivos , Autoavaliação , Inquéritos e Questionários , Adulto Jovem
7.
J Surg Res ; 245: 295-301, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31421376

RESUMO

BACKGROUND: One-per-mil tumescent technique could provide local anesthesia in surgical procedures despite using low lidocaine concentration. Tumescence environment within the tissue may play a role in supporting local anesthesia effect. This study aims to delineate whether the tumescence environment, created by one-per-mil solution without a local anesthetic agent, had a local anesthesia effect. METHODS: Four different compositions and volumes of tumescent solutions containing 1:1,000,000 epinephrine were injected into 50 Swiss Webster mice. The animals were divided into five groups: group A, a tumescent solution with 0.2% lidocaine; group B, a tumescent solution with 0.04% lidocaine; group C, a tumescent solution without lidocaine; group D, a doubled volume of tumescent solution without lidocaine; and group E, controls. Local anesthesia effects were tested by using the formalin test (n = 25) and tail immersion test (n = 25). Pain response behavior in the form of paw licking duration and tail withdrawal latency was observed. The analysis of variance and Kruskal-Wallis tests were used to test the statistical difference. Significance was set at P < 0.05. RESULTS: The four interventional groups showed less pain response behavior and significantly longer tail withdrawal latency (P < 0.05) than the control group. However, the groups showed nonsignificantly shorter paw licking duration than the control (P > 0.05). Group A had the fastest onset of the local anesthesia effect. CONCLUSIONS: The tumescence environment was potentially able to provide a local anesthesia effect, although the solution did not contain a local anesthetic agent as proved by the tail immersion test.


Assuntos
Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Epinefrina/administração & dosagem , Dor/prevenção & controle , Animais , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Injeções Subcutâneas , Lidocaína/administração & dosagem , Masculino , Camundongos , Dor/diagnóstico , Dor/etiologia , Medição da Dor , Procedimentos Cirúrgicos Operatórios/efeitos adversos
8.
Int J Gynaecol Obstet ; 148(1): 113-117, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31593299

RESUMO

OBJECTIVE: To evaluate the safety and efficacy of flushing the cervical canal and the uterine cavity with local anesthetic in order to reduce the pain felt by patients during office hysteroscopy. METHODS: A double-blind randomized controlled trial was conducted between May 1, 2018, and February 28, 2019, involving 260 women undergoing office hysteroscopy at Kasr Al Ainy Hospital, Cairo, Egypt. Women were randomized using a computerized random number generator to intrauterine and intracervical instillation 5 minutes before the procedure of either 5 mL lidocaine 2% diluted in 15 mL normal saline, or 20 mL normal saline alone. The primary outcome measure was the visual analog scale (VAS) pain score reported by women during the procedure. Secondary outcomes included VAS score at 10 and 30 minutes after the procedure, the need for analgesia, and occurrence of vasovagal attacks. RESULTS: Women in the lidocaine flushing group reported a significantly lower VAS score during the procedure (1.8 ± 1.1 vs 5.2 ± 1.8) and 10 and 30 minutes after it (1.3 ± 1.15 and 0.8 ± 0.9 vs 4.3 ± 2.1 and 2.98 ± 1.96) when compared with control women (P<0.001). More women without lidocaine flushing experienced vasovagal attacks (25/130 vs 9/130, P<0.001) and needed analgesia (84/130 vs 13/130, P<0.001) when compared with women with lidocaine flushing. CONCLUSION: Flushing of the cervical canal and uterine cavity with local anesthetic significantly decreased pain sensation in women undergoing office hysteroscopy. CLINICALTRIALS.GOV: NCT03530488.


Assuntos
Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Histeroscopia/métodos , Lidocaína/administração & dosagem , Adulto , Método Duplo-Cego , Egito , Feminino , Humanos , Pessoa de Meia-Idade , Manejo da Dor/métodos , Gravidez , Cuidados Pré-Operatórios/métodos
9.
Artigo em Russo | MEDLINE | ID: mdl-31851170

RESUMO

AIM: To compare the efficacy of 2% articaine solution and 2% lidocaine solution used to perform therapeutic nerve blocks of the large occipital nerve in patients with cervicogenic headache. MATERIAL AND METHODS: A randomized prospective comparative clinical study was conducted in two groups treated with articaine (n=22) or lidocaine (n=21). The therapeutic great occipital nerve blocks were performed on the 1st, 3d and 5th days of treatment. The efficacy of treatment was assessed by the pain intensity measured with the Visual Analogue scale (VAS) and the duration of individual pain paroxysms on the 5th and 10th days. RESULTS: The baseline VAS pain intensity was 6.3±1.2 and 5.9±2.0 centimeters, whereas the duration of individual pain paroxysms was 7.8±2.3 and 9.1±2.8 hours in the articaine group and the lidocaine group, respectively. By the 5th day, there was a more dramatically decrease in VAS pain intensity and duration in the articaine group (up to 3.0±0.8 and 4.3±1.2 centimeters VAS (p<0.05)) compared to the lidocaine group (up to 1.9±0.6 to 4.8±1.3 hours (p<0.05)). By the 10th day, the pain intensity did not differ between groups (1.2±0.5 and 1.7±0.7 centimeters (p>0.05)). The duration of pain episodes was still lower in the articaine group (0.5±0.08 hours) compared to the lidocaine group (2.4±0.8 hours) (p<0.05). CONCLUSION: Therapeutic large occipital nerve blocks with 2% solution of articaine show the significant decrease in pain intensity and duration of pain paroxysms in a short period of time for patients with cervicogenic headache.


Assuntos
Anestésicos Locais , Carticaína , Lidocaína , Bloqueio Nervoso , Cefaleia Pós-Traumática , Anestésicos Locais/administração & dosagem , Carticaína/administração & dosagem , Método Duplo-Cego , Humanos , Lidocaína/administração & dosagem , Medição da Dor , Cefaleia Pós-Traumática/terapia , Estudos Prospectivos
10.
Medicine (Baltimore) ; 98(48): e18168, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770265

RESUMO

RATIONALE: Recent years have witnessed a marked improvement in the safety and accuracy of nerve blocks with the help of ultrasound and other visualization technologies. This study reports a challenging case of a severe complication during the ultrasound-guided stellate ganglion block. PATIENT CONCERNS: A 28-year-old male patient with refractory migraine complained episodic pulsatile pain with photophobia, haphalgesia of the scalp for 3 years. INTERVENTIONS: Ultrasound-guided stellate ganglion block with 4 ml of 1% lidocaine was administrated. OUTCOMES: A sudden loss of consciousness and tonic-clonic seizure was occurred after negative aspiration and test dose. Further sonographic examination revealed a variation in the left vertebral artery, which remained unrecognized during the needle insertion because of its sliding ability under the differential pressure applied by the probe. LESSONS: Inadvertent intra-arterial injection of a local anesthetic agent could be minimized under the ultrasound guidance with various protective strategies, including the determination of any prior variation, optimizing the block route, maintaining a constant probe pressure, and using saline for the test dosage. This case resulted in the implementation of new protocols of the ultrasound-guided stellate ganglion block in our department.


Assuntos
Bloqueio Nervoso Autônomo , Complicações Intraoperatórias , Lidocaína , Convulsões , Gânglio Estrelado , Inconsciência , Artéria Vertebral , Adulto , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Bloqueio Nervoso Autônomo/efeitos adversos , Bloqueio Nervoso Autônomo/métodos , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/terapia , Lidocaína/administração & dosagem , Lidocaína/efeitos adversos , Masculino , Erros Médicos/prevenção & controle , Transtornos de Enxaqueca/cirurgia , Assistência ao Paciente/métodos , Convulsões/etiologia , Convulsões/terapia , Gânglio Estrelado/diagnóstico por imagem , Gânglio Estrelado/cirurgia , Resultado do Tratamento , Ultrassonografia de Intervenção/métodos , Inconsciência/etiologia , Inconsciência/terapia , Artéria Vertebral/anatomia & histologia , Artéria Vertebral/lesões
11.
Plast Reconstr Surg ; 144(4): 586e-596e, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31568288

RESUMO

BACKGROUND: Hand rejuvenation has become increasingly popular, but there are few reports published on the use of hyaluronic acid gels for correction of volume deficits in the dorsal hand. METHODS: This study evaluated the efficacy and safety of large-gel-particle hyaluronic acid with lidocaine, a 20-mg/ml hyaluronic acid gel with 0.3% lidocaine, compared to no treatment for the correction of volume deficits in the dorsal hand. This was a prospective, multicenter, split-hand study in 90 subjects who received treatment with product in one hand. The primary efficacy endpoint was based on a 1 point of improvement with treatment versus no treatment according to the Merz Hand Grading Scale at week 12. Other assessments included Central Independent Photographic Reviewers evaluations of hand photographs, Global Aesthetic Improvement Scale, subject satisfaction, and safety. RESULTS: The mean injection volume was 2.1 ml at the first treatment. Subjects demonstrated significantly higher response rates with treatment compared to no treatment at week 12 (85.9 percent versus 21.2 percent) and at weeks 16, 20, and 24 (p < 0.0001). Photographic Reviewers assessments showed consistently greater improvements in the treated hands compared with the untreated hands from week 12 to week 24. Most subjects and investigators (≥92.8 percent) reported improvements in Global Aesthetic Improvement Scale score across all time points with treatment. Treatment-related adverse events were reported in seven subjects (7.9 percent). Most of these were mild, and none were serious. CONCLUSION: Hyaluronic acid with lidocaine is safe, effective, and well tolerated for the correction of volume deficits in the dorsal hand. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.


Assuntos
Anestésicos Locais/administração & dosagem , Técnicas Cosméticas , Mãos , Ácido Hialurônico/administração & dosagem , Lidocaína/administração & dosagem , Rejuvenescimento , Adulto , Idoso , Anestésicos Locais/efeitos adversos , Técnicas Cosméticas/efeitos adversos , Feminino , Géis , Humanos , Ácido Hialurônico/efeitos adversos , Lidocaína/efeitos adversos , Masculino , Pessoa de Meia-Idade , Tamanho da Partícula , Estudos Prospectivos , Método Simples-Cego , Resultado do Tratamento
12.
J Low Genit Tract Dis ; 23(4): 279-286, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31592976

RESUMO

OBJECTIVE: The aim of the study was to assess the feasibility and acceptability of acupuncture's augmentation of lidocaine therapy in the treatment of provoked localized vulvodynia (PLV). MATERIALS AND METHODS: For 12 weeks, women with moderate to severe PLV were randomized to either 18 sessions of traditional acupuncture (TA) or non-TA (NTA). All participants applied lidocaine 5% cream 4 times daily to the vestibule. Feasibility was assessed by recruitment, enrollment, assessment completion, and blinding. Acceptability was assessed by study visit attendance and satisfaction. The primary outcome was change in tampon test scores from baseline to week 12 and follow-up at week 24. RESULTS: Nineteen women enrolled and 14 completed the study. Five withdrew because of lidocaine reaction (n = 2), inability to insert tampon (n = 1), starting a new medication (n = 1), or change in vulvar diagnosis (n = 1). Participants in both groups reported pain reduction for 12 weeks. There was no statistically significant difference between groups. Women in the TA group (n = 7) experienced less pain from baseline to 12 weeks (mean difference [MD] = 42.4 ± 19.4 and MD = 35.7 ± 17.8 at week 24). In the non-TA group (n = 7), women experienced a within-group MD of 28.7 ± 28.5 at 12 weeks and an MD of 36.7 ± 17.7. CONCLUSIONS: In this early-phase research, acupuncture augmentation of lidocaine was acceptable. The study procedures, with modifications, may be feasible for future investigation. Both acupuncture techniques showed a favorable effect; however, the contribution to pain relief is undetermined.


Assuntos
Acupuntura/métodos , Anestésicos Locais/administração & dosagem , Lidocaína/administração & dosagem , Vulvodinia/terapia , Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Resultado do Tratamento , Adulto Jovem
13.
Medicine (Baltimore) ; 98(42): e17450, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626100

RESUMO

BACKGROUND: Cerebral aneurysm surgery has significant mortality and morbidity rate. Inflammation plays a key role in the pathogenesis of intracranial aneurysms, their rupture, subarachnoid hemorrhage and neurologic complications. Proinflammatory cytokine level in blood and cerebrospinal fluid (CSF) is an indicator of inflammatory response. Cytokines contribute to secondary brain injury and can worsen the outcome of the treatment. Lidocaine is local anesthetic that can be applied in neurosurgery as regional anesthesia of the scalp and as topical anesthesia of the throat before direct laryngoscopy and endotracheal intubation. Besides analgesic, lidocaine has systemic anti-inflammatory and neuroprotective effect.Primary aim of this trial is to determine the influence of local anesthesia with lidocaine on the perioperative levels of pro-inflammatory cytokines interleukin-1ß, interleukin-6, and tumor necrosis factor-α in plasma and CSF in cerebral aneurysm patients. METHODS: We will conduct prospective randomized clinical trial among patients undergoing craniotomy and cerebral aneurysm clipping surgery in general anesthesia. Patients included in the trial will be randomly assigned to the lidocaine group (Group L) or to the control group (Group C). Patients in Group L, following general anesthesia induction, will receive topical anesthesia of the throat before endotracheal intubation and also regional anesthesia of the scalp before Mayfield frame placement, both done with lidocaine. Patients in Group C will have general anesthesia only without any lidocaine administration. The primary outcomes are concentrations of cytokines interleukin-1ß, interleukin-6 and tumor necrosis factor-α in plasma and CSF, measured at specific timepoints perioperatively. Secondary outcome is incidence of major neurological and infectious complications, as well as treatment outcome in both groups. DISCUSSION: Results of the trial could provide insight into influence of lidocaine on local and systemic inflammatory response in cerebrovascular surgery, and might improve future anesthesia practice and treatment outcome. TRIAL IS REGISTERED AT CLINICALTRIALS.GOV:: NCT03823482.


Assuntos
Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Citocinas/efeitos dos fármacos , Aneurisma Intracraniano/cirurgia , Lidocaína/administração & dosagem , Adolescente , Adulto , Idoso , Anestesia por Condução/métodos , Anestesia Geral/métodos , Craniotomia/métodos , Citocinas/sangue , Citocinas/líquido cefalorraquidiano , Feminino , Humanos , Aneurisma Intracraniano/sangue , Aneurisma Intracraniano/líquido cefalorraquidiano , Intubação Intratraqueal/métodos , Laringoscopia/métodos , Masculino , Pessoa de Meia-Idade , Faringe , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Couro Cabeludo , Resultado do Tratamento , Adulto Jovem
14.
Acta Biochim Pol ; 66(3): 285-290, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31531421

RESUMO

Lignocaine a first amino amide-type local anesthetic, when combined or co-administered with epinephrine, a sympathomimetic amine, allows to administer larger doses for numbing, to decrease bleeding, and to make the numbing effect last longer. The study presented here focuses on measures to prove this activity in patients with abdominal surgery. Liposomal formulations of lignocaine and lignocaine plus epinephrine were prepared by a thin film evaporation method. This formulation was injected successfully as liposomal infusion. Thus prepared liposomes were found to be fit for drug delivery when evaluated as per physicochemical parameters. The smooth, even surfaced liposomes with PDI of 0.298 (p<0.05) were found to be efficient in delivering the drug when tested in-vitro (lignocaine as a single drug was at 93.78%, and from combined dosage lignocaine was at 96.29% with 94.62% of release of epinephrine). The randomized, controlled trial was conducted with a population of children that had undergone abdominal surgery and who were grouped into three groups depending upon the type of formulation they received. The three groups of subjects were first one receiving lignocaine liposomal infusion only; second one with lignocaine plus epinephrine liposomal infusion; the third group served as control and received a saline solution only. The serum Cortisol concentration was found to be the least in Group II when compared to Group I. Similarly, end point measurements such as the cool sensation, warm sensation, hot pain, and the sensory blockade test had indicated the superiority of combination of lignocaine with epinephrine in lowering the pain threshold. The result obtained from the above study has shown that epinephrine markedly enhances the local anesthetic activity of lignocaine.


Assuntos
Anestésicos Locais/uso terapêutico , Epinefrina/uso terapêutico , Lidocaína/uso terapêutico , Manejo da Dor/métodos , Simpatomiméticos/uso terapêutico , Abdome Agudo/cirurgia , Anestésicos Locais/administração & dosagem , Criança , Pré-Escolar , Portadores de Fármacos/química , Combinação de Medicamentos , Composição de Medicamentos/métodos , Sinergismo Farmacológico , Epinefrina/administração & dosagem , Feminino , Humanos , Hidrocortisona/sangue , Lidocaína/administração & dosagem , Lipossomos/química , Masculino , Dor Pós-Operatória/tratamento farmacológico , Tamanho da Partícula , Simpatomiméticos/administração & dosagem
15.
J Stroke Cerebrovasc Dis ; 28(12): 104403, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31563566

RESUMO

BACKGROUND: Air embolism is an extremely rare complication that can follow gastrointestinal endoscopy. The most accepted treatment of cerebral air embolism (CAE) is hyperbaric oxygen (HBO). Limited evidence suggests that lidocaine may have a neuroprotective effect. The exact mechanism does not appear to be well elucidated. METHODS: We conducted a literature search using multiple combinations of keywords from PubMed and Ovid Medline databases according to the PRISMA guidelines. We included articles with cases of air embolism caused by an esophagogastroduodenoscopy (EGD). We excluded cases related to other procedures e.g. colonoscopy, endoscopic retrograde cholangiopancreatography, cholangioscopy, Kasai procedure, bronchoscopy, laparoscopy or thoracoscopy. We were able to identify 30 cases of CAE associated with EGD. We included our experience in treating one patient with CAE after elective EGD. RESULTS: Given the results of our literature search and this patient's characteristics, we chose to treat our patient with HBO and lidocaine infusion. Our case series consists of 31 patients of post EGD CAE, the mean age was 63.7 ± 11.14 years, 38.7% of the patients were women (n = 12). 38.7% of the cases underwent esophageal dilatation (n = 12), while 19.35% had EGD biopsy (n = 6), 9.6% had variceal ligation (n = 3), and 3.22% had variceal banding (n = 1). In 20 out of 31 cases, echocardiography has been documented, 20% of those patients (n = 4) had patent foramen ovale. HBO was used in treatment of 48% of cases (n = 15), among the included patients, 61% survived (n = 19). Our patient showed significant neurological improvement. CONCLUSIONS: Despite the rare incidence of CAE during or after EGD, physicians should be aware of this potential complication. In patients who develop sudden acute neurological symptoms, early diagnosis and intervention may prevent devastating neurological injury and death. The most accepted emergent treatment for CAE includes HBO, consideration of lidocaine, and work-up of source of the air embolism.


Assuntos
Embolia Aérea , Endoscopia Gastrointestinal/efeitos adversos , Embolia Intracraniana , Idoso , Idoso de 80 Anos ou mais , Embolia Aérea/epidemiologia , Embolia Aérea/fisiopatologia , Embolia Aérea/prevenção & controle , Embolia Aérea/terapia , Feminino , Humanos , Oxigenação Hiperbárica , Incidência , Infusões Parenterais , Embolia Intracraniana/epidemiologia , Embolia Intracraniana/fisiopatologia , Embolia Intracraniana/prevenção & controle , Embolia Intracraniana/terapia , Lidocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Fármacos Neuroprotetores/administração & dosagem , Medição de Risco , Fatores de Risco , Resultado do Tratamento
16.
Vet Clin North Am Small Anim Pract ; 49(6): 1109-1125, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31474415

RESUMO

Local anesthetics are the only class of drugs that can block transduction and transmission of nociception. Physical properties, mechanism of action, and pharmacokinetics of this class of drugs are reviewed in this article. The clinical use, such intravenous administration of lidocaine, and local and systemic toxic effects are covered. A review of current studies published in the human and veterinary literature on lidocaine patches (Lidoderm) and liposomal bupivacaine (Experal and Nocita) are discussed.


Assuntos
Anestesia Local/veterinária , Anestésicos Locais/administração & dosagem , Animais de Estimação , Anestesia Local/métodos , Animais , Lidocaína/administração & dosagem
17.
Clin Drug Investig ; 39(11): 1133-1139, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31471864

RESUMO

Tropicamide 0.02%/phenylephrine 0.31%/lidocaine 1% injectable solution (Mydrane®) is the first fixed-dose mydriatic/anaesthetic combination approved for intracameral use in adults undergoing cataract surgery. In a phase 3 trial in this setting, intracameral tropicamide/phenylephrine/lidocaine was at least as effective as a standard topical regimen of tropicamide plus phenylephrine in enabling successful capsulorhexis without the use of additional mydriatics. The intracameral preparation, which is administered via a single injection, provides rapid and sustained mydriasis through to the end of surgery, with recipients spending around half as long in preoperative/surgery rooms as standard topical regimen recipients in the phase 3 study. Moreover, significantly more of the intracameral than topical regimen recipients were free from pain or pressure in the eye/orbit before intraocular lens (IOL) implantation and had an IOL implanted without complications. Intracameral tropicamide/phenylephrine/lidocaine also displayed mydriatic efficacy in patients with diabetes in this trial. Overall, the preparation was generally well tolerated, with no serious adverse events leading to hospitalization or permanent vision loss. Thus, tropicamide/phenylephrine/lidocaine injectable solution is an emerging option for mydriasis/anaesthesia in adults undergoing cataract surgery.


Assuntos
Extração de Catarata/métodos , Catarata/tratamento farmacológico , Lidocaína/administração & dosagem , Midriáticos/administração & dosagem , Fenilefrina/administração & dosagem , Tropicamida/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Catarata/diagnóstico , Combinação de Medicamentos , Quimioterapia Combinada , Feminino , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Facoemulsificação/métodos , Estudos Prospectivos , Pupila/efeitos dos fármacos
18.
J Craniofac Surg ; 30(8): e796-e799, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31403517

RESUMO

Vascular malformations (VMs) are benign lesions of blood vessels originated from an error in vascular morphogenesis during the embryologic phase. Generally, when located in the head and neck region VMs occurs in lips, tongue, buccal mucosa, gums, or palate. The VMs are usually asymptomatic, varies in size and may cause facial asymmetries. Different therapeutic modalities are available to treat VMs, which include surgical excision, cautery, cryotherapy, laser therapy, and sclerosing agents. The authors report 2 patients with extensive VM in the tongue treated with intralesional injection of a low-dose solution of monoethanolamine oleate (MO) and lidocaine. The first patient was a 69-year-old male patient and the 2nd a 65-year-old woman. In both patients, it were performed weekly application of 1:1 MO (Ethamolin) with Lidocaine (lidocaine 3% 1:50,000) in the amount of 0.1 mL of the solution per cm3 of lesion, with a total of 12 applications for each patient at the end of the treatment, with good results and without complications. It is important to be alert in which situation sclerotherapy should be used and that small doses of the sclerotherapeutic agent is essential for the prevention of complications after the procedure. Therefore, these patients showed that the sclerotherapy with MO may be an effective and simple treatment for extensive oral benign vascular lesions. In both patients, there was a great improvement in the clinical aspect of the lesions and patient's satisfaction.


Assuntos
Lidocaína/uso terapêutico , Ácidos Oleicos/uso terapêutico , Soluções Esclerosantes/uso terapêutico , Doenças da Língua/tratamento farmacológico , Malformações Vasculares/tratamento farmacológico , Idoso , Feminino , Humanos , Injeções Intralesionais , Terapia a Laser , Lidocaína/administração & dosagem , Masculino , Ácidos Oleicos/administração & dosagem , Escleroterapia , Língua , Resultado do Tratamento
19.
J Shoulder Elbow Surg ; 28(9): 1743-1749, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31447123

RESUMO

BACKGROUND: Lateral epicondylitis (LE) is a painful condition typically caused by excessive use of tendons, resulting in tendinopathy, inflammation, pain, and sensitivity changes in the lateral elbow. Iontophoresis is a noninvasive method of systemic and local drug delivery by means of a current. The study aimed to evaluate the effects of iontophoresis in patients with LE. METHODS: We performed a randomized, double-blind clinical trial. Twenty-four patients with LE, randomized into an iontophoresis group and a galvanic current group. The iontophoresis group received a solution of dexamethasone (4 mg/mL) and gel lidocaine-applied on the negative electrode by means of a continuous current at 5 mA for 15 minutes-and the positive electrode received a base gel solution. Patients in the galvanic current group received the same protocol but using a base gel solution on both electrodes. RESULTS: Both groups showed a significant improvement in pain on exertion and rest; increased handgrip strength in elbow extension and flexion; and improved function, as evaluated by the Patient-Rated Tennis Elbow Evaluation scale (P < .05). Iontophoresis showed superior results compared with galvanic current in pain on exertion and rest and in the function of individuals with tennis elbow. CONCLUSION: Iontophoresis proved to be an effective technique in reducing pain and improving strength and function in individuals with LE (tennis elbow).


Assuntos
Iontoforese , Cotovelo de Tenista/terapia , Anestésicos Locais/administração & dosagem , Anti-Inflamatórios/administração & dosagem , Dexametasona/administração & dosagem , Método Duplo-Cego , Feminino , Géis , Força da Mão , Humanos , Lidocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente
20.
Urology ; 133: 72-77, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31465791

RESUMO

OBJECTIVE: To assess whether intraurethral anesthesia decreased voiding efficiency (VE), reduced catheterization pain, and impacted urodynamic parameters in healthy adult females. METHODS: In a randomized, double-blind, placebo-controlled trial, participants received two 5 mL doses of either intraurethral aqueous gel or 4% lidocaine gel. The primary outcome was VE during randomized condition uroflow, defined as voided volume/(voided volume + residual volume). The secondary outcomes were pain during catheterization and to confirm previously reported pressure-flow changes. A sample size of 10 per group was planned to detect a clinically significant decrease in VE with a power (1-ß) of 0.99. RESULTS: From October to December 2018, 23 women were screened and 18 were randomized to receive placebo (n = 10) or lidocaine (n = 8). Baseline uroflow VE was similar between the placebo and lidocaine groups (88 ± 6.6% vs 91 ± 5.8%, P = .33). After study drug administration, the changes in VE (post-pre) were similar between placebo and lidocaine groups (-5.4 ± 14% vs 1.7 ± 6.4%, P = .21). Visual analog scores were similar following catheterizations (26.7 ± 12.8 mm vs 36.9 ± 26.8 mm, P = .34). The lidocaine group exhibited lower average flow rates per voided volume (0.04 ± 0.02 s-1 vs 0.02 ± 0.01 s-1, P = .04). CONCLUSION: Intraurethral administration of 4% lidocaine did not decrease VE compared to placebo and did not change pain scores following catheterization. In the lidocaine group, the average flow rate per voided volume was lower. The decrease in flow rate after local anesthesia to the urethra may indicate that urethral sensory feedback contributes to voiding in human micturition.


Assuntos
Anestésicos Locais/administração & dosagem , Lidocaína/administração & dosagem , Dor/prevenção & controle , Cateterismo Urinário , Micção/efeitos dos fármacos , Urodinâmica/efeitos dos fármacos , Administração Tópica , Adulto , Anestésicos Locais/farmacologia , Método Duplo-Cego , Feminino , Humanos , Lidocaína/farmacologia , Uretra , Cateterismo Urinário/efeitos adversos
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