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BACKGROUND: During laparoscopic hysterectomy (LH), the elevation of intra-abdominal and intra-thoracic pressures due to pneumoperitoneum (PP) results in an increase in intracranial pressure (ICP). The Trendelenburg position (TP) is an accentuating factor. This trial aimed to assess the effect of intravenous (IV) lidocaine infusion on optic nerve sheath diameter (ONSD), a widely accepted surrogate measure for ICP, during PP and TP. METHODS: A randomized, placebo-controlled study was conducted on 66 patients scheduled for LH, equally divided into a lidocaine group and a saline group. ONSD, the primary outcome, was recorded before induction (T1), before PP initiation in the supine position (T2), five minutes (T3), 30 minutes (T4), and 60 minutes (T5) after PP and TP, and five minutes after termination of PP in the supine position (T6). Secondary outcomes included numerical rating scale (NRS) scores at arrival to the post-anesthesia care unit (PACU), 6, 12, and 24 hours after surgery, and postoperative adverse effects. RESULTS: ONSD at T4 and T5 was significantly lower in the lidocaine group than in the saline group (T4: 4.94±0.43 mm vs. 5.27±0.37 mm; P =0.003, T5: 5.08±0.46 vs. 5.41±0.38 mm; P =0.004). The lidocaine group had significantly lower NRS values than the saline group only at PACU arrival (median [Q1-Q3]: 5 [4-6] vs. 6 [5-6.25]; P =0.016). Fewer patients in the lidocaine group experienced postoperative headache (P =0.029). CONCLUSIONS: IV lidocaine during LH can attenuate the ONSD distension, decrease pain scores at PACU arrival, and reduce the incidence of postoperative headache.
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Anestésicos Locales , Histerectomía , Laparoscopía , Lidocaína , Nervio Óptico , Humanos , Femenino , Lidocaína/administración & dosificación , Persona de Mediana Edad , Nervio Óptico/efectos de los fármacos , Anestésicos Locales/administración & dosificación , Adulto , Infusiones Intravenosas , Inclinación de Cabeza , Método Doble Ciego , Presión Intracraneal/efectos de los fármacosRESUMEN
BACKGROUND: Palatal dysfunction (PD), which encompasses palatal instability (PI) and intermittent dorsal displacement of the soft palate, is the most common performance-limiting upper respiratory tract obstruction in young Thoroughbred racehorses. Soft palate thermocautery (SPT) performed under general anaesthesia is a routinely performed procedure for PD in some countries, but the procedure for and outcome of SPT performed under standing sedation has not been published. OBJECTIVES: (1) To describe a technique for SPT performed under standing sedation; and (2) to assess post-operative performance in horses compared to controls using the Racing Post rating (RPR), British Horseracing Authority official rating (OR), Performance Index and Earnings. STUDY DESIGN: Retrospective case series. METHODS: Medical records were reviewed for all horses that had SPT performed under standing sedation following topical and local infusion of lidocaine hydrochloride into the rostral soft palate, and that were identified to have PI by overground endoscopy. Two matched controls were identified for each case. The median RPR, OR, Performance Index and Earnings for the three pre-operative and three post-operative races were compared. RESULTS: No significant differences were identified between the SPT (n = 23) and Control groups (n = 46) for baseline characteristics or outcomes. MAIN LIMITATIONS: Retrospective study design, small sample size. CONCLUSIONS: No significant differences in racing performance were identified between horses that had SPT performed under standing sedation and controls.
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Enfermedades de los Caballos , Paladar Blando , Animales , Caballos/cirugía , Estudios Retrospectivos , Paladar Blando/cirugía , Masculino , Enfermedades de los Caballos/cirugía , Femenino , Lidocaína/administración & dosificaciónRESUMEN
INTRODUCTION: knee arthroscopy is a common orthopedic procedure associated with postoperative pain, so optimizing pain management is essential for patient recovery and satisfaction. Lidocaine, a local anesthetic with well-established safety profiles, offers a potential alternative to traditional analgesic methods. Research regarding lidocaine patches has been conducted in several types of surgeries (laparoscopy, gynecological surgery, prostatectomy, etc.) showing promising results for some. This study investigates the effectiveness of transdermal lidocaine 5% patches as a novel approach to postoperative analgesia after knee arthroscopy. MATERIAL AND METHODS: a randomized, single-blind, placebo-controlled trial was conducted with participants undergoing knee arthroscopy. Patients were divided into two groups: one receiving transdermal lidocaine 5% patches and the other a placebo, both along traditional postoperative pain management, and using opioid only in cases with moderate-severe pain. Pain scores, opioid consumption, and patient-reported outcomes were assessed at various postoperative intervals. RESULTS: there was a significant reduction in pain scores and opioid consumption in the lidocaine patch group compared to the placebo group. CONCLUSIONS: transdermal lidocaine 5% patches emerge as a promising adjunct to postoperative pain management in knee arthroscopy patients. Their ease of application, minimal side effects, and opioid-sparing effects contribute to a multifaceted analgesic approach. This study underscores the potential of transdermal lidocaine patches in enhancing the overall postoperative experience for knee arthroscopy patients, advocating for their consideration in clinical practice.
INTRODUCCIÓN: la artroscopía de rodilla es un procedimiento ortopédico común asociado con dolor postoperatorio, por lo que optimizar el manejo del dolor es esencial para la recuperación y la satisfacción del paciente. La lidocaína, un anestésico local con perfiles de seguridad bien establecidos, ofrece una alternativa potencial a los métodos analgésicos tradicionales. Se ha llevado a cabo investigación sobre los parches de lidocaína en diversos tipos de cirugías (laparoscopía, cirugía ginecológica, prostatectomía, etcétera), mostrando resultados prometedores en algunos casos. MATERIAL Y MÉTODOS: se realizó un ensayo clínico aleatorizado, ciego simple y controlado con placebo que incluyó participantes sometidos a artroscopía de rodilla. Los pacientes fueron divididos en dos grupos: uno recibió parches transdérmicos de lidocaína al 5% y otro un placebo, ambos junto con el manejo tradicional del dolor postoperatorio y utilizando opioides sólo en casos de dolor moderado a severo. Se evaluaron las puntuaciones de dolor, el consumo de opioides y los resultados informados por los pacientes en varios intervalos postoperatorios. RESULTADOS: se registró una reducción significativa en las puntuaciones de dolor y el consumo de opioides en el grupo de parches de lidocaína en comparación con el grupo de placebo. CONCLUSIONES: los parches transdérmicos de lidocaína al 5% emergen como un complemento prometedor para el manejo del dolor postoperatorio en pacientes sometidos a artroscopía de rodilla. Su facilidad de aplicación, mínimos efectos secundarios y efectos ahorradores de opioides contribuyen a un enfoque analgésico multifacético. Este estudio destaca el potencial de los parches de lidocaína transdérmica para mejorar la experiencia postoperatoria general de los pacientes con artroscopía de rodilla, abogando por su consideración en la práctica clínica.
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Anestésicos Locales , Artroscopía , Lidocaína , Dolor Postoperatorio , Parche Transdérmico , Humanos , Lidocaína/administración & dosificación , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/prevención & control , Artroscopía/métodos , Anestésicos Locales/administración & dosificación , Método Simple Ciego , Femenino , Masculino , Adulto , Persona de Mediana Edad , Articulación de la Rodilla/cirugía , Administración Cutánea , Analgésicos Opioides/administración & dosificación , Resultado del Tratamiento , Adulto JovenRESUMEN
Perioperative inflammatory responses are a series of endogenous immune responses produced by the body following surgical trauma. Excessive inflammatory response weakens the body's ability to repair surgical trauma and reduces the body's defense against the invasion of harmful factors, leading to a series of complications, such as infections, pain, and organ damage, which prolong the length of hospitalization and increase the risk of death. Lidocaine is a classical local anesthetic widely used in clinical practice because of its local anesthetic and antiarrhythmic effects. Several recent studies have shown that lidocaine modulates the body's inflammatory response, and that its anti-inflammatory properties can lead to analgesia, organ protection, and improved postoperative recovery. In this paper, we introduce the mechanism of the modulating effect of lidocaine on the perioperative inflammatory response and its clinical application, to provide a reference for the clinical prevention and treatment of the perioperative inflammatory response.
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Anestésicos Locales , Inflamación , Lidocaína , Lidocaína/administración & dosificación , Lidocaína/uso terapéutico , Humanos , Anestésicos Locales/administración & dosificación , Inflamación/prevención & control , Atención Perioperativa/métodos , Periodo Perioperatorio , Administración Intravenosa , Complicaciones Posoperatorias/prevención & controlRESUMEN
Local anesthesia is essential in dental practices, particularly for managing pain in tooth socket wounds, yet improving drug delivery systems remains a significant challenge. This study explored the physicochemical characteristics of lidocaine hydrochloride (LH) incorporated into a polyelectrolyte complex and poloxamer thermosensitivity hydrogel, assessing its local anesthetic efficacy in mouse models and its onset and duration of action as topical anesthetics in clinical trials. The thermoresponsive hydrogel exhibited a rapid phase transition within 1-3 minutes and demonstrated pseudo-plastic flow behavior. Its release kinetics followed Korsmeyer-Peppas, with 50% of biodegradation occurring over 48 h. In mouse models, certain thermogels showed superior anesthetic effects, with rapid onset and prolonged action, as evidenced by heat tolerance in tail-flick and hot plate models. In clinical trials, the LH-loaded thermoresponsive hydrogel provided rapid numbness onset, with anesthesia (Ton) beginning at an average of 46.5 ± 22.5 seconds and lasting effectively (Teff) for 202.5 ± 41.0 seconds, ranging from 120 to 240 seconds, indicating sustained release. These results highlight the promising properties of these formulations: rapid onset, prolonged duration, mucoadhesion, biodegradability, and high anesthesia effectiveness. This study demonstrates the potential for advancing local anesthesia across various medical fields, emphasizing the synergy between material science and clinical applications to improve patient care and safety.
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Anestésicos Locales , Sistemas de Liberación de Medicamentos , Hidrogeles , Lidocaína , Poloxámero , Lidocaína/administración & dosificación , Lidocaína/química , Animales , Hidrogeles/química , Anestésicos Locales/administración & dosificación , Anestésicos Locales/química , Ratones , Poloxámero/química , Sistemas de Liberación de Medicamentos/métodos , Polielectrolitos/química , Masculino , Liberación de Fármacos , Humanos , Preparaciones de Acción Retardada/administración & dosificación , Preparaciones de Acción Retardada/farmacocinéticaRESUMEN
Introduction: postoperative sore throat (POST) is a common complication after general anesthesia with endotracheal intubation caused by tracheal mucosal injury. Multiple techniques prevent postoperative sore throat (POST). Our study aimed to compare two techniques: intravenous and intracuff lidocaine versus placebo to prevent postoperative sore throat after general anesthesia with orotracheal intubation. Methods: we conducted a prospective double-blind, randomized controlled clinical trial involving patients, proposed for a scheduled surgery less than 240 minutes under general anesthesia with orotracheal intubation. Patients were divided into three groups: L group: infused with saline, cuff filled with alkalinized lidocaine. S group: Infused with 1.5 mg/kg of lidocaine, cuff filled with saline. T group: placebo: infused with saline, cuff filled with saline. Our primary outcome was the incidence of sore throat and their (visual analog scale) VAS score in the first 24 postoperative hours. Our secondary outcomes were the incidence of cough, dysphonia, dysphagia, and postoperative nausea and vomiting. Results: ninety patients were analyzed and divided into 3 groups of 30. The incidence of POST at the sixth postoperative hour, for placebo, the "L" group, and the "S" group, respectively, was 67%, 30%, and 47%. And at the 24th postoperative hours 67%, 13%, and 37%. Intravenous lidocaine reduced significantly the VAS of POST at the 24th hour (S: 6.80 ± 20.70; T: 20.67 ± 18.182; p= 0.02). Alkalinized lidocaine decreased significantly the VAS of POST in the sixth (L: 8.17 ± 22.761; T: 23 ± 21.838; p = 0.048) and the 24th postoperative hour (L: 6.33 ± 20.592; T: 20.67 ± 18.182; p= 0.019) with the lowest pain score. There was no statistically significant difference between the L and S groups at the 6 and 24 postoperative hours. Both lidocaine techniques reduced cough at emergence, with the superiority of alkalinized lidocaine (p=0.02). They decreased the incidence of cough, dysphonia, dysphagia, nausea, and vomiting compared to a placebo. Conclusion: intravenous and intracuff lidocaine allowed better control of postoperative sore throat.
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Anestesia General , Anestésicos Locales , Intubación Intratraqueal , Lidocaína , Faringitis , Complicaciones Posoperatorias , Humanos , Lidocaína/administración & dosificación , Faringitis/prevención & control , Faringitis/etiología , Método Doble Ciego , Masculino , Estudios Prospectivos , Femenino , Adulto , Anestésicos Locales/administración & dosificación , Persona de Mediana Edad , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Intubación Intratraqueal/efectos adversos , Anestesia General/métodos , Náusea y Vómito Posoperatorios/prevención & control , Náusea y Vómito Posoperatorios/epidemiología , Náusea y Vómito Posoperatorios/etiología , Adulto Joven , IncidenciaRESUMEN
The dose-response of intravenous lidocaine in preventing postoperative vomiting (POV) in children remains unclear. This study investigated whether intravenous lidocaine dose-dependently decreased POV risk within 24 h postoperatively in children undergoing tonsillectomy (with or without adenoidectomy) without severe complications. Patients aged 3-12 years (American Society of Anesthesiologists grade I-II) scheduled for elective tonsillectomy (with or without adenoidectomy) were enroled from December 2021 to March 2022. They were randomly grouped according to the lidocaine dose (A [0 mg kg-1], B [1 mg kg-1], C [1.5 mg kg-1], and D [2 mg kg-1]) and were administered the same induction protocol (sufentanil, propofol, and suxamethonium chloride). Anaesthesia was maintained with sevoflurane. The incidence of POV within 24 h postoperatively was 46, 40, 36, and 20% in groups A, B, C, and D, respectively, with significant differences between groups D and A. Postoperative analgesic rescues in groups A, B, C, and D were 62, 36, 34, and 16%, respectively, with significant differences between groups D and B, C and A, and D and A. No severe adverse events were reported. Intravenous lidocaine has a dose-dependent effect on reducing the risk of POV in children undergoing tonsillectomy (with or without adenoidectomy) without serious adverse events.Trial registration: Chinese Clinical Trial Registry, ChiCTR2100053006.
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Lidocaína , Náusea y Vómito Posoperatorios , Tonsilectomía , Humanos , Tonsilectomía/efectos adversos , Lidocaína/administración & dosificación , Lidocaína/uso terapéutico , Lidocaína/efectos adversos , Niño , Masculino , Preescolar , Femenino , Náusea y Vómito Posoperatorios/prevención & control , Adenoidectomía/efectos adversos , Relación Dosis-Respuesta a Droga , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéuticoRESUMEN
OBJECTIVE: Childhood experiences of pain associated with dental treatment can induce dental anxiety. Infe-rior alveolar nerve blocks are eight times more likely to fail in patients with irreversible pulpitis. The objective was to compare the effectiveness of lignocaine with and without pre-operative oral ibuprofen for controlling pain in primary mandibular molars scheduled for pulpectomy procedures in 5 to 9-year-old children. METHODS: One hundred and twenty-two children diagnosed with irreversible pulpitis in mandibular posterior teeth and scheduled for pulpectomy procedures were included. The children were assigned to one of the two groups, Treatment group A: Pre-operative with oral ibuprofen and local anaesthesia with 2% lignocaine (with adrenaline 1: 80000); Treatment group B: Pre-operative with oral placebo and local anaesthesia with 2% ligno-caine (with 1: 80000 adrenaline). Pain and pulse rate were recorded at baseline, one hour after administration of oral medication, fifteen minutes following administration of Inferior Alveolar Nerve Block (IANB), and also during the course pulpectomy. The results were statistically analysed using chi square test and repeated mea-sures analysis of variance (ANOVA). RESULTS: In treatment group A, 90.16% children had IANB success compared to 9.83% in group B.. The differ-ence in the success rate between two groups was statistically significant (p<0.001) with an odds ratio of 84. CONCLUSION: Oral medication with ibuprofen is effective in increasing the success rate of IANB with lignocaine for the treatment of irreversible pulpitis of 5 to 9-year-old children.
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Anestésicos Locales , Ibuprofeno , Lidocaína , Diente Molar , Pulpitis , Diente Primario , Humanos , Niño , Pulpitis/terapia , Lidocaína/administración & dosificación , Lidocaína/uso terapéutico , Ibuprofeno/administración & dosificación , Ibuprofeno/uso terapéutico , Femenino , Masculino , Preescolar , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico , Pulpectomía/métodos , Bloqueo Nervioso/métodos , Mandíbula , Administración Oral , Dimensión del Dolor/métodos , Resultado del TratamientoRESUMEN
OBJECTIVE: This study aimed to compare the effectiveness of lidocaine with magnesium sulphate in patients undergoing root canal treatment following irreversible pulpitis. METHODS: A total of 86 patients were randomised to receive 1.8 ml of 2% lidocaine replaced with 0.2 ml of 10% magnesium sulphate with 1: 80,000 epinephrine (n=43) as MGS group and 1.8 ml of 2% lidocaine with 1: 80,000 epinephrine (n=43) as LDC group. Preoperative visual analogue scale (VAS) pain scores were record-ed. Patients were instructed to report any perioperative pain felt during the access cavity preparation and when introducing the first patency file (#10 k) in the root canal and perioperative VAS recorded. RESULTS: The success rate of the inferior alveolar nerve block (IANB) was higher in the MSG group. The mean+-SD of perioperative pain was 0.16+-0.37 in the MSG group and 3.13+-0.77 in the LDC group. The MGS group produced better anaesthetic efficacy with a p-value of 0.01. CONCLUSION: Based on the results, adding 10% magnesium sulphate to 2% lidocaine increased the effective-ness of IANB in patients with symptomatic irreversible pulpitis of mandibular molar teeth.
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Anestésicos Locales , Lidocaína , Sulfato de Magnesio , Nervio Mandibular , Bloqueo Nervioso , Pulpitis , Humanos , Lidocaína/administración & dosificación , Lidocaína/uso terapéutico , Lidocaína/farmacología , Sulfato de Magnesio/administración & dosificación , Sulfato de Magnesio/uso terapéutico , Bloqueo Nervioso/métodos , Femenino , Masculino , Adulto , Método Doble Ciego , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico , Dimensión del Dolor/métodos , Adulto Joven , Resultado del Tratamiento , Persona de Mediana EdadRESUMEN
BACKGROUND: Postoperative sore throat is one of the main postoperative complaints in patients undergoing tonsillectomy. As the primary outcome, we aimed to determine whether endotracheal tube cuffs filled with alkalinized lidocaine are associated with a lower incidence of postoperative sore throat and anesthesia emergence phenomena in children undergoing tonsillectomy or adenotonsillectomy. We also assessed the potential additional benefits of IV dexamethasone in reducing postoperative laryngotracheal morbidity. METHODS: This is a clinical prospective, randomized, controlled trial. Patients were randomly allocated to one of four groups, as follows: air - endotracheal tube cuff filled with air; air/dex - endotracheal tube cuff filled with air and intravenous dexamethasone; lido - endotracheal tube cuff filled with alkalinized lidocaine; and lido/dex - endotracheal tube cuff filled with alkalinized lidocaine and intravenous dexamethasone. Perioperative hemodynamic parameters and the incidence of postoperative nausea and vomiting, coughing and hoarseness were recorded. Postoperative sore throat was assessed in the postanesthetic care unit and 24 hours post tracheal extubation. RESULTS: In total, 154 children aged 4-12 years, ASA physical status I or II, undergoing general anesthesia for elective tonsillectomy and adenotonsillectomy, were assessed for postoperative sore throat in this study. The incidence of postoperative sore throat 24 hours after tracheal extubation was significantly lower in the lido/dex group compared to groups air and air/dex (p = 0.01). However, no additional reduction in these symptoms was observed from the intravenous administration of dexamethasone when comparing the lido and lido/dex groups. Similarly, there were no differences among groups regarding perioperative hemodynamic variables or postoperative nausea and vomiting, coughing, and hoarseness during the study period. CONCLUSION: Intracuff alkalinized lidocaine, associated with intravenous dexamethasone, might be effective in reducing sore throat 24 hours post-tonsillectomy or adenotonsillectomy in children when compared to the use of air as the cuff insufflation media.
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Anestesia General , Anestésicos Locales , Dexametasona , Intubación Intratraqueal , Lidocaína , Faringitis , Complicaciones Posoperatorias , Tonsilectomía , Humanos , Dexametasona/administración & dosificación , Tonsilectomía/métodos , Tonsilectomía/efectos adversos , Lidocaína/administración & dosificación , Niño , Masculino , Preescolar , Femenino , Anestesia General/métodos , Faringitis/prevención & control , Faringitis/etiología , Faringitis/epidemiología , Estudios Prospectivos , Intubación Intratraqueal/métodos , Intubación Intratraqueal/efectos adversos , Anestésicos Locales/administración & dosificación , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/epidemiología , Administración Intravenosa , Náusea y Vómito Posoperatorios/epidemiología , Náusea y Vómito Posoperatorios/prevención & controlRESUMEN
INTRODUCTION: Non-compressible torso hemorrhagic (NCTH) shock is the leading cause of potentially survivable trauma on the battlefield. New hypotensive drug therapies are urgently required to resuscitate and protect the heart and brain following NCTH. Our aim was to examine the strengths and limitations of permissive hypotension and discuss the development of small-volume adenosine, lidocaine, and Mg2+ (ALM) fluid resuscitation in rats and pigs. MATERIALS AND METHODS: For review of permissive hypotension, a literature search was performed from inception up to November 2023 using PubMed, Cochrane, and Embase databases, with inclusion of animal studies, clinical trials and reviews with military and clinical relevance. For the preclinical study, adult female pigs underwent laparoscopic liver resection. After 30 minutes of bleeding, animals were resuscitated with 4 mL/kg 3% NaCl ± ALM bolus followed 60 minutes later with 4 h 3 mL/kg/h 0.9% NaCl ± ALM drip (n = 10 per group), then blood transfusion. Mean arterial pressure (MAP) and cardiac output (CO) were continuously measured via a left ventricular pressure catheter and pulmonary artery catheter, respectively. Systemic vascular resistance (SVR) was calculated using the formula: 80 × (MAP - CVP)/CI. Oxygen delivery was calculated as the product of CO and arterial oxygen content. RESULTS: Targeting a MAP of â¼50 mmHg can be harmful or beneficial, depending on how CO and SVR are regulated. A theoretical example shows that for the same MAP of 50 mmHg, a higher CO and lower SVR can lead to a nearly 2-fold increase in O2 supply. We further show that in animal models of NCTH, 3% NaCl ALM bolus and 0.9% NaCl ALM drip induce a hypotensive, high flow, vasodilatory state with maintained tissue O2 supply and neuroprotection. ALM therapy increases survival by resuscitating the heart, reducing internal bleeding by correcting coagulopathy, and decreasing secondary injury. CONCLUSIONS: In rat and pig models of NCTH, small-volume ALM therapy resuscitates at hypotensive pressures by increasing CO and reducing SVR. This strategy is associated with heart and brain protection and maintained tissue O2 delivery. Translational studies are required to determine reproducibility and optimal component dosing. ALM therapy may find wide utility in prehospital and far-forward military environments.
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Adenosina , Hipotensión , Resucitación , Animales , Porcinos , Resucitación/métodos , Ratas , Hipotensión/etiología , Hipotensión/fisiopatología , Adenosina/administración & dosificación , Adenosina/farmacología , Lidocaína/farmacología , Lidocaína/uso terapéutico , Lidocaína/administración & dosificación , Femenino , Choque Hemorrágico/terapia , Choque Hemorrágico/complicaciones , Choque Hemorrágico/fisiopatologíaRESUMEN
INTRODUCTION: Patients suffering from severe chronic pain often have problems finding an appropriate combination of painkillers. We retrospectively evaluated the effectiveness and safety of pulsed radiofrequency ablation (pRFA) of the genicular nerves in 96 patients with knee osteoarthritis (KO). We hypothesized that age, sex, and body mass index (BMI) may influence the quality of the pRFA treatment. MATERIAL AND METHODS: A diagnostic blockade with total volume of 9 ml of 1% lidocaine (WZF, Poland) combined with 4 mg of dexamethasone with subsequent pRFA with a radio frequency of 300-500 kHz under ultrasound guidance was used during the procedure. The study participants were assessed during regular monthly visits until 12 months. RESULTS: The nerves' ultrasound identification was successful in 90.62% of the cases. According to the numeric rating scale (NRS), pain was reduced by 50% or more in 64.06% of the cases. The average pain relief period lasted just over 7 and a half months. There were no pRFA-related complications or side effects of the drugs used. CONCLUSIONS: pRFA seems to be safe and effective for the treatment of chronic pain in KO. The outcome of the treatment may be related to the patient's age (block duration increased with patient age) and sex (in women, the therapeutic effect was more effectively prolonged) in our study group. There was also higher effectiveness of pRFA in high-BMI patients, which was close to statistical significance ( P = 0.053).
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Dolor Crónico , Osteoartritis de la Rodilla , Humanos , Femenino , Masculino , Estudios Retrospectivos , Osteoartritis de la Rodilla/complicaciones , Osteoartritis de la Rodilla/terapia , Anciano , Persona de Mediana Edad , Dolor Crónico/terapia , Dolor Crónico/etiología , Resultado del Tratamiento , Tratamiento de Radiofrecuencia Pulsada/métodos , Dimensión del Dolor , Anciano de 80 o más Años , Factores de Edad , Lidocaína/administración & dosificación , Lidocaína/uso terapéutico , Factores Sexuales , Ultrasonografía Intervencional/métodos , Índice de Masa CorporalRESUMEN
BACKGROUND AND OBJECTIVES: General practitioners excise many suspected skin cancers using local anaesthetics such as lignocaine, but the relationships between the dose and volume of the local anaesthetic and wound complications are unclear. This pilot study considers an association between the dose and volume and complications. METHOD: An audit was conducted of patient records from two time periods: one before and one after an education intervention. Data extracted included lignocaine (volume and dose), wound complications (dehiscence and infection) and the demographics of patients and clinicians. RESULTS: Both the dose and volume of lignocaine administered were significantly associated with complication rates (P=0.0084 and P=0.0209, respectively). In the post-intervention period, clinician behaviour changed, with a reduction in the volume and dose of lignocaine administered (P<0.001 and P<0.001, respectively) without episodes of inadequate analgesia. DISCUSSION: This pilot study reported a relationship between lidocaine dose and volume and rates of complications. Shortcomings of this study limit attribution of findings to clinical practice. However, the results justify further rigorous research.
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Anestésicos Locales , Lidocaína , Neoplasias Cutáneas , Humanos , Lidocaína/efectos adversos , Lidocaína/administración & dosificación , Lidocaína/uso terapéutico , Proyectos Piloto , Anestésicos Locales/administración & dosificación , Anestésicos Locales/efectos adversos , Anestésicos Locales/uso terapéutico , Neoplasias Cutáneas/cirugía , Masculino , Femenino , Persona de Mediana Edad , Anciano , Cicatrización de Heridas/efectos de los fármacos , AdultoRESUMEN
Purpose: This study aimed to investigate patients' expectative pain of spinal anesthesia puncture and anxiety pre-anesthesia, and to examine the effect of lidocaine-prilocaine cream and remimazolam prior to spinal anesthesia puncture on pain relief and anxiety release. Methods: Patients undergoing spinal anesthesia were divided into control, lidocaine-prilocaine cream, and lidocaine-prilocaine cream with remimazolam groups. A questionnaire consisting of The Amsterdam Preoperative Anxiety and Information Scale (APAIS) and patient's concerns and Visual Analog Scale (VAS) was used to evaluate patient's anxiety and pain. The primary outcomes were differences in VAS and anxiety scores. Patient's spinal anesthesia-related concerns, advent events and hemodynamic index were also recorded. Results: The expected spinal anesthesia puncture pain was 5.34±0.27 and anxiety scores before spinal anesthesia was 10.88 ± 0.64. A statistically significant positive correlation of 31.3% was detected between VAS and APAIS scores (r = 0.313; P=0.003). The VAS score at the time of puncture decreased by 29.7% (3.78±0.40, P=0.001) in lidocaine-prilocaine cream group and 29.2% (3.75±0.39, P=0.001) in lidocaine-prilocaine cream with remimazolam group compared with the expected VAS score. Lidocaine-prilocaine cream combined with or without remimazolam reduced the percentage of moderate pain (21.4% and 31.3% vs 50.0%, P=0.0001) and increased mild pain (60.7% vs 59.4% vs 22.7%, P=0.03). Anxiety score in lidocaine-prilocaine cream group was reduced by 2.84 (8.04±0.76 vs 10.88 ± 0.46, P=0.05) when compared with pre-anesthesia. Concerns about postoperative pain (P=0.03) and fear of the needle or intervention (P=0.000) both decreased post-anesthesia among groups. Conclusion: Approximately half of the patients scheduled for spinal anesthesia experienced a moderate level of preoperative anxiety. The patient's pain expectation from the spinal anesthesia puncture was moderate, which was higher than the actual pain. Lidocaine-prilocaine cream with or without remimazolam sedative before spinal anesthesia puncture reduced the patient's pain and anxiety scores after surgery.
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Anestesia Raquidea , Ansiedad , Lidocaína , Humanos , Masculino , Femenino , Ansiedad/tratamiento farmacológico , Persona de Mediana Edad , Adulto , Lidocaína/administración & dosificación , Lidocaína/farmacología , Prilocaína/administración & dosificación , Benzodiazepinas/administración & dosificación , Anestésicos Locales/administración & dosificación , Dimensión del DolorAsunto(s)
Anestésicos Locales , Laparoscopía , Lidocaína , Dolor Postoperatorio , Humanos , Dolor Postoperatorio/tratamiento farmacológico , Lidocaína/administración & dosificación , Lidocaína/efectos adversos , Laparoscopía/efectos adversos , Anestésicos Locales/administración & dosificación , Infusiones Intravenosas , Manejo del Dolor/métodos , Resultado del TratamientoRESUMEN
INTRODUCTION: Carotid endarterectomy is performed for patients with symptomatic carotid artery occlusions. Surgery can be performed under general and regional anesthesia. Traditionally, surgery is performed under deep cervical plexus block which is technically difficult to perform and can cause serious complications. This case series describes 5 cases in which an intermediate cervical plexus block was used in combination with a superficial cervical plexus block for Carotid endarterectomy surgery. METHODS: Five patients who were classified as American Society of Anesthesiologists 2-3 were scheduled for Carotid endarterectomy due to symptoms and more than 70% occlusion of the carotid arteries. The procedures were carried out in the University Teaching Hospital- Peradeniya, Sri Lanka. All patients were given superficial cervical plexus block followed by intermediate cervical plexus block using 2% lignocaine and 0.5% plain bupivacaine. RESULTS: Adequate anesthesia was achieved in 4 patients, and local infiltration was necessary in 1 patient. Two patients developed hoarseness of the voice, which settled 2 h after surgery. Hemodynamic fluctuations were observed in all 5 patients. No serious complications were observed. All 5 patients had uneventful recoveries. DISCUSSIONS: Regional anesthesia for CEA is preferable in patients who are medically complicated to undergo anesthesia or in patients for whom cerebral monitoring is not available. Intermediate cervical plexus block is described for thyroid surgeries in literature, but not much details on its use for carotid surgeries. Deep cervical plexus blocks has few serious complications which is not there with the use of ICPB making it a good alternative for CEA surgeries . CONCLUSIONS: Superficial cervical plexus block and intermediate cervical plexus block can be used effectively for providing anesthesia for patients undergoing Carotid endarterectomy. It is safe and easier to conduct than deep cervical plexus block and enables monitoring of cerebral function.
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Anestésicos Locales , Bupivacaína , Bloqueo del Plexo Cervical , Endarterectomía Carotidea , Humanos , Endarterectomía Carotidea/métodos , Bloqueo del Plexo Cervical/métodos , Masculino , Anciano , Femenino , Persona de Mediana Edad , Anestésicos Locales/administración & dosificación , Bupivacaína/administración & dosificación , Lidocaína/administración & dosificación , Plexo CervicalRESUMEN
BACKGROUND: The most important problem in tonsillectomy is pain in the early postoperative period. OBJECTIVE: We purposed to compare the effects of lidocaine, tetracaine, and articaine application to the peritonsillar bed on post-tonsillectomy pain in children. METHODS: The prospective, placebo-controlled study included 80 patients, ages 3-14, who were scheduled for elective tonsillectomy. Patients were randomly divided into four groups. Group 1 received 0.9% NaCl; group 2 received 2% lidocaine; group 3 received 2% tetracaine; and group 4 received 4% articaine to the tonsillary bed for 5 min just after the operation. All patients were evaluated in terms of pain and pain-related adverse events in the postoperative 24 h. RESULTS: All groups that used local anesthetics had significantly lower pain levels than the control group in the first eight hours (p < .001). Furthermore, the articaine group had a lower pain score than the tetracaine group at the eighth hour (p < .05). The articaine group had a lower pain score at the 16th hour than both the control and tetracaine groups (p < .05). There was no significant difference between the groups at the 24th hour (p > .05). CONCLUSION AND SIGNIFICANCE: We recommend the immediate application of topical articaine to the tonsillar bed following the procedure to enhance postoperative pain management.
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Anestésicos Locales , Carticaína , Lidocaína , Dolor Postoperatorio , Tetracaína , Tonsilectomía , Humanos , Niño , Tetracaína/administración & dosificación , Carticaína/administración & dosificación , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/prevención & control , Anestésicos Locales/administración & dosificación , Lidocaína/administración & dosificación , Lidocaína/uso terapéutico , Masculino , Femenino , Tonsilectomía/efectos adversos , Estudios Prospectivos , Preescolar , Adolescente , Administración Tópica , Dimensión del Dolor , Método Doble CiegoRESUMEN
It remains unclear whether dosage adjustment of intravenous lidocaine is necessary during general anesthesia for elderly patients over 75 years old. This study aimed to investigate the effects of age on the pharmacokinetics (PK) and safety of intravenous lidocaine in patients undergoing general anesthesia. A total of 599 plasma samples were collected from 76 general anesthesia patients across three age groups: 18-64, 65-74, and ≥ 75 years. Lidocaine was administered intravenously at a dose of 1.5 mg/kg for the 18-64 and 65-74 years groups, while the dose was adjusted to 1.0 mg/kg for the ≥ 75 years group. The plasma concentrations of lidocaine and its active metabolites were measured using a validated ultra-performance liquid chromatography-tandem mass spectrometry assay, and the data were analyzed using a noncompartmental analysis. The results revealed no significant age-related differences in the PK of lidocaine and its metabolites. Among the three age groups, over 90 % of patient achieved a lidocaine concentration within a safe and effective range when the dosage was normalized to 1.5 mg/kg. In conclusion, age-based dosage adjustment was unnecessary for intravenous lidocaine in patients below 86 years undergoing general anesthesia.
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Administración Intravenosa , Anestesia General , Anestésicos Locales , Lidocaína , Humanos , Lidocaína/administración & dosificación , Lidocaína/farmacocinética , Lidocaína/sangre , Anciano , Persona de Mediana Edad , Anestesia General/métodos , Masculino , Adulto , Femenino , Anciano de 80 o más Años , Adulto Joven , Estudios Prospectivos , Anestésicos Locales/administración & dosificación , Anestésicos Locales/farmacocinética , Anestésicos Locales/sangre , Adolescente , Factores de Edad , Relación Dosis-Respuesta a DrogaRESUMEN
OBJECTIVE: This study evaluates intratympanic lidocaine's efficacy and safety for tinnitus relief in sudden sensorineural hearing loss (SSNHL) patients. METHODS: In a double-blind randomized controlled trial, 100 SSNHL patients with unilateral tinnitus received either intratympanic lidocaine or saline plus usual care. Treatment impact was assessed at 1 and 3 months using the Tinnitus Handicap Inventory, subjective visual analog scale, pure-tone audiometry. RESULTS: The lidocaine group demonstrated significant tinnitus relief according to the Tinnitus Handicap Inventory and visual analog scale, without pure-tone audiometry improvement or serious adverse events throughout the study period. CONCLUSION: Intratympanic lidocaine provides a safe, efficacious treatment option for SSNHL tinnitus. Further studies should refine the dosage and delivery parameters because of SSNHL's heterogenous nature.
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Anestésicos Locales , Audiometría de Tonos Puros , Pérdida Auditiva Sensorineural , Pérdida Auditiva Súbita , Inyección Intratimpánica , Lidocaína , Acúfeno , Humanos , Acúfeno/tratamiento farmacológico , Método Doble Ciego , Masculino , Femenino , Lidocaína/administración & dosificación , Lidocaína/uso terapéutico , Persona de Mediana Edad , Pérdida Auditiva Sensorineural/tratamiento farmacológico , Adulto , Resultado del Tratamiento , Pérdida Auditiva Súbita/tratamiento farmacológico , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico , AncianoRESUMEN
BACKGROUND: Tracheal tube cuff pressure will increase after pneumoperitoneum when the cuff is inflated with air, high pressure can cause tracheal mucosal damage. This prospective trial aimed to assess if inflating with normal saline or lidocaine can prevent increase of tracheal tube cuff pressure and tracheal mucosal damage in laparoscopic surgeries with general anesthesia. Whether changes of tracheal tube cuff transverse diameter (CD) can predict changes of tracheal tube cuff pressure. METHODS: Ninety patients scheduled for laparoscopic resection of colorectal neoplasms under general anesthesia were randomly assigned to groups air (A), saline (S) or lidocaine (L). Endotracheal tube cuff was inflated with room-temperature air in group A (n = 30), normal saline in group S (n = 30), 2% lidocaine hydrochloride injection in group L (n = 30). After intubation, tracheal tube cuff pressure was monitored by a calibrated pressure transducers, cuff pressure was adjusted to 25 cmH2O (T0.5). Tracheal tube cuff pressure at 15 min after pneumoperitoneum (T1) and 15 min after exsufflation (T2) were accessed. CD were measured by ultrasound at T0.5 and T1, the ability of ΔCD (T1-0.5) to predict cuff pressure was accessed. Tracheal mucous injury at the end of surgery were also recorded. RESULTS: Tracheal tube cuff pressure had no significant difference among the three groups at T1 and T2. ΔCD had prediction value (AUC: 0.92 [95% CI: 0.81-1.02]; sensitivity: 0.99; specificity: 0.82) for cuff pressure. Tracheal mucous injury at the end of surgery were 0 (0, 1.0) in group A, 0 (0, 1.0) in group S, 0 (0, 0) in group L (p = 0.02, group L was lower than group A and S, p = 0.03 and p = 0.04). CONCLUSIONS: Compared to inflation with air, normal saline and 2% lidocaine cannot ameliorate the increase of tracheal tube cuff pressure during the pneumoperitoneum period under general anesthesia, but lidocaine can decrease postoperative tracheal mucosa injury. ΔCD measured by ultrasound is a predictor for changes of tracheal tube cuff pressure. TRIAL REGISTRATION: Chinese Clinical Trial Registry, identifier: ChiCTR2100054089, Date: 08/12/2021.