Lidocaine Pretreatment Research Articles

Lidocaine pre-treatment for Succinylcholine induced postoperative myalgia and associated factors: Longitudinal study

IntroductionPostoperative myalgia in surgical patients is mainly caused by the routinely administered depolarizing muscle relaxant, Succinylcholine. There are many proposed strategies but no one were indicated as ideal preventive mechanisms for Succinylcholine induced post-operative myalgia. Even if data were sparse, Lidocaine pretreatment can reduce postoperative myalgia which requires further supportive evidences urging the initiation of this study. MethodsProspective longitudinal cohort study was conducted from March to May 2021 at Dessie Comprehensive Specialized Hospital on 208 adult surgical patients. Patients pretreated with Lidocaine preoperatively were grouped as exposed and others as unexposed. Patients meeting the inclusion criteria during the study period were selected sequentially from the daily operation schedule list. Postoperative myalgia level was measured using post-operative myalgia survey repeatedly. The result was analyzed by Cochran's Q test and generalized estimating equation (GEE). Adjusted odds ratio with 95 % confidence interval and p value < 0.05 was used to show the difference, direction and strength of association. ResultExposure specific incidence rate showed that 22 %, 22 % and 29.8 % of patients exposed to Lidocaine and 40.6 %, 42.7 % and 34 % not exposed to Lidocaine developed myalgia at 12, 24, and 48 h respectively. There is no significant difference in the incidence of myalgia over time between the repeated measurements in Lidocaine exposed patients (p = 0.513) but in non-exposed patients (p = 0.003). Also, there is no difference in the distribution of other predictors between Lidocaine exposed and non-exposed groups (p > 0.05). Exposure to Lidocaine reduces postoperative myalgia significantly [AOR = 0.33, 95 % CI = (0.17,0.66)]. Multimodal analgesia [AOR = 0.32, 95 % CI = (0.18,0.55)], non-steroidal anti-inflammatory drugs alone [AOR = 0.47, 95 % CI = (0.29,0.76)], postoperative immobility [AOR = 0.61, 95 % CI = (0.47,0.8)], and being male [AOR = 0.48, 95 % CI = (0.26,0.87)] were other determinants in reducing Succinylcholine induced postoperative myalgia. ConclusionLidocaine pretreatment can significantly reduce the occurrence of Succinylcholine induced postoperative myalgia. Additionally, usage of multimodal analgesia with non-steroidal anti-inflammatory drugs or even only non-steroidal anti-inflammatory drugs in the intraoperative and postoperative period can reduce Succinylcholine induced postoperative myalgia.

Comparison of 2% lidocaine infiltration and eutectic mixture of local anesthetics cream application before spinal needle insertion for pain reduction and assessment of maternal satisfaction levels in women undergoing cesarean section at a tertiary care se.

This study aimed to compare two analgesic pretreatment techniques for assessing pain reduction before spinal needle insertion and the subsequent patient satisfaction levels in pregnant female patients undergoing cesarean sections. Sixty pregnant female patients scheduled for elective cesarean section under spinal anesthesia were randomly assigned to two groups. The Lidocaine group received local skin infiltration with 2% lidocaine pretreatment before spinal needle introducer insertion, whereas the eutectic mixture of local anesthetics (EMLA) group received EMLA (lidocaine 2.5% and prilocaine 2.5%) cream pretreatment for at least 30 min before spinal needle introducer insertion. Subjective and objective pain scores, procedure duration, number of attempts, maternal satisfaction, and decisions regarding future numbing procedures and regional anesthesia were assessed. The demographic characteristics of the patients were similar between groups. The mean visual analogue scale pain score was significantly lower in the EMLA group compared to the lidocaine group (P < 0.05). Additionally, the objective pain score was significantly lower in the EMLA group (P < 0.05). The duration of spinal block placement was significantly longer in the lidocaine group than in the EMLA group (P < 0.05). The number of attempts to perform the spinal block placement was similar in both groups. However, women in the EMLA group expressed greater overall satisfaction than those in the lidocaine group (76.7% vs. 20.0%, P < 0.05). Analgesic pretreatment with EMLA cream is superior to local skin infiltration with lidocaine in pregnant patients undergoing elective cesarean section under spinal anesthesia.

Comparative study between lidocaine, magnesium sulfate and dexmedetomidine in alleviation of pain induced by intravenous injection of propofol

Background Propofol is the most widely used intravenous anaesthetic agent for induction and maintenance of anaesthesia. Pain on injection of propofol is a common problem. Propofol injection pain, despite various interventions, still occurs during the anaesthesia induction and causes intense discomfort and anxiety in patients. Objective Compare the efficacy of lidocaine, magnesium sulfate and dexmedetomidine drugs in reduction of pain of propofol. Also, study the effects of these drugs on cardiovascular system. Subjective This prospective controlled randomized double-blind study was carried out on 90 adult patients ASA status I or II, haemodynemically stable and Scheduled for elective surgery under general anaesthesia by propofol intravenous induction. Results The pain level during administration showed a significant decrease in group D (dexmedetomidine) less than both group L and M and there was no significant effect of the three drugs on haemodynamic parameters. Conclusions Dexmedetomidine is an effective and safe way to reduce the intensity and incidence of propofol injection pain. Magnesium and lidocaine pretreatment are equally effective in attenuating propofol-induced pain with some priority of magnesium sulphate more than lidocaine. There were no significant effects of the drugs on haemodynamics parameters

Lidocaine pretreatment attenuates inflammatory response and protects against sepsis-induced acute lung injury via inhibiting potassium efflux-dependent NLRP3 activation.

Sepsis may often result in acute lung injury (ALI), with a high mortality and morbidity. Available evidence indicates that activation of NLRP3 inflammasome to induce macrophage inflammation plays a crucial role in the inflammation progression of ALI and lidocaine can attenuate inflammatory responses. We hypothesized that lidocaine may attenuate inflammatory response andsepsis-induced ALI by inhibiting potassium efflux-dependent NLRP3 activation. C57BL/6N mice were randomized and divided into six groups (n = 6) receiving different treatments. Lung vascular permeability and histological changes in the lungs were evaluated by Evans blue dye, bronchoalveolar lavage analysis and hematoxylin and eosin staining. J774A.1 macrophages were divided into 12 groups receiving different treatments. The expression of both NLRP3 inflammasome activation-related protein and P2X7 in the macrophages was measured by immunofluorescence staining and Western blots. The whole cell currents were determined by a voltage-patch clamp technique. Challenge with LPS led to ALI in mice with an increased lung injury score (0.54 ± 0.09), which was significantly attenuated by lidocaine pretreatment (0.20 ± 0.08, P < 0.0001). Lidocaine pretreatment significantly decreased the NLRP3 activation and IL-1β release in the macrophages. Furthermore, lidocaine pretreatment down-regulated the expression of P2X7 receptors, inhibited LPS- and ATP-induced sodium (Na+) inward flow, and maintained the intracellular K+ level in the macrophages. In addition, activation of Na+ influx did not eliminate anti-inflammatory effect of lidocaine. The activation of NLRP3 could be suppressed by extracellular K+ level in a dose-dependent model. However, lidocaine pretreatment eliminated NLRP3 activation and IL-1β release induced by K+ efflux, and decreased outward K+ current and extracellular K+ level in the macrophages challenged by LPS/ATP. Lidocaine pretreatment can attenuate thesepsis-induced ALI by an anti-inflammatory mechanism of inhibiting K+ efflux-dependent NLRP3 activation.

Intravenous lidocaine bolus for reducing nefopam-induced venous pain: A randomized, intrasubject comparison trial.

Intravenous nefopam reduces postoperative pain and opioid consumption but can cause infusion-related pain. We aimed to investigate whether lidocaine can effectively reduce this pain. This prospective, randomized, double-blind, controlled, intrasubject comparison trial included 42 patients (20-60 years) undergoing elective surgery under regional or peripheral anesthesia. In the postanesthesia care unit, two 50 mL syringes containing nefopam (20 mg) diluted in saline (100 mL) were sequentially infused in 15 min into venous catheters in the left and right arms. Patients were randomly assigned to the "left side" or "right side" group based on the arm in which a bolus of 1% lidocaine (2 mL) (study group) was administered before nefopam infusion. Normal saline (2 mL) was administered on the control side. Numerical Rating Scale scores and the incidence of pain (scores > 3) and nausea or vomiting were recorded at 1, 5, 10, and 15 min. The analysis included 42 patients (84 infusions). Compared with the placebo, lidocaine lowered the mean infusion-related pain at 1 (0.07 vs. 2.21, P < 0.001), 5 (2 vs. 4.21, P < 0.001), 10 (2.02 vs. 3.95, P < 0.001), and 15 min (1.62 vs. 3.16, P = 0.003). At 5 min, significantly higher percentages of infusion sites with moderate and higher pain scores (> 3) were observed on the control side (30.95% vs. 14.29%, P = 0.000). Seven patients exhibited nausea or vomiting (16.7%). For the nefopam infusion rate and concentration that we used, a 20 mg lidocaine pretreatment bolus significantly reduces infusion-related pain.

The Valsalva Maneuver Is Not as Effective as Lidocaine for the Attenuation of Pain on Injection of Propofol: A Randomized Controlled Study.

Background and objectiveLidocaine pretreatment is considered the gold standard for attenuating pain on injection of propofol. Valsalva maneuver (VM) causes baroreceptor reflex arc-induced antinociception by increasing the intrathoracic pressure. We aimed to evaluate the efficacy of VM in alleviating the pain on injection of propofol in this randomized comparative study.MethodsA total of 90 patients were recruited for this randomized study. They were classified into two groups. Patients in group D received 5-mL 4% lidocaine in saline intravenously while the venous drainage was occluded. Then they were asked to press a rubber ball as hard as they could. Patients in group V received 5-ml saline pretreatment. They were then asked to perform VM by blowing into rubber tubing connected to a manometer and raising and holding the pressure up to 40 mmHg. The verbal response and behavioral signs were recorded with a score corresponding to no, mild, moderate, or severe pain. A t-test was performed to compare the mean of variables between the two groups. The Kolmogorov-Smirnov test was used for testing the equality of the distribution function of pain scores between the groups. Repeated measures analysis of variance (ANOVA) was performed to test the heart rate and mean arterial pressure (MAP) at different points of observation.ResultsThe incidence of pain and pain scores were significantly higher among the patients in the VM group as compared to those in the lidocaine with distraction group.ConclusionsVM performed immediately before the injection failed to attenuate the pain produced by propofol as compared to lidocaine pretreatment along with distraction.

A comparative study of pain on injection with propofol long-chain triglycerides versus propofol medium/long-chain triglycerides with lignocaine

Background: Propofol long-chain triglyceride (LCT) is the most commonly used intravenous anesthetic drug, which has pain on injection as its major disadvantage. Many drugs have been used to alleviate this pain with variable efficacy, among them lidocaine pretreatment is most popular. Propofol medium-chain triglyceride (MCT)/LCT emulsion has the ability to decrease pain on injection. The availability of propofol with two different formulations necessitates a comparison of pain on injection with lidocaine pretreatment. Aim: The aim of this study was to study the incidence and intensity of pain on injection with propofol LCTs versus propofol MCT/LCTs with lignocaine. Materials and Methods: This prospective, double-blind, and randomized controlled study included 120 American Society of Anesthesiology Grade I and II participants undergoing General Anesthesia. In Group A, patients were induced with 1% propofol LCT (2 mg/kg) with 2% lidocaine 2 ml and in Group B 1% propofol MCT/LCT (2 mg/kg) with 2% lidocaine 2 ml. Assessment of pain on injection was performed after 30% of total induction dose was injected at a rate of 1 ml/s by Verbal Rating Scale. Results: Group A reported an incidence of pain in 28.4% and Group B with 13.3%. There was a statistically significant difference in the incidence and intensity of pain with propofol MCT/LCT along with lignocaine. Sixteen patients in Group A and eight patients in Group B had mild pain, whereas one patient in Group A and none of them in Group B had moderate pain. Conclusion: Premixing lignocaine with MCT/LCT propofol significantly reduces both the incidence and intensity of pain as compared to LCT propofol with lignocaine.

Effect and Mechanism of Lidocaine Pretreatment Combined with Dexmedetomidine on Oxidative Stress in Patients with Intracranial Aneurysm Clipping.

This study aimed to explore the effect and mechanism of lidocaine pretreatment combined with dexmedetomidine on oxidative stress in patients with intracranial aneurysm clipping. Many studies have used various drugs such as lidocaine to explore the effect and mechanism of lidocaine pretreatment. A total of 80 patients with intracranial aneurysm clipping surgery were randomly divided into 4 groups: the single lidocaine group, single dexmedetomidine group, lidocaine combined with dexmedetomidine group, and control group. The thread embolism method was used to establish a stable intracranial aneurysm model of Hashimoto rats. Fifty adult rats were randomly divided into a sham operation group, ligation of the left common carotid artery and bilateral posterior branch of renal artery, lidocaine group, dexmedetomidine group, and lidocaine combined with dexmedetomidine group. The colorimetric method was used to determine the oxidative stress indicators in brain tissue: MDA content, SOD activity, and T-AOC content. The western blot method characterized the protein levels related to oxidative stress: nNOS, iNOS, and NADPH oxidase subunits p22phox, gp91phox, and p47phox. The differences in each index between the groups were statistically significant (P < 0.05). Animal experiment results revealed that the content of MDA in the brain tissue of rats in the LD group was significantly lower than that in the single-drug group and sham group. The T-AOC and SOD concentrations in the LD group were significantly higher than those in the single-drug group and sham group, and the differences between the groups were statistically significant (P < 0.05). The protein expression of the LD group was significantly lower than that of the drug-alone group and model group, and the difference between groups was statistically significant (P < 0.05). To sum up, lidocaine pretreatment combined with dexmedetomidine can effectively maintain the hemodynamic stability of patients with intracranial aneurysm clipping and reduce postoperative oxidative stress response. Its mechanism of action may be related to the inhibition of oxidative stress damage mediated by nNOS, iNOS, and p22phox, gp91phox, and p47phox in the hippocampus. Our study has significant and applicable medical aspects in lidocaine pretreatment combined with dexmedetomidine on oxidative stress in patients.

Effect of Lidocaine Pre-Treatment on Protamine-Induced Pulmonary Vascular Reaction During the Repair of Congenital Heart Disease.

BackgroundProtamine is a polycationic, and a strong basic peptide isolated from Clupeidae or Salmonidae fishes’ sperm, which is rich in arginine and highly alkaline.ObjectiveTo explore the effect of lidocaine pre-treatment on protamine-induced pulmonary vascular reaction during the repair of congenital heart disease.MethodsEighty patients undergoing repair of congenital heart disease were randomly divided into four groups: A1 (non-pulmonary hypertension + lidocaine pre-treatment) group, A2 (non-pulmonary hypertension + normal saline) group, B1 (pulmonary hypertension + lidocaine pre-treatment) group, and B2 (pulmonary hypertension + normal saline) group. Hemodynamic parameters, pulmonary inflammation, and pulmonary function were assessed at six intraoperative time points, two intraoperative time points and three intraoperative time points, respectively. P-value <0.05 was considered statistically significant.ResultsA2 group exhibited increased PAP, Paw, RI and A-aDO2. B2 group exhibited increased Paw, RI and A-aDO2 and decreased Cydn and OI after protamine administration. These changes were not observed in A1 and B1 group. Compared with A1 and B1 groups, plasma TXB2 level in A2 and B2 group was higher, but 6-keto-PGF1a in A2 and B2 groups was lower. Incidence of protamine adverse reactions in A1 and B1 group was lower than that in A2 and B2 group.ConclusionPrecondition of lidocaine before neutralization of heparin may be effective for protamine-induced pulmonary vascular reaction during CHD repair.

An Observational Study of Propofol Mct-Lct Versus Propofol Lct with Lidocaine Pretreatment for Pain During Induction in General Anaesthesia

Aims and Objectives: To compare efficacy between Propofol Medium Chain Triglycerides-Long ChainTriglycerides and Propofol Long Chain Triglycerides with lidocaine pretreatment under venous occlusionon propofol induced pain.Material and Methods: 50 patients of age 18 to 55 years of either gender of ASA I or II Grade were assignedto two groups of 25 each undergoing elective surgeries under general anaesthesia.Patients in Group Mreceived Propofol MCT-LCT 1% (without any pretreatment with Lidocaine) and Group L received PropofolLCT 1% with Lidocaine pretreatment under venous occlusion. Following propofol injection, patients wereasked for any sensation of pain at injection site during propofol injection till patient was unconscious. It wasgraded as per 4 point verbal pain score, with 0 being No pain to 3 being severe pain.Anaesthesia was induced by a standard technique of intravenous induction. Endotracheal intubation wasdone after giving injection succinyl choline (2mg/kg) I V and was maintained on O2, N2O, Isofluraneand Atracurium. Monitoring of heartrate, blood pressure and SPO2 were done during the surgery . Aftersurgery, reversal of neuromuscular blockade was done and extubation was performed. After that patient wastransferred to recovery room.Result and Summary: Both the groups were comparable in term of demographics and ASA grading. It wasobserved that in the group L a significantly higher proportion (80%) of patients experienced pain while inthe Group M only 44% patients experienced pain during propofol administration. (P value-0.0044- highlysignificant). We observed that the pain intensity score seen in group L was 0, 1, 2 and 3 in 20%, 48%, 20%and 12% of the patients , while in the group M was 0 and 1 in 56% and 44% of the patients, respectively andnone of the patients had pain score of 2 and 3. A significantly higher proportion of patients in group M hadpain intensity score of 0 (P value&lt;0.01)which was statistically highly significant. Pre and post-operativevitals were comparable in both the groups.Conclusion: The study concluded that Propofol MCT-LCT is better in view of less incidence and severityof pain on injection during induction of anaesthesia than Propofol LCT with lidocaine pretreatment undervenous occlusion.

Efficacy of Intravenous Paracetamol in Combination with Lidocaine Pretreatment for Reducing Pain During Injection of Propofol

IntroductionThe association of pain and discomfort of moderate to high severity and a high incidence with the intravenous (IV) administration of propofol is well known. Various physical and pharmacological methods are used to minimize propofol-induced pain, but the best intervention is still unknown. Therefore, our aim was to determine the analgesic efficacy of IV paracetamol when used in combination with lidocaine pretreatment in reducing propofol injection pain.Materials and methodsThis double-blind, randomized controlled trial was conducted after receiving the approval of our institutional research ethics board. A total of 74 patients were included after providing informed consent, and participants were placed into two equal groups: group A received IV paracetamol (1 g) in combination with lidocaine pretreatment prior to the injection of propofol, and group B received lidocaine pretreatment alone prior to propofol injection. After propofol injection, all participants were asked to evaluate pain on the visual analog scale.ResultsPatients who received the lidocaine-paracetamol combination reported significantly more pain-free responses (51.35%) than those from patients who received lidocaine pretreatment alone (8.11%; P<0.05). The analgesic efficacy of group A was positive in 36 patients (97.3%), and for group B, the analgesic efficacy was positive in 24 patients (64.9%).ConclusionThe administration of IV paracetamol with lidocaine pretreatment was more effective than lidocaine pretreatment alone in reducing the pain caused by the injection of propofol. Physicians should consider using IV paracetamol in combination with lidocaine pretreatment when patients require IV propofol to ease patient suffering and reduce pain, which may help provide optimal patient care.

English

English

Reduction in the succinylcholine induced myalgia with lidocaine

Background and aim: There has been an increasing need to find an easily available, effective and feasible method of reducing the incidence of myalgia. Hence, the purpose of the present study is to evaluate and compare the effect of pretreatment with intravenous lidocaine in succinylcholine induced post operative myalgia. Materials and methods: Total of 160 patients were included in the study. Each of the participants were informed about the study, and the informed consent was signed by all. Total of 160 patients were divided into two groups. Group A consists of 80 patients, they were administered with intravenous lidocaine 3 minutes before administering succinylcholine and the rest 80 patients were taken as control group. Results: There is significant reduction in pain over time within the two treatment groups. Though the intensity of Post Operative Myalgia does not significantly reduce (p>0.016) from 1hr to 24hrs in any of the groups, there is a significant reduction (p< 0.016) in the intensity of Post Operative Myalgia from 24hrs to 48hrs in all the treatment groups. Conclusion: Lidocaine was found to be superior increasing the number of patients without muscle pain and decreasing the frequency of moderate and severe myalgia. Moderate and severe pain were reported only in (2.5%, 0%), (10%, 2.5%) and (5%, 0%) patients at 1hr, 24hrs and 48hrs respectively. Thus lidocaine pretreatment is concluded to be the most effective method of preventing succinylcholine myalgia.

Comparative Study of Lidocaine and Palonosetron Pretreatment in Reduction of Propofol Induced Injection Pain

Comparative Study of Lidocaine and Palonosetron Pretreatment in Reduction of Propofol Induced Injection Pain

Pain During Venous Cannulation.

The pain of venous puncture for the cannulation of peripheral veins is disturbing to many patients. This is the first clinical trial of the efficacy of local anesthesia in comparison to placebo (no pretreatment) in a control group, as a function of the size of the cannula. A randomized, controlled trial of fully factorial design was performed to study pain during venipuncture after local anesthesia either with intra - dermally injected lidocaine or with a vapocoolant spray, in comparison to placebo. A standardized protocol was used for structured communication with the patient to provide the greatest feasible degree of patient blinding (trial registration number DRKS00010155). The primary endpoints were the subjective discomfort of the patient during preparation and puncture of a vein of the dorsum of the hand, assessed on a numerical rating scale (NRS) from 0 (no discomfort) to 10 (unbearable discomfort), and the rate of unsuccessful puncture. The intention-to-treat analysis of all 450 patients revealed that the reported degree of pain during venipuncture depended to a large extent on the caliber of the chosen venous cannula. For a 17-gauge (17G) cannula, both the vapocoolant spray (NRS = 2.6 ± 1.3) and lidocaine (NRS = 3.5 ± 2.2) lessened the discomfort due to venipuncture compared to control treatment (5.0 ± 1.5). The effect of vapocoolant spray compared to the control was both clinically relevant and statistically significant (p < 0.0001). When a smaller 20G cannula was used, however, vapocoolant spray improved discomfort by only 0.8 NRS points, which, though still statistically significant (p = 0.0056), was no longer clinically relevant. The rate of unsuccessful puncture was higher after lidocaine pretreatment (12.7%) than after either vapocoolant spray (4.7%; p = 0.0066) or no pretreatment (4.0%; p = 0.0014). Local anesthesia can be recommended before venipuncture only if a large cannula is used (e.g., ≥ 17G). Vapocoolant spray may be at least as useful as lidocaine injection; it prevents pain to a similar extent and is associated with a lower rate of unsuccessful puncture.

(162) Pre-surgical intraplantar resiniferatoxin decreases post-operative pain in rats with plantar incision

Post-operative pain is a major cause of morbidity and suffering. Central sensitization during surgical intervention has been implicated in the development of chronic pain this may, in part, be due to inadequate peri-operative and post-operative analgesia. Neurons expressing TRPV1 (transient receptor potential cation channel subfamily V) have been implicated in nociception in a variety of pain models. The present study investigated therapeutic and molecular aspects of perioperative ablation of TRPV1-containing peripheral nerve terminals with intraplantar RTX (resiniferatoxin) in a surgical incision pain model. Furthermore, as RTX has algesic actions before institution of analgesia, the effect of lidocaine administered before RTX on post-operative hyperalgesia was investigated. Sprague-Dawley rats were administered RTX and/or lidocaine in the perioperative window prior to intraplantar incision in a 2x2 factorial design. Evoked pain to mechanical and thermal stimulation was assessed, as was spontaneous pain with measurement of guarding and home cage monitoring. RNA was extracted from spinal cord dorsal horn on post-operative day 2 for transcriptomic analysis. Plantar incision caused thermal hyperalgesia, but intraplantar RTX attenuated responses to noxious infrared diode laser thermal A-delta or C-fiber stimulation during the 4 days of the study (p<0.05). Mechanical allodynia, measured by Von Frey stimulation, was pronounced over the first 2 post-operative days, and was also attenuated by pre-emptive RTX. Guarding of the wound was most pronounced at 4 hours and 24 hours pre-emptive RTX attenuated this measure of spontaneous pain (assessed by guarding score, p<0.05). Mechanical pain sensation, measured by pinprick, was preserved after RTX treatment, as was motoric function (measured by time spent on rotarod). Lidocaine pre-treatment had no effect on any of the behavioral assays. Transcriptomic analysis for differential gene expression was also undertaken. Peri-operative administration of RTX, delivered in a clinically relevant manner, was efficacious in decreasing post-operative pain.

Lidocaine Pretreatment Reduces the Discomfort of Intranasal Midazolam Administration: A Randomized, Double-blind, Placebo-controlled Trial.

Intranasal (IN) midazolam is a commonly prescribed medication for pediatric sedation and anxiolysis. One of its most frequently encountered adverse effects is discomfort with administration. While it has been proposed that premedicating with lidocaine reduces this undesirable consequence, this combination has not been thoroughly researched. The objective of our study was to assess whether topical lidocaine lessens the discomfort associated with IN midazolam administration. This was a double-blind, randomized, placebo-controlled trial performed in an urban, academic pediatric emergency department. Children 6-12 years of age who were receiving IN midazolam for procedural sedation received either 4% lidocaine or 0.9% saline (placebo) via mucosal atomizer. Subjects were subsequently given IN midazolam in a similar fashion and then rated their discomfort using the Wong-Baker FACES Pain Rating Scale (WBS). The primary endpoint of WBS score was analyzed with a two-tailed Mann-Whitney U-test, with p < 0.05 considered statistically significant. Seventy-seven patients were enrolled over a consecutive 8-month period. One child was excluded from analysis due to a discrepancy in recording the drug identification number. Study groups were similar in regard to demographic information and indication for sedation. Subjects who received IN lidocaine reported less discomfort with IN midazolam administration (median WBS = 3, interquartile range [IQR] = 0-6) than those who received placebo (median WBS = 8, IQR = 2-9; p = 0.006). Premedication with topical lidocaine reduces the discomfort associated with administration of IN midazolam (ClinicalTrials.gov, NCT02396537).

Heated carrier fluids in decreasing propofol injection pain: a randomized, controlled trial.

BackgroundPropofol is a commonly used intravenous drug during anesthetic induction because of its rapid onset and short duration. However, the injection pain that patients experience is so severe that they recall the induction of anesthesia as the most painful part of the perioperative period. Therefore, the objective of this study was to determine the effect of heated carrier fluids (40℃) in decreasing propofol injection pain.MethodsA randomized, controlled clinical trial was conducted in 90 patients aged 18 to 65 who were scheduled for either elective or urgent surgery under general anesthesia classified as American Society of Anesthesiologists physical status I or II. Patients were allocated into the following 3 groups: 1) Group W (n = 30) who received 200 ml of heated carrier fluids for 20 minutes prior to propofol injection; 2) Group L (n = 30) who received 200 ml of heated carrier fluids for 20 minutes prior to 0.5 mg/kg 1%lidocaine 1 minute before propofol injection; 3) Group C (control group, n = 30) who received 200 ml of room temperature fluids prior to propofol injection. Pain was evaluated using verbal pain score (VPS).ResultsGroup W and Group L showed significant reduction (P = 0.001) in the incidence and severity of injection pain compared to Group C. VPS scores were significantly lower in Group W and Group L compared to those of Group C. Incidence of propofol injection pain was statistically different between Group W (P = 0.005) and Group L (P = 0.037) compared to Group C, but not statistically different between Group W and Group L (P = 0.432).ConclusionsBoth sole injection of heated carrier fluids and the combination of 0.5 mg/kg 1%lidocaine pretreatment effectively reduced propofol injection pain.

Evaluation of palonosetron for the prevention of pain on injection of LCT/MCT propofol: Randomized controlled comparison with lidocaine

Background: Long-chain triglyceride/medium-chain triglyceride (LCT/MCT) propofol is less painful than standard long chain triglyceride (LCT) propofol; however, there is still a need to reduce severe pain. 5-Hydroxytryptamine type 3 (5-HT3) receptor antagonists have an analgesic effect during the injection of standard LCT propofol. This study compared the incidence of moderate-to-severe injection pain with LCT/MCT propofol using pretreatment with palonosetron versus pretreatment with saline or lidocaine. Methods: This prospective, randomized double-blind study divided 98 patients scheduled for general anesthesia into three groups: control (n = 33), palonosetron (n = 32), and lidocaine (n = 33) groups. An 18-gauge intravenous catheter was inserted into the peripheral vein at the dorsum of the hand. The patient’s vein was occluded by a rubber tourniquet at mid-forearm, and we then administered 2 ml of the pretreatment drug. One minute after venous occlusion, we released the tourniquet and administered LCT/MCT propofol 2 mg/kg for 10 –15 seconds. The degree of pain on propofol injection was evaluated using a 4-point scale. Results: The incidence of moderate-to-severe pain in the control, palonosetron, and lidocaine groups was 9.1, 15.6, and 12.1%, respectively. The incidence of overall pain was lower in the lidocaine group than in the control or palonosetron group. Conclusions: Palonosetron and lidocaine pretreatment does not reduce moderate-to-severe pain on injection of 1% LCT/MCT propofol. Lidocaine pretreatment reduced the overall incidence of injection pain. (Anesth Pain Med 2016; 11: 249-254)

Neuroprotective and anti-inflammatory effects of lidocaine in kainic acid-injected rats.

Lidocaine, the most commonly used local anesthetic, inhibits glutamate release from nerve terminals. Given the involvement of glutamate neurotoxicity in the pathogenesis of various neurological disorders, this study investigated the role of lidocaine in hippocampal neuronal death and inflammatory events induced by an i.p. injection of kainic acid (KA) (15 mg/kg), a glutamate analog. The results showed that KA significantly led to neuronal death in the CA3 pyramidal layers of the hippocampus and this effect was attenuated by the systemic administration of lidocaine (0.8 or 4 mg/kg, i.p.) 30 min before KA injection. Moreover, KA-induced microglia activation and gene expression of proinflammatory cytokines, namely, interleukin-1β, interleukin-6, and tumor necrosis factor-α, in the hippocampus were reduced by the lidocaine pretreatment. Altogether, the results suggest that lidocaine can effectively treat glutamate excitotoxicity-related brain disorders.