Topical Application Of Lidocaine Research Articles

Evaluation of acceptance and preference of topical lidocaine application versus articaine injection anesthesia after nonsurgical periodontal treatment: A randomized clinical trial.

To compare acceptance and preference of topical lidocaine gel anesthesia with articaine injection anesthesia in patients with moderate periodontitis undergoing scaling and root debridement. Ninety-one patients completed this randomized multicenter split-mouth controlled study and underwent two separate periodontal treatment sessions on different days, one with a topical intrapocket lidocaine gel application and the other with an articaine injection anesthesia in a different order depending on randomization. Parameters measured were the patients' preference for topical lidocaine gel anesthesia or injection anesthesia with articaine (primary efficacy criterion), their maximum and average pain, and their intensity of numbness as well as experience of side effects; the probing depth; and the dentists' preference and their evaluations of handling/application, onset and duration of anesthetic effect, and patient compliance. After having experienced both alternatives, 58.3% of the patients preferred the topical lidocaine gel instillation into the periodontal pockets. The safety profile of the lidocaine gel differed positively from the safety profile of articaine injection in type and frequency of adverse drug reactions. The dentists' acceptance and preference regarding either anesthetic method studied were balanced. Instillation of lidocaine gel into the periodontal pocket is a preferred alternative to injection anesthesia for most of the patients and an equivalent alternative for dentists in nonsurgical periodontal therapy.

Open Exploration and Reduction of Paediatric Supracondylar Humerus Fracture with Pink, Pulseless Hand in Resource-Limited Settings.

Background: Supracondylar humerus fractures (SHFs) are common paediatric injuries, with high risk of vascular compromise. Some patients present with a 'pink, pulseless hand', caused by occlusion of brachial artery flow but with collateral circulation preserving distal perfusion. Management of these patients remains controversial, especially when resources may be limited for prolonged hospitalisation and serial monitoring by skilled staff. The aim of this study is to present the intraoperative findings, surgical procedures done and outcomes at 6 weeks for patients with paediatric supracondylar fractures with a pink pulseless hand. Methods: We retrospectively identified 13 patients who presented to a public hospital between January 2019 and May 2023 with a displaced SHF and pink, pulseless hand. All patients underwent an open reduction with an anterior approach allowing for exploration, protection and repair of neurovascular structures. Distal flow was restored in the brachial artery either with topical lidocaine application, thrombectomy or artery reconstruction. Results: Out of 13 patients, all had intact median nerves and 10 had intact arteries (69%), of which seven were interposed at the fracture site and four were in vasospasm. Of the three patients with true arterial injury (23%), two had a crushed artery and one had thrombosis of the artery. Peripheral pulses were restored within an hour of fracture open reduction in all patients. At final follow-up, a mean 6 weeks postoperatively, all patients had recovered without neurovascular deficit, compartment syndrome or Volkmann ischemic contracture. Conclusions: In resource-limited settings, we recommend performing open exploration and reduction for patients with SHFs with pink, pulseless hand. This approach prevents iatrogenic neurovascular injury during closed reduction attempts, allows for immediate repair of a brachial artery injury and avoids unnecessary hospitalisation and serial monitoring. Level of Evidence: Level IV (Therapeutic).

A Case Report of Refractory Postherpetic Neuralgia After Ramsay Hunt Syndrome Treated With Tympanic Nerve Neurectomy.

Ramsay Hunt syndrome is a facial nerve palsy that arises from herpes zoster infection. In rare cases, postherpetic neuralgia is a complication following Ramsay Hunt syndrome. Pain management to address postherpetic neuralgia includes facial nerve blocks, medications such as gabapentin, carbamazepine and botulinum toxin injections, and pulsed radiofrequency. Despite the reported benefits for patients with glossopharyngeal nerve pain, neurectomy as a treatment has rarely been described. A 45-year-old patient visited our ENT clinic for chronic right-sided facial, ear, and jaw pain that persisted for 9 years following the development of Ramsay Hunt syndrome. She trialed multiple medications including gabapentin, carbamazepine, and botulinum toxin injections with minimal relief to her symptoms. The patient underwent a diagnostic myringotomy with topical application of lidocaine to the tympanic nerve. This resulted in temporary relief of her pain until the effects of the lidocaine subsided. The patient was subsequently offered lysis of the right tympanic nerve for more definitive management. The patient experienced significant pain reduction after the right tympanic neurectomy procedure. Chronic postherpetic neuralgia following Ramsay Hunt syndrome can cause significant impairment in a patient's quality of life. For patients with ear pain refractory to conservative management, a tympanic neurectomy can be considered.

Superior Laryngeal Nerve Block in Transcutaneous Vocal Fold Injection: A Pilot Study

Topical lidocaine remains the mainstay for anesthesia in transcutaneous vocal fold injection (VFI). While using topical lidocaine, laryngologists sometimes encounter uncontrolled reflexes or poor compliance. Superior laryngeal nerve block (SLNB) provides deep and rapid anesthesia on the larynx above the vocal folds and abolishes the glottic closure reflex. Herein, we present a pilot study to evaluate the feasibility and safety of SLNB for transcutaneous VFI and explored its usefulness. Fifty-nine patients were prospectively anesthetized with SLNB during transcutaneous VFI for unilateral vocal fold paralysis. In the SLNB group, 0.5 to 1 mL of 2% lidocaine was infiltrated on bilateral SLNs through the thyrohyoid membrane. As the control group, we included previous 47 patients who underwent VFI with topical lidocaine. In the control group, 10% lidocaine spray was applied to the laryngopharyngeal mucosa. Demographic data, laryngeal exposure, patient compliance, procedural interruption, and complications were investigated. Patient compliance was evaluated based on the frequency of cough and swallowing during VFI procedures. SLNB enabled endoscopic contact on the epiglottis and pharyngeal wall without gag reflex and provided good exposure of the procedure field on the vocal folds. In the SLNB group, the laryngeal exposure is significantly better than in the control (P=0.005). The frequency of cough and swallowing was significantly lower in the SLNB group than in the control (P < 0.001). The number of procedural interruptions was lower in the SLNB group than in the control (P < 0.001). There was no acute or delayed complication related to SLNB such as bleeding, hematoma, delayed sensory/swallowing problems, or unscheduled hospital visits. SLNB might be safe and effective for anesthesia in transcutaneous VFI. SLNB could be a good anesthetic option for patients with poor compliance despite the sufficient application of topical lidocaine.

Effect of preemptive topical application of lidocaine or prilocaine–lidocaine on successful catheterization of ear veins in New Zealand White rabbits

ObjectiveTo compare 5% lidocaine ointment applied for 10 minutes before intravenous (IV) catheterization to a eutectic mixture of local anesthetics (2.5% lidocaine and 2.5% prilocaine; EMLA) cream applied for 10 or 60 minutes prior and a water-based placebo for 60 minutes for successful marginal ear IV catheterization in rabbits. Study designRandomized, blinded, complete crossover, controlled trial. AnimalsA total of 10 intact male, New Zealand White rabbits aged 4 months. MethodsAfter application of one of the treatments on the marginal ear vein, an operator unaware of the treatment attempted IV catheter placement. Successful IV catheterization was considered as a catheter inserted at the first attempt, safely secured, with appropriate patency. Generalized linear mixed models were developed to identify relevant predictors of successful catheter placement. ResultsEars that had EMLA cream applied 60 minutes before the catheterization attempt had more than 10 times the odds of successful catheter placement [odds ratio (OR)=10.75; 95% confidence interval (CI), 1.92–60.16; p < 0.008] compared with placebo. Both the application of EMLA cream or lidocaine ointment 10 minutes before the catheterization attempt resulted in approximately three times the odds of successful catheter placement compared with placebo, but were not statistically significant. Conclusions and clinical relevanceApplication of EMLA cream on the marginal ear vein 60 minutes before catheterization increases the chance of successful IV catheter placement in conscious rabbits.

Topical lidocaine anesthesia for nasopharyngeal sampling – a double-blind randomized placebo-controlled trial

Introduction and aim. The aim of this study is to evaluate the effects of topical lidocaine application for nasopharyngeal sampling, on pain perception, the comfort of the patients, and the application difficulty for healthcare staff. Material and methods. This study conducted with 100 healthy volunteers (50 participants in Lidocaine group and 50 participants in Placebo group). Two ml of a solution containing 10 mg/ml of lidocaine was applied to each nostril of the participants in the Lidocaine group, and the same dose of 0.9% NaCl to the Placebo group. We compared the changes in pain intensity and discomfort intensity using two numerical rating scales, the frequency of undesirable reactions, and the judgment of the practitioner staff. Results. There were statistically significant decreases in pain and discomfort scores in the Lidocaine group. Similarly, there were statistically significant decreases in the frequency of all undesirable reactions except “grimace”, in the second sampling in the Lidocaine group, however, there was a statistically significant decrease only in “holding staff’s hand” in second sampling in the Placebo group. Conclusion. Intranasal lidocaine application reduces the pain that occurs during nasopharyngeal sampling and makes the procedure easier for the patient and the healthcare worker.

Two different methods of lidocaine inhalation before diagnostic flexible bronchoscopy: effects on post-bronchoscopy respiratory symptoms

Use of topical anesthesia before flexible bronchoscopy for the evaluation of the upper airways prevents cough and stridor during and after the procedure while reducing the need for sedation. In practice, lidocaine is the medication of choice before bronchoscopy. There various types of nebulizers used for inhalation treatments. In this study, we compared the respiratory tract symptoms after flexible bronchoscopy between children who received pre-procedure topical lidocaine with mesh or jet nebulizers. We enrolled 4–18 years old subjects that underwent flexible bronchoscopy due to treatment-resistant asthma in this retrospective case-control study. Twenty subjects received topical lidocaine with jet nebulizers while 20 received it with mesh nebulizers. Age, sex, duration of bronchoscopy, duration of anesthesia, time to awaken, and time to recovery were recorded as well as cough and laryngospasm scores after flexible bronchoscopy. Severe cough after flexible bronchoscopy was not encountered in the mesh nebulizers group but was seen in 10% of the jet nebulizers group (p = 0.027). On the other hand, age, sex, duration of bronchoscopy, duration of anesthesia, time to awaken, and time to recovery were not significantly different between the mesh and jet nebulizer groups (p = 0.44, 0.34, 0.51, 0.88, 0.88, and 0.22, respectively). Moreover, croup and laryngospasm scores between the two groups were similar (p = 0.62, 0.50 respectively). Cough score was significantly worse jet nebulizers group (p = 0.03). Topical lidocaine application with mesh nebulizers decreases the most common complication, cough, after flexible bronchoscopy in children more effectively compare to jet nebulizers. Thus, mesh nebulizers may be a faster way of nebulization before flexible bronchoscopy as an alternative to jet nebulizers.

Topical Application of Lidocaine and Bupivacaine to Disbudding Wounds in Dairy Calves: Safety, Toxicology and Wound Healing.

Simple SummaryDisbudding is a common, but painful procedure performed on calves to prevent horn growth. Tri-Solfen® is a combination local anaesthetic and antiseptic formulation which, applied topically to the disbudding wound, is reported to reduce calf pain. Applied in this manner, the local anaesthetics in Tri-Solfen®, lidocaine and bupivacaine, are reported to be poorly absorbed, resulting in low risk of neurological or cardiotoxic effects. The potential impacts on other blood, urine and tissue parameters and on wound healing when used in this manner, and/or accidental overdose situations are unknown, however. We performed experiments investigating (i) the safety of Tri-Solfen® (including overdose situations) and (ii) the impact of Tri-Solfen® on disbudding wound healing under field conditions. No adverse health effects were observed in Tri-Solfen®-treated animals, even those receiving 5× the recommended dose, with no clinically significant differences in measured parameters between placebo and Tri-Solfen® groups. No negative impacts on wound healing were noted. Conversely, lower levels of bacterial wound colonisation were evident, and there was reduced incidence of abnormal wounds at days 11–12 in Tri-Solfen®-treated animals.Tri-Solfen® is a combination topical anaesthetic and antiseptic solution containing lidocaine, bupivacaine, adrenaline and cetrimide. Applied to wounds, it is reported to reduce the pain experienced by calves following thermocautery disbudding. While lidocaine and bupivacaine are widely used in medicine, conflicting data exist on the impact of these compounds when applied directly to the surgical wound. To investigate the safety of Tri-Solfen® applied to thermocautery disbudding wounds of calves, experiments were performed to measure (i) the safety of Tri-Solfen® (including in overdose situations); and (ii) the impact of Tri-Solfen® application at recommended doses on disbudding wound healing under field conditions. Haematological, biochemical and urinalysis parameters did not show clinically significant differences between placebo and Tri-Solfen® groups (1×, 3× and 5× dose). No adverse health impacts were reported. Histopathological analysis of wounds noted a reduction in bacterial colonies in Tri-Solfen®-treated wounds. Under field conditions, no negative impacts on wound healing were noted. Conversely, there was reduced incidence of abnormal wounds, with an associated trend toward improved average daily gain at days 11–12 in Tri-Solfen®-treated animals. These data are considered to support the safety of topical anaesthesia, as formulated in Tri-Solfen®, to the thermocautery disbudding wound in calves.

Clinician's perspective on neuropathic pain and use of Lidocaine 5% patch with hydrogel technology in postherpetic neuralgia

Background: Neuropathic pain (NP) is a condition that affects the quality of life (QoL) of many patients. It is often difficult to treat effectively due to the complexity of this disorder. This study was aimed to assess clinician's perspectives on NP, particularly for postherpetic neuralgia (PHN), posttraumatic neuralgia (PTN), and painful diabetic neuropathy (PDN). Further, the study aimed to evaluate the safety and efficacy of lidocaine 5% patch with hydrogel technology in PHN. Materials and Methods: These two aspects were assessed through two prospective survey-based questionnaire studies that were conducted from January 2018 to December 2018 with clinicians from relevant specialties across India. Data were collected from clinicians' inputs based on their clinical practice and statistically analyzed. Results: More than half of the clinicians reported prolonged duration of NP in PHN, PTN, and PDN conditions. After applying lidocaine 5% patch with hydrogel technology, around 83.58% of clinicians opined that patients experienced a cooling and soothing effect due to the presence of a hydrogel layer in the patch. A significant reduction in pain score was reported by 76.11% of clinicians and 79.1% of them agreed that there was pain relief during the intermittent patch-free period also. The majority of the doctors (74.6%) reported an absence of any side effects. Conclusion: Study findings revealed that topical application of lidocaine 5% patch with hydrogel technology is safe and effective in PHN.

Characterization Of Vaginitis Among Women Complaining Of Genital Tract Symptoms

Vaginitis is the inflammation of the vagina as a result of a change in the balance of normal flora affecting women of reproductive age. It is one of the most frequent reasons that women visit clinics. The objective of this study was to determine the importance of&#x0D; laboratory diagnosis methods in the treatment of the disease and to study the symptoms and risk factors associated with vaginitis among women with genital tract symptoms. Vaginal swabs were collected from 50 women attending Maternity hospital and Chwarchra dormitory camps in Sulaimani city. Samples were examined microbiologically and causative agents were isolated. All relevant clinical information such as patient demographic profiles, socioeconomic variables, risk factors and symptoms have been collected by questionnaire based study. Different species of microorganisms were isolated from vaginal samples including yeast and bacteria. Culture analysis and gram stain had shown that bacterial vaginosis was 22%, while the rate of yeast infection was 16%. The higher percentage was 62% for the normal flora (Lactobacillus). Microscopic examination of patient’s vaginal swabs revealed that 63.6% of infectious group had high level of epithelial cells (&gt;10), while the most patients with non-infectious vaginitis had (10) or less epithelial cell in the microscopic field. The presence of epithelial cell was significantly associated with infectious vaginitis (p-value 0.04). Most patients were aged between 25-35 years. The result showed a significant association between infectious vaginosis with education level (p-value 0.02). The most common symptom present among patients with infectious vaginitis group was itching (38.5%) and smelly discharge (40%). The majority of women had history of previous infections in both infectious and non-infectious vaginitis groups. Furthermore, there was different types of vaginitis including infectious vaginitis (bacterial and yeast infection) and non-infectious vaginitis. Therefore, it is essential to perform laboratory examination for the patients to detect the causative agents of vaginitis, and ensure the most appropriate treatment can be administered. In addition, the treatment of vaginitis can be done by topical application of Lidocaine 5% ointment (as a local anesthetic) nightly for seven weeks has been shown to decrease the pain of vaginitis in women.

Evaluation of the time to desensitization of the larynx of cats following topical lidocaine application.

The objective of this study was to evaluate the time to decreased reactivity of the arytenoid cartilages in cats after application of topical lidocaine. One hundred and ten mixed-breed cats were randomly assigned to one of five groups based on the time between application of lidocaine and stimulation of the larynx: 5 (T5), 15 (T15), 30 (T30), 45 (T45) or 60 (T60) s. Cats were premedicated with dexmedetomidine, ketamine and buprenorphine. Anesthesia was induced with propofol to effect. Lidocaine 2% (2 mg/kg) was applied topically to the vocal cords using a catheter attached to a syringe under direct laryngoscopy. After lidocaine application, the designated time elapsed and the vocal cords were stimulated with the patient end of an endotracheal tube. Severity of reaction was reported as none, mild, moderate or severe. All cats were intubated after the reactivity score was recorded. Anesthesia was maintained with isoflurane and 100% oxygen while cats were spayed or castrated. Cats were monitored in recovery for signs of respiratory complications and pain. There was a significant difference in overall reactivity score between T5 and T45 (P = 0.0038). Also, there was a significant difference in the number of cats with no reaction compared with cats with any reaction between T5 and T30 (P = 0.03), as well as between T5 and T45 (P = 0.0028). No cat had a severe reactivity score at T45 or T60. All cats were successfully intubated. There were no complications during intubation, maintenance of anesthesia or recovery. As the lowest overall reactivity score occurred at T45, it is recommended to wait at least 45 s after application of topical lidocaine before attempting tracheal intubation.

Efficacy of topical agents for prevention of postoperative sore throat after single lumen tracheal intubation: a Bayesian network meta-analysis.

The optimal choice of prophylactic drugs to decrease postoperative sore throat is unclear. The objective of this network meta-analysis (NMA) was to compare and rank 11 topical agents used to prevent postoperative sore throat. Various databases were searched independently for randomized-controlled trials (RCTs) comparing topical agents used for the prevention of postoperative sore throat. Inclusion criteria were parallel group studies comparing intervention with active or inactive control and reporting postoperative sore throat. The primary outcome was postoperative sore throat at 24 hr. Secondary outcomes were early sore throat at 4-6 hr, cough, and hoarseness at 24 hr. Evidence was synthesized from 70 RCTs reporting 7,141 patients. Topical application of lidocaine, corticosteroids, ketamine, magnesium, benzydamine, water-based lubricant, and liquorice applied along the tracheal tube, to the tracheal tube cuff, gargled or sprayed were compared with intracuff air and each other. Bayesian NMA showed that magnesium (odds ratio [OR], 0.10; 95% credible interval [CrI], 0.03 to 0.26), liquorice (OR, 0.14; 95% CrI, 0.03 to 0.55), and steroid application (OR, 0.11; 95% CrI, 0.06 to 0.22) most effectively prevented postoperative sore throat at 24 hr. Topical lidocaine was the least effective intervention. Topical application of magnesium followed by liquorice and corticosteroids most effectively prevented postoperative sore throat 24 hr after endotracheal intubation.

Topical application of lidocaine or bupivacaine in the healing of surgical wounds in dogs

Purpose:To analyze the anesthetic drugs interference with wound healing when used in the surgical bed.Methods:Macro and microscopic aspects of healing of surgical wounds were evaluated after instillation of topical anesthetics without vasoconstrictor or saline solution 0.9% as control in the transsurgical period. Thirty dogs, males and females were divided into two experimental groups. In both groups, two circular punch lesions of 6 mm diameter were performed in the abdomen. In group 1, lidocaine was instilled in one of the lesions and saline solution in the contralateral lesion. In group 2 the procedure was repeated with the use of bupivacaine. The macroscopic assessment of the lesions was performed on the first, third and tenth postoperative day. The excisional biopsy was performed on the tenth day and the samples were submitted for histopathological examination.Results:The macroscopic analysis had a significant difference between groups. Microscopic analysis was not significant between groups.Conclusions:The topical application of lidocaine and bupivacaine in the surgical wound is feasible and it does not influence skin healing. The benefit of such a practice, which has been the subject of other studies, seems to outweigh the risks.

Assessment of craniofacial hyperhidrosis and flushing by sphenopalatine blockade - a randomized trial.

Craniofacial hyperhidrosis (CFH) and flushing express nervous system autonomic dysfunction. Available reference treatments lack good compliance. The study objective was to investigate variations of CFH/flushing after two methods of sphenopalatine ganglion (SPG) blockade. CFH patients (n=25) were randomized in a ratio of 1:3 in two groups; 1) endoscopic application of topical lidocaine over SPG (TL; n=7); 2) endoscopic injection of lidocaine in the SPG (IL; n=18). CFH, flushing, rhinorrhoea, nasal obstruction, and smell detection were scored by Visual Analogue Scale (VAS). Nasal endoscopy, acoustic rhinometry, mucociliary transport test, smell/taste test, Schirmer test, Short Form-12, Chronic Skin Diseases Questionnaire, and Skin Satisfaction Questionnaire were also performed at visit 0, 1, 3 and 6 months. At baseline, groups reported similar CFH VAS (TL: 89.3 plus or minus 17.5mm; IL: 85.7 plus or minus 22.1mm) or flushing VAS (TL: 52.7 plus or minus 30mm; IL: 59 plus or minus 33.8mm). After 6 months, the least squares mean of CFH VAS in IL was -38.1 (-47.3 to -28.9) compared to TL 1.9 (-12.2 to 15.9). However, flushing VAS did not improve. Any rhinological measure nor quality of life test showed significant changes. One patient presented controlled epistaxis intraoperatively during IL. This preliminary study shows the sphenopalatine blockade injection as a safe procedure. Patients with CFH or flushing had significant improvement after lidocaine injection which lasted 6 months. Due to the small sample and the lack of objective measures more studies are needed.

Medications for pain relief in outpatient endometrial sampling or biopsy: a systematic review and network meta-analysis

To determine the most effective analgesia for pain relief during the outpatient endometrial biopsy (OEB) or outpatient hysteroscopy with endometrial aspiration (EA). Systematic review and network meta-analysis of randomized controlled trials. Not applicable. Pre- or postmenopausal women undergoing OEB or outpatient hysteroscopy with EA for evaluation of uterine pathology. We conducted an electronic search of the following bibliographic databases: Medline via PubMed, SCOPUS, Web of Science, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials (CENTRAL). The intensity of pain during, immediately after, and 10-30minutes after procedure assessed by the 10-cm visual analog scale. Lidocaine spray was the most effective medication for reducing pain during OEB (P-score = 0.83) and immediately after OEB (P-score = 0.96). On the other hand, naproxen sodium was the most effective medication for reducing pain during outpatient hysteroscopy with EA (P-score = 1.00), followed by misoprostol plus lidocaine (P-score = 0.87). Lidocaine spray, either alone or with topical application of lidocaine, is the most effective medication for reducing the pain during and after the OEB. Naproxen sodium is the most effective analgesic option during outpatient hysteroscopy with EA.

A newly identified nociresponsive region in the transitional zone (TZ) in rat sensorimotor cortex

The primary somatosensory cortex (S1) comprises a number of functionally distinct regions, reflecting the diversity of somatosensory receptor submodalities innervating the body. In particular, two spatially and functionally distinct nociceptive regions have been described in primate S1 (Vierck et al., 2013; Whitsel et al., 2019). One region is located mostly in Brodmann cytoarchitectonic area 1, where a subset of neurons exhibit functional characteristics associated with myelinated Aδ nociceptors and perception of 1st/sharp, discriminative pain. The second region is located at the transition between S1 and primary motor cortex (M1) in area 3a, where neurons exhibit functional characteristics associated with unmyelinated C nociceptors and perception of 2nd/slow, burning pain. To test the hypothesis that in rats the transitional zone (TZ) – which is a dysgranular region at the transition between M1 and S1 – is the functional equivalent of the nociresponsive region of area 3a in primates, extracellular spike discharge activity was recorded from TZ neurons in rats under general isoflurane anesthesia. Thermonoxious stimuli were applied by lowering the contralateral forepaw or hindpaw into a 48–51 °C heated water bath for 5–10 s. Neurons in TZ were found to be minimally affected by non-noxious somatosensory stimuli, but highly responsive to thermonoxious skin stimuli in a slow temporal summation manner closely resembling that of nociresponsive neurons in primate area 3a. Selective inactivation of TZ by topical lidocaine application suppressed or delayed the nociceptive withdrawal reflex, suggesting that TZ exerts a tonic facilitatory influence over spinal cord neurons producing this reflex. In conclusion, TZ appears to be a rat homolog of the nociresponsive part of monkey area 3a. A possibility is considered that this region might be primarily engaged in autonomic aspects of nociception.

The Recovery Curve of Soleus and Gastrocnemius H-Reflex After Applying Tripolar Electrical Stimulation on the Anesthetized Skin of Vertebral Column: An Emphasis on the Early and Secondary Facilitation Phases

Introduction: Computer modeling studies have shown that depolarization of the posterior and anterior root fibers can be achieved by surface tripolar electrical stimulation. This study investigated the soleus and gastrocnemius H-reflex recovery curve after applying tripolar electrical stimulation on the anesthetized skin of vertebral column. We emphasized on the early and secondary facilitation phases of the H-reflex recovery curve. Material and Methods: A total of 15 healthy nonathletic female volunteers (mean±SD age: 27.20±3.17 years) were enrolled in this study. H-reflex recovery curves of the soleus and gastrocnemius muscles were recorded before skin anesthesia and then 15 minutes after it (with lidocaine 10%) and finally after application of Transcutaneous Electrical Nerve Stimulator (TENS) or placebo TENS (TENS on/off). Tripolar TENS with pulse width of 300 µs, frequency of 80 Hz and intensity of 1.5 times of the sensory threshold was used for 15 minutes at the level of T11. To record the H-reflex recovery curve, 34 paired stimuli were used with the intensity of 30% H max and interstimulus intervals between 1 and 202 ms. After drawing the H-reflex recovery curve, amplitude, slope, area under the curve, and threshold of the early and secondary facilitation phases were calculated. Results: After application of topical lidocaine, the sensory threshold of the skin vertebral column increased significantly. Fifteen minutes after applying local anesthesia, peak amplitude, slope, and area under the curve of the early facilitation phase significantly decreased in gastrocnemius and soleus muscles. After tripolar TENS application on the anesthetized skin of vertebral column, the slope of the early facilitation phase decreased significantly in the soleus (P=0.047). Also, area under the curve of the secondary facilitation phase significantly increased in both muscles. Conclusion: These findings suggest the excitatory effect of skin anesthesia on the motoneurons activities. Changing the H-reflex recovery curve after application of tripolar TENS on the anesthetized skin may confirm deep penetration of this type of electrical stimulation.

Lidocaine controls pain and allows safe wound bed preparation and debridement of digital ulcers in systemic sclerosis: a retrospective study.

In Systemic Sclerosis (SSc), digital ulcers (DU) are painful, difficult to heal, and frequently infected. To reduce the risk of bacterial infection and to prevent chronicity, it is essential to carefully remove necrotic tissue from DU, with maximum patient comfort. Debridement, although very efficacious, is invasive and causes local pain: lidocaine is a local anesthetic commonly used as to fight pain during debridement procedures. The aim of the study was to evaluate the efficacy of lidocaine 4% in pain control during debridement procedure of DU in SSc. One hundred eight DU characterized by pain Numeric Rating Scale (NRS) >3/10 before starting the procedure were treated with lidocaine 4% (lidocaine cloridrate 200mg in 5ml of injecting solution). Pain was measured with NRS (0-10) before starting debridement, after 15min of lidocaine application and at the end of the procedure. In DU, in respect to baseline (mean NRS 6.74±2.96), pain after application of lidocaine 4% for 15min was significantly lower (mean NRS 2.83±2.73) (p<0.001). At the end of the procedure, pain control was still maintained and significantly lower (mean NRS 2.88±2.65) in respect to baseline (p<0.001). No systemic adverse event due to topical lidocaine were observed. In SSc, topical application of lidocaine 4% significantly reduces pain, allowing a safe debridement procedure, thus improving the management of DU.

Abstract: Intermittent Irrigation of the Microvascular Anastomosis Site During the Critical First 72 Hours

INTRODUCTION: Although up to 99 percent of free tissue transfers are eventually successful, the rate of reexploration necessary to achieve this is still high despite advances in technique and monitoring.1 We explore the benefits of intermittent postoperative irrigation of the microvascular anastomosis site with lidocaine. PURPOSE: To share our experience with a simple, safe and effective technique that can be easily adopted at minimal cost. RATIONALE: Blood, vascular manipulation, stretching, hypothermia, vasopressors, increased catecholamine states are some of the local and systemic factors that can lead to vasospasm of both artery and vein. While up to 94 percent of plastic surgeons use an intraoperative vasodilator to counteract this, little has been reported on postoperative use of vasodilators.2,3,4 The vasospasm-inducing noxious stimuli may persist in this period and lead to a cascade of events culminating in flap compromise. Studies have shown that the first 72 hours are the critical period during which overwhelming majority of compromised flaps are recognized.5 TECHNIQUE: The cut end of an intravenous catheter tube is placed in close proximity to the anastomosis avoiding direct contact. The other end of the tube is brought out through the wound edge, fixed to the skin with non-absorbable suture and connected to a 10-milliliter syringe filled with one percent lidocaine. The nurse infuses slowly one milliliter every hour amounting to a total of 240 mg of lidocaine per day. The catheter is removed after 72 hours. RESULTS: The senior author has used this technique in 3698 cases (50 percent of which involved lower extremity reconstruction) over the past 25 years. The 6.6 percent rate of re-exploration corroborates with published literature. None of the cases requiring reexploration demonstrated any evidence of vasospasm. Decreased pain and opioid requirements was an expected favorable outcome. However, an unexpected benefit noted early in the series was the cleansing effect of the gentle irrigation, removing small collections of blood, exudate or saliva from the vicinity of the anastomosis site. No inadvertent disruption of the anastomosis, increased bleeding or systemic sign of lidocaine toxicity was identified. CONCLUSION: A simple intraoperative measure can not only minimize the risk of a potentially disastrous vasospasm, but also provide the additional benefits of better pain control and clean microvascular anastomosis site. DISCLOSURE/FINANCIAL SUPPORT:None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. REFERENCES: 1. Bui DT, Cordeiro PG, Hu QY, Disa JJ, Pusic A, Mehrara BJ. Free flap reexploration: indications, treatment, and outcomes in 1193 free flaps. Plast Reconstr Surg. 2007;119:2092–100. 2. Yu JT, Patel AJ, Malata CM. The use of topical vasodilators in microvascular surgery. J Plast Reconstr Aesthet Surg. 2011;64:226–8. 3. Yokoyama T, Tosa Y, Kadomatsu K, Sato K, Hosaka Y. A novel approach for preventing the development of persistent vasospasms after microsurgery for the extremities: intermittent topical lidocaine application. J Reconstr Microsurg. 2010;26:79–85. 4. Gu YD, Yuan W, Gong XY.Value of irrigation with a lidocaine solution in tissue transplantation. Zhonghua Wai Ke Za Zhi. 1987;25:215–7, 253. Chinese. 5. Chen KT, Mardini S, Chuang DC, Lin CH, Cheng MH, Lin YT, Huang WC, Tsao CK, Wei FC. Timing of presentation of the first signs of vascular compromise dictates the salvage outcome of free flap transfers. Plast Reconstr Surg. 2007;120:187–95.

The effect of topical lidocaine on muscle artefacts in awake canine electroencephalogram recordings

Muscle artefacts in electroencephalogram recording data interfere with diagnostic accuracy. Lidocaine may reduce these artefacts. The objective of this study was to determine the effect of topical lidocaine on muscle artefacts in unanesthetized canine electroencephalogram (EEG) recording data. Topical 4% lidocaine was applied to each electrode site for six treated dogs prior to subdermal wire electrode placement and compared against historical untreated controls. Twenty-minute recordings began 30 min after lidocaine application. Three epochs (early, middle, and end) were sampled from each recording and scored for muscle artefact incidence and severity by two blinded reviewers. No significant treatment effects on incidence and severity were found. Application of topical lidocaine does not appear to reduce the occurrence of muscle artefacts in canine EEG recordings.