lidocaine

This study aimed to determine the effect of adding low doses of dexmedetomidine as an adjuvant to lidocaine in regional intravenous anesthesia in patients receiving surgery.

In the present clinical trial, 120 patients' candidates for upper extremity orthopedic surgery with regional venous anesthesia in 4 groups of 30 people distributed in groups respectively 0.6, 0.5 and 0.4 micrograms/kg of dexmedetomidine plus 0.5 lidocaine were injected and in the fourth group, an equal volume of normal saline was administrated. Patients were examined and compared before drug injection and 1, 5, 10, 15, 30, 45 and 60 minutes after drug injection in terms of time of onset and recovery of sensory and motor block, hemodynamic parameters, postoperative pain intensity and analgesic consumption.

The average pain intensity during the research in the four dexmedetomidine groups was 0.6, 0.5, 0.4 and the control group, respectively, 2.12 ± 1.33, 2.82 ± 0.76, 2.26 ± 2.3, and 4.4 ± 1.5, and the difference between the groups was significant (>0.001). P). In the two-by-two analysis of the groups, the average pain intensity was significant between the two groups: dexmedetomidine 0.6 and control (P<0.001), dexmedetomidine 0.5 and control (P=0.003), and dexmedetomidine 0.4 and control (P<0.001).

Using a dose of 0.6 micrograms/kg of dexmethomidine along with lidocaine leads to a decrease in the severity of the postoperative period, a decrease in the need for painkillers, and also an increase in the time of postoperative pain relief in patients.

We aimed to compare the effect of 0.75% ropivacaine and 2% lidocaine with 1:100,000 epinephrine on intraoperative bleeding and postoperative pain following mandibular third molar surgery.

In this split-mouth clinical trial, 60 patients required bilateral impacted third molar of the mandible were prepared for operation in the Department of Maxillofacial Surgery of Mashhad Dental Faculty, Mashhad, Iran. Surgery was performed randomly on one side using ropivacaine and on the other side with lidocaine with epinephrine. The intraoperative bleeding, the postoperative pain (at 3, 6, 12, 18, and 24 hours after the operation), and the difficulty of the surgery were measured in each group and compared.

In all postoperative time intervals, the pain was lower in the ropivacaine group than in the lidocaine group. The rate of intraoperative bleeding in the ropivacaine group was lower than in the lidocaine group. In the lidocaine group, pain initially increased and reached its maximum value after three hours, but decreased after the sixth hour and reached its minimum value 24 hours after surgery. In the ropivacaine group, the pain increased initially and was at its peak at 3 and 6 hours, after which it decreased and reached its lowest value at 24 hours.

Postoperative pain was less in the 0.75% ropivacaine group than in the 2% lidocaine with 1:100,000 epinephrine group during all postoperative periods. Also, the amount of bleeding during the operation was less in the ropivacaine group.

One of the most commonly used local anesthetic (LA) agents in dentistry is lidocaine. Hypersensitivity reactions to lidocaine have been reported. In such cases, it is crucial to record a detailed clinical history and perform allergy testing to select a suitable alternative LA agent. This report presents the experience of observing a case of lidocaine allergy, supported by a review of the literature on the condition. A rare case of delayed hypersensitivity reaction to lidocaine is reported, where the patient exhibited swelling and erythema of the upper labial mucosa. Intradermal testing confirmed an allergic reaction to lidocaine. The patient was successfully treated with an alternative LA agent, allowing for the completion of dental procedures without complications. This highlights the importance of careful diagnostic measures to manage such rare but significant allergic reactions effectively. This case highlights the importance of recording a proper clinical history and performing allergy testing before the administration of LA to prevent severe allergic reactions. Additionally, patients identified as allergic to LA agents should be thoroughly counseled, informed about their condition, and provided with a clear explanation of all available treatment options

This study aimed to compare the efficacy of buccal infiltration anesthesia (BIA) with 4% articaine versus inferior alveolar nerve block (IANB) with 2% lidocaine for extraction of primary mandibular molars.

This single-blind randomized controlled clinical trial evaluated 100 children between 4-8 years requiring extraction of primary mandibular molars. The children were randomly assigned to two groups (n=50) of IANB with 2% lidocaine and 1:100,000 epinephrine (control), and BIA with 4% articaine and 1:200,000 epinephrine. The Wong-Baker Faces Pain Rating Scale (WBFPS) and the Face, Legs, Activity, Cry, and Consolability (FLACC) scale were used to assess the analgesic efficacy of each technique, and the resultant behavioral reaction of children. Data were analyzed by the Mann-Whitney, Chi-square, and independent t-tests (alpha=0.05). 

In total, 43 girls and 57 boys with a mean age of 6.59±1.20 years were evaluated. The mean FLACC score was 0.98 in the lidocaine and 1.44 in the articaine group with no significant difference (P=0.246). The mean WBFPS score was significantly higher in the articaine than in the lidocaine group (P=0.039), but the difference between the two groups separately for each tooth type was not significant (P>0.05).

Despite the significantly lower pain score of the IANB with lidocaine group, BIA with 4% articaine was comparable to IANB with 2% lidocaine in behavioral control of children, and may be considered as an acceptable alternative.

This study compared the efficacy of buccal infiltration anesthesia (BIA) with articaine versus inferior alveolar nerve block (IANB) with lidocaine for pulpotomy of primary mandibular second molars under intravenous sedation.  

This split-mouth randomized clinical trial was conducted on 29 uncooperative children (Frankl scores I & II) between 3-6 years with bilateral primary mandibular second molars requiring pulpotomy. After intravenous sedation, one random quadrant received IANB with 2% lidocaine and the respective tooth underwent pulpotomy with mineral trioxide aggregate and subsequent coronal restoration with a stainless-steel crown. The other quadrant received BIA with 4% articaine in the next session for pulpotomy of the respective tooth. The behavior of children was evaluated right after receiving the sedative (T0), during anesthetic injection (T1), during pulp exposure (T2), and in the recovery room (T3) using non-verbal pain scale-revised (NVPS-R). Data were analyzed by one-way and two-way repeated measures ANOVA (alpha=0.05). 

The odds of calmness of children during the entire procedure were 1.7 times higher in BIA than IANB but this difference was not significant (P=0.061). The mean heart rate (HR) of children was generally higher in IANB than BIA (P=0.04 at T1, P<0.001 at T2, and P=0.01 at T3). The effect of time on HR was also significant (P<0.001). Blood oxygen saturation rate (SPO2) was higher in BIA than IANB during the procedure (P<0.001).

BIA with articaine had optimal efficacy comparable to that of IANB with lidocaine for pulpotomy of primary second molars under sedation.

Episiotomy is a commonly performed obstetric procedure that often results in perineal pain for women.

This study aimed to compare the effects of lidocaine alone and lidocaine combined with clove oil on pain at the episiotomy site.

This randomized clinical trial was conducted at Baharloo Hospital in Tehran, involving 65 nulliparous women who underwent episiotomy. Perineal pain was assessed using the Visual Pain Intensity Scale (VAS) and the McGill Questionnaire. The control group received a 2% lidocaine injection, while the intervention group received a combination of 0.8% clove oil and 2% lidocaine to alleviate pain before the episiotomy. The clove oil was applied topically to the episiotomy site 10 minutes prior to the lidocaine injection. During the episiotomy repair stage, both groups received a 2% lidocaine injection. Pain intensity was measured using the aforementioned tools at 1, 6, and 12 hours after episiotomy repair.

There was no statistically significant difference in average pain intensity between the two groups before and 12 hours after the intervention (P > 0.05). However, at 1 and 6 hours after the intervention, the combination of clove oil and lidocaine resulted in significantly lower pain compared to the lidocaine-only group (P < 0.05).

Considering the greater effectiveness of lidocaine combined with clove oil in reducing episiotomy site pain intensity and the absence of side effects, this method can be recommended as an adjuvant therapy to reduce pain at the episiotomy site.

Statement of the Problem:

 Conventional injection technique with adrenaline during removal of impacted third molar of mandible had proportionally increased pain during administration with slow onset of action and shorter duration of anesthesia.  

The purpose of this study was to compare the effective nature of 8.4% and 7.5% buffered lidocaine hydrochloride during surgical removal of mandibular impacted third molar.

This prospective crossover study included 50 patients requiring bilateral removal of impacted mandibular third molars. Group I included 50 impacted mandibular third molars that were administered with 8.4% buffered lidocaine hydrochloride and group II included 50 impacted mandibular third molars were administered with 7.5% buffered lidocaine hydrochloride. The outcome variables were pain on injection, time of onset of anesthesia, and duration of action of anesthesia. The above parameters were recorded by the investigator and statistically analyzed through Chi-square test using SPSS software.

Patients in group I had mild pain (1.02) and patients in group II (5.74) had moderate pain with a statistical significance of p< 0.05 for group I respectively. The mean onset of action of anesthesia in group I was 0.08 seconds and 0.59 seconds in group II (p< 0.05). The duration of anesthesia was 342.51 minutes from group I and 122.06 minutes in group II (p< 0.05) respectively.

Lidocaine hydrochloride buffered with 8.4 % sodium bicarbonate was found to be more effective in reduction of pain during injection, also had a faster onset of action and longer duration of the action of anesthesia when compared to 7.5% buffered lidocaine hydrochloride.

Flexible bronchoscopy is employed to diagnose a range of respiratory disorders. Local airway anesthesia is mandatory to facilitate tracheal intubation. It is commonly done by injection of diluted lidocaine through working channel of bronchoscope via Spray-as-you-go (SAYGO) method. Other methods such as airway nerve block (ANB) by direct injection of lidocaine are also used to increase patient comfort. The aim of this study was to compare patient and physician satisfaction during bronchoscopy in two groups receiving SAGO alone versus combination of SAYGO and ANB. In a double-blinded randomized clinical trial, 68 patients undergoing bronchoscopy were divided into two groups. The first group received local anesthesia solely through the SAYGO method, while the second group received a combination of SAYGO and ANB. Both groups received intravenous sedation. The anesthesia level was assessed using Ramsay score. Patient and physician satisfaction with bronchoscopy was evaluated on a numeric scale of 1 to 5. Combination of ANB and SAYGO resulted in significantly higher satisfaction score both in physician [3.4±1.6 and 4.6±0.8] and patients [3.5±1.3 and 4.9±0.4] (P<0.001). Thirteen individuals (38.2%) in the SAYGO and four individuals (11.8%) in SAYGO+ANB experienced a drop in oxygen levels (P=0.023). Additionally, sedation levels (Ramsay sedation scale score) were significantly higher in the first group (4) compared to the second group (3) (P=0.001). Combining ANB with SAYGO resulted in higher patient and physician comfort during bronchoscopy in comparison to SAYGO alone with no increase in complications.

Statement of the Problem: 

Gag reflex is among the most common problems during dental and endoscopic procedures. Benzydamine hydrochloride is a non-steroidal anti-inflammatory medica-tion and a local anesthetic that might be useful in reducing the gag reflex.

This study aimed to evaluate the effects of benzydamine hydrochloride mouthwash on the intensity of the gag reflex.

In this randomized clinical trial study, 30 participants aged 21-26 with a gag trigger point index (GTPI) higher than 2 were divided into 2 groups. In the case group, 15 ml of 0.15% benzydamine hydrochloride mouthwash was gargled for 1 minute, and after 10 minutes GTPI test was conducted. In the control group, 4 puffs of 10% lidocaine spray were applied to the mucosa of the targeted area, and after 5 minutes, GTPI was measured. Participants were asked about the taste and smell of the medications.

GTPI was significantly reduced in both groups. In the lidocaine group, the GTPI score changed from 4.47 to 2.00 (P<0.001), and that for the benzydamine group was 4.20 to 1.47 (P<0.001). The variance rate of the gag reflex was -2.73 and -2.47 in the benzydamine group and lidocaine group, respectively. However, this reduction was not statistically significant between the two groups. Also, benzydamine mouthwash has a significantly better taste and smell than lido-caine (P= 0.001).

The results of this study showed that benzydamine mouthwash could be used quite effectively in reducing the gag reflex.

Context: 

While lidocaine patches have been shown to be effective in ameliorating postoperative pain following procedures such as laparoscopic surgeries, midline incision gynecological surgery, and radical prostatectomy, their effectiveness is questionable in other conditions. Therefore, this review aimed to explore the pain-reducing efficacy of lidocaine patches in individuals undergoing surgery for gastrointestinal (GI) problems.

Evidence Acquisition:

 A literature search was conducted using the following keywords and Boolean operators: "[(digestive system surgical procedures [MeSH Terms]) OR abdominal surgery OR gastrointestinal surgical procedures) AND (postoperative pain), AND ((lidocaine [MeSH Terms]) OR lidocaine patch)]". After reviewing the titles and abstracts, 5 studies were included in the review.

 Three out of the 5 studies reviewed reported that lidocaine patches significantly reduced pain compared to control drugs and placebos. Another study reported a reduction in pain in lidocaine patch receivers, but this finding was statistically insignificant. All the studies reviewed reported a significant or marginally significant decrease in the use of opioids in lidocaine patch receivers.

 The effectiveness of lidocaine patches in alleviating postoperative pain is inconclusive. Considering the potential efficacy of lidocaine patches in reducing pain and the need for opioid use following abdominal surgeries, it seems necessary to conduct studies with larger sample sizes to clarify this issue.

This study aimed to assess and compare the effects of intranasal administration of lidocaine andremifentanil on the condition of LMA insertion and cardiovascular response. From March 2019 to March 2020, this double-blind randomized clinical trial study was conductedon 60 patients, who underwent general anesthesia with LMA insertion at Faiz Hospital, Isfahan, Iran. Afterinduction of anesthesia and before placing the laryngeal mask, the first group received remifentanil 1 μg/Kg,the second group received lidocaine 2% 1 mg/Kg, and the third group received normal saline with the samevolume intranasally. The conditions of LMA insertion and hemodynamic changes that occurred during itsinsertion were investigated. In terms of demographics characteristics (p>0.05), success in placing the LMA on the first try(p=0.73), number of attempts to insert LMA (p=0.61), performance of LMA (p=0.73), need for additionalpropofol (p=0.53), frequency of gagging (p=0.53), cough (p=0.15) p), and laryngospasm (p=0.99) did notdiffer significantly. In the remifentanil group, the cardiovascular response to LMA injection was less than thatof the lidocaine group. Moreover, both groups were lower than the saline group, but no significant differencewas observed In facilitating LMA insertion, the effect of intranasal remifentanil was comparable to intranasallidocaine. Intranasal remifentanil was somewhat more effective than intranasal lidocaine in weakening thecardiovascular response to LMA insertion, but it did not outperform lidocaine.

 Colonoscopy is an invasive and short-term diagnostic-therapeutic method that is associated with significant pain, discomfort, and anxiety in patients. Thus, various sedation and analgesia methods are used to reduce these complications.

 This study compared the effect of dexmedetomidine versus intravenous lidocaine on colonoscopy candidates under sedation with propofol-fentanyl.

 This double-blind clinical trial was conducted on two groups of randomly divided patients (n = 60 each) referring to the colonoscopy unit of Imam Khomeini Hospital in Ahvaz, Iran. The first group was given 2% intravenous lidocaine with an initial dose of 1.5 mg/kg and a maintenance dose of 1 mg/kg/h, plus propofol 0.5 mg/kg and 1 µg/kg fentanyl. In contrast, the second group was given dexmedetomidine with an initial dose of 1 µg/kg and a maintenance dose of 0.5 µg/kg/h plus 0.5 mg/kg propofol and 1 µg/kg fentanyl. Hemodynamic changes, degree of sedation, and patients' pain were measured and recorded at certain intervals.

 No significant differences were observed between the dexmedetomidine and lidocaine groups regarding gender, age, and weight (P > 0.05), and the two groups were homogeneous in this regard. The two groups were significantly different with respect to their heart rate after sedation (from 5 to 20 minutes) (P < 0.05), which was lower in the group receiving dexmedetomidine. In terms of mean arterial blood pressure, no significant difference was found between the dexmedetomidine and lidocaine groups (P > 0.05). With respect to the pain score at the end of the procedure, the two groups were significantly different (P < 0.05), with the group receiving dexmedetomidine obtaining a lower score.

 Although the use of lidocaine and dexmedetomidine is associated with the least hemodynamic changes, dexmedetomidine can create more suitable and favorable conditions during and after colonoscopy by inducing a higher degree of sedation and more analgesia.

Although most of the metabolism of local anesthetics (LAs) takes place in the liver, no study has investigated the effect of these anesthetics on the kidney function of single‑kidney humans or animals. The present study was conducted to examine the effect of LAs on renal function in single‑kidney rats.

The present experimental animal study with two control groups was done in an animal laboratory. Forty‑two rats were randomly assigned to seven groups of six rats, including two control groups and five experimental groups. The experimental groups underwent intraperitoneal anesthesia with 2% lidocaine, 2% lidocaine with 1:80,000 epinephrine, 4% articaine, 3% prilocaine with 0.03 IU Felypressin, and 3% mepivacaine, respectively. Unilateral nephrectomy was done. After 24 h, the rats’ blood urea nitrogen (BUN), serum creatinine (Cr), and blood specific gravity (BSG) were measured. A standard dose of anesthetics was injected into the peritoneum for 4 days afterward. Then, these indices were measured again 24 h after the last injection. Data were analyzed using IBM SPSS (version 21.0). One‑way analysis of variance, Tukey’s honestly significant difference post hoc, and paired t‑tests were used for statistical analysis. P < 0.05 was considered statistically significant.

The results indicated significant differences among groups in the rats’ BUN and serum Cr 24 h after nephrectomy (P < 0.05). However, there were no significant differences in BUN, BSG, and Cr among groups after the interventions.

LAs did not affect renal function in single‑kidney rats. Therefore, dentists can use the anesthetics in single‑kidney people.

Effective postoperative pain control in microdiscectomy surgery is crucial to managing the disease and improving the patient's quality of life. Therefore, this study aimed to assess the potential effectiveness of 2% lidocaine in reducing pain immediately after discectomy surgery.

A total of 60 patients who underwent microdiscectomy surgery were enrolled in this randomized clinical trial study. They were randomly assigned to three groups: one group received lidocaine just before the incision, another group received lidocaine just before closing the incision, and the third group served as the control. Pain scores were measured at 1, 2, 3, 4, 8, and 12 h after the surgery using a Visual Analogue Scale.

The demographic and clinical characteristics of the study population, including age, weight, length of surgery, gender, and history of diabetes, hypertension, and previous surgery, were comparable across all three groups (P>0.05). There was a significant reduction in pain scores over time in the groups that received lidocaine before (P<0.001) and during surgery (P=0.002). Moreover, there were significant differences in pain scores at all time points among the three groups. Both groups receiving lidocaine showed significantly lower pain scores than the control group (Pbefore surgery=0.005 and Pduring surgery<0.001). However, no significant difference was observed between the groups receiving lidocaine (P=0.080).

These findings highlight the effectiveness of a local injection of 2% lidocaine either before or during the surgery in managing post-incisional surgical pain after discectomy.