Intravenous Administration Of Lidocaine Research Articles

Effect of intravenous lidocaine on the ED50 of propofol induction dose in elderly patients undergoing painless gastroscopy: a prospective, randomized, double-blinded, controlled study

BackgroundIntravenous lidocaine could be a potential alternative adjuvant to propofol-based sedation for gastroscopy in elderly patients. This study aimed to evaluate the effect of intravenous lidocaine on the median effective dose (ED50) of propofol induction dose in elderly patients undergoing painless gastroscopy.MethodsThe study included 70 patients aged ≥ 60 years undergoing painless gastroscopy with 64 randomly assigned to either group L (2% lidocaine 1.5 mg/kg, n = 31) or group N (equal volume normal saline, n = 33). All patients received propofol induction following 0.1 μg/kg intravenous sufentanil. The Dixon “up-and-down” sequential method was used, with a 1.5 mg/kg initial induction dose of propofol followed by a 0.1 mg/kg sequential variable dose. The primary endpoint was the ED50 of the propofol induction dose. The total propofol dose, recovery time, adverse events, and local anesthetic intoxication reactions were also recorded.ResultsThe ED50 of propofol induction dose was 0.670 (95% confidence interval [CI] 0.216–0.827) mg/kg in group L and 1.118 (95% CI 0.803–1.232) mg/kg in group N. There was a statistically significant difference between the two groups (p < 0.001). The incidence of hypotension and propofol injection pain were lower in group L than in group N (p < 0.05). Furthermore, the orientation recovery time in group L was shorter compared to group N (p < 0.05). None of the participants in group L observed local anesthetic intoxication reactions after receiving lidocaine.ConclusionsThe administration of intravenous lidocaine to elderly patients undergoing painless gastroscopy resulted in a significant 40% reduction in the ED50 of propofol induction dose, which may be related to the decreased incidence of hypotension and injection pain, as well as the improved post-gastroscopy orientation recovery.Trial registrationChiCTR, ChiCTR2200065530. Registered on 08 November 2022.

Perioperative intravenous lidocaine in thoracoscopic surgery for improved postoperative pain control: a randomized, placebo-controlled, double-blind, superiority trial.

Pain, including associated pain management, remains a burden on patients after thoracic surgery. Our objective was to investigate whether perioperative intravenous administration of lidocaine reduces postoperative morphine consumption and pain intensity after video-assisted thoracoscopic surgery (VATS). In this double-blind, placebo-controlled superiority trial, patients undergoing VATS with a planned duration of ≤90 minutes were randomized within an intention-to-treat setting. Patients received either intravenous lidocaine or placebo as a bolus of 1.5 mg/kg 30 minutes before incision, followed by a continuous infusion of 3.0 mg/kg/hour until 2 hours after skin closure. Pain and morphine consumption were evaluated when resting and when coughing 1, 2, 4, 8, 16, 24, and 48 hours after skin closure and in a follow-up 14, 90, and 180 days postoperatively. Twenty-eight patients were included in the lidocaine group, 24 in the placebo group. Patients' characteristics and preoperative pain scores were similar in both groups. When coughing, patients of the lidocaine group had less pain within 24 hours after skin closure than the placebo group (4.60±1.64 vs. 5.52±1.65; P=0.02). Morphine consumption was not statistically significantly lower in lidocaine group (18.22±12.87 vs. 21.26±9.39 mg; P=0.26). There were no significant differences between groups in secondary outcomes. Our results suggest that perioperative intravenous lidocaine administration reduces pain scores after VATS. The beneficial clinical effects are limited. Nevertheless, intravenous lidocaine may be helpful as part of a multimodal analgesia protocol or with patients in whom the use of other analgesics is contraindicated. ClinicalTrials.gov NCT03677817.

Ефективність і безпечність безперервного внутрішньовенного введення лідокаїну як компонента інтраопераційного знеболювання та післяопераційної інтенсивної терапії при обширних резекціях печінки

Purpose - to improve the effectiveness and determine the safety of intraoperative analgesia and postoperative intensive care for extensive liver resections with intravenous lidocaine compared with traditional analgesia and the use of epidural anesthesia. Materials and methods. 108 patients of 18 years of age and older who underwent extensive liver resection were examined and analyzed. The studied patients were stratified into three groups, depending on the choice of intra- and postoperative analgesia: the Group I (22 patients) - intravenous lidocaine administration + traditional intra- and postoperative analgesia, the Group II (73 patients) - epidural anesthesia (EDA) in the thoracic spine + traditional intra - and postoperative analgesia, the Group III (13 patients) - control, which used only traditional intra- and postoperative analgesia. Probability of differences was assessed using Student’s t-test, non-parametric Mann-Whitney U-test, Pearson’s χ2 test. Results. The blood lidocaine concentration in 2 hours after surgery was higher in the Group II (2.37±1.08 μg/ml) compared to the Group I (1.84±1.16 μg/ml). The values for 14 hours after the intervention did not differ (2.62±2.56 μg/ml - in the Group I, 2.85±1.25 μg/ml - in the Group II). In some cases, the local anesthetic content exceeded the toxic level without corresponding clinical symptoms. Intravenous lidocaine administration led to a decrease pain intensity within 4 days after surgery by almost 1.5 times, epidural administration - by 1.5-2 times compared to the standard analgesia, and was also accompanied by a lengthening of the time interval until the first injection of narcotic analgesics from 86.968.2 min to 394.3666.5 and 553.252.8.5 min, respectively. Changing the route of local anesthetic administration from epidural to intravenous led to decrease intraoperative volume of infusion therapy from 9.4±2.5 ml/kg/h to 7.4±1.3 ml/kg/h, as well as to reduction of the norepinephrine dose to eliminate hypotension by 1.3 times. Lidocaine administration attenuated the intensity of the systemic inflammatory response syndrome, which was manifested by a reduction in the concentration of IL-1, IL-4, IL-10 compared to multicomponent analgesia without a statistical difference with the epidural route of lidocaine administration. Conclusions. The use of lidocaine as an adjuvant in traditional intra- and postoperative analgesia for extensive liver resection reduces pain intensity and the degree of systemic inflammatory response syndrome. Changing the method of using lidocaine from epidural to intravenous leads to more stable intraoperative blood circulation, reduction the volume of infusion therapy and the need for sympathomimetic support without increasing blood concentration, and in the proposed method is an attractive alternative to epidural analgesia. The research was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the patients was obtained for the research. No conflict of interests was declared by the authors.

Examination of the Rate and Extent of Drug Released from Commercial Topical Delivery Systems During Wear: An Example with Lidocaine Topical Systems.

This study aimed to determine the extent and rate of lidocaine released in vivo from two bioequivalent topical delivery systems (TDS) by using complementary assessments: pharmacokinetic analysis in healthy human volunteers, and residual lidocaine in TDS following 12h of wear. The goal was to explore a potentially more clinically meaningful strength presentation than percent active pharmaceutical ingredient loaded in topical systems. A three-arm, open-label, crossover clinical study was conducted in 23 human subjects, with 5% lidocaine topical systems from two manufacturers, and intravenous lidocaine administration. Residual drug and LC-MS/MS analyses were performed on worn TDS and serum samples. The rate and extent of drug released from the TDS during wear were determined through (1) calculations of consumed lidocaine via analysis of residual drug in worn TDS, and (2) a pharmacokinetic approach via derivation of the absolute clearance and serum lidocaine concentration at steady state. Overall the pharmacokinetic approach underestimated the amount transferred to the subject and exhibited greater variability, which may relate to natural inter-subject variability in pharmacokinetic parameters. Further, lidocaine TDS are intended for localized, not systemic, delivery and this may also explain some of the variability seen in the systemic serum concentrations. The residual drug and pharmacokinetic approaches align well for transdermal formulations, but the differences in administration route (topical versus transdermal) all but eliminates the potential use of the pharmacokinetic approach unless additional compartmental modeling is explored.

The effect of intravenous lidocaine on postoperative cognitive dysfunction: a systematic review and meta-analysis

BackgroundPostoperative cognitive dysfunction (POCD) has been reported as a significant complication in elderly patients. Various methods have been proposed for reducing the incidence and severity of POCD. Intravenous lidocaine administration has been reported in the literature to reduce POCD, but the effect of lidocaine remains controversial.MethodsWe screened Medline, Embase, Cochrane Library, and China National Knowledge Infrastructure (up to April 2022) databases following a search strategy for intravenous lidocaine on POCD. We also screened related bibliographies on lidocaine for POCD. Ten articles comprising 1517 patients were selected and analyzed. We divided the postoperative follow-up period as follows: short term (<30 days), medium term (30–90 days), and long term (>90 days).OutcomesWe found that lidocaine could attenuate the overall incidence of POCD, especially in the short term. There were no differences between lidocaine and placebo on the overall severity of POCD.ConclusionLidocaine administered intravenously could attenuate the overall incidence of POCD and its severity in the short term.

A protocol for a pilot study to assess the feasibility of a randomised clinical trial of perioperative intravenous lidocaine on colorectal cancer outcome after surgery (FLICOR trial)

BackgroundCancer recurrence after curative cancer surgery significantly impacts patients and healthcare services. Before surgery, a small number of clinically undetectable circulating tumour cells are often present. The surgical stress response promotes the distribution and proliferation of circulating tumour cells leading to cancer recurrence and metastasis. Preclinical evidence suggests that lidocaine may exert ‘anti-cancer’ effects and alleviate pro-metastatic environments. The Feasibility Study of Lidocaine Infusion During Bowel Cancer Surgery for Cancer Outcome (FLICOR) will assess the feasibility of conducting a clinical trial on perioperative intravenous lidocaine infusion for postoperative colorectal cancer outcomes. MethodsThe study is a double-blinded, randomised, controlled pilot study for a full trial comparing intravenous lidocaine administration at 1.5 mg kg−1 bolus followed by 1.5 mg kg−1 h−1 infusion for 24 h with placebo in patients undergoing minimally invasive (laparoscopy or robotic) colorectal cancer surgery. The feasibility of data collection instruments will be measured, including those for future economic evaluation and clinical and patient-reported outcomes. For the exploratory outcomes, blood samples will be collected before and after surgery on days 0, 1, and 3. Recruitment is planned for two NHS Trusts over 6 months with a 12-month follow-up. Patients and clinicians will be asked for their feedback on the study process. Dissemination planStudy data will be disseminated to trial participants, the public, and academic communities. The work will be presented at national and international conferences to stimulate interest and enthusiasm for centres to participate in the future definitive trial. This research will also be published in peer-reviewed open-access journals. Clinical trial registrationISRCTN29594895 (ISRCTN), NCT05250791 (ClinicalTrials.gov). Protocol version number and date3.0, February 8, 2023.

Appropriate Duration of Perioperative Intravenous Administration of Lidocaine to Provide Satisfactory Analgesia for Adult Patients Undergoing Colorectal Surgery: A Meta-Analysis of Randomized Controlled Trials.

Perioperative lidocaine infusion has been reported to alleviate pain intensity after colorectal surgery. However, there is no consensus on whether prolonged lidocaine infusion is more effective than short lidocaine infusion. This meta-analysis aimed to determine an appropriate duration of lidocaine infusion in patients undergoing colorectal surgery. We searched the PubMed, EMBASE, Web of Science, and Cochrane Library databases to identify articles published before December 17, 2021. Randomized controlled trials comparing intravenous lidocaine with placebo for pain relief in patients undergoing colorectal surgery were included. The primary outcome was pain scores (visual analog scale [VAS], 0-10 cm) at 24 hours postoperatively at rest and on movement. Secondary outcomes included pain scores at 12, 48, and 72 hours postoperatively, analgesic consumption (mg), gastrointestinal function return (hour), length of hospital stay (days), and incidence of complications. According to the duration of lidocaine infusion, studies were grouped into infusion for at least 24 hours (prolonged lidocaine infusion) and less than 24 hours (short lidocaine infusion) to assess the impact of lidocaine infusion duration on the outcomes of interests. Quantitative analyses were performed using a random effects model. Eleven studies with 548 patients were included. Five studies used prolonged lidocaine infusion, while 6 studies used short lidocaine infusion. Prolonged lidocaine infusion reduced postoperative pain scores versus placebo at 24 hours at rest (mean difference [MD], -0.91 cm; 95% confidence interval [CI], -1.54 to -0.28; P = .02) and on movement (MD, -1.69 cm; 95% CI, -2.15 to -1.22; P < .001), while short lidocaine infusion showed no benefit. Compared with placebo, prolonged lidocaine infusion reduced pain scores at 12 hours at rest and at 12 and 48 hours on movement, but short lidocaine infusion did not. However, there was no significant difference in pain scores between the prolonged and short lidocaine infusion groups at these time points. Compared with placebo, prolonged lidocaine infusion shortened the length of hospital stay (MD, -1.30 days; 95% CI, -1.72 to -0.88; P < .001) and time to first postoperative defecation (MD, -12.51 hours; 95% CI, -22.67 to -2.34; P = .02). There were no differences between groups regarding the other outcomes. The analgesic effect of intravenous lidocaine may depend on the duration of infusion, and our results suggest that lidocaine infusion should be administered for at least 24 hours after colorectal surgery. Since overall evidence quality was low, further high-quality, large-sample trials are needed to explore an optimal lidocaine infusion strategy in patients undergoing colorectal surgery.

The concentration of lidocaine in the blood after intravenous and epidural administration with extensive hepatic resections

The aim of the work: to identify the concentration of lidocaine in patients’ blood during an extensive hepatic resection, with its intravenous and epidural administration in dynamics for intra- and postoperative analgesia, to evaluate its analgesic effect and toxicity potential. Materials and methods. The study included 27 patients, who underwent hepatic resection with preservation of 30–60 % of the parenchyma. For all patients, multicomponent intraoperative anesthesia was used. Depending on the adjuvant, patients were divided into two groups: the main group (group 1) consisted of 7 patients who received intravenous (IV) administration of lidocaine, and a comparison group of 20 patients (group 2) whose complex anesthesia was supplemented with thoracic epidural anesthesia (EDA). To solve the tasks was to develop and validate a rapid, sensitive and robust method for the detection and quantification of lidocaine in human plasma using purification by coagulation and ultracentrifugation with cooling followed Liquid chromatography with Orbitrap HRMS method. The method showed a dynamic linear range of 0.1 to 1000 ng/mL with a linearity expressed by the regression coefficient (R2) and a value of 0.9947. The quantitation limit (LOQ) was found to be 1 ng/mL and the detection limit (LOD) 0.3 ng/mL. Recovery accuracy and repeatability were satisfactory. Finally, the method was applied to 54 real human plasma. Results and Discussion. 2 hours after the surgery, there was a tendency (P = 0.29) for a higher concentration of lidocaine in the blood by 28.8 % after epidural administration of lidocaine compared with intravenous administration (1.84 μg/ml in group 1, 2.37 µg/ml – in group 2, p = 0.29), with no fundamental difference 14 hours after surgery (2.62 µg/ml and 2.85 µg/ml, p = 0.76). Epidural administration of the drug was also accompanied by a tendency to increase the frequency of hemodynamic disorders, which was reflected in an increase in the dose of norepinephrine, which was intended to correct blood circulation parameters, by 1.3 times (total dose in group 1 (158.4±58.1) ng, group 2 – (206.9±76.4) ng, p = 0.14). No life-threatening toxic reactions were noticed in any of the cases. The use of lidocaine as an adjuvant for intra- and postoperative analgesia by intravenous and epidural administration with extensive hepatic resections, in most cases, does not lead to an increase of the drug compound in the blood higher than the generally accepted toxic content is. The content of the drug in the blood can be exceeded with epidural administration compared with intravenous administration. The analgesic effect of intravenous lidocaine is not lower than the epidural and may even last longer until the first administration of a narcotic analgesic after surgery for pain relief. However, epidural block is accompanied by intraoperative hemodynamic instability and an increase in the total dose of norepinephrine to correct blood circulation parameters.

A Peculiar Wide Complex Tachycardia During Flecainide Treatment.

A Peculiar Wide Complex Tachycardia During Flecainide Treatment.

Does intravenous lidocaine added to nonsteroidal anti-inflammatory drugs reduce pain during colposcopy? A prospective randomized double-blind study.

In recent years, lidocaine infusion for pain management during long operations is becoming more widespread in anesthesiology practice. However, only a limited number of studies have reported the intravenous use of lidocaine for short-term interventions. The aim of this study was to investigate the effectiveness of intravenous lidocaine use in pain management during colposcopic cervical biopsy and endocervical curettage (ECC). Patients between the ages of 18 and 65 years with abnormal cytological findings or who were determined to be human papillomavirus (HPV)-positive were included in this randomized double-blind study. The lidocaine group (Group L, n = 30) was intravenously administered 50 mg dexketoprofen + 1.5 mg/kg lidocaine in 10 mL saline for 3 min 30 min before the procedure. The control group (Group C, n = 30) was intravenously administered 50 mg dexketoprofen in 10 mL saline for 3 min, 30 min before the procedure. During the procedure, pain scores were assessed using the visual analogue scale (VAS). In addition, patients, operator satisfaction and duration of procedure were assessed. There were no differences in the demographic data of the groups. Pain scores during biopsy and ECC were significantly lower in Group L than in Group C (p < 0.001). The duration of the procedure was significantly shorter in Group L than in Group C (5.00 ± 0.78 vs 6.12 ± 1.16, respectively; p < 0.001). Patient and operator satisfaction were significantly higher in Group L than in Group C (p < 0.001). Intravenous lidocaine administration can be used as an alternative approach to reduce pain and increase operator and patient satisfaction during colposcopy-directed biopsy and ECC procedures in office settings.

Beyond the Raskin Protocol: Ketamine, Lidocaine, and Other Therapies for Refractory ChronicMigraine.

Purpose of ReviewThe purpose of this review is to discuss the available evidence and therapeutic considerations for intravenous drug therapy for refractory chronic migraine.Recent FindingsIn carefully monitored settings, the inpatient administration of intravenous lidocaine and ketamine can be successful in treating refractory chronic migraine.SummaryMany patients with refractory chronic migraine have experienced treatment failure with the Raskin protocol. The use of aggressive inpatient infusion therapy consisting of intravenous lidocaine or ketamine, along with other adjunctive medications, has become increasingly common for these patients when all other treatments have failed. There is a clear need for prospective studies in this population comprised of patients who have largely been excluded from other studies.

Perioperative Intravenous Lidocaine Infusion for Postoperative Analgesia in Patients Undergoing Surgery of the Spine: Systematic Review and Meta-Analysis.

We conducted a systematic review and meta-analysis to examine the impact of perioperative intravenous lidocaine infusion on pain management scores, opioid consumption, adverse events, and hospital length of stay in patients undergoing spinal surgery. We included randomized controlled trials evaluating the use of perioperative intravenous lidocaine in adult and pediatric patients undergoing spinal surgery. Primary outcomes were postoperative pain scores at rest and at 2, 4-6, 24, and 48 hours and adverse events attributable to lidocaine administration. We searched electronic databases from their inception to the present. We used Cochrane's standard methods. We used a random-effects model to synthetize data. We conducted three subgroup analyses: patients undergoing major surgery vs patients undergoing minor surgery, patients with chronic pain conditions vs patients without, and adult vs pediatric patients. A total of eight studies were included that compared patients having intravenous lidocaine (n = 349) with controls (n = 343). Intravenous lidocaine administration was associated with significantly reduced visual analog pain scores at 2 hours (mean difference [MD] = -1.13), 4-6 hours (MD = -0.79), and 24 hours (MD = -0.50) postoperatively. In the adults, efficacy of treatment was extended to 48 hours (MD = -0.72). Perioperative intravenous lidocaine administration was associated with reduced perioperative opioid consumption at 24 and 48 hours, as well as decreased hospital length of stay. Perioperative intravenous lidocaine infusion consistently improves analgesic measures in adult and pediatric populations in the first 24 hours, with an effective decrease in opioid consumption noted to 48 hours. These results are most generalizable in the adult population in the first 4-6 to 24 postoperative hours.

Effect of Intravenous Lidocaine on Inflammatory and Apoptotic Response of Ischemia-Reperfusion Injury in Pigs Undergoing Lung Resection Surgery.

Background Ischemia-reperfusion injury is one of the most critical phenomena in lung transplantation and causes primary graft failure. Its pathophysiology remains incompletely understood, although the inflammatory response and apoptosis play key roles. Lidocaine has anti-inflammatory properties. The aim of this research is to evaluate the effect of intravenous lidocaine on the inflammatory and apoptotic responses in lung ischemia-reperfusion injury. Methods We studied the histological and immunohistochemical changes in an experimental model of lung transplantation in pigs. Twelve pigs underwent left pneumonectomy, cranial lobectomy, caudal lobe reimplantation, and 60 minutes of graft reperfusion. Six of the pigs made up the control group, while six other pigs received 1.5 mg/kg of intravenous lidocaine after induction and a 1.5 mg/kg/h intravenous lidocaine infusion during surgery. In addition, six more pigs underwent simulated surgery. Lung biopsies were collected from the left caudal lobe 60 minutes after reperfusion. We conducted a double study on these biopsies and assessed the degree of inflammation, predominant cell type (monocyte-macrophage, lymphocytes, or polymorphous), the degree of congestion, and tissue edema by hematoxylin and eosin stain. We also conducted an immunohistochemical analysis with antibodies against CD68 antigens, monocyte chemoattractant protein-1 (MCP-1), Bcl-2, and caspase-9. Results The lungs subjected to ischemia-reperfusion injury exhibited a higher degree of inflammatory infiltration. The predominant cell type was monocyte-macrophage cells. Both findings were mitigated by intravenous lidocaine administration. Immunohistochemical detection of anti-CD68 and anti-MCP-1 showed higher infiltration in the lungs subjected to ischemia-reperfusion injury, while intravenous lidocaine decreased the expression. Ischemia-reperfusion induced apoptotic changes and decreased Bcl-2 expression. The group treated with lidocaine showed an increased number of Bcl-2-positive cells. No differences were observed in caspase-9 expression. Conclusions In our animal model, intravenous lidocaine was associated with an attenuation of the histological markers of lung damage in the early stages of reperfusion.

Efficacy of Intravenous Use of Lidocaine in Postoperative Pain Management After Laparoscopic Colorectal Surgery: A Meta-analysis and Meta-regression of RCTs.

Current literature reports regarding the effect of lidocaine in laparoscopic colectomies are still inconclusive. The purpose of this study was to review the current literature and estimate the overall effect of intravenous lidocaine administration in postoperative recovery of patients submitted to laparoscopic colectomies. This study was completed based on the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. A systematic screening using scholar databases was performed (Medline, Scopus, Web of Science, CENTRAL). In total, 8 studies and 407 patients were included in this meta-analysis. Introduction of intravenous lidocaine in the perioperative analgesia scheme did not improve hospitalization duration (p=0.23), morphine consumption (p=0.96), perioperative bowel function (first flatus p=0.40, first bowel opened p=0.13, first diet p=0.16), or the overall complication rates (p=0.42). Overall, high heterogeneity levels were identified. Current evidence indicates that lidocaine does not improve rehabilitation after laparoscopic colectomies.

Effect of intravenous administration of lidocaine on the ED50 of propofol induction dose during gastroscopy in adult patients: A randomized, controlled study.

Propofol provides a prominent sedation effect in gastroscopy. However, sedation with propofol alone during gastroscopy might result in circulatory and respiratory depression. This study aimed to test the hypothesis that the addition of intravenous lidocaine to propofol-based sedation could decrease the ED50 of propofol induction dose during gastroscopy in adult patients while the respiratory and haemodynamic stability were not compromised. Patients undergoing gastroscopy were randomly enrolled into lidocaine+propofol (L+P) group or normal saline+propofol (NS+P) group. Subjects were initially administered intravenous bolus of 1.5mg/kg lidocaine in L+P group or equivalent volume of 0.9% saline in NS+P group. Anaesthesia was then induced with a single bolus of 1.0μg sufentanil followed by injection of propofol in all patients. The induction dose of propofol for each individual patient was determined by the protocol of Dixon "up-and-down" method for both groups. The primary end point was the ED50 of propofol induction dose. Totally, 48 patients were enrolled and completed this study. Compared with the NS+P group, the ED50 of propofol induction dose was significantly reduced in the L+P group (2.01mg/kg vs. 1.69mg/kg) (U=61.5, p<0.001). The addition of intravenous lidocaine significantly reduced the ED50 of propofol induction dose during gastroscopy in adult patients. The present clinical trial was registered at http://www.chictr.org.cn/ (registration No. ChiCTR1900024025, 23 June 2019).

Pre-procedure intravenous lidocaine administration on propofol consumption for endoscopic retrograde cholangiopancreatography: A prospective, randomized, double-blind study.

The endoscopic retrograde cholangiopancreatography (ERCP) procedure is generally performed in patients with high comorbidity. We aimed to reduce the consumption of propofol by adding lidocaine before ERCP. Eighty ERCP patients with ASA I-III, aged between 45-75years, were randomly divided into two groups. Lidocaine group (group L, n=40), received 1-mg midazolam, 1.5mg/kg lidocaine, and 1mg/kg propofol intravenously. The control group (group C, n=40) received 1-mg midazolam, saline in the same volume as the lidocaine group, and 1mg/kg propofol intravenously. Propofol was administered with intermittent bolus doses. Propofol consumption, oropharyngeal reflex, recovery time, endoscopist satisfaction, ketamine need, and side-effects were recorded. Propofol consumption during the procedure was statistically lower in group L than in the control group (157.25±39.16mg vs 228.75±64.62mg respectively, P<0.001). Additionally, recovery time was statistically faster in group L compared with the control group (7.78±3.95min vs 11.92±3.24min respectively, P<0.001). The oropharyngeal reflex was less in group L than control group (6/40 vs 15/40 respectively, P=0.042). There was no significant difference between the two groups regarding visual analogue scale scores and endoscopist satisfaction (P>0.05). We recommend the use of intravenous lidocaine before the ERCP procedure as it reduces propofol consumption, recovery times, and oropharyngeal reflex.

Preventing pain after breast surgery: A systematic review with meta-analyses and trial-sequential analyses.

The aim of this systematic review was to indirectly compare the efficacy of any intervention, administered perioperatively, on acute and persistent pain after breast surgery. We searched for randomized trials comparing analgesic interventions with placebo or no treatment in patients undergoing breast surgery under general anaesthesia. Primary outcome was intensity of acute pain (up to 6hr postoperatively). Secondary outcomes were cumulative 24-hr morphine consumption, incidence of postoperative nausea and vomiting (PONV), and chronic pain. We used an original three-step approach. First, meta-analyses were performed when data from at least three trials could be combined; secondly, trial sequential analyses were used to separate conclusive from unclear evidence. And thirdly, the quality of evidence was rated with GRADE. Seventy-three trials (5,512 patients) tested loco-regional blocks (paravertebral, pectoralis), local anaesthetic infiltrations, oral gabapentinoids or intravenous administration of glucocorticoids, lidocaine, N-methyl-D-aspartate antagonists or alpha2 agonists. With paravertebral blocks, pectoralis blocks and glucocorticoids, there was conclusive evidence of a clinically relevant reduction in acute pain (visual analogue scale>1.0cm). With pectoralis blocks, and gabapentinoids, there was conclusive evidence of a reduction in the cumulative 24-hr morphine consumption (> 30%). With paravertebral blocks and glucocorticoids, there was conclusive evidence of a relative reduction in the incidence of PONV of 70%. For chronic pain, insufficient data were available. Mainly with loco-regional blocks, there is conclusive evidence of a reduction in acute pain intensity, morphine consumption and PONV incidence after breast surgery. For rational decision making, data on chronic pain are needed. This quantitative systematic review compares eight interventions, published across 73 trials, to prevent pain after breast surgery, and grades their degree of efficacy. The most efficient interventions are paravertebral blocks, pectoralis blocks and glucocorticoids, with moderate to low evidence for the blocks. Intravenous lidocaine and alpha2 agonists are efficacious to a lesser extent, but with a higher level of evidence. Data for chronic pain are lacking.

Safe anesthesia, analgesic and sedation in the surgery of head and neck tumors

Highly traumatic surgical interventions for head and neck tumors were performed in 62 adult patients under conditions of multimodal opioid-free general anesthesia, which included dexmedetomidine, lidocaine, nefopam, and sevoflurane. In 18 cases, due to trismus II – IV degree, fibro optic nasotracheal intubation was used, in 10 patients with laryngeal stenosis, the operation was started with tracheotomy under local anesthesia. In all 28 cases, local anesthesia was supplemented by sedation with intravenous (IV) administration of dexmedetomidine and lidocaine, which was enhanced by the addition of sub-drug doses (10–20 mg) of ketamine. Consciousness and spontaneous breathing were preserved in all observations. Before intubation, propofol and rocuronium were added, and at the stage of the main operation, against the background of intravenous infusion of dexmedetomidine and lidocaine, inhalation of sevoflurane vapors (1–1.5 MAC). In 62 cases, the course of the operation and anesthesia was smooth, awakening and restoration of spontaneous breathing occurred after the end of the operation. Postoperative pain relief for the first two days was in the form of a continuous iv infusion of a 3-component mixture of 1% lidocaine and two non-opioid analgesics (nefopam and tenoxicam) using a disposable elastomeric pump. In the next 3-4 days, they switched to intramuscular administration of nefopam and tenoxicam. The quality of pain relief was high, without clinically significant complications. Only in three cases, at the beginning of mastering the technique, it was necessary to resort to an additional single injection of promedol or tramadol.

Complications associated with closure of the linea alba using a combination of interrupted vertical mattress and simple interrupted sutures in equine laparotomies

Objectives(1) Evaluate the occurrence and variables associated with incisional morbidities (IMs) after ventral median laparotomy when using interrupted vertical mattress sutures (IVMS) and (2) determine the occurrence of abdominal bandage-associated...

Intravenous lidocaine affects oxaliplatin pharmacokinetics in simultaneous infusion.

Oxaliplatin is a chemotherapeutic agent used to treat malignancies of the gastrointestinal tract. Neuropathy is a frequent dose-limiting side-effect of oxaliplatin therapy, without preventive or curative strategies. Concomitant administration of intravenous lidocaine could be a promising treatment. However, the effect of intravenous lidocaine on oxaliplatin pharmacokinetics was never studied before. We evaluated the effect of lidocaine on the area under the curve and Cmax of oxaliplatin as a part of a larger study addressing the prevention and treatment of oxaliplatin induced peripheral neuropathy with lidocaine. In this prospective cross-over trial, patients received an oxaliplatin cycle with and without lidocaine (bolus 1.5 mgkg-1 followed by 1.5 mgkg-1h-1 in 3 h). Levels of oxaliplatin, measured as ultrafiltrable platinum were determined at 10 min after cessation of oxaliplatin infusion and hourly thereafter. Outcomes are the difference in area under the curve of oxaliplatin (primary) and the difference in the Cmax of oxaliplatin (secondary). No difference in the %Δ area under the curve of oxaliplatin (-2.40 ± 7.66, 90% CI +10.50 to -15.31) was found. However, %Δ Cmax of oxaliplatin (-28.72 ± 6.01, 90% CI -18.59 to -38.85) was lower to a statistically significant extent in the chemotherapy cycle with lidocaine. No (serious) adverse events were reported. Lidocaine does not affect the area under the curve of oxaliplatin, which is the most important parameter in drug interaction studies and for oxaliplatin treatment effect. The lower Cmax in the chemotherapeutic cycle with lidocaine is significant and remarkable, but with an unknown exact mechanism or clinical significance, making further research desirable.