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Chin J, Kaneshiro B, Elia J, Raidoo S, Savala M, Soon R. Buffered lidocaine for paracervical blocks in first-trimester abortions: a randomized controlled trial. Contracept X 2020; 2:100044. [PMID: 33196038 PMCID: PMC7644856 DOI: 10.1016/j.conx.2020.100044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/27/2020] [Accepted: 10/07/2020] [Indexed: 11/30/2022] Open
Abstract
Objective The objective was to evaluate if buffered lidocaine decreases injection pain as compared to plain lidocaine for paracervical blocks during first-trimester outpatient surgical abortions. Study design We conducted a randomized, double-blind, placebo-controlled trial among women undergoing outpatient uterine aspiration of a first-trimester pregnancy or an early pregnancy loss. Subjects received a paracervical block with either lidocaine 1% 20 mL or lidocaine 1% 18 mL plus sodium bicarbonate 8.4% 2 mL. The primary outcome was pain from injection of the paracervical block measured on a 100-mm visual analog scale (VAS). Secondary outcomes included pain after cervical dilation, uterine aspiration and overall satisfaction with pain control. Scores were compared using the Mann–Whitney U test. We aimed to detect a 15-mm difference in pain from injection of the paracervical block. Results From May 2017 to October 2018, 48 women received plain lidocaine and 50 women received buffered lidocaine. Groups were similar in demographics. We found no clinically or statistically meaningful difference in pain when evaluating median VAS scores for paracervical block injection between the buffered and plain lidocaine [30.0 (interquartile range (IQR) 15.3–64.5); 44.5 (IQR 18.3–65), respectively, p = .32]. We found no difference in secondary outcomes between buffered and plain lidocaine. Conclusion Buffered lidocaine for paracervical blocks in first-trimester outpatient surgical abortions does not decrease injection pain as compared to plain lidocaine. Implications statement Buffering the paracervical block in first-trimester outpatient surgical abortions does not decrease injection pain as compared to plain lidocaine, nor does it increase patient satisfaction. Eliminating sodium bicarbonate allows for a more cost-effective and readily available solution for paracervical blocks.
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Affiliation(s)
- Jennifer Chin
- University of Hawaii, Department of Obstetrics, Gynecology, and Women's Health, 1319 Punahou St., Suite 824, Honolulu, HI 96826, USA
| | - Bliss Kaneshiro
- University of Hawaii, Department of Obstetrics, Gynecology, and Women's Health, 1319 Punahou St., Suite 824, Honolulu, HI 96826, USA
| | - Jennifer Elia
- University of Hawaii, Department of Obstetrics, Gynecology, and Women's Health, 1319 Punahou St., Suite 824, Honolulu, HI 96826, USA
| | - Shandhini Raidoo
- University of Hawaii, Department of Obstetrics, Gynecology, and Women's Health, 1319 Punahou St., Suite 824, Honolulu, HI 96826, USA
| | - Michael Savala
- University of Hawaii, Department of Obstetrics, Gynecology, and Women's Health, 1319 Punahou St., Suite 824, Honolulu, HI 96826, USA
| | - Reni Soon
- University of Hawaii, Department of Obstetrics, Gynecology, and Women's Health, 1319 Punahou St., Suite 824, Honolulu, HI 96826, USA
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Kaur S, Dhawan J, Gupta R, Chawla S. Comparison of Magnesium Sulfate and Ketamine with Ropivacaine in Supraclavicular Brachial Plexus Block: A Randomized Controlled Trial. Anesth Essays Res 2020; 14:143-148. [PMID: 32843808 PMCID: PMC7428122 DOI: 10.4103/aer.aer_96_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 06/17/2019] [Accepted: 06/20/2019] [Indexed: 11/16/2022] Open
Abstract
Background: Supraclavicular brachial plexus block offers good operating conditions with limited postoperative analgesia. Magnesium sulfate (MgSO4) and ketamine block peripheral nociception mediated via N-methyl-D-aspartate receptors. Aims: The aim of this study was to evaluate the effect of MgSO4 and ketamine on the duration of analgesia in brachial block. Settings and Design: This was a prospective, randomized, controlled double-blind study. Materials and Methods: One hundred and five adult patients were randomly divided into three groups: Group I = 27 mL of 0.5% ropivacaine; Group II = 27 mL of 0.5% ropivacaine + 250 mg MgSO4; and Group II = 27 mL of 0.5% ropivacaine + 2 mg.kg−1 ketamine. Normal saline was added to make a total volume of 30 mL. The onset and duration of the sensorimotor blockade, quality and duration of postoperative analgesia, and adverse effects were assessed. Statistical Analysis: Statistical analysis was performed using SPSS, version 17.0 software (SPSS, Inc., Chicago, IL, USA). Chi-square test was used for nonparametric and ANOVA for parametric data. Post hoc Student's paired t-test was applied wherever indicated. The results were expressed as mean and standard deviation or numbers (%). P < 0.05 was considered as statistically significant. Results: The duration of analgesia was significantly longer in Group II (8.78 ± 0.97 h) compared to Group I (6.76 ± 0.92 h; P < 0.001) and Group III (7.1 ± 0.89 h; P < 0.001). Intervention groups had lower postoperative visual analog scores at 8, 12, and 24 h compared to the control group. Sedation, nystagmus, and hallucinations were observed in Group III. Conclusion: The addition of MgSO4 to ropivacaine in supraclavicular brachial plexus block significantly prolongs the duration of analgesia. MgSO4 improves the quality of postoperative analgesia with lesser incidence of side effects when compared to ketamine.
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Affiliation(s)
- Shubhdeep Kaur
- Department of Anaesthesia, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India
| | - Jonny Dhawan
- Department of Anaesthesia, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India
| | - Ruchi Gupta
- Department of Anaesthesia, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India
| | - Sunil Chawla
- Department of Anaesthesia, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India
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Li H, Cheng Y, Li J, Chen Y, Yuan J, Yang S, Shi H, Li W, Yang S, Wang W, Xu G, Zhao S. NaHCO3-Buffered Lidocaine Gel for Outpatient Rigid Cystoscopy in Men. J Perianesth Nurs 2016; 31:154-7. [PMID: 27037169 DOI: 10.1016/j.jopan.2014.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 03/08/2014] [Accepted: 05/19/2014] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to explore the effect of NaHCO3-buffered lidocaine gel as a topical anesthetic agent for pain relief for rigid cystoscopy. DESIGN Prospective randomized controlled trial. METHODS ASA I-II male patients undergoing rigid cystoscopy randomly received 10 mL 2% Carbocaine lidocaine gel with 1 mL 0.9% saline (group 1) or 1 mL 5% NaHCO3 solution (group 2). After 3 minutes exposure, the cystoscope was inserted into the urethra. On receiving the gel, cystoscope insertion, and intravesical observation, pain score was recorded using the visual analog scale. FINDINGS The gel pH with or without NaHCO3 was 7.20 and 6.41, respectively. The concentration of soluble lidocaine in the gel was stable for 24 hours or more. The visual analog scale score in group 2 was significantly lower (1.3 ± 0.9) than in group 1 (5.28 ± 1.99). No adverse effects were recorded. CONCLUSION Alkalized lidocaine gel resulted in successful analgesia for rigid cystoscopy in men without adverse effects.
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Cepeda MS, Tzortzopoulou A, Thackrey M, Hudcova J, Arora Gandhi P, Schumann R. WITHDRAWN: Adjusting the pH of lidocaine for reducing pain on injection. Cochrane Database Syst Rev 2015; 2015:CD006581. [PMID: 25993661 PMCID: PMC10641661 DOI: 10.1002/14651858.cd006581.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
May 2015 This review was originally published in 2010 and at that time complied with Cochrane’s Commercial Sponsorship Policy. The Commercial Sponsorship policy was updated in 2014 (http://community.cochrane.org/organisational‐policy‐manual/appendix‐5‐commercial‐sponsorship‐policy ). This review is no longer compliant with that policy. The non conflicted members of the original team of authors have decided not to update the review. We have therefore decided to withdraw the review and seek new authors to update it The editorial group responsible for this previously published document have withdrawn it from publication.
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Affiliation(s)
- M Soledad Cepeda
- Johnson & Johnson Pharmaceutical Research and DevelopmentPharmacoepidemiologyPO BOX 200, M/S K304TitussvilleNJUSA08560
| | - Aikaterini Tzortzopoulou
- Tufts Medical CenterDepartment of Anesthesiology800 Washington streetBostonMassachusettsUSA02111
| | - Michael Thackrey
- University of California, San FranciscoFamily and Community MedicineFamily Health Center995 Potrero Avenue, Ward 83San FranciscoCaliforniaUSA94110
| | - Jana Hudcova
- Lahey ClinicDepartment of Surgical Critical Care41 Mall RoadBurlingtonMassachusettsUSA01805
| | - Preeti Arora Gandhi
- Tufts Medical CenterDepartment of Anesthesiology800 Washington streetBostonMassachusettsUSA02111
| | - Roman Schumann
- Tufts Medical CenterDepartment of Anesthesiology800 Washington streetBostonMassachusettsUSA02111
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Opperer M, Gerner P, Memtsoudis SG. Additives to local anesthetics for peripheral nerve blocks or local anesthesia: a review of the literature. Pain Manag 2015; 5:117-28. [DOI: 10.2217/pmt.15.2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
SUMMARY A multitude of studies have focused on individual additives to local anesthetics and their effect on quality, onset, duration, spread and selectivity, as well as the potential toxic effects of their use. This review aims to give a broad overview of the current evidence in this developing field, based on beneficial and adverse effects of these drugs. We discuss the limitations of the available data and hope to convey implications and future perspectives for clinicians and researchers alike.
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Affiliation(s)
- Mathias Opperer
- Department of Anesthesiology, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
- Department of Anesthesiology, Paracelsus Medical University, Müllnerhauptstraße 48, 5020 Salzburg, Austria
| | - Peter Gerner
- Department of Anesthesiology, Paracelsus Medical University, Müllnerhauptstraße 48, 5020 Salzburg, Austria
| | - Stavros G Memtsoudis
- Department of Anesthesiology, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
- Department of Anesthesiology, Paracelsus Medical University, Müllnerhauptstraße 48, 5020 Salzburg, Austria
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Cepeda MS, Tzortzopoulou A, Thackrey M, Hudcova J, Arora Gandhi P, Schumann R. Adjusting the pH of lidocaine for reducing pain on injection. Cochrane Database Syst Rev 2010:CD006581. [PMID: 21154371 DOI: 10.1002/14651858.cd006581.pub2] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Lidocaine administration produces pain due to its acidic pH. OBJECTIVES The objective of this review was to determine if adjusting the pH of lidocaine had any effect on pain resulting from non-intravascular injections in adults and children. We tested the hypothesis that adjusting the pH of lidocaine solution to a level closer to the physiologic pH reduces this pain. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, to June 2010); Ovid MEDLINE (1966 to June 2010); EMBASE (1988 to June 2010); LILACS (1982 to June 2010); CINAHL (1982 to June 2010); ISI Web of Science (1999 to June 2010); and abstracts of the meetings of the American Society of Anesthesiologists (ASA). We checked the full articles of selected titles. We did not apply any language restrictions. SELECTION CRITERIA We included double-blinded, randomized controlled trials that compared pH-adjusted lidocaine with unadjusted lidocaine. We evaluated pain at the injection site, satisfaction and adverse events. We excluded studies in healthy volunteers. DATA COLLECTION AND ANALYSIS We separately analysed parallel-group and crossover trials; trials that evaluated lidocaine with or without epinephrine; and trials with pH-adjusted lidocaine solutions < 7.35 and ≥ 7.35. To explain heterogeneity, we separately analysed studies with a low and higher risk of bias due to the level of allocation concealment; studies that employed a low and a higher volume of injection; and studies that used lidocaine for different types of procedures. MAIN RESULTS We included 23 studies of which 10 had a parallel design and 13 were crossover studies. Eight of the 23 studies had moderate to high risk of bias due to the level of allocation concealment.Pain associated with the infiltration of buffered lidocaine was less than the pain associated with infiltration of unbuffered lidocaine in both parallel and crossover trials. In the crossover studies, the difference was -1.98 units (95% confidence interval (CI) -2.62 to -1.34) and in the parallel-group studies it was -0.98 units (95% CI -1.49 to -0.47) on a 0 to 10 scale. The magnitude of the pain decrease associated with buffered lidocaine was larger when the solution contained epinephrine. The risk of bias, volume of injection, and type of procedure failed to explain the heterogeneity of the results.Patients preferred buffered lidocaine (odds ratio 3.01, 95% CI 2.19 to 4.15). No adverse events or toxicity were reported. AUTHORS' CONCLUSIONS Increasing the pH of lidocaine decreased pain on injection and augmented patient comfort and satisfaction.
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Affiliation(s)
- M Soledad Cepeda
- Pharmacoepidemiology, Johnson & Johnson Pharmaceutical Research and Development, PO BOX 200, M/S K304, Titussville, NJ, USA, 08560
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Lange G, Venter EK, Meyer BJ. Bone Scan 14 Days After a Toxic Lignocaine Reaction. Clin Nucl Med 2004; 29:43-4. [PMID: 14688599 DOI: 10.1097/01.rlu.0000102871.70998.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Greta Lange
- Department of Nuclear Medicine, Pretoria Academic Hospital, Pretoria, Republic of South Africa.
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Fuchsjäger-Mayrl G, Zehetmayer M, Plass H, Turnheim K. Alkalinization increases penetration of lidocaine across the human cornea. J Cataract Refract Surg 2002; 28:692-6. [PMID: 11955913 DOI: 10.1016/s0886-3350(01)01233-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To test the hypothesis that corneal permeability of lidocaine complies with the principle of nonionic diffusion. SETTING Department of Ophthalmology and Institute of Pharmacology, Vienna, Austria. METHODS Human corneas, mounted in an in vitro perfusion system under short-circuit conditions, were exposed on the epithelial (tear) side to lidocaine 4% in a buffered solution of pH 5 or pH 7. The endothelial bathing solutions had a constant pH of 7.4. Both solutions were adjusted to an osmolarity of 290 mOsm/L. The lidocaine permeability of the isolated corneas was assessed from the fluxes of 14C-labeled lidocaine across the tissue, measured at 15-minute intervals for 180 minutes, and corrected for the unidirectional fluxes of 3H-polyethylene glycol, a marker for the extracellular pathway. The corneal tissue content of lidocaine was estimated from the time span until the unidirectional lidocaine fluxes across the cornea reached a steady state. RESULTS The mean transcorneal fluxes of lidocaine in the steady state (90 to 180 minutes) were 72% higher at pH 7 than at pH 5 (101 mmol/min +/- 37 (SD) versus 59 +/- 34 nmol/min.cornea; P <.002). The corneal content of lidocaine in the steady state was 65% higher at pH 7 than at pH 5 (2.8 +/- 0.9 micromol/cornea versus 1.7 +/- 1.2 micromol/cornea; not significant). CONCLUSIONS A shift in solution pH from 5 to 7 significantly increased the corneal permeability of topically applied lidocaine. Alkaline pH-adjustment of topical lidocaine solutions is easy to perform by adding sodium bicarbonate. The main clinical advantages of anesthetic solutions buffered at pH 7 are increased penetration rates, effectiveness, prolonged action time, and a reduction in local irritation and lacrimation.
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