Lidocaine

Purpose A eutectic mixture of local anesthetics (EMLA) is commonly used to provide topical anesthesia for intravenous (iv) cannulation. One of its side effects is vasoconstriction, which may render cannulation more difficult. A gel formulation of amethocaine (Ametop™) is now commercially available. The aim of this study was to compare EMLA and Ametop™ with regard to the degree of topical anesthesia afforded, the incidence of vasoconstriction and the ease of iv cannulation. Methods Thirty two ASA 1 adult volunteers had a # 16 gauge iv cannula inserted on two separate occasions using EMLA and Ametop™ applied in a double blind fashion for topical anesthesia. Parameters that were recorded after each cannulation included visual analogue pain scores (VAPS), the presence of vasoconstriction and the ease of cannulation, graded as: 1 = easy, 2 = moderately difficult, 3 = difficult and 4 = failed. Results The mean VAPS ± SD after cannulation with Ametop™ M was 12 ± 9.9 and with EMLA was 25.3 ± 16.6 (P = 0.002). Vasoconstriction occurred after EMLA application on 17 occasions and twice after Ametop™ (P = 0.001). The grade of difficulty of cannulation was 1.44 ± 0.88 following EMLA and 1.06 ± 0.25 with Ametop™ (P = 0.023). Conclusions Intravenous cannulation was less painful following application of Ametop™ than EMLA. In addition, Ametop™ caused less vasoconstriction and facilitated easier cannulation. Its use as a topical anesthetic agent is recommended, especially when iv access may be problematic. Objectif Un mélange eutectique d’anesthésiques locaux (MEAL) est souvent utilisé pour l’anesthésie topique lors d’une canulation intraveineuse (iv). La vasoconstriction, qui est l’un des effets secondaires du MEAL, peut compliquer la mise en place d’une canule. Une présentation en gel d’améthocaïne (Ametop™) est maintenant offerte dans le commerce. Le but de la présente étude était de comparer le MEAL et l’Ametop™ en regard du degré d’anesthésie topique fourni, de l’incidence de la vasoconstriction et de la facilité de la canulation iv. Méthode: On a inséré, en deux occasions séparées chez 32 volontaires adultes d’état physique ASA 1, une canuleiv de calibre 16 en utilisant en double aveugle le MEAL et Ametop™ pour réaliser l’anesthésie topique. Après chaque canulation, on a enregistré les paramètres suivants: les scores de douleur à l’échelle visuelle analogue (EVA), la présence de vasoconstriction et la facilité de canulation notée 1 = facile, 2 = modérément difficile, 3 = difficile et 4 = impossible. Résultats Les scores moyens à l’EVA ± l’écart type ont été de 12 ± 9,9 à la suite de la canulation avec Ametop™ M et de 25,3 ± 16,6 après le MEAL (P = 0,002). La vasoconstriction est survenue en 17 occasions après l’application du MEAL et deux fois plus souvent après Ametop™ (P = 0,001). Le degré de difficulté de canulation a été de 1,44 ± 0,88 après le MEAL et de 1,06 ± 0,25 après Ametop™ (P = 0,023). Conclusion La canulation intraveineuse est moins douloureuse après l’application d’Ametop™ que celle du MEAL. De plus, l’Ametop™ a provoqué moins de vasoconstriction et a facilité l’introduction d’une canule. Son usage comme anesthésique topique est recommandé, surtout lorsqu’une action rapide est nécessaire ou que l’accèsiv peut être problématique.

The aim of this work was the evaluation of conductivity assessments for the monitoring and controlling the release study process of chlorhexidine and lidocaine hydrochloride from the ionic polyacrylic gel, applying different temperatures. According to performed measurements of release, the chlorhexidine, characterized by very low water solubility, is observed in the acceptor compartment in the amount of 2.0-3.0% and its level depends of the temperature. The amount of well soluble lidocaine hydrochloride released in parallel conditions was between 60 and 70%. Beyond, the assessments confirm the presence of a specific bond between the chlorhexidine imine groups and polyacrylic acid carboxylic groups. Presented method may be applied in the prediction of release rates, before actual release analysis, and may assure better evaluation of the systems.

Mandibular infiltration has been routinely avoided in treating mandibular molars because of its questionable adequacy. The purpose of our investigation was to determine the effectiveness of mandibular infiltration compared with mandibular block in treating primary molars in children, and to relate the effectiveness to age and type of treatment performed. The study population consisted of 89 cooperative children, 3 to 9 years old, requiring the same type of treatment on contralateral mandibular molars. The half-mouth study design was used. Dental procedures included class I and II amalgam restorations, stainless steel crowns, formocresol pulpotomies, and extractions. Evaluations of pain and behavior for each anesthesia technique and type of treatment were made using sounds, motor, and ocular changes indicating pain and the Frankl Behavior Rating Scale. Evaluations were made upon probing, rubber dam placement, and during tooth preparation and extraction. No statistically significant d...

Ambulatory phlebectomy is an elegant outpatient procedure for the removal of varicose veins. One of the keys to its success is the ability to perform the procedure under local anesthesia. A new form of anesthesia, tumescent anesthesia, has been developed for liposuction surgery and is now being expanded for use in other surgical disciplines. To determine the efficacy and safety as well as review the use and advantages of tumescent anesthesia in ambulatory phlebectomy. A retrospective review of phlebectomy cases performed in our offices under tumescent anesthesia. The reported level of intraoperative and postoperative pain was very low. The complication rate was consistent with other reports except for a higher number of hematomas (3.4%). Tumescent anesthesia provides a very safe, comfortable method of anesthetizing patients for ambulatory phlebectomy. Epinephrine, in appropriate concentrations, should be a part of all tumescent anesthetic solutions used for phlebectomy as it may decrease the incidence of hematoma.

Myofascial pain syndrome is defined as ``pain and/or autonomic phenomena referred from active myofascial trigger points''. Trigger point injection is an effective treatment option, which is widely used to treat myofascial pain. Trigger point injection in the cervicothoracic regions can be associated with pneumothorax. In this paper, we presented a patient who developed pneumothorax after trigger point injection. This case report indicates there is a risk of pneumothorax during trigger point injection in the cervicothoracic regions.

To describe current newborn circumcision pain interventions and to identify which forms of analgesia were most effective. Each male newborn was assessed for pain during the circumcision procedure and at 15-minute intervals after the procedure using the FLACC pain scale. The type and combination of analgesia was also recorded on the pain assessment record. Pain scores were highest for newborns receiving no analgesia during circumcision. Newborns circumcised with the dorsal block and the ring block in combination with the concentrated oral sucrose had the lowest pain scores. The sucrose alone did not provide sufficient analgesia; however, it did reduce the FLACC score somewhat when used in conjunction with other analgesics/anesthesia. Information obtained from this project facilitated a change in policy wherein newborn circumcision is performed only with the use of analgesia and not concentrated oral sucrose alone.

This study describes the management of 216 patients with post-traumatic iatrogenic lingual nerve injuries (LNIs; n=93) and inferior alveolar nerve injuries (IANI; n=123). At initial consultation, 6% IANI and 2% LNI patients had undergone significant resolution requiring no further reviews. Reassurance and counselling was adequate management for 51% IANI and 55% LNI patients. Systemic or topical medication was offered as pain relief to 5% of patients. Additional cognitive behaviour therapy (CBT) was offered to 8% of patients. Topical 5% lidocaine patches reduced pain and allodynia in 7% of IANI patients, most often used without any other form of management. A small percentage of IANI patients (4%) received a combination of therapies involving CBT, surgery, medication and 5% lidocaine patches. Exploratory surgery improved symptoms and reduced neuropathic area in 18 LNI and 15 IANI patients resulting in improved quality of life. In conclusion, the authors suggest a more diverse and per...

Repetitive transcranial magnetic stimulation (rTMS) is a form of neurostimulation therapy that was recently approved by the Food and Drug Administration for the treatment of depression. Repetitive transcranial magnetic stimulation is considered noninvasive and relatively safe; however, there have been reports of scalp pain during and at the site of stimulation. This case report documents the use of topical lidocaine to reduce scalp pain during rTMS administration. All patients had a diagnosis of major depressive disorder according to research diagnostic criteria and were washed off antidepressant medications before treatment. Patients were given active rTMS treatment during a masked, open-label, or long-term follow-up treatment schedule. Treatment was delivered to the left dorsolateral prefrontal cortex at 120% of the patient's observed motor threshold. Ten patients received 3000 magnetic pulses per session with an on time of 4 seconds and an off time of 26 seconds. Patients who...

We compared the efficacy and safety of ultrasound-guided haematoma block with that of procedural sedation and analgesia in patients with acute distal radial fracture reduction pain control. This was a randomised clinical trial on adult patients conducted in two teaching hospitals. Patients received intravenous midazolam plus fentanyl in the procedural sedation and analgesia group, and fracture site injection of lidocaine 10% in the ultrasound guided haematoma block group. We measured pain scores before reduction, during reduction and 5, 10 and 15 min after reduction by a numeric rating scale, and patient and physician satisfaction by a four-level Likert scale. Time to discharge, early adverse effects and late complications were also compared. We enrolled 160 patients with distal radial fracture and randomised 143 patients into two groups (after excluding 17 patients). Pain was effectively controlled in both groups. Pain scores had no statistically significant difference before and d...

Behavioral and physiological changes were measured following tail-docking in primiparous heifers. One month before projected first parturition, 21 heifers were assigned to control (nondocked), docked, or docked with lidocaine groups. Heifers were banded to initiate tail-docking and the necrotic tail was removed after 144 h. Physiological, immunological, and behavioral measures were taken for 240 h following banding. Cortisol was not different for control and treated heifers. Haptoglobin increased for docked heifers by 168 h postbanding (24 h postdocking). Alpha1-acid glycoprotein decreased as haptoglobin increased, and alpha1-acid glycoprotein increased until 240 h postbanding. Tumor necrosis factor-alpha increased only with lidocaine and did not show an effect of docking by 240 h postbanding. Lymphocyte phenotyping demonstrated increased CD4+ and CD8+ peripheral blood mononuclear cells for docked plus lidocaine heifers and gammadelta+ cells of those heifers tended to be reduced com...

Background and objective:  The Pharmacy Department at the Western General Hospital in Edinburgh prepares a topically applied product in which morphine sulphate is incorporated into Instillagel® for use in reducing pain associated with rectal and other cancers. A stability indicating method was required for assessment of the stability of this combination.Methods:  A gradient high performance liquid chromatography method was developed to assess stability and an LC-MS method was used to characterize the degradants from forced degradation of the components in the formulation.Results and discussion:  The method was found to have acceptable inter- and intra-day precisions. Under all storage conditions investigated morphine sulphate remained within 98·1% and 103·2% of the initial concentration, lidocaine hydrochloride within 96·07% and 104·9% and chlorhexidine gluconate within 97·3% and 105·5%, except for samples stored at 37 °C beyond 240 h. A sample of the admixture was stored up to 7 months at 37 °C and was found to be reasonably stable with only the chlorhexidine concentration declining appreciably to 92% of the initial concentration. Some of the degradants of chlorhexidine and morphine were characterized by liquid chromatography mass spectrometry. It could be concluded that the admixture was stable for over 22 days at 4 °C protected from light, over 22 days at 25 °C exposed to normal light, and for 7 months at 37 °C protected from light.Conclusion:  The components in the combination were found to have good long-term stability.

A randomized, controlled, double-blind trial. To assess the effectiveness of fluoroscopically directed caudal epidural injections in managing chronic low back and lower extremity pain in patients with disc herniation and radiculitis with local anesthetic with or without steroids. The available literature on the effectiveness of epidural injections in managing chronic low back pain secondary to disc herniation is highly variable. One hundred twenty patients suffering with low back and lower extremity pain with disc herniation and radiculitis were randomized to one of the two groups: group I received caudal epidural injections with an injection of local anesthetic, lidocaine 0.5%, 10 mL; group II patients received caudal epidural injections with 0.5% lidocaine, 9 mL, mixed with 1 mL of steroid. The Numeric Rating Scale (NRS), the Oswestry Disability Index 2.0 (ODI), employment status, and opioid intake were utilized with assessment at 3, 6, and 12 months posttreatment. The percentage of patients with significant pain relief of 50% or greater and/or improvement in functional status with 50% or more reduction in ODI scores was seen in 70% and 67% in group I and 77% and 75% in group II with average procedures per year of 3.8 ± 1.4 in group I and 3.6 + 1.1 in group II. However, the relief with first and second procedures was significantly higher in the steroid group. The number of injections performed was also higher in local anesthetic group even though overall relief was without any significant difference among the groups. There was no difference among the patients receiving steroids. Caudal epidural injection with local anesthetic with or without steroids might be effective in patients with disc herniation or radiculitis. The present evidence illustrates potential superiority of steroids compared with local anesthetic at 1-year follow-up.