Mixture Of Lidocaine Research Articles

Lidocaine-based Topical Anesthetic With Disinfectant (LidoDin) Versus EMLA for Venipuncture

To examine the efficacy and safety of a new topical anesthetic containing a disinfection ingredient (LidoDin cream) in reducing the pain associated with venipuncture by comparing it with the proven eutectic mixture of lidocaine 2.5% and prilocaine 2.5% (EMLA cream). A single-blind, randomized, controlled trial was conducted on a study population consisting of a convenience sample of patients aged 12 to 16 years who presented at our Emergency Department between November 2007 and April 2008. The Visual Analog Scale (VAS) was used for pain assessment. Before the study, the bactericidal effect of the LidoDin cream on skin flora was tested. Twenty patients were enrolled to each arm of the study. Mean patient age was 13.6 years for the LidoDin group and 14.12 years for the EMLA group (P=0.347). Male patients accounted for 55% of the patients in the LidoDin group, compared with 40% in the EMLA group (P=0.527). Skin reaction scores of the LidoDin group for erythema and edema were not statistically different than those of the EMLA group (P=0.73 and P=0.75, respectively). Patient VAS scores and nurse VAS scores of the LidoDin group were not statistically different than those of the EMLA group (P=0.57 and P=0.93, respectively). This pilot study demonstrated that LidoDin and EMLA seem to be equally safe and effective topical anesthetics for venipuncture. Future studies are planned to determine, if LidoDin reduces the rate of local skin infection in patients treated with multiple daily subcutaneous injections of medications.

Thermodynamic studies of mixtures for topical anesthesia: Lidocaine–salol binary phase diagram

The lidocaine–salol binary system has been investigated by differential scanning calorimetry, direct visual observations, and X-ray powder diffraction, resulting in a temperature-composition phase diagram with a eutectic equilibrium. The eutectic mixture, found at 0.423 ± 0.007 lidocaine mole-fraction, melts at 18.2 ± 0.5 °C with an enthalpy of 17.3 ± 0.5 kJ mol −1. This indicates that the liquid phase around the eutectic composition is stable at room temperature. Moreover, the undercooled liquid mixture does not easily crystallize. The present binary mixture exhibits eutectic behavior similar to the prilocaine–lidocaine mixture in the widely used EMLA ® topical anesthetic preparation.

Stability of the mixture of technetium-99m human serum albumin and lidocaine hydrochloride for clinical application

To evaluate the stability of the mixture of technetium-99m (99mTc) human serum albumin (HSA) with the local anesthetic lidocaine hydrochloride. We assessed three preparations of the radiotracer, 99mTc-HSA, filtered 99mTc-HSA, and a mixture of 99mTc-HSA with lidocaine hydrochloride and then filtered. Time sequence evaluation was performed on all the specimens (n= 10) at 0, 30, 60, 90, 120, 150, and 180 min after preparation. Measurements of radiochemical purity as labeling stability and pH value change were conducted for each group of specimens. We found no definite difference in the stability before and after the filtering procedure for 99mTc-HSA. However, we showed a decline of stability in the mixture of 99mTc-HSA with lidocaine. The filtered specimens showed a relatively higher pH value, towards a more neutral status, as compared with the unfiltered specimens. Though pain relief for the patient receiving sentinel lymph node mapping is important, a preparation of a mixture of 99mTc-HSA and lidocaine may cause radiolabeling instability. Furthermore, compared with the filtered 99mTc-sulfur colloid, a filtering procedure does not change the labeling stability of the 99mTc-HSA. On the contrary, the filtered preparation was neutralized closer to the physiologic condition. For lymphoscintigraphic studies,our results suggested that pretreatment with local anesthesia followed by subdermal injection of a filtered 99mTc-HSA rather than a pre-mixture with lidocaine is appropriate for clinical application.

Effective plexus anaesthesia in a patient with Ehlers–Danlos syndrome type III

Effective plexus anaesthesia in a patient with Ehlers–Danlos syndrome type III

Horner Syndrome After Temporomandibular Joint Arthroscopy: A New Complication

A healthy 58-year-old woman had undergone arthroscopy of both temporomandibular joints because of bilateral mandibular clicks and recurrent episodes of jaw block that did not respond to nonsurgical treatment. The preoperative examination showed general restriction of mandibular motility (maximal oral aperture 26 mm, right and left lateral deviation 11 and 8 mm, respectively, protrusion 10 mm, and dental erosion without significant muscular contractures). Magnetic resonance imaging demonstrated bilateral anterior disc displacement with reduction and restricted motility of the right condyle (Fig 1). Uneventful arthroscopy of both joints was performed under general anesthesia, after conventional nasotracheal intubation. The head was placed in a donut, in a natural position, not overextended, with a mild tilt. The double puncture technique was used (first, 4 mL of a mixture of lidocaine and adrenaline was injected into the superior joint space using a 23-gauge needle, followed by continuous perfusion of lactated Ringer's solution). During the procedure, the.

Minimum Effective Volume of Local Anesthetic for Ultrasound-Guided Supraclavicular Brachial Plexus Block

The aim of this study was to determine the minimum effective anesthetic volume required to produce an effective supraclavicular block for surgical anesthesia using an ultrasound (US)-guided technique. Twenty-one adults undergoing elective upper limb surgery received a US-guided supraclavicular block. The initial volume of local anesthetic (LA; 50:50 mixture of lidocaine 2% and bupivacaine 0.5% with epinephrine) injected was 30 mL, which was subsequently varied by 5 mL for each consecutive patient according to the response of the previous patient. The minimum effective anesthetic volume in 50% of patients was determined using the Dixon and Massey up-and-down method. The effective volume in 95% of patients (ED95) was calculated using probit transformation and logistic regression. The minimum effective anesthetic volume in 50% and calculated effective volume in 95% of patients were 23 mL (95% confidence interval, 13-39 mL) and 42 mL (95% confidence interval, 19-65 mL), respectively. Seven patients received supplemental LA, with no patient requiring a general anesthetic. In this study, the minimum volume required for US-guided supraclavicular block in 50% of patients was 23 mL, and in 95% of patients was 42 mL. Under the present study conditions, the calculated volume of LA required for US-guided supraclavicular block does not seem to differ from the conventionally recommended volume required for supraclavicular blocks using non-US-based nerve localization techniques.

The Influence of a Eutectic Mixture of Lidocaine and Prilocaine on Minor Surgical Procedures

A eutectic mixture of lidocaine and prilocaine (EMLA) has been shown to be effective in reducing pain from needle sticks, including those associated with blood sampling and intravenous insertion. To evaluate the effectiveness of EMLA cream applied before needle puncture for local anesthetic administration before minor surgical procedures in this double-blind, randomized, controlled, parallel-group study. Patients were randomly assigned to receive EMLA or placebo cream (Aqueous) applied under an occlusive dressing. After the procedure, patients were asked to rate the needle prick and procedure pain on a visual analog scale (0=no pain; 10=maximum pain). A total of 94 minor surgical procedures (49 in EMLA and 45 in control) were performed. The mean needle-stick pain score in the EMLA group was significantly lower than in the control group (2.7 vs. 5.7, p<.001, Mann-Whitney U-test). There was also significantly lower procedure pain in the EMLA group than in the control group (0.83 vs. 1.86, p=.009). There were no complications associated with the use of EMLA. EMLA effectively reduces the preprocedural needle-stick pain and procedural pain associated with minor surgical procedures.

A Comparison of the Pharmacodynamics and Pharmacokinetics of Bupivacaine, Ropivacaine (with Epinephrine) and Their Equal Volume Mixtures with Lidocaine Used for Femoral and Sciatic Nerve Blocks: A Double-Blind Randomized Study

Mixtures of lidocaine with a long-acting local anesthetic are commonly used for peripheral nerve block. Few data are available regarding the safety, efficacy, or pharmacokinetics of mixtures of local anesthetics. In the current study, we compared the effects of bupivacaine 0.5% or ropivacaine 0.75% alone or in a mixed solution of equal volumes of bupivacaine 0.5% and lidocaine 2% or ropivacaine 0.75% and lidocaine 2% for surgery after femoral-sciatic peripheral nerve block. The primary end point was onset time. In a double-blind, randomized study, 82 adults scheduled for lower limb surgery received a sciatic (20 mL) and femoral (20 mL) peripheral nerve block with 0.5% bupivacaine (200 mg), a mixture of 0.5% bupivacaine 20 mL (100 mg) with 2% lidocaine (400 mg), 0.75% ropivacaine (300 mg) or a mixture of 0.75% ropivacaine 20 mL (150 mg) with 2% lidocaine (400 mg). Each solution contained epinephrine 1:200,000. Times to perform blocks, onset times (end of injection to complete sensory and motor block), duration of sensory and motor block, and morphine consumption via IV patient-controlled analgesia were compared. Venous blood samples of 5 mL were collected for determination of drug concentration at 0, 5, 15, 30, 45, 60, and 90 min after placement of the block. Patient demographics and surgical times were similar for all four groups. Sciatic onset times (sensory and motor block) were reduced by combining lidocaine with the long-acting local anesthetic. The onset of bupivacaine-lidocaine was 16 +/- 9 min versus 28 +/- 12 min for bupivacaine alone. The onset of ropivacaine-lidocaine was 16 +/- 12 min versus 23 +/- 12 for ropivacaine alone. Sensory blocks were complete for all patients within 40 min for those receiving bupivacaine-lidocaine versus 60 min for those receiving bupivacaine alone and 30 min for those receiving ropivacaine-lidocaine versus 40 min for those receiving ropivacaine alone (P < 0.05). Duration of sensory and motor block was significantly shorter in mixture groups. There was no difference among groups for visual analog scale pain scores and morphine consumption during the 48 h postoperative period, except for bupivacaine alone (median: 9 mg) versus bupivacaine-lidocaine mixture (15 mg), P < 0.01. There was no difference in the incidence of adverse events among groups. Plasma concentrations of bupivacaine and ropivacaine were higher, and remained elevated longer, in patients who received only the long-acting local anesthetic compared to patients who received the mixture of long-acting local anesthetic with lidocaine (P < 0.01). Mixtures of long-acting local anesthetics with lidocaine induced faster onset blocks of decreased duration. Whether there is a safety benefit is unclear, as the benefit of a decreased concentration of long-acting local anesthetic may be offset by the presence of a significant plasma concentration of lidocaine.

Heated lidocaine/tetracaine patch (Synera™, Rapydan™) compared with lidocaine/prilocaine cream (EMLA®) for topical anaesthesia before vascular access

We compared the lidocaine/tetracaine patch [Synera (USA), Rapydan (Europe)], a novel heat-aided patch using a eutectic mixture of lidocaine 70 mg and tetracaine 70 mg, with a eutectic mixture of lidocaine 25 mg ml(-1) and prilocaine 25 mg ml(-1) (EMLA Cream). The agents were administered at different time periods for local topical anaesthesia before a vascular access procedure. In this double-blind, paired study, 82 adult volunteers were randomized to receive the lidocaine/tetracaine patch on one anticubital surface and lidocaine/prilocaine cream on the other concurrently for 10, 20, 30, or 60 min before a vascular access procedure. Subjects rated pain intensity using a 100 mm visual analogue scale (VAS). Skin reactions and adverse events were also evaluated. Median VAS scores were significantly lower for the lidocaine/tetracaine patch than for lidocaine/prilocaine cream in the 10 min (P=0.010), 20 min (P=0.042), and 30 min (P=0.001) application groups. The lidocaine/tetracaine patch was associated with significantly more erythema than lidocaine/prilocaine cream at 20, 30, and 60 min, whereas lidocaine/prilocaine cream produced more blanching than the lidocaine/tetracaine patch at 30 and 60 min. Two subjects reported nausea and faintness associated with the vascular access procedure; one was withdrawn from the study. The lidocaine/tetracaine patch provided effective anaesthesia with an application time as short as 10 min and was better than lidocaine/prilocaine cream at all application times shorter than 60 min, demonstrating a substantial improvement in time to onset of anaesthesia. The lidocaine/tetracaine patch provided an important alternative to lidocaine/prilocaine cream for topical local anaesthesia.

Treatment of Common Warts with an Intralesional Mixture of 5-Fluorouracil, Lidocaine, and Epinephrine: A Prospective Placebo-Controlled, Double-Blind Randomized Trial

Treatment of Common Warts with an Intralesional Mixture of 5-Fluorouracil, Lidocaine, and Epinephrine: A Prospective Placebo-Controlled, Double-Blind Randomized Trial

Effects of Nasal Application of an Epinephrine and Lidocaine Mixture on the Hemodynamics and Nasal Mucosa in Oral and Maxillofacial Surgery

Our purpose was to investigate the influences of nasal pretreatment with a mixed solution of epinephrine and lidocaine (E-L pretreatment) on the systemic hemodynamics and the mucosa of the inferior nasal concha, which is carried out for expansion of the nasal cavity and the prevention of mucosal injury before nasotracheal intubation. Subjects included 29 adult patients undergoing oral and maxillofacial surgery. This study consisted of 2 parts. In part 1 (n = 18), the effects of E-L pretreatment on the systemic hemodynamics were studied before (pre-Anesth group, n = 10) and after (post-Anesth group, n = 8) induction of anesthesia. Changes of the mucosal volume and the blood flow of the inferior nasal concha also were observed by optic bronchoscopy and noncontact type laser-Doppler flowmetry, respectively. In part 2 (n = 11), changes in the serum concentrations of epinephrine and lidocaine after the E-L pretreatment were determined by high performance liquid chromatography and enzyme immunoassay, respectively. The heart rate increased at 2 and 3 min after E-L pretreatment in pre-Anesth group (P < .05), but not in post-Anesth group. The cross section of the nasal cavity decreased from 66% to 42% (n = 8, P < .05). The mucosal blood flow decreased from 60 to 22 AU (n = 8, P < .01). The serum epinephrine concentration increased from 24 to 185 pg/mL. The E-L pretreatment provided characteristic evidence for useful expansion of the nasal cavity and for reduction of the nasal mucosal blood flow with less systemic hemodynamic effects, although further investigation is needed for the determination of the proper epinephrine concentration in E-L pretreatment.

Cardiopulmonary arrest and resuscitation following an extradural injection in a normovolemic dog

AbstractObjective – To describe general anesthesia and successful resuscitation of a dog developing asystole and apnea during extradural injection of local anesthetic and an opioid.Case Summary – A Beagle with a ruptured cranial cruciate was premedicated with acepromazine and methadone. Anesthesia was induced with propofol and, after endotracheal intubation, maintained using isoflurane in oxygen. During extradural injection of a mixture of lidocaine, bupivacaine, and morphine the dog developed apnea and asystole. Cardiopulmonary cerebral resuscitation was started promptly and the dog was successfully resuscitated.New Information Provided – Asystole and apnea are possible serious side effects of extradural anesthesia in dogs. With adequate monitoring and early detection successful resuscitation is possible.

Measurement of surgical stress in anaesthetized children

BackgroundThe surgical stress index (SSI), derived from a combination of heart rate (HR) and photoplethysmographic amplitude (PPGA) time series, is a novel method for continuous monitoring of intraoperative stress and has been validated in adults. The applicability of SSI and its constituents to monitoring children has not been previously evaluated. MethodsIn this controlled trial, 22 anaesthetized patients, aged 4–17 yr, undergoing strabismus surgery were randomized into two groups, Group LL and Group BSS. Patients in Group LL received topical conjunctival anaesthesia with a 1:1 mixture of lidocaine 2% and levobupivacaine 0.75%, and patients in Group BSS received balanced salt solution. ResultsEndotracheal intubation (n=22) increased median (range) SSI from 39.2 (22.6–55.6) to 53.6 (35.8–63.3) (P<0.001), decreased PPGA from 5.62 (2.79–9.69) to 5.27 (2.59–7.54)% (P=0.001), and increased the difference of response entropy (RE) and state entropy (SE) of frontal biopotentials (RE−SE) from 3.1 (0.06–9.1) to 5.7 (0.6–9.4) (P=0.01). Conventional haemodynamic variables also increased, median (range) HR from 72.9 (56.7–113.8) to 84.2 (60.4–124.8) beats min−1 (P<0.001), and systolic non-invasive arterial pressure (S-NIBP) from 87 (78–143) to 103 (79–125) (P=0.007). When 3 min baseline before surgery was compared with 12 min of surgery, median (range) SSI increased from 43.3 (31.2–58.0) to 49.9 (39.3–57.2) (P=0.042) vs from 46.6 (26.8–57.8) to 52.1 (31.7–60.1) (P=0.024) and PPGA decreased from 6.60 (3.10–8.24) to 5.80 (3.03–7.65)% (P<0.001) vs from 5.51 (3.25–9.84) to 5.06 (3.08–8.99)% (P=0.042), in Groups LL and BSS, respectively, but SSI or other indicators did not differ significantly between the groups. ConclusionsSSI, PPGA, HR, NIBP, RE, and RE−SE detect autonomic responses to nociceptive stimuli in anaesthetized children undergoing strabismus surgery.

Relieving the Pain of Sentinel Lymph Node Biopsy Tracer Injection

Sentinel lymph node biopsy (SLNB) has been reliably accurate as a minimally invasive surgical alternative for identifying lymphatic breast metastasis. During mapping, the injection of a radioactive tracer or isosulfan blue dye to differentiate the SLN is acutely painful. The use of the eutectic mixture of lidocaine and prilocaine (EMLA) cream to reduce tracer injection pain has been reported anecdotally. A retrospective study compared injection discomfort of 20 women who had undergone SLNB without EMLA and 20 women who had undergone SLNB with the EMLA protocol. Results indicated a significant difference in mean pain rating. Standards of care should include the use of EMLA prior to intradermal SLN tracer injection unless contraindicated.

A Randomized, Double-Blind Comparison of Two Topical Anesthesic Formulations Prior to Electrodesiccation of Dermatosis Papulosa Nigra

Liposomal lidocaine 4% (L.M.X.4 cream, Ferndale Laboratories Inc., Ferndale, MI, USA) has been proposed as a more rapidly acting topical anesthetic than the eutectic mixture of lidocaine 2.5% and prilocaine 2.5% (EMLA cream, AstraZeneca LP, Wilmington, DE, USA) for venipuncture and laser procedures. However, their anesthetic efficacy has not been previously compared for electrosurgical destruction of superficial skin lesions. To test the hypothesis that L.M.X.4 and EMLA differ in anesthetic efficacy when applied under occlusion for 30 minutes prior to electrodesiccation of papules of dermatosis papulosa nigra. Forty adults were randomly assigned to treatment with either agent for 30 minutes under Tegaderm. The study drug was administered for an additional 30 minutes if the electrodesiccation of the first few papules was too painful. One subject treated with EMLA versus none treated with L.M.X.4 experienced complete anesthesia after a single 30-minute application. Nineteen of 20 (95%) subjects treated with EMLA versus 18 of 20 (90%) subjects treated with L.M.X.4 required only a single application (p = .49). Pain scores after the initial 30-minute application (scale: 0 = none to 10 = very severe) were EMLA 3.3 +/- 2.2 (mean +/- SD) versus L.M.X. 4 2.9 +/- 2.0 (p = .46). EMLA and L.M.X.4 provide comparable levels of anesthesia after a single 30-minute application under occlusion prior to electrodesiccation of superficial skin lesions.

Treatment of Common Warts with an Intralesional Mixture of 5-Fluorouracil, Lidocaine, and Epinephrine

Treatment of Common Warts with an Intralesional Mixture of 5-Fluorouracil, Lidocaine, and Epinephrine

Prolonged cutaneous analgesia in rats induced by 3‐acetylaconitine as an additive

Abstract3‐Acetylaconitine (3AA) is an “aconitine‐like” plant alkaloid that has been used as an analgesic agent for the treatment of chronic pain and rheumatoid arthritis in China. Aconitine‐like alkaloids appear to target the CNS for their analgesic action, although they also display local anesthetic properties. We tested whether 3AA prolonged cutaneous analgesia in rats when co‐injected with lidocaine (0.5%) and epinephrine (1:200,000), a mixture commonly used in infiltration anesthesia. Inhibition of the cutaneous trunci muscle reflex was evaluated quantitatively by pinpricks applied to the injected area. Co‐injection of lidocaine and epinephrine with 3AA ranging within 50–125 µM elicited complete cutaneous analgesia in vivo lasting 3–12 h, and full recovery occurred after ∼5–8 days in a 3AA concentration‐dependent manner. In contrast, cutaneous analgesia induced by the mixture of lidocaine and epinephrine or by 3AA alone in rats was significantly shorter. No adverse systemic effects or local toxicities were evident after injection of 3AA as an additive. Our results suggest that “aconitine‐like” alkaloids could be exploited as an additive for long‐lasting cutaneous analgesia. Drug Dev Res 69: 83–88, 2008. © 2008 Wiley‐Liss, Inc.

Brief report: A randomized controlled trial of Synera™ versus lidocaine for epidural needle insertion in labouring parturients

Skin infiltration with lidocaine, although brief, can be very stressful, painful, and may perpetuate anxiety. Synerat, a local anesthetic patch, which contains an oxygen-activated heating component to enhance the delivery of a eutectic mixture of lidocaine (70 mg) and tetracaine (70 mg), has provided analgesia for minor, dermatological procedures. We hypothesized that the analgesic effect of Synera, for pain in labouring parturients, would be superior to the traditional infiltration of lidocaine prior to epidural needle insertion.With Institutional Review Board approval, we recruited women, who consented to epidural labour analgesia and who met the following criteria: older than 18 yr; body mass index less than 45 kg x m(-2); and with no history of hypersensitivity to any study medications. We randomized the labouring parturients into Synera (SS) or placebo (PL) groups. Group SS received the Synera patch and infiltration with saline prior to epidural needle insertion. Group PL received a placebo patch and infiltration with 2% lidocaine.The groups were similar with respect to age, estimated gestational age, gravidity, parity, and body mass index. The subjects' pain, with epidural placement, was significantly greater in the SS group (P < 0.001). More SS subjects required additional, deep, local anesthetic infiltration compared to PL (P = 0.02).The Synera patch provided inferior analgesia, for performing epidural labour analgesia in labouring parturients, compared to traditional infiltration with 2% lidocaine.

Treatment of Common Warts with an Intralesional Mixture of 5-Fluorouracil, Lidocaine, and Epinephrine: A Prospective Placebo-Controlled, Double-Blind Randomized Trial

5-Fluorouracil is an antimetabolite that has been known to be effective for the treatment of common warts. The objective was to evaluate the efficacy of a combination of 5-fluorouracil, lidocaine, and epinephrine (5-FU+LE) for the treatment of common warts. Of the 40 patients initially enrolled, 34 patients with at least 68 verruca vulgaris (one pair for each subject) completed the study. The selected warts were randomized into two treatment groups, with one wart on each patient receiving intralesional 5-FU+LE (4 mL of 50 mg/mL 5-fluorouracil and 1 mL of a mixture of 20 mg/mL [2%] lidocaine and 0.0125 mg/mL epinephrine) and the other receiving intralesional normal saline placebo using a Mantoux needle. Patients received up to four injections at weekly intervals and were followed at 1 and 6 months after the initial injection. Complete response was observed in 64.7% of the warts treated with 5-FU+LE compared to 35.3% in the warts treated with placebo (p<.05). Systemic reaction or treatment-related adverse medical events and recurrence rate did not differ significantly between two groups. The results show that intralesional 5-FU+LE is a safe and effective approach for common warts with high success rate.

Comparison of 4% articaine and 0.5% levobupivacaine/2% lidocaine mixture for sub-Tenon’s anaesthesia in phacoemulsification cataract surgery: a randomised controlled trial

Backgound/aims:The aim of this study was to compare the efficacy and safety of 4% articaine with a mixture containing equal volumes of 2% lidocaine and 0.5% levobupivacaine without hyaluronidase for...