Lidocaine For Analgesia Research Articles

Short-term clinical effectiveness of 5% lidocaine patch after arthroscopic rotator cuff repair: study protocol for a randomized, double-blinded, placebo-controlled clinical trial

BackgroundArthroscopic rotator cuff repair (ARCR) often causes unbearable postoperative pain, even more severe than before surgery. Opioids are the drugs of choice for temporary postoperative analgesia. However, this conventional approach also has some side effects and potential for drug abuse. The aims of this study are expected to verify the effect of 5% lidocaine patch (LP5) on the intensity of early postoperative pain, functional recovery and quality of life in patients undergoing ARCR.MethodsIn this randomized, double-blind, and placebo-controlled clinical trial, a total of 102 postoperative patients undergoing ARCR will be randomly assigned to either the LP5 group, receiving topical lidocaine analgesia, or the placebo control group. The primary outcome measure will be the change in the American Shoulder Elbow Surgeons score from pre-operation to 90 days post-operation. Secondary outcomes will include pain scores, range of motion, opioid use, safety indicators, blinding assessment and several shoulder function score questionnaires. The effect of the allocated treatment will be assessed at preoperative baseline and at 7-, 14-, 30- and 90-day postoperatively.DiscussionIn this study, the efficacy and safety of the 5% lidocaine patch will be evaluated in terms of short-term clinical symptoms in patients undergoing ARCR. The results of this study will help determine whether LP5 is effective in early functional recovery in ARCR and whether it relieves pain and reduces opioid consumption.Trial registrationChinese Clinical Trial Registry (http://www.chictr.org.cn) ChiCTR2200060108. Registered on 19 May 2022.

Analgesic Effects, Birth Process, and Prognosis of Pregnant Women in Normal Labor by Epidural Analgesia Using Sufentanil in Combination with Ropivacaine: A Retrospective Cohort Study.

Objective The objective is to evaluate the analgesic, labor, and prognostic effects of patient-controlled epidural analgesia (PCEA) versus sufentanil in conjunction with ropivacaine in normal labor. Methods Sixty pregnant women who had a normal delivery at our hospital between February 2019 and April 2021 were included. Pregnant women were arbitrarily assigned to a control group and a research group. Pregnant women in the control group received lidocaine analgesia and PCEA with sufentanil combined with ropivacaine in the research group. Satisfaction with care, fetal umbilical artery blood flow, VAS score, labor and bleeding, neonatal Apgar score and incidence of adverse events were analyzed. Results First, we made a comparison of satisfactory performance of nursing care. The satisfaction rate of the research group was 100.00%, compared to 83.33% for the control group. Nursing satisfaction was higher in the research group, and the difference was statistically significant (P < 0.05). Following analgesia, PI, RI, and S/D values of umbilical artery blood flow were lower in the research group than those in the control group, but the difference was not statistically significant (P > 0.05). The VAS scores at 10 min, 20 min, and 30 min were found to be lower in the research group than in the control group after analgesia, and the difference was statistically significant (P < 0.05). Bleeding was significantly lower in the research group for all stages of labor, and the difference was statistically significant (P < 0.05). Apgar scores at 1 minute, 5 minutes, and 10 minutes postpartum were greater in the research group than in the control group, and the difference was statistically significant (P < 0.05). As a final note, the incidence of pruritus, hypotension, respiratory depression, nausea, and vomiting was found to be lower in the research group than in the control group, and the difference was statistically significant (P < 0.05). Conclusion PCEA with sufentanil coupled with ropivacaine was used to perform labor analgesia. With significant reduction in maternal pain and assurance of labor, ropivacaine combined with sufentanil epidural labor analgesia did not reduce fetal umbilical artery blood flow without extended labor. It could not affect the labor process or the safety of the fetus, which is safe for the mother and fetus.

Use of Lidocaine Analgesia Prior To Steroid Injection in Reducing Post-Traumatic Hypertrophic Scars

Background and Aim: Hypertrophic scars are painful and can develop after surgery or trauma, with symptoms varying from an intractable allodynia to minor itch. Extraneural and intraneutral structures could be involved in painful scars issue. The standard treatment for hypertrophic scars is intralesional steroid injections. The present study aimed to investigate the lidocaine analgesia for pain relief in post-traumatic hypertrophic scars. Place and Duration: Burn Centre Dr Ruth K.M. Pfao Civil Hospital, Karachi and the department of Plastics and Burn Surgery, Bolan Medical Complex Hospital, Quetta during the period from October 2020 to September 2021. Methodology: Thirty-five patients with post-traumatic hypertrophic scars were enrolled in this study. Steroids were injected through scars with or without Lidocaine (-10°C) applications for 15 seconds. Ethical approval was taken from the institutional ethical committee. In this experimental protocol, two arms were used. In the first arm, two scars on the same patient's body were randomly assigned as control or experimental scars. Patients were used as their own controls because everyone experiences pain differently. Scars were injected into patients once a month, and pain intensity scores were recorded after each injection. A visual analog score (VAS) was used for the evaluation of pain severity or degree in each individual. Results: Of the total 35 hypertrophic scars patients, about 23 (65.7%) and 12 (34.3%) were females and male respectively. The overall mean age was 32.67±5.83 years. All the hypertrophic scars patients with age ranges from 20 to 65 years were enrolled. Of the total lesions, the presence of hypertrophic scars on the arms, shoulder, back, and chest were 7 (20%), 3 (8.6%), 9 (25.7%), and 16 (45.7%) respectively. The visual analogue score for control and pretreated was 2.8±1.42 and 7.91±1.29 respectively. The VAS pain score was significantly associated (p&lt;0.1) with difference in VAS score of control and pretreated scars. Conclusion: The present study found that lidocaine analgesia provides significant pain relief in post-traumatic hypertrophic scars prior to steroid injection. It also provides a safe and effective way for enhancing the management of disease and patient compliance. Keywords: Hypertrophic scars, Lidocaine Analgesia, Pain relief, Steroid Injection.

Comparison of the Effect of Lidocaine in Combination to Meloxicam and/or Metamizole Sodium Epidurally on Analgesic Parameters, and Health Status of Holstein Cattle

Objective- This practice performed to compare the quality of analgesia, hematological parameters, and prevalence of cardiac dysrhythmias following epidural administration of lidocaine, lidocaine-meloxicam, and lidocaine-Metamizole sodium in cows. Animals- Fifteen adult Holstein cows aged between 3-5 years were assigned into three equal groups. Design- Each cow received the lidocaine (0.22 mg/kg), lidocaine-meloxicam (0.11 mg/kg – 0.25 mg/kg) or lidocaine-Metamizole sodium (0.11 mg/kg -4 mg/kg) randomly via epidural injection into first intercoccygeal space. Procedure- Analgesia onset and duration were recorded. Heart rate, respiratory rate, rectal temperature, and ruminal motility were also recorded at 0, 5, 15, 30, 45, 60, 90 and 120 minutes, Electrocardiograms at 0, 60 and 120 minutes and blood samples were collected through the caudal vein at 0, 30, 60, 90 and 120 minutes. Detection of arrhythmias was done by checking 60 seconds of each electrocardiogram.Results- analgesia onset in lidocaine-metamizole treatment was significantly longer than that of the other groups (p 0.05). Also, the duration of analgesia was significantly longer in lidocaine treatment compared to other experimental groups (p 0.05). Hematological parameters changes were not significantly different and all of the detected cardiac arrhythmias were physiologic among treatments (p > 0.05). Conclusions and Clinical Relevance- Aforementioned dosages could be used in cows without any clinical, cardiac, and hematological side effects. Lidocaine analgesia was reliable; however, the authors were not sure about adequate analgesia resulted after injection the half-dose of meloxicam and Metamizole in combination with lidocaine therefore, further studies should be done.

Pre-, Peri-, and Postoperative Intravenous Ropivacaine versus that of Lidocaine for Analgesia after Hand-Assisted Laparoscopic Surgery of Left Colon Cancer: A Retrospective Analysis

Purposes Pre-, peri-, and postoperative intravenous lidocaine are reported effective in the management of postoperative pain in laparoscopic colorectal surgery but until the time, that of ropivacaine is not tested for the same. The objectives of the study were to evaluate the effectiveness of pre-, peri-, and postoperative intravenous ropivacaine against that of lidocaine on the postoperative pain, bowel function recoveries, and hospital stays in patients who underwent surgery of left colon cancer. Materials and methods Data regarding total doses of fentanyl required, bowel function recoveries, surgical-related complications, and hospital stays of 367 patients who underwent hand-assisted laparoscopic surgery of left colon cancer were retrospectively collected and analyzed. Patients received pre-, peri-, and postoperative intravenous normal saline (NS cohort, n = 104), or that of lidocaine (LC cohort, n = 145), or that of ropivacaine (RC cohort, n = 118). Results Fewer dose of fentanyl was required in patients of RC cohort than those of NS (9 doses/patient vs. 11 doses/patient, p < .0001, q = 27.445) and LC (9 doses/patient vs. 10 doses/patient, p < .0001, q = 9.911) cohorts. Patients of the RC cohort had less time to first drink, first bowel movement, full diet, and hospital stay than those of NS and LC cohorts (p < .05 and q > 3.329 for all). Conclusions Pre-, peri-, and postoperative intravenous ropivacaine are safe and effective than that of normal saline or lidocaine in hand-assisted laparoscopic surgery of left colon cancer.

Effects of double-catheter epidural analgesia by lidocaine injection respectively on the delivery outcomes and maternal-infant complications for persistent posterior or lateral occipital position of protracted active phase

Objective: To evaluate the effect of dual-tube epidural segmental injection of lidocaine analgesia on the delivery outcome and maternal and infant complications of persistent posterior occipital position postpartum or lateral occipital position postpartum patients with protracted active phase. Methods: The full and single-term primiparas (n=216, 37 to 42 weeks gestation, 22 to 35 years) diagnosed as persistent posterior or lateral occipital position during the active period were selected from the Department of Obstetrics of Qingdao Municipal Hospital from January 2015 to October 2019. The subjects were randomly assigned into two groups: double-tube epidural block group (n=108) and single-tube epidural block group (n=108), 1% lidocaine was used for epidural analgesia respectively under ultrasound guidance. Senior midwife or obstetricians implement new partogram, and guide women to perform position management, and push or rotate the fetal head in a timely manner. Observation indicators: general condition, the use of non-pharmacological analgesic measures, analgesia related conditions and pain visual analogue scale (VAS) score, delivery-related indicator, cesarean section indication, anesthesia-related indicator, maternal and child complications. Results: (1) General condition: the age, weight, height, gestational age, the ratio of persistent lateral or posterior occipital position, cephalic score, and neonatal birth weight between the two groups of women were not statistically significant (all P>0.05). (2) The use of non-pharmacological analgesic measures: the women's Lamaze breathing method, Doula delivery companionship, percutaneous electrical stimulation, and other measures between two groups were compared, and there were not significant differences (all P>0.05). (3) Analgesia related conditions and VAS scores of women undergoing vaginal delivery: compared with the single-tube epidural block group (n=40), the second-partum time of the women in the double-tube epidural block group (n=59) was significantly shortened [(124±44) vs (86±33) minutes, P<0.01]; after 30 minutes of analgesia (4.4±0.5 vs 0.9±0.5, P<0.01), during forced labor in the second stage of labor (5.7±0.6 vs 1.3±0.4, P<0.01), the VAS scores of pain were also significantly reduced (P<0.01). (4) Labor-related indicators: compared with the single-tube epidural block group, the natural delivery rate (21.3% vs 49.1%) and the delivery experience satisfaction rate (51.9% vs 98.1%) of women in the double-tube epidural block group were significantly increased (all P<0.01), cesarean section rate (63.0% vs 45.4%), instrument assisted rate (15.7% vs 5.6%) decreased significantly (all P<0.05). (5) Cesarean section indications: compared with the single-tube epidural block group, the cesarean section rate caused by prolonged labor or protracted active phase of women in the double-tube epidural block group was significantly reduced (38.0% vs 22.2%； P<0.05), and the fetal distress, intrauterine infection, and social factors caused by cesarean section between the two groups were compared, while the differences were not statistically significant (all P>0.05).(6) Anesthesia related indexes: the block planes of the maternal upper tube administration in the double-tube epidural block group were mostly T7, T8, T9-L2 and L3,While,the block planes in the single-tube epidural block group were mostly T10, T11-S1, S2, S3, and the modified Bromage score were all 0. (7) Maternal and child complications: compared with the single-tube epidural block group, the postpartum hemorrhage rate (18.5% vs 7.4%), the perineal lateral cut rate (20.4% vs 5.6%), the neonatal asphyxia rate (12.0% vs 3.7%), ICU rate of transferred neonates (13.9% vs 4.6%) in the double-tube epidural block group were significantly reduced (all P<0.05). Soft birth canal injury rate, puerperal disease rate and neonatal birth rate between two groups were compared, and there were not statistically significant differences (all P>0.05). Conclusion: Dual-tube epidural segmental injection of lidocaine analgesia could increase the natural delivery rate of women with posterior occipital or lateral occipital position with active stagnation, reduce the rate of cesarean section and the rate of transvaginal instruments, and reduce the complications of mother and child.

Repeated Intravenous Lidocaine Infusions for Patients with Fibromyalgia: Higher Doses of Lidocaine Have a Stronger and Longer-Lasting Effect on Pain Reduction.

To determine the effect of escalating doses of lidocaine infusion with or without added magnesium on pain levels and the duration of pain relief in patients with fibromyalgia (FM). A retrospective chart review of 74 patients diagnosed with FM who underwent at least three escalating doses of intravenous (IV) lidocaine infusions (5 mg/kg of body weight, 7.5 mg/kg, and 7.5 mg/kg of lidocaine + 2.5 g of magnesium sulfate) was conducted. Each patient's subjective impression of change in pain intensity and duration of pain relief after each treatment was recorded, along with an 11-point numeric rating scale (NRS) for pain intensity, immediately before and after each infusion. Short-term lidocaine analgesia was evaluated by the reduction in NRS pain score according to the patients reported pre- (immediately before treatment) and post-treatment (immediately after treatment) values. There was a statistical difference in the NRS score reduction between doses 5 mg/kg and 7.5 mg/kg of lidocaine (P = 0.009). Long-term analgesia was evaluated at follow-up visits by the patient's subjective impression of change in pain intensity and duration of pain relief. There was a statistical difference in the percentage of pain relief and the mean duration of pain relief between the treatments with 5 mg/kg and 7.5 mg/kg of lidocaine (P = 0.007 and P = 0.003). Although there was a trend of greater response to magnesium sulfate as a beneficial adjunct to the lidocaine infusion, we were unable to find a statistically significant difference for any of the variables studied. This study demonstrated that escalating doses of IV lidocaine to 7.5 mg/kg safely and effectively reduced the pain with prolonged effect in a significant number of patients diagnosed with fibromyalgia. Larger, prospective clinical studies are required to confirm this finding.

Intrauterine lidocaine and naproxen for analgesia during intrauterine device insertion: randomized controlled trial

BackgroundThis study evaluates oral naproxen and intrauterine instillation of lidocaine for analgesia with intrauterine device (IUD) placement as compared to placebo.MethodsThis was a randomized, double-blind, placebo-controlled trial. Patients desiring levonorgestrel 52 mg IUD or Copper T380A IUD were randomized into treatment groups. Patients received either oral naproxen 375 mg or placebo approximately 1 h prior to procedure in conjunction with 5 mL of 2% lidocaine or 5 mL of intrauterine saline. The primary outcome was pain with IUD insertion measured on a visual analog scale immediately following the procedure. Prespecified secondary outcomes included physician pain assessment, post procedure analgesia, satisfaction with procedure, satisfaction with IUD, and pain assessment related to IUD type.ResultsFrom June 4, 2014 to October 28, 2016 a total of 160 women desiring Copper T380A or levonorgestrel 52 mg intrauterine device insertion and meeting study criteria were enrolled and randomized in the study. Of these, 157 (78 in the Copper T380A arm, 79 in the levonorgestrel 52 mg) received study treatment medication. There were 39 in naproxen/lidocaine arm, 39 in placebo/lidocaine arm, 40 in naproxen/placebo arm, and 39 in placebo/placebo arm. There were no differences in the mean pain scores for IUD placement between treatment groups (naproxen/lidocaine 3.38 ± 2.49; lidocaine only 2.87 ± 2.13; naproxen only 3.09 ± 2.18; placebo 3.62 ± 2.45). There was no difference in self-medication post procedure or in satisfaction with the procedure and IUD among women in the treatment arms or by type of IUD.ConclusionNaproxen with or without intrauterine lidocaine does not reduce pain with IUD placement.Clinical trial registrationClinicaltrials.gov, NCT02769247. Registered May 11, 2016, Retrospectively registered

Randomized Clinical Trial of Lidocaine Analgesia for Transurethral Bladder Catheterization Delivered via Blunt Tipped Applicator in Young Children

Transurethral bladder catheterization (TUBC) is a painful, frequently performed procedure for collecting sterile urine. We sought to determine if administration of intraurethral lidocaine before TUBC using a blunt tipped syringe decreases procedural pain in young children in the pediatric emergency department. Randomized clinical trial of children 0 to 36 months old requiring TUBC for collection of urine in a pediatric emergency department was performed. Patients received intraurethral 2% lidocaine jelly or usual care (no analgesia). Randomization was stratified by sex. Intraurethral lidocaine jelly was administered via Uro-Jet, 5 minutes before TUBC. Baseline child state, lidocaine application, TUBC, and child state 1 minute post-TUBC were videotaped. Neither providers nor parents were blinded to study arm. Videos were scored by a trained, independent, blinded reviewer using the Faces, Legs, Arms, Cry, and Consolability (FLACC) and Modified Behavioral Pain Score scales. Pain scores were compared using the Wilcoxon rank sum test. Our primary outcome was difference in FLACC scores between groups. Eighty children were enrolled in the study, and 73 had analyzable data. No differences were detected in pain by mean FLACC score between intervention (8; 95% confidence interval, 7-9) and control (9; 95% confidence interval, 8-10) groups. There were no differences between groups in mean FLACC score when stratified by age or sex or in mean Modified Behavioral Pain Score. Intraurethral lidocaine for TUBC for urine collection using a blunt tipped applicator did not improve procedural pain scores. Pain scores were high across groups. Further study should be performed to improve analgesia for this highly painful procedure.

Lidocaine analgesia for removal of vacuum-assisted closure dressings.

Lidocaine analgesia for removal of vacuum-assisted closure dressings.

Naloxone prolongs cutaneous nociceptive block by lidocaine in rats.

We aimed to investigate the local anesthetic properties of naloxone alone or as an adjunct for the local anesthetic lidocaine. After the block of the cutaneous trunci muscle reflex (CTMR) with drugsdelivery by subcutaneous infiltration, cutaneous nociceptive block was tested on the ratsꞌ backs. We demonstrated that naloxone, as well as lidocaine, elicited cutaneous analgesia dose-dependently. The relative potency in inducing cutaneous analgesia was lidocaine [22.6 (20.1 - 25.4) μmol/kg] > naloxone [43.2 (40.3 - 46.4) μmol/kg] (P<0.05). On an equianesthetic basis [50% effective dose (ED50 ), ED25 , and ED75 ], naloxone displayed a greater duration of cutaneous analgesic action than lidocaine (P<0.01). Coadministration of lidocaine (ED95 or ED50 ) and ineffective-dose naloxone (13.3μmol/kg) intensifies sensory block (P<0.01) with prolonged duration of action (P<0.001) compared with lidocaine (ED95 or ED50 ) alone or naloxone (13.3μmol/kg) alone on infiltrative cutaneous analgesia. The preclinical data showed that naloxone is less potent than lidocaine as an infiltrative anesthetic, but its analgesic duration was longer than that of lidocaine. Furthermore, naloxone prolongs lidocaine analgesia, acting synergistically for nociceptive block.

Lidocaine or meloxicam analgesia decrease nociception as indicated by cardiovascular responses of halothane-anaesthetized Bos indicus bull calves during surgical castration

Lidocaine or meloxicam analgesia decrease nociception as indicated by cardiovascular responses of halothane-anaesthetized Bos indicus bull calves during surgical castration

Concurrent validity of different functional and neuroproteomic pain assessment methods in the rat osteoarthritis monosodium iodoacetate (MIA) model.

BackgroundLack of validity in osteoarthritis pain models and assessment methods is suspected. Our goal was to 1) assess the repeatability and reproducibility of measurement and the influence of environment, and acclimatization, to different pain assessment outcomes in normal rats, and 2) test the concurrent validity of the most reliable methods in relation to the expression of different spinal neuropeptides in a chemical model of osteoarthritic pain.MethodsRepeatability and inter-rater reliability of reflexive nociceptive mechanical thresholds, spontaneous static weight-bearing, treadmill, rotarod, and operant place escape/avoidance paradigm (PEAP) were assessed by the intraclass correlation coefficient (ICC). The most reliable acclimatization protocol was determined by comparing coefficients of variation. In a pilot comparative study, the sensitivity and responsiveness to treatment of the most reliable methods were tested in the monosodium iodoacetate (MIA) model over 21 days. Two MIA (2 mg) groups (including one lidocaine treatment group) and one sham group (0.9 % saline) received an intra-articular (50 μL) injection.ResultsNo effect of environment (observer, inverted circadian cycle, or exercise) was observed; all tested methods except mechanical sensitivity (ICC <0.3), offered good repeatability (ICC ≥0.7). The most reliable acclimatization protocol included five assessments over two weeks. MIA-related osteoarthritic change in pain was demonstrated with static weight-bearing, punctate tactile allodynia evaluation, treadmill exercise and operant PEAP, the latter being the most responsive to analgesic intra-articular lidocaine. Substance P and calcitonin gene-related peptide were higher in MIA groups compared to naive (adjusted P (adj-P) = 0.016) or sham-treated (adj-P = 0.029) rats. Repeated post-MIA lidocaine injection resulted in 34 times lower downregulation for spinal substance P compared to MIA alone (adj-P = 0.029), with a concomitant increase of 17 % in time spent on the PEAP dark side (indicative of increased comfort).ConclusionThis study of normal rats and rats with pain established the most reliable and sensitive pain assessment methods and an optimized acclimatization protocol. Operant PEAP testing was more responsive to lidocaine analgesia than other tests used, while neuropeptide spinal concentration is an objective quantification method attractive to support and validate different centralized pain functional assessment methods.

Septoplasty and tonsillectomy: acute stress response as a measure of effectiveness of local anesthetics

To compare the effectiveness of lidocaine and articaineused as local anesthetics in septoplasty and tonsillectomy based on the physiological stress response. The study included 125 patients with nasal septum deviation (NSD) and chronic tonsillitis (CT). The patients presenting with NSD were divided into two groups. Those comprising group 1A (n=32) were treated with a 2% lidocaine solution for local infiltration analgesia (LIA), the patients of group 1B (n=30) were given 2%articaine as LIA. Group 2A contained 32 patients with CT treated with lidocaine, group 2B consisted of 31 patients given articaine. In all the patients, the overall heart rate variability (HRV) including its high, low, and very low components was measured. Evaluation of HRV revealed a certain degree of disadaptation in the patients of groups 1B and 2A. High dispersion of SDANN, SDNN index, andrMSSD in group 1Bas well as SDANN values in group 2A indicates the sympathetic/parasympathetic imbalance. The high-frequency component was augmented in group 2B which suggested the prevalence of parasympathetic tone, but its high dispersion was just aswell indicative of disadaptation. Local analgesia with articaine during septoplasty leads tosympathetic/parasympathetic imbalance during the early postoperative period. Lidocaine analgesia for tonsillectomy does not prevent disadaptation induced by surgical stress.

Effects of Intravenous Versus Epidural Lidocaine Infusion on Pain Intensity and Bowel Function After Major Large Bowel Surgery: a Double-Blind Randomized Controlled Trial

BackgroundWe compared the effects of intravenous lidocaine (IVL) with lumbar epidural lidocaine analgesia (LEA) on pain and ileus after open colonic surgery. MethodsBetween December 2011 and February 2013, 60 patients were randomly allocated to IVL, LEA, or control group. The IVL group received intraoperatively lidocaine 2 % intravenously (1.5 mg/kg bolus, 2 mg/kg/h infusion) and normal saline (NS) epidurally. The LEA group received lidocaine epidurally (1.5 mg/kg bolus, 2 mg/kg/h infusion) and NS intravenously. The control group received NS both intravenously and epidurally, as bolus and infusion. All NS volumes were calculated as if containing lidocaine 2 % at the aforementioned doses. We assessed pain intensity at rest/cough at 1, 2, 4, 12, 24, and 48 h postoperatively (numerical rating scale 0–10), 48-h analgesic consumption, and time to first flatus passage. ResultsData from 60 patients (20 per group) were analyzed. The IVL group had significantly lower pain scores at rest and cough compared to LEA or control group only at 1, 2, and 4 h postoperatively (P < 0.005 for all comparisons). The 48-h analgesic requirements and time to first flatus passage did not differ significantly between IVL group and LEA or control group (P > 0.05). ConclusionsCompared with LEA-lidocaine or placebo, intravenous lidocaine offered no clinically significant benefit in terms of analgesia and bowel function.

Lidocaine Analgesia for Removal of Wound Vacuum-Assisted Closure Dressings

Wound vacuum-assisted closure (VAC) is a technique used frequently by orthopedic surgeons to facilitate wound closure. Bedside VAC removal can be a source of great pain for patients, which we hypothesize can be decreased by topical lidocaine application. This was a prospective randomized double-blinded, placebo-controlled trial (registered on clinicaltrials.gov), utilizing the crossover intervention technique. The study was carried out at a level 1 trauma center. Nondiabetic, adult patients requiring at least 2 extremity wound VAC dressing changes were involved. In a double-blinded fashion, topical lidocaine (1%) was compared with topical normal saline (0.9% NaCl) after injection into the VAC sponge. The crossover intervention technique, wherein each patient received an independent VAC change with lidocaine and saline, served to control for all possible patient characteristics. Randomization determined which sample was given first or second. The patients were evaluated for visual analog pain scores, narcotic requirement, and wound characteristics. : A total of 11 patients were enrolled for a total of 21 VAC changes (mean wound size 133 cm); 1 patient withdrew after his first VAC dressing was changed with saline. Controlling for pre-VAC change pain, the lidocaine intervention was associated with 2.4 points less on the 0-10 visual analog scale for pain (P value <0.001, -3.0 to -1.7) and 1.7 mg less morphine-equivalents administered (P value <0.001, -2.3 to -1.1) during the VAC sponge removal. The patients undergoing an extremity wound VAC dressing removal at the bedside should be pretreated with topical lidocaine because it decreases pain and narcotic requirements. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Quality of lidocaine analgesia with and without midazolam for intravenous regional anesthesia

Midazolam has analgesic effects mediated by gamma aminobutyric acid-A receptors. This study was designed to evaluate the effect of midazolam on anesthesia and analgesia quality when added to lidocaine for intravenous regional anesthesia (IVRA). Forty patients undergoing hand surgery were randomly assigned to two groups to receive IVRA. The control group received 3mg/kg lidocaine 2% w/v diluted with saline to a total volume of 40ml, and the midazolam group received an additional 50μg/kg midazolam. Sensory and motor block onset and recovery times, tourniquet pain, intraoperative analgesic requirements, sedation, and anesthesia quality were recorded. Postoperative pain and sedation scores, time to first analgesic requirements, analgesic use in the first 24h, and side effects were noted. Sensory and motor block onset and recovery times did not differ significantly between groups. Tourniquet pain scores were lower at 10, 15, 20, and 30min (P<0.0001) in the midazolam group. Three (15%) patients in the midazolam group required fentanyl for tourniquet pain compared with thirteen (65%) patients in the control group (P=0.02). Patients in both groups received fentanyl once. Midazolam group showed that significantly less patients required diclofenac for postoperative analgesia (P<0.01) and analgesic-free period during first postoperative 24h was significantly longer (726.8±662.8min vs. 91.0±35.9min, P<0.0001). Postoperative pain scores were lower (P<0.0001) and sedation scores higher (P<0.05) for the first 2h in the midazolam group. Addition of midazolam to lidocaine for IVRA improves anesthesia quality and enhances intraoperative and postoperative analgesia without causing side effects.

Effect of Epidural Neuraxial Blockade-dependent Sedation on the Ramsay Sedation Scale and the Composite Auditory Evoked Potentials Index in Surgical Intensive Care Patients

Peripheral deafferentation induced by neuraxial anesthesia reduces the degree of cortical arousal. This study investigated whether epidural analgesia blockade decreased sedation, as measured by the rapidly extracted auditory evoked potentials index, A-line autoregressive index (AAI) and Ramsay Sedation Scale (RSS) in sedated surgical intensive care patients, and looked at whether this was a concentration-dependent effect of lidocaine. Forty patients underwent major lower abdominal surgery and received epidural analgesia in the surgical intensive care unit. Patients were continuously sedated with propofol to achieve an RSS value of 3, randomly divided into two groups, and received epidural analgesia with 10 mL of 0.5% or 1% lidocaine. Sedation was evaluated using the RSS and AAI, and analgesia was evaluated using a visual analog scale (VAS). RSS, AAI, electromyography (EMG) activity of AAI and VAS values were recorded at 5 minutes before and 30, 60 and 90 minutes after epidural lidocaine administration. Epidural 0.5% lidocaine produced a reduction of AAI, EMG and VAS at 30, 60 and 90 minutes after administration. For 1% epidural lidocaine administration, AAI, EMG and VAS were also reduced at 30, 60 and 90 minutes after epidural lidocaine administration. However, there was no difference in the AAI between the two concentrations; moreover, no significant change was observed in the RSS. Epidural lidocaine analgesia could potentiate sedation in patients evaluated by the AAI, but had no effect on the RSS. The present study suggests that the AAI could provide an objective and more precise index than the RSS in evaluation of sedation level in patients who are undergoing epidural pain management in the intensive care unit.

Pain Quality Predicts Lidocaine Analgesia among Patients with Suspected Neuropathic Pain

Oral sodium channel blockers have shown mixed results in randomized controlled trials despite the known importance of sodium channels in generating pain. We hypothesized that differing baseline pain qualities (e.g. "stabbing" vs "dull") might define specific subgroups responsive to intravenous (IV) lidocaine-a potent sodium channel blocker. A prospective cohort study of 71 patient with chronic pain suspected of being neuropathic were recruited between January 2003 and July 2007 and underwent lidocaine infusions at Stanford University Hospital in a single-blind nonrandomized fashion. Baseline sensory pain qualities were measured with the Short-Form McGill Pain Questionnaire (SF-MPQ). Pain intensity was measured with a visual analog scale (VAS). Factor analysis demonstrated two underlying pain quality factors among SF-MPQ sensory items: a heavy pain and a stabbing pain. Baseline heavy pain quality, but not stabbing quality predicted subsequent relief of pain intensity in response to lidocaine. In contrast, these factors did not predict divergent analgesic responses to placebo infusions. In response to each 1 mcg/mL increase in lidocaine plasma level, patients with high heavy pain quality drop their VAS 0.24 (95% CI 0.05-0.43) more points than those with low heavy pain quality (P < 0.013). "Heavy" pain quality may indentify patients with enhanced lidocaine responsiveness. Pain quality may identify subgroups among patients with suspected neuropathic pain responsive to IV lidocaine. Further investigation is warranted to validate and extend these findings.

A controlled, randomised trial comparing single to multiple application lidocaine analgesia in paediatric patients undergoing urethral catheterisation procedures

The aim of this study was to evaluate if discomfort levels are statistically significant when two different topical and intraurethral precatheterisation analgesia strategies are used. The primary objective of this research project was to examine methods to decrease pain experienced by paediatric cystogram patients. Paediatric patients undergoing urinary catheterisations frequently report discomfort. To alleviate catheterisation discomfort in children, some institutions have either used sedation techniques or topical analgesia strategies. Standardisation of topical anaesthetic application prior to paediatric urinary catheterisation has not been demonstrated in the research literature. A prospective, single-blind, randomised, controlled trial. The trial was performed with infants and children aged two months-eight years. The first group received one application of lidocaine five minutes prior to catheterisation. The control group received two applications, spaced five minutes apart prior to catheterisation. The FLACC pain score, as the primary outcome variable, was assessed at the time of the catheterisation. Secondary outcome variables including pre- and postcatheterisation heart rate and parental perception were also measured. Two hundred children between two months-eight years of age were randomly assigned for study inclusion with 91 patients enrolled into the two application groups and 109 patients into the single application group. No statistically significant differences (p = 0.779) in the mean FLACC pain score at the time of the catheterisation between the intervention (single application) group (mean = 3.30) and the control (two application) group (mean = 3.39), heart rate or parental perceptions were observed. Topical and intraurethral lidocaine analgesia strategies prior to urinary catheterisation provide an important tool in reducing discomfort for paediatric patients undergoing urinary catheterisation procedures. This study confirms that multiple applications of intraurethral lidocaine gel add little additional benefits in reducing discomfort over single intraurethral application techniques.