Mucosal co-delivery of ketorolac and lidocaine using polymeric wafers for dental application

The current study aimed to investigate the effectiveness of a developed sodium alginate and polyvinylpyrrolidone K-25 (PVP K-25) polymeric wafer for the co-delivery of ketorolac and lidocaine to soft tissues for healing and pain control following gingivectomy. Nine ketorolac/lidocaine lyophilized wafers were formulated and assessed for their hydration capacity, mucoadhesion ability and in vitro release profile to select the optimum system for further clinical investigation. Wafer F6 containing 2:1 sodium alginate to PVP K-25 and 10% glycerol showed optimum properties and was selected for the clinical study. Twenty patients were included in the study and the ketorolac/lidocaine wafer was assessed versus a market product. Visual pain analog was evaluated daily for the first week and wound healing index was evaluated for one week, two weeks and one month following the procedure. The developed ketorolac/lidocaine polymeric wafer proved to be an effective method of reducing pain and discomfort together with enhancing wound healing following gingivectomy.     

利多卡因导致老年心肌梗死患者精神障碍的临床特点及护理

目的 了解治疗量利多卡因导致老年心肌梗死患者精神障碍的临床特点，为临床护理提供依据。方法 对34例发生精神障碍老年患者的临床资料进行分析。结果 利多卡因导致老年心肌梗死患者精神障碍的临床特点主要表现为兴奋多语、神志不清，躁动不安、嗜睡，感觉异常发生在精神障碍的早期。结论 在应用利多卡因时一定要严格掌握剂量和滴注速度．护士要做好护患沟通和宣教，了解精神障碍的临床特点，做好预见性护理，及时发现并处理早期症状，在保护好躁动患者的同时要做好自我保护。在预防室性心律失常的同时要注意预防利多卡因导致精神障碍的发生。     

间苯三酚与利多卡因联用对绝经期妇女取环术效果的评价

目的：评价间苯三酚与利多卡因联用对绝经后妇女宫内节育器取出术的使用效果。方法：将绝经后行取环术的87例妇女分为观察组和对照组,观察组予术前间苯三酚联合术中局部用利多卡因阻滞麻醉,对照组患者予术中常规使用利多卡因局部阻滞麻醉,比较2组患者术中宫颈口松弛情况和镇痛及取环效果。结果：观察组患者的镇痛和取环效果显著优于对照组（P〈0.05）;前者宫颈口松弛情况与后者比较,其差异无统计学意义（P〉0.05）。结论：间苯三酚与利多卡因用于绝经妇女取环术,可显著减轻患者疼痛,改善取环效果。     

A ação analgésica da lidocaína intravenosa no tratamento da dor crônica: uma revisão de literatura

BackgroundPain is a public health problem, greatly impairing quality of life. Almost 80% of patients with chronic pain reported that their pain interferes with activities of daily living, and two thirds reported that the pain causes negative impact on their personal relationships. The physical and functional disability, whether temporary or permanent, compromises the professional activity and causes work absenteeism, increasing costs of health systems.ObjectivesThe aim of this review is to analyze, based on the literature, the analgesic effect of lidocaine administered intravenously for the treatment of chronic pain and to evaluate the reduction of pain intensity in patients with chronic pain, focusing on musculoskeletal and neuropathic etiology.MethodologyThe method used was a review of the literature, consisting in searching the scientific literature on the efficacy of intravenous lidocaine infusion in the treatment of patients with chronic pain.ContentOf the 19 studies reviewed, 12 had results that confirm the analgesic effect of intravenous lidocaine in patients with chronic pain. Most authors used doses of 5 mg/kg infused for 30 minutes or more, producing significant analgesia with variable duration (minutes to weeks).ConclusionsBased on the literature review, it is not possible to uniformly specify the most effective and safe dose of lidocaine administered intravenously for the treatment of neuropathic or musculoskeletal pain. As for effectiveness, the intravenous infusion of lidocaine as an alternative for the treatment of chronic pain of various etiologies seems very promising, but further studies need to be conducted.     

Local anaesthetic agents

Local anaesthetics are weak bases and consist of a lipophilic aromatic ring, a link and a hydrophilic amine. The chemistry of the link classifies them as amides or esters. They act by blocking the sodium ionophore, especially in the activated state of the channel, and frequency dependence can be shown. The speed of onset is related to dose and proportion of drug in the unionized lipid-soluble form, which in turn is determined by the pK_a and the ambient pH. Local anaesthetic agents, being weak bases, are bound in the plasma to α1-acid glycoproteins, influencing duration of action. Esters undergo hydrolysis by esterases in the plasma. Amides are subject to phase I and II hepatic cytochrome P450 metabolism. The development of the S-enantiomers, levobupivacaine and ropivacaine, has not been without some controversy with regards to therapeutic benefits when assessed by clinical potency models such as the minimum local analgesic concentration (MLAC). Drugs derived from biological toxins that target and bind to the sodium ionophore are gaining acceptance for use as analgesics in chronic pain.     

Lidocaine in the early phase of acute myocardial infarction: the controversy over prophylactic or selective use

In acute myocardial infarction, lidocaine is considered the drug of choice for the treatment of malignant ventricular arrhythmias. While initially a so-called "selective" treatment strategy prevailed, in which lidocaine was administered only after the onset of certain "warning arrhythmias," the prophylactic use of lidocaine in acute myocardial infarction has been gaining wider usage in intravenous and intramuscular application in recent years. Both therapeutic applications have been found to be problematic of late, which has led to increasingly restrictive use of lidocaine. While in selective treatment forms, the definition and prompt recognition of the so-called warning arrhythmias created especially acute problems, the prophylactic therapeutic use is problematic due to the occurrence of sometimes serious side effects, which is to be expected as the size of the collective being treated increases. Both treatment forms also appear limited by the narrow preventive efficacy of lidocaine against malignant ventricular arrhythmias, especially against ventricular fibrillation. The current therapeutic recommendation for lidocaine in acute myocardial infarction should be limited to patients presenting with very frequent and complex ventricular arrhythmias, especially when these are elicited by an R-on-T phenomenon. Side effects and other therapeutic problems encountered when the therapeutic modality is switched or adjusted can be greatly reduced by careful dosing and selection of the optimal combination substances.     

中老年心血管病患者口腔麻醉前后的血压和心率变化

目的:分析中老年心血管病患者在接受拔牙术时口腔麻醉前后的血压和心率变化情况。方法:收集在北京大学人民医院口腔科进行心电监护拔牙的中老年心血管病患者共1969例。使用心电监护仪测量患者在口腔麻醉前后的血压、心率,记录并统计分析血压、心率的变化情况。结果:所有患者在口腔麻醉后未出现危及生命的严重并发症。术前患者血压、心率的第95百分位数分别为165/95 mmHg(1 mmHg=0.133 kPa)、95次/min。在麻醉前血压≥165/95 mmHg的患者和<165/95 mmHg的患者中,分别9.9%(21/212)和0.4%(7/1757)的患者麻醉后血压≥180/110 mmHg,两者差异有统计学意义(P<0.01)。共28例(1.42%)患者麻醉后血压≥180/110 mmHg,其中17例患者休息后复测血压仍未下降,终止拔牙治疗。与麻醉前比较,麻醉后患者的平均心率显著升高[73(四分位数间距=16)次/min vs 74(四分位数间距=17)次/min,P<0.01]。结论:对于心血管病得到有效治疗且病情稳定的中老年患者,口腔麻醉安全、有效。建议中老年心血管病患者在血压<165/95 mmHg、心率<95次/min的情况下,接受全身情况综合评估后进行口腔麻醉。     

Lidocaine hydrocarbonate and lidocaine hydrochloride for cesarean section: transplacental passage and neonatal effects

Twenty-six patients, ASA physical status 1, scheduled for elective cesarean section, were divided at random into two groups and received via an epidural catheter 20 ml of 2.2% lidocaine hydrocarbonate (17.3 mg.ml-1 lidocaine base) with 5 micrograms.ml-1 epinephrine freshly added (Group CO2 = 13 patients) or 20 ml of 2% lidocaine hydrochloride (17.3 mg.ml-1 lidocaine base) also with 5 micrograms.ml-1 epinephrine freshly added. Following clampage of the umbilical cord (at 40.1 +/- 4.9 min after the injection of lidocaine for the CO2 group and at 41.0 +/- 5.4 min for the HCl group), serum concentrations of lidocaine were measured both in the mother and in the umbilical vein. All newborns were examined by the same blinded pediatrician with Apgar scores at 1, 5 and 10 min and with Neurobehavioral Adaptive Capacity Scores (NACS) at 15 min, 2 h and 24 h. The concentrations of lidocaine in the serum were comparable in both groups: in the mothers 8.61 +/- 1.48 mumol.l-1 for the CO2 group vs 8.04 +/- 2.36 mumol.l-1 for the HCl group and in the newborns 3.86 +/- 0.84 mumol.l-1 for the CO2 group vs 3.92 +/- 0.95 mumol.l-1 for the HCl group. The ratio of umbilical vein to maternal vein concentrations of lidocaine was also similar in both groups: 0.45 +/- 0.07 for the CO2 group vs 0.54 +/- 0.24 for the HCl group. The percentage of newborns with a normal NACS (score > or = 35/40) was equal in both groups, i.e. 91% at 15 min and 2 h of life and 100% at 24 h of life.(ABSTRACT TRUNCATED AT 250 WORDS)     

改良麻醉方法在会阴切开镇痛中的效果观察

目的 探讨经阴道分娩的产妇改良会阴麻醉方法的临床应用效果.方法 将200例经阴道分娩行会阴切开术,无妊娠合并症的产妇随机分为两组各100例.会阴切开时按摩阿氏穴镇痛,缝合时应用0.5%利多卡因局部浸润和湿敷处理者为改良组,传统浸润麻醉者为对照组.产后护理和治疗均相同.比较两组产妇会阴麻醉镇痛效果、切口出血量、缝合时间、肿胀和愈合情况.结果 改良组镇痛效果优于对照组(P＜0.01);改良组切口出血、缝合时间、肿胀明显少于对照组(P＜0.01);两组会阴切口甲级愈合无显著差异(P＞0.05).结论 改良局部浸润麻醉方法符合产妇生理需求,且操作简便.临床应用效果明显优于传统局部浸润麻醉方法.