Beneficial effect of intravenous lidocaine in cutaneous chronic graft-versus-host disease secondary to donor lymphocyte infusion
Voltarelli JcHeshu Jalal AhmedEJA PatonAna Beatriz P. L. StracieriPeter HolmanAsad BasheyMário Sérgio Soares de Azeredo CoutinhoBP SimõesED BallEwa Carrier
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Refractory (planetary science)
Scleroderma (fungus)
Summary: Purpose: We report the successful management of a 10‐year‐old girl with intractable frontal lobe epilepsy by using lidocaine tapes and continuous subcutaneous lidocaine infusion. Methods: This patient's seizures were refractory to conventional antiepileptic drugs (AEDs) and mexiletine, but they responded well to the intravenous infusion of lidocaine. The intravenous infusion of lidocaine was replaced by lidocaine tape therapy, and subsequently by continuous subcutaneous lidocaine infusion therapy. The lidocaine tape (Penles, Nihon Lederle, Tokyo Japan) used was a stamp‐sized (30.5 × 50.0 mm) tape containing 18 mg of lidocaine. We used 25 lidocaine tapes every 12 h (50 tapes/day). Lidocaine hydrochloride (10%) was administered continuously at a dose of 1.5 mg/kg/h (0.3 ml/hour) through a 27‐G needle that was inserted in the subcutaneous tissue. Results: Lidocaine tape therapy showed good efficacy for 1 year. After that, six lidocaine tapes were added 6 h after the exchange of 25 lidocaine tapes [62 tapes/day (25,6,25,6)], because the seizures became frequent when the lidocaine tapes were being exchanged. The seizures were then well controlled, but dermatitis due to the lidocaine tapes grew serious, and lidocaine tape therapy had to be stopped. Continuous subcutaneous infusion of lidocaine applied in place of lidocaine tapes provided long‐term seizure control without remarkable side effects. Conclusions: Lidocaine tape therapy and continuous subcutaneous lidocaine infusion therapy were considered to be useful for controlling this patient's seizures. This is the first report to describe the efficacy of continuous subcutaneous lidocaine infusion therapy for epilepsy.
Lidocaine Hydrochloride
Subcutaneous injection
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Transdermal absorption of lidocaine was determined by measuring plasma lidocaine concentrations following skin application of 5% lidocaine patches. Two lidocaine patches were placed on the ventral abdominal midline of seven dogs for 72 hours. Lidocaine was detectable in plasma 12 hours after patch application, and it reached steady-state concentrations between 24 and 48 hours. Plasma lidocaine levels decreased dramatically at 60 hours post-application. Low plasma lidocaine concentrations remained for 6 hours after patch removal. No clinically significant side effects were noted.
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High doses of lidocaine are administered to patients undergoing liposuction. Monoethylglycinexylidide, the active metabolite of lidocaine, is 80 to 90 percent as potent as lidocaine, and its relative toxicity is approximately that of lidocaine. Monoethylglycinexylidide has not previously been measured in studies on lidocaine in liposuction. The aims of this study were to characterize systemic exposure to lidocaine and monoethylglycinexylidide and to measure lidocaine and monoethylglycinexylidide levels within the tissues. Five female volunteers between the ages of 29 and 40 years underwent liposuction. Lidocaine (1577 to 2143 mg, corresponding to 19.9 to 27.6 mg/kg) was infiltrated during the procedure. Levels of lidocaine and monoethylglycinexylidide in blood and lipoaspirate were assessed perioperatively. Tissue lidocaine and monoethylglycinexylidide levels were measured postoperatively using a microdialysis technique in vivo. The peak (maximal) concentration of lidocaine plus monoethylglycinexylidide was 2.2 to 2.7 microg/ml. Time to peak lidocaine plus monoethylglycinexylidide was 8 to 28 hours after infiltration began. Absorbed lidocaine was estimated to be 911 to 1596 mg; therefore, 45 to 93 percent (mean, 64 percent) of the infiltrated dose was ultimately absorbed. Lipoaspirate analysis showed that 9.1 to 10.8 percent (mean, 9.7 percent) of the infiltrated dose was removed during the procedure. Tissue lidocaine levels below 5 microg/ml were demonstrated from 4 to 8 hours postoperatively. The peak lidocaine plus monoethylglycinexylidide concentration was within safe limits in this group of subjects. Time to peak lidocaine plus monoethylglycinexylidide signifies a delayed peak and therefore a longer period of potential lidocaine toxicity than was originally thought. Microdialysis results demonstrated that tissue lidocaine levels may be subtherapeutic within 4 to 8 hours of the procedure. Investigation into factors controlling the resorption of lidocaine during liposuction is warranted in an effort to improve the duration of effect. Furthermore, considering the active metabolite monoethylglycinexylidide, longitudinal studies are necessary to determine whether improving the side effect profile of lidocaine by reducing the dose administered during liposuction may be possible without decreasing the perioperative analgesic effect.
Microdialysis
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Microstructural Change of Muscle Damage and Regeneration Following Intramuscular Lidocaine Injection
일반적으로 근육과 인대를 치료할 때 여러 가지 물리치료를 시행하는데, 치과분야에서도 물리치료를 시행하고 있다. 이 중 국소마취제가 포함된 근육 내 주사요법은 근막 발통점을 화학적, 기계적으로 분쇄시킴으로써 근육통의 발통점을 종식시키는 치료로 그 방법에 대한 논란이 계속되어 왔다. 이에 백서 대퇴근과 상완근에 다양한 농도의 국소마취제인 lidocaine이 포함된 근육 내 주사요법을 시행한 후 그 조직손상 및 치유과정을 현미경적으로 관찰함으로써 그 효과에 대하여 과학적으로 확인하고자 하였다. 본 연구에서는 270g 내외의 생후 7주된 Sprague-Dawley계 웅성 백서의 대퇴근과 상완근에 각각 생리식염수,0.5%, 1%, 2%, 4%의 lidocaine을 주사하였다. 그 후 3일, 7일, 14일째에 회생하여 실험부위를 각각 절취 한 후 표본을 만들어 광학현미경으로 관찰하였으며, 그 결과는 다음과 같다. 1. 생리식염수를 주사한 모든 군의 조직에서는 별다른 병리조직학적 변화가 관찰되지 않았다. 2. 실험 3일군에서 1% 이상의 lidocaine을 주사한 근육에서 림프구가 침윤되었고 모세혈관이 증식 되었으며,lidocaine의 농도가 증가됨에 따라 염증반응이 심화되었다. 3. 실험 3일군과 7일군 모두, 2%와 4% lidocaine을 주사한 실험군에서 일련의 염증반응과 함께 근 섬유 다발의 해리현상이 관찰되었다. 4. 실험 7일군에서는 1% 이상의 lidocaine을 주사한 근육에서 반흔조직이 뚜렷이 관찰되었다. 5. 0.5%, 1%의 lidocaine을 주사한 실험 14일군에서는 별다른 병리조직학적 변화가 관찰되지 않았다. 6. 2%의 lidocaine을 주사한 실험 14일군에서는 eosin에 강하게 염색되는 다수의 근섬유가 관찰되었고, 4%의 lidocaine을 주사한 실험군에서는 반흔조직이 뚜렷이 관찰되었다. 이상의 결과로, lidocaine이 포함된 근육 내 주사 시 조직의 변화 즉, 육아조직 형성 및 근섬유의 해리, 반흔조직의 형성을 관찰할 수 있었으며, 이러한 조직의 반응은 lidocaine의 농도가 1% 이상에서 뚜렷하게 관찰되었다. 또한 1% 이상의 lidocaine을 주사한 조직에서 형성된 반흔조직은 14일 이후에도 소실되지 않고 뚜렷하게 관찰할 수 있었다. 따라서 근육에 lidocaine을 사용한 주사법을 시행할 경우 1%이내의 농도로 사용하여야 할 것으로 생각된다.
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We read with interest the study on airway topicalisation in morbidly obese patients by Wieczorck et al. using atomised lidocaine [1]. They state in their method that the lidocaine was delivered via an atomiser but did not include a schematic diagram or photograph to illustrate this equipment or show how it was used. The atomiser was used to deliver 40 ml of lidocaine 2% to one group of patients and 40 ml of 4% to the other. The latter group received a total dose of 1600 mg of lidocaine. The mean body weight of this group was 151.8 kg, who received, therefore, 10.54 mg.kg−1 of lidocaine. The British Thoracic Society guidelines for flexible bronchoscopy recommend a total dose of topical lidocaine of no more than 8.2 mg.kg−1 [2]. The authors clearly describe how they measured the plasma lidocaine concentrations by means of arterial blood sampling. They report the peak plasma lidocaine level as 6.5 μg.ml−1 in the 4% group. At this level, other studies have reported features of lidocaine toxicity, with some early symptoms being seen at 4 μg.ml−1 [3]. We would be interested to know more precisely the method of administration and the origin of the dose of lidocaine administered to patients in this study.
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หลกการและวตถประสงค : หลงการผ าตดส องกล องในจมกผ ป วย มกไดรบการใสวสดหามเลอดอยางนอยประมาณ 24 ชวโมง จงนาเอาวสดนออก ซงพบวามอาการปวด ดงนน การศกษาน ต องการประเมนประสทธภาพของ 4% lidocaine ในการลดอาการ ปวดน วธการศกษา: การศกษาเชงทดลองแบบสม ในผปวยทรบการ ผาตดสองกลองในจมกทโรงพยาบาลศรนครนทร ตงแตวนท 4 สงหาคม 2554 ถง 15 พฤศจกายน 2555 แบ งเป น กล มทดลองใช 4% lidocaine และ กล มควบคมใช 0.9% normal saline หยดลงบน วสดหามเลอดกอนนาเอาวสดออก โดยแพทยและผปวยไมทราบ ชนดของสาร ผ ป วยจะถกประเมนระดบความปวดก อน และระหว าง นาเอาวสดออก ผลการศกษา: ผ ป วย 60 ราย มอายระหว าง 21-74 ป ก อนนาเอา วสดออกผปวย 52 รายมระดบความปวดนอย และ 8 รายม ความปวดปานกลาง ในผปวยทมความปวดนอยกอนนาเอาวสด ออกพบว า กล มท ได รบ normal saline มอาการปวดเพ มข นน อยกว า (p = 0.142) ซงตางจากผปวยทมความปวดปานกลางพบวา กล มท ได รบ lidocaine มอาการปวดเพ มข นน อยกว า (p = 0.089) และไม พบว ามผลข างเคยงรนแรงจาก lidocaine สรป: การหยด 4% lidocaine ลงบนวสดหามเลอดนนพบวา ในกล มผ ป วยท มอาการปวดปานกลางมแนวโน มท จะสามารถลดอาการ ปวดได แตไมมนยสาคญทางสถต อยางไรกตามเนองจากผปวย ในกล มน มจานวนน อย จงควรมการศกษาเพ มเตมต อไป คาสาคญ: การหามเลอดออกจากจมก, อาการปวด, การผาตด ส องกล องภายในโพรงจมก, Lidocaine
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Lidocaine Hydrochloride
Volunteer
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background The safe upper limit of lidocaine dosage in tumescent anesthesia for liposuction has been reported to be 35 mg/kg. objective This study was undertaken to: 1) evaluate the safety of tumescent anesthesia in liposuction when lidocaine doses greater than 35 mg/kg are required, 2) determine the time interval when the peak plasma lidocaine level occurs following administration of tumescent anesthesia, and 3) assess if the safety of large volume tumescent anesthesia is due to significant lidocaine removed by liposuction. methods Sixty patients who underwent liposuction with a mean lidocaine dose of 57 mg/kg were prospectively evaluated for development of any signs or symptoms of lidocaine toxicity by multiple interviews over a 24-hour period. In addition, another 20 patients who received a mean lidocaine dose of 55 mg/kg had serial plasma lidocaine level measurements over a 24-hour period following liposuction. The lidocaine level of the aspirate was also measured to assess any significant lidocaine removed by liposuction. results No evidence of lidocaine toxicity was found based on subjective evaluation of 60 patients as well as determined by plasma sampling of 10 patients. The peak plasma lidocaine concentration occurred at approximately 4 or 8 hours after infusion of tumescent anesthesia. The 24-hour plasma lidocaine level suggests that residual lidocaine is present in the subcutaneous tissue allowing for postoperative analgesia beyond this time. A negligible amount of lidocaine was removed by liposuction as determined by the lidocaine level of the aspirate. conclusion This study suggests that tumescent anesthesia with a total lidocaine dose of up to 55 mg/kg is safe for use in liposuction.
Liposuction
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Interstitial cystitis (IC), sometimes referred to as IC/bladder pain syndrome, is a substantial health care problem. Once considered a rare, orphan disease, it is now believed to be relatively common. This pilot study was undertaken to determine if the combination of heparin and alkalinized lidocaine (heparin-lidocaine) was more efficacious than alkalinized lidocaine at relieving pain and urgency symptoms associated with IC and also capable of yielding higher lidocaine absorption.A single blind study was conducted on 14 IC patients with a heparin-lidocaine combination versus alkalinized lidocaine instilled intravesically. In a separate study serum lidocaine levels for heparin-alkalinized lidocaine combination versus USP lidocaine only were determined by high performance liquid chromatography.Alkalinized lidocaine and heparin have been reported to provide relief from pain and urgency symptoms associated with IC. The heparin-lidocaine combination significantly reduced the % of bladder pain (38% versus 13%, p = 0.029) and urgency (42% versus 8% p = 0.003) compared to lidocaine. In addition the GAR was significantly better for the heparin-lidocaine combination at both 1 hr % improved (77% versus 50%, p = 0.04) and 24 hrs (57% versus 23%, p = 0.002) after study drug treatment. Serum lidocaine levels for the heparin-lidocaine combination were significantly higher compared to USP lidocaine (unalkalinized). The mean +/- SEM was 0.45 +/- 0.09 µg/mL and 0.20 +/- 0.05 µg/mL, respectively (p = 0.019).In this pilot study the heparin-lidocaine combination results in significantly better relief of IC symptoms compared to alkalinized lidocaine and the combination yields higher lidocaine absorption than USP lidocaine.
Bladder Pain Syndrome
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Refractory (planetary science)
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