Intravenous Administration Of Lidocaine Research Articles

Degree of pain in intravenous injection of propofol with intravenous lidocaine administration; A Literature Review Study

Intravenous propofol injection is widely used for anesthesia induction and sedation, though it often causes discomfort and pain at the injection site, leading to patient anxiety. Lidocaine, a local anesthetic, has been studied for its ability to reduce this pain by inhibiting sodium channels, thereby decreasing neuronal excitability and pain transmission. Research indicates that intravenous lidocaine effectively reduces the occurrence and intensity of pain during propofol injection. This study aims to assess the effectiveness of intravenous lidocaine in minimizing pain related to propofol injection. A literature review was conducted, analyzing studies from 2018 to 2024 obtained from databases such as Google Scholar, PubMed, and ScienceDirect. Twelve articles meeting the selection criteria were reviewed. The findings consistently show that intravenous lidocaine significantly lowers the pain associated with propofol injection. Additionally, lidocaine use reduced the required propofol dosage and improved patient satisfaction. The studies suggest that administering intravenous lidocaine before or during propofol injection is a practical approach to reducing injection pain. Future research should focus on optimizing the parameters that enhance lidocaine's analgesic effects, ultimately improving patient comfort and satisfaction in procedures involving sedation.

The effect of perioperative intravenous lidocaine infusion on postoperative sleep of elderly patients with colorectal cancer: A randomized controlled study

BackgroundPostoperative sleep disturbance (POSD) caused by postoperative pain can impede the enhanced rapid recovery of elderly patients with colorectal cancer. We propose that perioperative intravenous lidocaine infusion may enhance postoperative sleep quality by alleviating postoperative pain in elderly patients undergoing laparoscopic radical resection for colorectal cancer. MethodsSixty-three elderly patients were divided into two groups: the lidocaine group (group L) and the placebo group (group C). Patients in group L received intravenous injection of lidocaine 1.5 mg/kg during the induction of anesthesia, followed by lidocaine 1.0 mg kg−1 h−1 during surgery and for 24 h after surgery. Patients in group C received the same volume of normal saline. The primary outcome was postoperative sleep function, which was evaluated using the Athens Insomnia Scale (AIS). The secondary outcomes included the pain-at-rest and pain-on-movement of patients at 2, 4, 6, 12, 24, 48, and 72 h after surgery, opioid and propofol consumption, bowel function recovery time, postoperative complications, and lidocaine side effects. ResultsCompared to group C, AIS scores in group L were significantly lower on day 1 (12.9 ± 4.0 vs 10.6 ± 3.9, P < 0.05), day 3 (8.6 ± 4.2 vs 6.2 ± 3.9, P < 0.05), and 1 week (4.3 ± 3.1 vs 2.2 ± 2.5, P < 0.05) after surgery. There were no significant differences in VAS scores between the two groups. The intraoperative consumption of propofol and remifentanil was significantly reduced in group L. Lidocaine infusion significantly shortened the recovery time of bowel function. There were no statistical differences between the two groups regarding the incidences of PONV and postoperative pulmonary complications. No cases of local anesthetic toxicity occurred in either group. ConclusionsPerioperative intravenous administration of lidocaine can facilitate the restoration of postoperative sleep function in elderly patients undergoing laparoscopic radical resection of colorectal cancer.

Intravenous lidocaine for postoperative analgesia management in paediatrics: A systematic review with meta-analysis of published studies.

The administration of intravenous lidocaine during the peri-operative period may improve pain management after paediatric surgery. To explore the decrease in postoperative pain intensity and opioid consumption associated with peri-operative lidocaine administration in the paediatric population. A systematic review with meta-analysis of randomised controlled trials and a Grading of Recommendations Assessment, Development and Evaluation (GRADE) analysis. Extensive literature review. This study includes clinical trials conducted during surgery that examined the effect of intravenous lidocaine compared with placebo on postoperative pain management. Lidocaine administration decreased pain intensity in PACU (standardised mean difference (SMD) = -1.89 [-3.75, -0.03], I2 = 97%, P of I2 < 0.001) and on postoperative day 1 (SMD = -2.02 [-3.37, -0.66], I2 = 96%, P of I2 < 0.001, number of studies = 5). Lidocaine was associated with a decrease in opioid consumption on postoperative day 1 (SMD = -1.2 [-2.19, -0.2], I2 = 93%, P of I2 < 0.001) but not on postoperative day 2 (SMD = -1.73 [-3.9, 0.44], I2 = 96%, P of I2 < 0.001). GRADE analyses resulted in low-quality results. Subgroup analyses revealed that pain intensity in PACU and opioid consumption on postoperative day 1 decreased when lidocaine was administered during both the intra-operative and postoperative periods. The use of lidocaine is associated with improved pain management. However, further studies are needed to increase the level of evidence and determine the optimal administration regimen for pain management.

Comparing intravenous lidocaine and pethidine for pain management in emergency department patients with femoral bone fracture: a randomized controlled trial

BackgroundIntravenous lidocaine has shown promise as an effective analgesic in various clinical settings, but its utility for pain management in emergency departments, especially for bone fractures, remains relatively understudied.ObjectiveThis study compared intravenous lidocaine to pethidine for femoral bone fracture pain management.MethodsThis double-blind, randomized, controlled clinical trial was conducted in the emergency department of AJA University of Medical Sciences affiliated hospitals. Patients aged 18–70 years-old with femoral bone fracture and experiencing severe pain, defined as a numerical rating scale (NRS) of pain ≥ 7, were included in the study. One group received intravenous pethidine (25 mg), while the other group received intravenous lidocaine (3 mg/kg, not exceeding 200 mg), infused with 250 ml saline over 20 min. Pain levels were evaluated before treatment administration (0 min) and at 10, 20, 30, 40, 50, and 60 min after treatment administration using the NRS.ResultsSeventy-two patients were enrolled in the study. Demographic characteristics and pain scores were similar between the two groups. The mean pain scores upon arrival for the lidocaine and pethidine groups were 8.50 ± 1 and 8.0 ± 1, respectively; after one hour, they were 4.0 ± 1 and 4.0 ± 1, respectively. While there was a statistically significant reduction in pain in both groups after one hour, there were no clinically or statistically significant differences between the two groups (p = 0.262). Pethidine had a higher incidence of adverse events, though not statistically significant. Additionally, females required more rescue analgesics.ConclusionThe administration of intravenous lidocaine is beneficial for managing pain in femoral bone fractures, suggesting that lidocaine could be a potent alternative to opioids.Trial RegistrationIRCT20231213060355N1 (https://irct.behdasht.gov.ir/trial/74624) (30/12/2023).

Perioperative intravenous lidocaine infusion improves postoperative analgesia after hysterectomy: A systematic review and meta-analysis of randomized controlled trials.

The effectiveness of intravenous lidocaine in reducing acute pain after hysterectomy remains uncertain. We conducted a meta-analysis of randomized controlled trials (RCTs) to investigate the impact of intravenous lidocaine on post-hysterectomy recovery. This study was completed based on the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. A systematic search was conducted in PubMed/MEDLINE, the Cochrane Controlled Trials Register (CENTRAL), and Embase up to July 27, 2023. We identified randomized controlled trials (RCTs) involving hysterectomy patients comparing lidocaine to a placebo. Outcome measures included postoperative pain scores at rest and during movement, opioid consumption, postoperative nausea and vomiting (PONV), improvements in functional gastrointestinal recovery, and Quality of Recovery (QoR) scores. Nine RCTs were included in the meta-analysis, comprising 352 patients who received intravenous lidocaine and 354 controls. The analysis revealed that intravenous lidocaine significantly reduced postoperative pain scores at rest at 2, 6, 8, and 24 hours following hysterectomy, as well as postoperative opioid consumption within 24 hours and PONV rates. Furthermore, no observed benefit was noted in shortening the time to first flatus with intravenous lidocaine administration post-hysterectomy. Intravenous lidocaine administration effectively reduces acute postoperative pain, opioid consumption, and PONV rates following hysterectomy. Lidocaine serves as an opioid-sparing agent, reducing the morphine equivalent dose while maintaining a similar degree of postoperative pain.

Electrical alternans

A 71-year-old woman presented with a two-month history of anorexia. Her medical history was notable for Mucosa-Associated Lymphoid Tissue lymphoma (MALToma) of the stomach and hemodialysis. Laboratory tests revealed electrolyte imbalances such as low levels of potassium, calcium, phosphorus, and magnesium. Gradual improvement was attempted to avoid refeeding syndrome, but ventricular fibrillation developed during routine hemodialysis and was immediately treated with electronic defibrillation. Later, a diagnosis of takotsubo cardiomyopathy and central pontine myelination was added. Follow-up electrocardiography showed a QTc interval of 633 ms and electrical alternans of the QRS complexes and T waves (Figure 1). Electrical alternans is a rare phenomenon and special attention should be paid when electrical alternans includes T-wave alternans, a finding indicative of severe electrical instability [1,2]. In our case, careful control of electrolytes and continuous administration of intravenous lidocaine prevented the recurrence of fatal arrhythmias, although nonsustained ventricular tachycardia was often seen on the monitor.

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.

Effect of lidocaine on salicylate-induced tinnitus in guinea pigs: A focus on the auditory cortex.

This study aimed to investigate the effects of the intravenous administration of lidocaine in the auditory cortex after the systemic administration of salicylate. Healthy male albino Hartley guinea pigs were divided into two groups. The control group received only lidocaine, whereas the experimental group received lidocaine after checking for the effects of salicylate. Extracellular recordings of spikes in the primary auditory cortex and dorsocaudal areas in healthy albino Hartley guinea pigs were continuously documented (pre- and post-lidocaine, pre- and post-salicylate, and post-salicylate after adding lidocaine to post-salicylate). We recorded 160 single units in the primary auditory cortex from five guinea pigs and 155 single units in the dorsocaudal area from another five guinea pigs to confirm the effects of lidocaine on untreated animals. No significant change was detected in either the threshold or Q10dB value after lidocaine administration in the primary auditory cortex and dorsocaudal areas. Spontaneous firing activity significantly decreased after lidocaine administration in the primary auditory cortex and dorsocaudal areas. Next, we recorded 160 single units in the primary auditory cortex from five guinea pigs and 137 single units in the dorsocaudal area from another five guinea pigs to determine the effects of lidocaine on salicylate-treated animals. The threshold was significantly elevated after salicylate administration; however, no additional change was detected after adding lidocaine to the primary auditory cortex and dorsocaudal areas. Regarding the Q10dB value, lidocaine negated the significant changes induced by salicylate in the primary auditory cortex and dorsocaudal areas. Moreover, lidocaine negated the significant changes in spontaneous firing activities induced by salicylate in the primary auditory cortex and dorsocaudal areas. In conclusion, changes in the Q10dB value and spontaneous firing activities induced by salicylate administration are abolished by lidocaine administration, suggesting that these changes are related to the presence of tinnitus.

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.