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Cardiovascular Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Lidocaine is commonly used as a local anesthetic. This amide is also effective systemically in the treatment of ventricular and supraventricular tachycardia. Amide-type local anesthetics given for paracervical block are associated with spasm of the uterine arteries, causing decreased uterine blood flow. Lidocaine crosses the placenta quickly with fetal levels attaining approximately 50 percent of maternal levels in less than an hour (Rotmensch et al., 1983). Lidocaine’s half-life is two times longer in the fetus/neonate (3 h) than in the mother (1.5–2 h) (Brown et al., 1976). Fetal lidocaine elimination is also prolonged and may persist for up to 48 hours after birth (Garite and Briggs, 1987). IMPORTANT NOTE: most information available regarding pharmacokinetics of lidocaine in pregnant and postpartum women and newborns is from studies of regional or local anesthesia (Rotmensch et al., 1983).
Assessing and managing pain
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Lindsey Pollard, Harriet Barker
Capsaicin creams and patches are used for focal neuropathic pain, including post-shingles pain and painful diabetic neuropathy; however, they can only be prescribed under the direct supervision of a hospital consultant (NICE 2013). Capsaicin, which is the active ingredient in chilli peppers, works as a counter irritant interfering at peripheral nerve endings with substance P, a neurotransmitter involved in pain processing. Lidocaine plasters are also licensed for use in the post-shingles pain causing allodynia (skin pain to non-painful stimuli). Lidocaine works by blocking sodium at the periphery and thus preventing the electrical nerve impulse from building up. Both of these should be assessed within 2–4 weeks of commencing to assess effect and if they are of no benefit, then they should be stopped.
Pharmacology of Local Anesthetics
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2021
Pamela E. Macintyre, Stephan A. Schug
Lidocaine is available in a number of preparations: ointments, jelly, topical solutions including a spray, and formulations for injection. It has also been administered by nebulizer to obtain topical anesthesia of the upper airway and intravenously for the treatment of cardiac arrhythmias and neurpathic pain and to improve postoperative recovery of gastrointestinal (GI) function (van der Wal et al, 2016) (see Chapter 12).
Analgesic efficacy of local anesthesia during thyroid fine-needle aspiration biopsy: A PRISMA-compliant systematic review and meta-analysis of randomized controlled trials
Published in Egyptian Journal of Anaesthesia, 2023
Ebraheem Albazee, Rawan Jamal Alhubail, Mahmoud Abdelaziz Alsakka, Khaled Ahmad Al Sadder, Sabri Moussa Hammoud, Abdulrazzaq Alshakhri
Previous reports have shown that both NFIL and EMLA cream decreased the discomfort and pain related to FNAB when compared to a placebo. The primary drawback of EMLA cream is that it must be given at least an hour preceding FNAB, which may hinder its use in busy clinics. In contrast, lidocaine, provided by needle-free administration, works within one to three minutes. The quick onset and simplicity of usage reduces the amount of time needed for FNAB and allows for the frequent use of needle-free administration of lidocaine in busy facilities. The use of a needle-free delivery system was also reported to be more effective than EMLA cream, as LA with needle-free delivery of lidocaine was less time-consuming than EMLA cream. This also may contribute to the fact that the pain of needle insertion of LA may possibly be as bad as or even worse than the needle biopsies themselves, while the needle-free injection system eliminates pain related to needle insertion of LA. The targeting of the thyroid nodule for FNAB may be complicated by slight tissue swelling that develops underneath the biopsy site following the injection of lidocaine, particularly in patients with superficial nodules or nodules smaller than 10 mm. This might decrease the diagnostic yield of FNAB, which is not a problem for EMLA application [8].
Lidocaine-loaded dissolving microneedle for safe local anesthesia on oral mucosa for dental procedure
Published in Expert Opinion on Drug Delivery, 2023
Hyunkyu Lee, Hye Su Min, Mingyu Jang, Geonwoo Kang, Seongdae Gong, Chisong Lee, Young Woo Song, Ui-Won Jung, Somin Lee, Hyeon Yeol Ryu, Huisuk Yang, Hyungil Jung
In the present study, we conducted a pharmacokinetic and safety evaluation of lidocaine-loaded DMNs applied to the oral mucosa (oral Li-DMNs) that can penetrate the oral epithelial tissue. This oral Li-DMNs have a sufficiently strong penetration force to be applied to the oral mucosa. The oral Li-DMNs gradually dissolved over time and completely dissolved within 3 min to deliver lidocaine. The topical drug delivery of lidocaine and its systemic effects were compared with a gel-type local anesthetic agent. Despite a lower lidocaine dose than that of the gel-type, the oral Li-DMN delivered a concentration of 521 ± 90 µg/g lidocaine in porcine oral mucosa, which was similar to the amount delivered by the gel-type (401 ± 56 µg/g). In the pharmacokinetic study, Cmax of the oral Li-DMN was detected as 23.4 ± 3.4 ng/mL, which was lower than 522.6 ± 59.1 ng/mL of the gel-type, implying low systemic circulation. In the oral mucosa irritation test, oral Li-DMN application did not cause oral mucosal irritation. Through these studies, we demonstrated that oral Li-DMNs are a biocompatible and safe formulation for efficient local delivery of the drug to the oral mucosa, with low systemic circulation. The oral Li-DMN is a novel drug delivery system for local anesthetics that has the potential to deliver lidocaine efficiently, safely, and conveniently. Oral Li-DMNs may possibly enter the oral anesthesia market by meeting the requirements of the Food and Drug Administration (FDA).
Optimization of pleural multisite anesthetic technique during CT-guide microwave ablation of peripheral lung malignancy for improving treatment tolerance
Published in International Journal of Hyperthermia, 2022
Hao Hu, Fulei Gao, Jinhe Guo, Gaojun Teng, Zhi Wang, Bo Zhai, Rong Liu, Jiachang Chi
Our study has the following limitations. The study was retrospective, which is obviously inferior to a randomized control trial to assess this technique. Second, the area of subpleural anesthesia, which is based on the assessment of the area of thermal ablation radiation on CT images, requires injection of anesthesia at multiple subpleural sites to achieve pleural surface coverage. To some extent, subpleural puncture path can be affected by the shape of the pleura and the obstruction of anatomical structures such as ribs, which eventually lead to the insufficient drug coverage on the pleural region. The diffusion effect of drug between tissues can compensate for this deficiency to some extent. Third, lidocaine is currently used as a local anesthetic, the time interval between the effective effects of anesthesia is short. However, patients with longer operation duration, subpleural anesthesia could be injected again during the ablation period, depending on the patient's pain tolerance. Fourth, the technique requires injection at multiple subpleural sites, which increases the rate of complications such as pneumothorax and bleeding. The operator’s experience and meticulous operation can reduce the incidence of complications.