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1.
Anaesthesia ; 76(2): 238-250, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33141959

RESUMO

Intravenous lidocaine is used widely for its effect on postoperative pain and recovery but it can be, and has been, fatal when used inappropriately and incorrectly. The risk-benefit ratio of i.v. lidocaine varies with type of surgery and with patient factors such as comorbidity (including pre-existing chronic pain). This consensus statement aims to address three questions. First, does i.v. lidocaine effectively reduce postoperative pain and facilitate recovery? Second, is i.v. lidocaine safe? Third, does the fact that i.v. lidocaine is not licensed for this indication affect its use? We suggest that i.v. lidocaine should be regarded as a 'high-risk' medicine. Individual anaesthetists may feel that, in selected patients, i.v. lidocaine may be beneficial as part of a multimodal peri-operative pain management strategy. This approach should be approved by hospital medication governance systems, and the individual clinical decision should be made with properly informed consent from the patient concerned. If i.v. lidocaine is used, we recommend an initial dose of no more than 1.5 mg.kg-1 , calculated using the patient's ideal body weight and given as an infusion over 10 min. Thereafter, an infusion of no more than 1.5 mg.kg-1 .h-1 for no longer than 24 h is recommended, subject to review and re-assessment. Intravenous lidocaine should not be used at the same time as, or within the period of action of, other local anaesthetic interventions. This includes not starting i.v. lidocaine within 4 h after any nerve block, and not performing any nerve block until 4 h after discontinuing an i.v. lidocaine infusion.


Assuntos
Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Lidocaína/administração & dosagem , Lidocaína/uso terapêutico , Dor Pós-Operatória/prevenção & controle , Administração Intravenosa , Anestésicos Locais/efeitos adversos , Comorbidade , Consenso , Humanos , Infusões Intravenosas , Lidocaína/efeitos adversos , Bloqueio Nervoso , Segurança do Paciente , Recuperação de Função Fisiológica , Medição de Risco , Resultado do Tratamento
2.
Anaesthesia ; 76(2): 189-198, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32564365

RESUMO

Peri-operative lidocaine infusion warrants investigation in bariatric surgery because obese patients present different physiological and pharmacological risks. This single-centre, prospective, randomised double-blind placebo-controlled study enrolled obese patients scheduled for laparoscopic bariatric surgery using an enhanced recovery protocol. Patients received either lidocaine (bolus of 1.5 mg.kg-1 , then a continuous infusion of 2 mg.kg-1 .h-1 until the end of the surgery, then 1 mg.kg-1 .h-1 for 1 h in the recovery area) or identical volumes and rates of 0.9% saline. The primary outcome was the consumption of the equivalent of oxycodone consumption over the first 3 postoperative days. Secondary outcomes were: postoperative pain; incidence of nausea and vomiting; bowel function recovery; and lengths of stay in the recovery area and in hospital. Plasma concentrations of lidocaine were measured. On the 178 patients recruited, data were analysed from 176. The median (IQR [range]) equivalent intravenous oxycodone consumption was 3.3 mg (0.0-6.0 [0.0-14.5]) and 5.0 mg (3.3-7.0 [3.3-20.0]) in the lidocaine and saline groups, respectively (difference between medians (95%CI): 1.7 (0.6-3.4) mg; p = 0.004). Length of stay in the recovery area, postoperative pain, nausea and vomiting, day of recovery of bowel function, and length of stay in hospital were not different between groups. Mean (SD) lidocaine plasma concentrations were 2.44 (0.70) µg.ml-1 and 1.77 (0.51) µg.ml-1 at the end of surgery and 1 hour after the end of infusion, respectively. Lidocaine infusion during bariatric surgery resulted in a clinically non-relevant difference in postoperative oxycodone consumption.


Assuntos
Analgésicos Opioides/uso terapêutico , Anestésicos Locais/uso terapêutico , Cirurgia Bariátrica , Lidocaína/uso terapêutico , Dor Pós-Operatória/prevenção & controle , Adulto , Analgesia Controlada pelo Paciente , Analgésicos Opioides/administração & dosagem , Anestésicos Locais/administração & dosagem , Método Duplo-Cego , Feminino , Humanos , Laparoscopia , Tempo de Internação , Lidocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Obesidade/cirurgia , Oxicodona/administração & dosagem , Oxicodona/uso terapêutico , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Náusea e Vômito Pós-Operatórios/epidemiologia , Estudos Prospectivos , Recuperação de Função Fisiológica
4.
Medicine (Baltimore) ; 99(49): e23408, 2020 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-33285730

RESUMO

Even though chronic abdominal pain is 1 of the most common reasons for hospital visits, diagnostic testing is often time-consuming and treatment is inadequate. Abdominal myofascial pain syndrome (AMPS) is usually not included as a differential diagnosis, but it should be considered in cases of chronic abdominal pain. The purpose of this study was to investigate the clinical characteristics of AMPS and to assess the effect of sonography-guided trigger point injections (TPI).A total of 100 patients with AMPS from 2012 to 2018 were retrospectively evaluated for clinical characteristics and TPI effects. AMPS was diagnosed using Srinivasan and Greenbaum's criteria, and the TPIs were performed at intervals of 2 to 4 weeks. The Visual Analog Scale (VAS) ratio was calculated by subtracting the final VAS from the initial VAS score and dividing it by the initial VAS score after injections, and the patients were divided into 4 groups: non-responders, mild, moderate, and good responders.The median duration of pain was 12 months, and the median number of hospital visits before TPI was 2. Of the 100 patients, 66 (66%) were categorized as good responders, 11 (11%) as moderate responders, 7 (6.9%) as mild responders, and 16 (15.7%) as non-responders. When the initial and final VAS scores were compared, the sonography-guided injections were found to be effective in alleviating pain (P < .001). Moreover, patients who received the injections 2 or more times tended to have more significant pain reduction than those who received a single injection (P < .001).Patients with AMPS suffer from long-term pain and undergo many hospital visits and diagnostic tests. TPI with lidocaine can be an effective and safe treatment for patients with chronic AMPS.


Assuntos
Dor Abdominal/tratamento farmacológico , Anestésicos Locais/uso terapêutico , Lidocaína/uso terapêutico , Síndromes da Dor Miofascial/tratamento farmacológico , Pontos-Gatilho , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/administração & dosagem , Doença Crônica , Feminino , Humanos , Lidocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Retrospectivos , Índice de Gravidade de Doença , Ultrassonografia de Intervenção , Adulto Jovem
5.
BMJ ; 370: m3027, 2020 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-33315586

RESUMO

OBJECTIVE: To study whether a high volume injection without corticosteroids improves clinical outcome in addition to usual care for adults with chronic midportion Achilles tendinopathy. DESIGN: Patient and assessor blinded, placebo controlled randomised clinical trial. SETTING: Sports medicine department of a large district general hospital, the Netherlands. PARTICIPANTS: 80 adults (aged 18-70 years) with clinically diagnosed chronic midportion Achilles tendinopathy and neovascularisation on ultrasonography. 39 were randomised to a high volume injection without corticosteroids and 41 to placebo. INTERVENTIONS: Participants were instructed to perform an exercise programme for 24 weeks (usual care) combined with one 50 mL high volume injection of saline and lidocaine (intervention group) or one 2 mL placebo injection of saline and lidocaine (placebo group) at baseline. MAIN OUTCOME MEASURES: Primary outcome was pain and function assessed using the validated Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire at 24 weeks (analysed using a generalised estimation equations model). Secondary outcomes were patient satisfaction, return to sport, degree of ultrasonographic Doppler flow, visual analogue scale on 10 hop test, power and flexibility of the gastrocnemius and soleus muscles, pain detect questionnaire for neuropathic pain, and pain coping inventory. Participants were evaluated at baseline and at 2, 6, 12, and 24 weeks. RESULTS: Only one participant (1%) was lost to follow-up. The estimated mean VISA-A score improved significantly, from 40.4 (95% confidence interval 32.0 to 48.7) at baseline to 59.1 (50.4 to 67.8) at 24 weeks in the high volume injection group and from 36.9 (27.1 to 46.8) to 58.5 (47.9 to 69.1) in the placebo group. The VISA-A score over time did not differ between the groups (adjusted between group difference at 24 weeks 0.5 points, 95% confidence interval -17.8 to 18.8). No significant between group differences were found for patient satisfaction (21/37 (57%) v 19/39 (49%) patients, P=0.50) and return to desired sport (15/29 (52%) v 19/31 (61%) patients active in sports, P=0.65) at 24 weeks. None of the other secondary outcomes differed between the two groups. CONCLUSIONS: A high volume injection without corticosteroids in addition to usual care is not effective for symptom reduction in patients with chronic midportion Achilles tendinopathy. On the basis of our findings, we cannot recommend the use of a high volume injection in this patient group. TRIAL REGISTRATION: ClinicalTrials.gov NCT02996409.


Assuntos
Tendão do Calcâneo , Anestésicos Locais/administração & dosagem , Lidocaína/administração & dosagem , Solução Salina/administração & dosagem , Tendinopatia/tratamento farmacológico , Adolescente , Adulto , Idoso , Anestésicos Locais/uso terapêutico , Doença Crônica , Terapia Combinada , Relação Dose-Resposta a Droga , Método Duplo-Cego , Quimioterapia Combinada , Terapia por Exercício , Feminino , Seguimentos , Humanos , Injeções , Lidocaína/uso terapêutico , Masculino , Pessoa de Meia-Idade , Solução Salina/uso terapêutico , Tendinopatia/diagnóstico , Tendinopatia/terapia , Resultado do Tratamento , Adulto Jovem
6.
Medicine (Baltimore) ; 99(48): e23332, 2020 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-33235097

RESUMO

BACKGROUND: Perioperative intravenous lidocaine has been reported to have analgesic and opioid-sparing effects in many kinds of surgery. Several studies have evaluated its use in the settings of spine surgery. The aim of the study is to examine the effect of intravenous lidocaine in patients undergoing spine surgery. METHODS: We performed a quantitative systematic review. Databases of PubMed, Medline, Embase database and Cochrane library were investigated for eligible literatures from their establishments to June, 2019. Articles of randomized controlled trials that compared intravenous lidocaine to a control group in patients undergoing spine surgery were included. The primary outcome was postoperative pain intensity. Secondary outcomes included postoperative opioid consumption and the length of hospital stay. RESULT: Four randomized controlled trials with 275 patients were included in the study. postoperative pain compared with control was reduced at 6 hours after surgery (WMD -0.50, 95%CI, -0.76 to -0.25, P < .001), at 24 hours after surgery (WMD -0.50, 95%CI, -0.70 to -0.29, P < .001) and at 48 hours after surgery (WMD -0.57, 95%CI, -0.96 to -0.17, P = .005). The effect of intravenous lidocaine on postoperative opioid consumption compared with control revealed a significant effect (WMD -15.36, 95%CI, -21.40 to -9.33 mg intravenous morphine equivalents, P < .001). CONCLUSION: This quantitative analysis of randomized controlled trials demonstrated that the perioperative intravenous lidocaine was effective for reducing postoperative opioid consumption and pain in patients undergoing spine surgery. The intravenous lidocaine should be considered as an effective adjunct to improve analgesic outcomes in patients undergoing spine surgery. However, the quantity of the studies was very low, more research is needed.


Assuntos
Anestésicos Locais/uso terapêutico , Lidocaína/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Coluna Vertebral/cirurgia , Administração Intravenosa , Analgésicos Opioides/administração & dosagem , Anestésicos Locais/administração & dosagem , Humanos , Tempo de Internação , Lidocaína/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto
7.
Ideggyogy Sz ; 73(9-10): 345-348, 2020 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-33035414

RESUMO

Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing/short-lasting unilateral neuralgiform headache with cranial autonomic features (SUNCT/SUNA) is a rare severe headache. At the time of an attack, it can hinder a patient from eating and requires acute intervention. The sphenopalatine ganglion is an extracranial parasympathetic ganglion with both sensory and autonomic fibers. Sphenopalatine ganglion block has long been used in the treatment of headache, particularly when conventional methods have failed. Here, we present a patient who was resistant to intravenous lidocaine, but responded rapidly to sphenopalatine ganglion block during an acute episode of SUNCT/SUNA.


Assuntos
Lidocaína/uso terapêutico , Síndrome SUNCT/terapia , Bloqueio do Gânglio Esfenopalatino/métodos , Cefaleia , Humanos , Neuralgia , Síndrome SUNCT/diagnóstico , Bloqueio do Gânglio Esfenopalatino/efeitos adversos , Resultado do Tratamento
8.
Am J Emerg Med ; 38(10): 2185-2193, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33071078

RESUMO

INTRODUCTION: Although available studies have not demonstrated that antiarrhythmic drugs could increase long-term survival or survival with favorable neurological outcome, some studies have shown that the rate of hospital admission is higher with amiodarone or lidocaine than with placebo. To study the effects of antiarrhythmic drugs during cardiac arrest, a meta-analysis was conducted to assess the efficacy of amiodarone and/or lidocaine. METHODS: We searched studies from inception until Jan 21, 2020. The primary endpoint was survival to hospital discharge in cardiac arrest, and the secondary endpoints were survival to hospital admission/24 h and favorable neurological outcome. RESULTS: A total of 9 studies were included. In head-to-head studies, amiodarone (odds ratio [OR] 2.96, 95% credible interval [CrI] 1.02-8.53) and lidocaine (OR 3.12, 95% CrI 1.08-9.98) had superior effects on survival to hospital admission/24 h compared to the combination of the two drugs. In terms of survival to hospital discharge, amiodarone (OR 1.18, 95% CrI 1.03-1.35) and lidocaine (OR 1.22, 95% CrI 1.06-1.41) were more effective than placebo. Amiodarone (OR 1.20, 95% CrI 1.02-1.41) was significantly better than placebo in favorable neurological outcome. However, there was no significant difference in other pairwise comparisons. The surface under cumulative ranking curve (SUCRA) revealed that lidocaine was the most effective therapy for survival to hospital admission (84.1%) and discharge (88.4%), while amiodarone was associated with a more favorable neurological outcome (88.2%). CONCLUSIONS: Lidocaine had the best effect on both survival to hospital admission and discharge, while amiodarone was associated with a more favorable neurological outcome. TRIAL REGISTRATION: This study is registered with PROSPERO, number CRD42020171049.


Assuntos
Amiodarona/uso terapêutico , Parada Cardíaca/tratamento farmacológico , Lidocaína/uso terapêutico , Amiodarona/efeitos adversos , Amiodarona/normas , Antiarrítmicos/normas , Antiarrítmicos/uso terapêutico , Teorema de Bayes , Humanos , Lidocaína/efeitos adversos , Lidocaína/normas , Metanálise em Rede , Análise de Sobrevida
9.
J Spec Oper Med ; 20(3): 128-134, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32969018

RESUMO

Future expeditionary missions are expected to occur in more remote austere environments where combat medics and casualties may have to wait up to 7 days before resupply or safe evacuation. Currently, there is no effective fluid therapy for hemorrhagic shock (HS) at the point-of-injury and continuum-of-care over this extended period. We have been developing a small-volume IV or IO ALM therapy for noncompressible HS and have shown in preclinical models that it extends survival to 3 days, reduces abdominal bleeding by 60%, blunts inflammation, corrects coagulopathy, preserves platelet function, and prevents immunodeficiency. The ALM-survival phenotype is associated with an upregulation of the master genes of metabolism and mitochrondrial biogenesis in heart and brain and a downregulation in the periphery. Future translational studies will investigate the timing and nature of the "switch" and extend survival to 7 days. We will also discuss some of the controversies of ALM resuscitation in pigs, present our Systems Hypothesis of Trauma (SHOT), and discuss future clinical safety trials before field use.


Assuntos
Choque Hemorrágico , Adenosina/uso terapêutico , Animais , Hidratação , Lidocaína/uso terapêutico , Magnésio/uso terapêutico , Ressuscitação , Choque Hemorrágico/terapia , Suínos
10.
PLoS One ; 15(9): e0239896, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32986770

RESUMO

INTRODUCTION: Pain management is the pillar of caring for patients with traumatic rib fractures. Intravenous lidocaine (IVL) is a well-established non-opioid analgesic for post-operative pain, yet its efficacy has yet to be investigated in trauma patients. We hypothesized that IVL is associated with decreased inpatient opioid requirements among patients with rib fractures. METHODS: We retrospectively evaluated adult patients presenting to our Level 1 trauma center with isolated chest wall injuries. After 1:1 propensity score matching patients who received vs did not receive IVL, we compared the two groups' average daily opioid use, opioid use in the last 24 hours of admission, and pain scores during admissions hours 24-48. We performed multivariable linear regression for these outcomes (with sensitivity analysis for the opioid use outcomes), adjusting for age as a moderating factor and controlling for hospital length of stay and injury severity. RESULTS: We identified 534 patients, among whom 226 received IVL. Those who received IVL were older and had more serious injury. Compared to propensity-score matched patients who did not receive IVL, patients who received IVL had similar average daily opioid use and pain scores, but 40% lower opioid use during the last 24 hours of admission (p = 0.002). Multivariable regression-with and without sensitivity analysis-did not show an effect of IVL on any outcomes. CONCLUSION: IVL was crudely associated with decreased opioid requirements in the last 24 hours of admission, the time period associated with opioid use at 90 days post-discharge. However, we did not observe beneficial effects of IVL on multivariable adjusted analyses; we are conducting a randomized control trial to further evaluate IVL's opioid-sparing effects for patients with rib fractures.


Assuntos
Administração Intravenosa , Assistência ao Convalescente/métodos , Analgésicos não Entorpecentes/uso terapêutico , Lidocaína/uso terapêutico , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Fraturas das Costelas/cirurgia , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos não Entorpecentes/administração & dosagem , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Feminino , Humanos , Escala de Gravidade do Ferimento , Lidocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Morfina/administração & dosagem , Morfina/uso terapêutico , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento
13.
Sci Rep ; 10(1): 10552, 2020 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-32601348

RESUMO

Lyme borreliosis is the most prevalent vector-borne disease in northern hemisphere. Borrelia burgdorferi sensu lato spirochetes are transmitted by Ixodes species ticks. During a blood meal, these spirochetes are inoculated into the skin where they multiply and often spread to various target organs: disseminated skin sites, the central nervous system, the heart and large joints. The usual diagnosis of this disease relies on serological tests. However, in patients presenting persistent clinical manifestations, this indirect diagnosis is not capable of detecting an active infection. If the serological tests are positive, it only proves that exposure of an individual to Lyme spirochetes had occurred. Although culture and quantitative PCR detect active infection, currently used tests are not sensitive enough for wide-ranging applications. Animal models have shown that B. burgdorferi persists in the skin. We present here our targeted proteomics results using infected mouse skin biopsies that facilitate detection of this pathogen. We have employed several novel approaches in this study. First, the effect of lidocaine, a local anesthetic used for human skin biopsy, on B. burgdorferi presence was measured. We further determined the impact of topical corticosteroids to reactivate Borrelia locally in the skin. This local immunosuppressive compound helps follow-up detection of spirochetes by proteomic analysis of Borrelia present in the skin. This approach could be developed as a novel diagnostic test for active Lyme borreliosis in patients presenting disseminated persistent infection. Although our results using topical corticosteroids in mice are highly promising for recovery of spirochetes, further optimization will be needed to translate this strategy for diagnosis of Lyme disease in patients.


Assuntos
Corticosteroides/uso terapêutico , Grupo Borrelia Burgdorferi/efeitos dos fármacos , Lidocaína/uso terapêutico , Doença de Lyme/tratamento farmacológico , Pele/microbiologia , Corticosteroides/administração & dosagem , Animais , Borrelia burgdorferi , Lidocaína/administração & dosagem , Camundongos , Pele/efeitos dos fármacos
14.
Medicine (Baltimore) ; 99(25): e20680, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569199

RESUMO

RATIONALE: Herpes zoster (HZ) involving sacral dermatome is very rare, which can sometimes cause voiding dysfunction. PATIENT CONCERNS: A 52-year-old man presented with acute pain and voiding dysfunction, following HZ in his right sacral dermatomes. DIAGNOSES: Twenty two days before presentation HZ occurred and 9 days after the onset of the HZ, he had trouble with starting urination and weak urine stream which was managed with tamsulosin 0.4 mg orally once a day and intermittent urinary catheterization. He was treated with 150 mg of pregabalin 2 times a day, tramadol 50 mg 2 times, and acetaminophen 600 mg 2 times a day. However, his pain intensity was 5 on the numerical analogue scale (NRS) from 0 (no pain) to 10 (worst pain imaginable). INTERVENTIONS: Fluoroscopy guided caudal block was performed with a mixture of 0.5% lidocaine 10 mL and triamcinolone 40 mg. OUTCOMES: One day after the procedure, the pain decreased to 1 on the NRS score. In addition, voiding difficulty greatly improved. Three days after the intervention, the patient reported complete resolution of pain and voiding dysfunction. He currently remains symptom free at a 3-month follow-up. LESSONS: A caudal block with steroid can be an effective option for treatment of acute voiding dysfunction and pain following sacral HZ.


Assuntos
Anestesia Caudal/métodos , Herpes Zoster/complicações , Neuralgia Pós-Herpética/tratamento farmacológico , Manejo da Dor/métodos , Sacro/virologia , Bexiga Urinaria Neurogênica/virologia , Anestésicos Locais/uso terapêutico , Fluoroscopia , Glucocorticoides/uso terapêutico , Humanos , Lidocaína/uso terapêutico , Masculino , Pessoa de Meia-Idade , Medição da Dor , Tansulosina/uso terapêutico , Triancinolona/uso terapêutico , Bexiga Urinaria Neurogênica/terapia , Cateterismo Urinário , Agentes Urológicos/uso terapêutico
15.
Rev. cuba. oftalmol ; 33(2): e818, tab, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1139072

RESUMO

RESUMEN Objetivo: Evaluar la eficacia de una combinación de lidocaína 2 por ciento y fenilefrina 1 por ciento administrada intracameralmente para provocar midriasis intraoperatoria en la cirugía de catarata. Métodos: Realizamos un estudio prospectivo, comparativo, de serie de casos en 70 ojos de igual número de pacientes quienes fueron sometidos a cirugía de catarata mediante facoemulsificación con implante de lente intraocular, en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer" entre septiembre del año 2017 y febrero de 2018. 35 pacientes fueron dilatados con una combinación de fenilefrina y lidocaína inyectada en la cámara anterior justo antes de la cirugía (grupo midriáticos intracamerales) y otros 35 ojos se dilataron con un colirio midriático como se realiza cotidianamente y de manera tradicional (grupo midriáticos tópicos). La eficacia se evaluó mediante la medición del diámetro pupilar (pupilometría) realizada con un compás quirúrgico en diferentes momentos de la cirugía en ambos grupos de estudio. Los resultados de ambos grupos se compararon entre sí. Resultados: En ambos grupos de pacientes se lograron diámetros pupilares superiores a los 7 mm justo antes de la capsulorrexis, aunque fueron ligeramente mayor en el grupo midriáticos tópicos (8,17 vs. 7,55 mm). En las mediciones posteriores todas las pupilometrías del grupo midriáticos intracamerales fueron superiores y se mantuvieron por encima de los 7 mm, mientras las del grupo midriáticos tópicos sufrieron una reducción paulatina hasta el final de la cirugía (5,68 mm). Conclusiones: La combinación de lidocaína más fenilefrina aplicada de manera intracameral es efectiva para provocar una midriasis adecuada y mantenida durante la cirugía de catarata(AU)


ABSTRACT Objective: Evaluate the efficacy of the combination 2 percent lidocaine / 1 percent phenylephrine administered intracamerally to achieve intraoperative mydriasis in cataract surgery. Methods: A prospective comparative study was conducted of a case series of 70 patients (70 eyes) who underwent cataract surgery by phacoemulsification with intraocular lens implantation at Ramón Pando Ferrer Cuban Institute of Ophthalmology from September 2017 to February 2018. Of the total eyes, 35 were dilated with a combination of phenylephrine and lidocaine injected into the anterior chamber just before surgery (MIC group), whereas the remaining 35 were dilated with mydriatic eye drops in the habitual traditional manner (MT group). Efficacy was evaluated in the two study groups measuring the pupil diameter (pupilometry) with a surgical compass at several moments during the surgery. The results for each group were compared. Results: In both groups patients achieved pupil diameters above 7 mm just before capsulorhexis, though values were slightly higher in the MT group (8.17 vs. 7.55 mm). Later measurement showed that in the MIC group all pupilometries were higher, remaining above 7 mm, whereas in the MT group they underwent gradual reduction until the end of surgery (5.68 mm). Conclusions: The combination of lidocaine and phenylephrine administered intracamerally is effective to achieve appropriate, sustained mydriasis during cataract surgery(AU)


Assuntos
Humanos , Fenilefrina/uso terapêutico , Extração de Catarata/métodos , Facoemulsificação/métodos , Implante de Lente Intraocular/efeitos adversos , Lidocaína/uso terapêutico , Estudo Comparativo , Estudos Prospectivos , Quimioterapia Combinada/métodos
16.
J Dairy Sci ; 103(8): 7339-7350, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32505405

RESUMO

Disbudding is a common procedure practiced in the dairy industry and is known to cause pain when performed without pain control. Dairy producers who disbud calves with caustic paste are less likely to provide pain control than those using cautery. Little research has been conducted on pain control for caustic paste disbudding and no studies have specifically examined calves under 9 d of age. The objective of this study was to evaluate the efficacy of local anesthesia and nonsteroidal anti-inflammatory drug analgesia on indicators of pain and inflammation in dairy calves disbudded using caustic paste. One hundred forty Holstein heifer calves 1 to 9 d of age were enrolled in 28 blocks and randomly allocated to 1 of 5 treatments: sham control (SH); positive control (POS); lidocaine cornual nerve block (LC); meloxicam (MEL); and lidocaine cornual nerve block plus meloxicam (LCM). We measured outcomes including serum cortisol and haptoglobin, pressure sensitivity, and lying behavior. Data were analyzed using mixed linear regression models with treatment as a fixed effect, baseline values as a covariate, and trial block as a random effect. Compared with the POS group, the LCM group had reduced serum cortisol at 15, 30, 45, and 60 min post-disbudding; cortisol values were not different between LC, LCM, and SH calves at these time points. At 60, 90, 120, and 180 min post-disbudding, LCM calves had reduced cortisol compared with LC calves, whereas, values did not differ between LCM and SH calves at these time points. At 3 to 4 d post-disbudding, the LCM group tended to have reduced haptoglobin, but no differences were found between groups at 180 min and 7 d post-disbudding. At 60, 90, and 120 min post-disbudding, LC and LCM treated calves had decreased pressure sensitivity compared with other groups. No differences were seen in pressure sensitivity between groups at 180 min, 3 to 4 or 7 d post-disbudding. No differences in lying behavior were found between treatment groups on any of the 7 d following disbudding. These findings demonstrate that the combination of a local anesthetic with a nonsteroidal anti-inflammatory drug is beneficial for reducing indicators of pain and inflammation in young calves disbudded with caustic paste.


Assuntos
Dor Aguda/veterinária , Anestésicos Locais/uso terapêutico , Bem-Estar do Animal , Anti-Inflamatórios não Esteroides/uso terapêutico , Doenças dos Bovinos/prevenção & controle , Cáusticos/uso terapêutico , Dor Aguda/prevenção & controle , Analgesia/veterinária , Anestesia Local/veterinária , Animais , Bovinos , Cauterização/efeitos adversos , Cauterização/veterinária , Indústria de Laticínios , Feminino , Cornos/cirurgia , Lidocaína/uso terapêutico , Meloxicam/administração & dosagem , Bloqueio Nervoso/veterinária , Pomadas/uso terapêutico
17.
Diabetes ; 69(8): 1804-1814, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32471808

RESUMO

Painful diabetic peripheral neuropathy (DPN) is difficult to manage, as treatment response is often varied. The primary aim of this study was to examine differences in pain phenotypes between responders and nonresponders to intravenous lidocaine treatment using quantitative sensory testing. The secondary aim was to explore differences in brain structure and functional connectivity with treatment response. Forty-five consecutive patients who received intravenous lidocaine treatment for painful DPN were screened. Twenty-nine patients who met the eligibility criteria (responders, n = 14, and nonresponders, n = 15) and 26 healthy control subjects underwent detailed sensory profiling. Subjects also underwent multimodal brain MRI. A greater proportion of patients with the irritable (IR) nociceptor phenotype were responders to intravenous lidocaine treatment compared with nonresponders. The odds ratio of responding to intravenous lidocaine was 8.67 times greater (95% CI 1.4-53.8) for the IR nociceptor phenotype. Responders to intravenous lidocaine also had significantly greater mean primary somatosensory cortex cortical volume and functional connectivity between the insula cortex and the corticolimbic circuitry. This study provides preliminary evidence for a mechanism-based approach for individualizing therapy in patients with painful DPN.


Assuntos
Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Neuropatias Diabéticas/diagnóstico por imagem , Neuropatias Diabéticas/tratamento farmacológico , Imagem por Ressonância Magnética/métodos , Adolescente , Adulto , Idoso , Encéfalo/efeitos dos fármacos , Estudos de Coortes , Feminino , Humanos , Lidocaína/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Observacionais como Assunto , Fenótipo , Inquéritos e Questionários , Adulto Jovem
18.
Intern Med ; 59(17): 2191-2195, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32461529

RESUMO

A 72-year-old lady with atrial fibrillation and chronic renal failure was hospitalized due to bradycardic shock with electrocardiographic QRS prolongation. She had experienced limb shaking two days before hospitalization, and additionally developed hallucinations one day before admission. Pilsicainide intoxication was diagnosed from a review of her medications and electrocardiographic findings. Consequently, continuous hemodiafiltration was performed resulting in a resolution of the hallucinations and the QRS prolongation. This is a rare case of psychiatric symptoms caused by pilsicainide intoxication. It is important to know the mode of excretion of a drug and to adjust its dose, so that such drug-related incidents can be avoided.


Assuntos
Antiarrítmicos/toxicidade , Fibrilação Atrial/tratamento farmacológico , Alucinações/induzido quimicamente , Alucinações/terapia , Lidocaína/análogos & derivados , Lidocaína/toxicidade , Bloqueadores do Canal de Sódio Disparado por Voltagem/toxicidade , Idoso , Antiarrítmicos/uso terapêutico , Feminino , Hemodiafiltração/métodos , Humanos , Lidocaína/uso terapêutico , Masculino , Resultado do Tratamento , Bloqueadores do Canal de Sódio Disparado por Voltagem/uso terapêutico
19.
Am J Vet Res ; 81(6): 479-487, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32436793

RESUMO

OBJECTIVE: To compare the extent of inflammation and catabolic collagen response in the middle carpal joints (MCJs) of healthy horses following intra-articular injection of 2% lidocaine, 2% mepivacaine, lactated Ringer solution (LRS), or 0.1% methyl parahydroxybenzoate. ANIMALS: 17 adult horses. PROCEDURES: In the first of 2 experiments, the left middle carpal joint (MCJ) of each of 12 horses was injected with 10 mL of 2% lidocaine (n = 3), 2% mepivacaine (3), or LRS (control; 6). After a 4-week washout period, the right MCJ of the horses that received lidocaine or mepivacaine was injected with 10 mL of LRS, and the right MCJ of horses that received LRS was injected with 10 mL of 2% lidocaine (n = 3) or 2% mepivacaine (3). In experiment 2, the left MCJ of each of 5 horses was injected with 10 mL of 0.1% methyl parahydroxybenzoate. After a 48-hour washout period, the right MCJ of each horse was injected with 10 mL of LRS. Synovial fluid (SF) samples were aseptically collected before and at predetermined times after each injection. Synovial fluid WBC count, neutrophil percentage, and total protein, neutrophil myeloperoxidase, neutrophil elastase, and Coll2-1 concentrations were compared among treatments. RESULTS: Both lidocaine and mepivacaine induced SF changes indicative of inflammation and a catabolic collagen response, but the magnitude of those changes was more pronounced for lidocaine. Methyl parahydroxybenzoate did not cause any SF changes indicative of inflammation. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that mepivacaine was safer than lidocaine for intra-articular injection in horses.


Assuntos
Doenças dos Cavalos/tratamento farmacológico , Mepivacaína/uso terapêutico , Animais , Biomarcadores , Cavalos , Injeções Intra-Articulares/veterinária , Lidocaína/uso terapêutico , Líquido Sinovial
20.
Adv Clin Exp Med ; 29(5): 587-595, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32459401

RESUMO

BACKGROUND: Disturbances in pancreatic microcirculation, beginning with vasoconstriction, are crucial in early pancreatitis and progression to necrotizing pancreatitis. Thus, vascular-targeted treatment aiming to restore a sufficient level of microcirculation through vasodilation would possibly reduce the severity of pancreatitis. Lidocaine is an anti-arrhythmic and local anesthetic drug, which also acts as a vasodilator at higher concentrations. OBJECTIVES: To evaluate the efficacy of intra-arterial infusion of lidocaine into the celiac trunk in treatment of cerulein-induced acute pancreatitis. MATERIAL AND METHODS: Wistar rats (n = 20) were randomly divided into 2 equal groups: the control group (NaCl group, n = 10) and the study group (lidocaine group, n = 10). All subjects underwent surgical intervention with intra-arterial infusion of 0.9% NaCl (control group) or 1% lidocaine hydrochloride (study group) into the celiac trunk. Blood samples were collected 5 times at regular intervals from each rat for amylase and lipase measurements. Histopathological analysis of the pancreas was performed. RESULTS: A total number of 16 rats (control group n = 7, study group n = 9) were included. In the postoperative course, the study group (lidocaine group) revealed lower values of serum amylase and lipase levels compared to the control group (NaCl group), except the values at the 1st treatment point, which appeared 1 h after intraoperative drug injection. Significantly lower treatment endpoint levels of pancreatic enzymes were seen in the lidocaine group. Moreover, no differences were observed between the 1st and the last treatment point in the control group; however, these differences were significant for both enzymes in the study group. Histopathology revealed reduced pancreatitis severity in the study group compared to the controls. CONCLUSIONS: Intra-arterial lidocaine infusion into the celiac trunk decreases pancreatitis severity. What is more, this study demonstrates the relevance of early vasodilation in the therapy of acute pancreatitis.


Assuntos
Ceruletídeo/efeitos adversos , Lidocaína/administração & dosagem , Pancreatite/tratamento farmacológico , Doença Aguda , Animais , Ceruletídeo/uso terapêutico , Infusões Intra-Arteriais , Lidocaína/uso terapêutico , Pâncreas/efeitos dos fármacos , Pâncreas/patologia , Pancreatite/induzido quimicamente , Pancreatite/patologia , Distribuição Aleatória , Ratos , Ratos Wistar , Resultado do Tratamento
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