Preventing pain on injection of propofol: A comparison between lignocaine pre-treatment and lignocaine added to propofol

Publisher's copy made available with the permission of the publisherA randomized double-blind study compared two methods of preventing the pain from injection of propofol, lignocaine pre-treatment followed by propofol and lignocaine added to propofol. One hundred patients received a 4 ml solution intravenously with a venous tourniquet for 1 minute, followed by propofol mixed with 2 ml of solution. Patients were divided into two treatment groups of 50 patients each: 4 ml 1% lignocaine pre-treatment followed by propofol and 2 ml saline, or 4 ml saline followed by propofol and 2 ml 2% lignocaine. Pain was assessed with a 100 mm visual analogue scale after induction and in recovery. The incidence of injection pain was 8% in the propofol mixed with lignocaine group, and 28% in the lignocaine pre-treatment group. This difference is statistically significant (P=0.017). For those patients who had pain, the mean pain score was 26.5 on induction for the propofol with lignocaine group (n=4), while the mean score was 44.4 for the pre-treatment group (n=13). The difference was not statistically significant (P=0.25). None of the propofol mixed with lignocaine group recalled pain, while 13 of the pre-treatment group did so. Lignocaine pre-treatment does not improve the immediate or the recalled comfort of patients during propofol induction when compared to lignocaine added to propofol. It is recommended that lignocaine should be added to propofol for induction rather than given before induction.P. Lee, W. J. Russellhttp://www.aaic.net.au/Article.asp?D=200339

Pain relief for women with cervical intraepithelial neoplasia undergoing colposcopy treatment

Treatment for CIN is usually undertaken in an outpatient colposcopy clinic to remove the pre-cancerous cells from the cervix. It commonly involves lifting the cells off the cervix with electrically heated wire (diathermy) or laser, or destroying the abnormal cells with freezing methods (cryotherapy). This is potentially a painful procedure. The purpose of this review is to determine which, if any, pain relief should be used during cervical colposcopy treatment. We identified 17 trials and these reported different forms of pain relief before, during and after colposcopy. Evidence from two small trials showed that women having a colposcopy treatment had less pain and blood loss if the cervix was injected with a combination of a local anaesthetic drug and a drug that causes blood vessels to constrict (narrow), compared with placebo. Although taking oral pain-relieving drugs (e.g. ibuprofen) before treatment on the cervix in the colposcopy clinic is recommended by most guidelines, evidence from two small trials did not show that this practice reduced pain during the procedure. Most of the evidence in this field is of a low to moderate quality and further research may change these findings. Additionally, we were unable to obtain evidence with regards to dosage of the local anaesthetic drug or method of administering local anaesthetic into the cervix. There is need for high-quality trials with sufficient numbers of participants in order to provide the data necessary to estimate these effects

Local Anaesthesia Suppressing Idiopathic Ventricular Tachycardia - A Cause of Non-inducible Arrhythmia During Electrophysiology Study

AbstractA 13year old boy having idiopathic ventricular tachycardia had non-inducible tachycardia twice on electrophysiology (EP) study due to suppression of arrhythmia by local anaesthetic agent, lignocaine. This case report demonstrates a cause of non-inducibility or arrhythmia during EP study and effect of lignocaine in suppression of idiopathic ventricular tachycardia

Cardiovascular, respiratory, gastrointestinal and behavioral effects of intravenous lidocaine in healthy, conscious horses and evaluation of the relationship with lidocaine and monoethylglycinexylidide serum concentrations

This study aimed to evaluate the relationship between the serum concentrations of lidocaine/ monoethylglycinexylidide (MEGX) and their effects on several systems in horses. Five healthy, conscious horses received a two-hour placebo intravenous infusion followed by a two-hour lidocaine infusion (bolus of 1.3 mg/kg over ten minutes followed by a continuous rate infusion of 0.05 mg/kg/min). Lidocaine and MEGX serum concentrations were sampled every ten to fifteen minutes during the experiment, and the presence of muscle fasciculations and loss of balance as well as the respiratory, digestive and cardiovascular systems of the five horses were evaluated by means of different non-invasive methods. During the lidocaine infusion, the mean (f SD) lidocaine and MEGX concentrations were respectively 768.88 +/- 93.32ng/ml and 163.08 +/- 108.98 ng/ml. The infusion of lidocaine significantly influenced the presence of fasciculations, caused a statistically but non-clinically significant decrease of systolic and diastolic blood pressures, which were both correlated with lidocaine and MEGX serum concentrations, and it increased the duodenal contractions frequency, which was correlated with the serum lidocaine concentration. In this study, mild hypotensive and prokinetic effects of short-term lidocaine infusion were observed

Enhanced recovery after surgery

Enhanced Recovery or Fast Track Recovery after Surgery protocols (ERAS) have significantly changed perioperative care following colorectal surgery and are promoted as reducing the stress response to surgery. The present systematic review aimed to examine the impact on the magnitude of the systemic inflammatory response (SIR) for each ERAS component following colorectal surgery using objective markers such as C-reactive protein (CRP) and interleukin-6 (IL-6). A literature search was performed of the US National Library of Medicine (MEDLINE), EMBASE, PubMed, and the Cochrane Database of Systematic Reviews using appropriate keywords and subject headings to February 2015. Included studies had to assess the impact of the selected ERAS component on the SIR using either CRP or IL-6. Nineteen studies, including 1898 patients, were included. Fourteen studies (1246 patients) examined the impact of laparoscopic surgery on the postoperative markers of SIR. Ten of these studies (1040 patients) reported that laparoscopic surgery reduced postoperative CRP. One study (53 patients) reported reduced postoperative CRP using opioid-minimising analgesia. One study (142 patients) reported no change in postoperative CRP following preoperative carbohydrate loading. Two studies (108 patients) reported conflicting results with respect to the impact of goal-directed fluid therapy on postoperative IL-6. No studies examined the effect of other ERAS components, including mechanical bowel preparation, antibiotic prophylaxis, thromboprophylaxis, and avoidance of nasogastric tubes and peritoneal drains on markers of the postoperative SIR following colorectal surgery. The present systematic review shows that, with the exception of laparoscopic surgery, objective evidence of the effect of individual components of ERAS protocols in reducing the stress response following colorectal surgery is limited

Drug Points: Apparent interaction between warfarin and levonorgestrel used for emergency contraception

No abstract available

Study on Sedation with Local Analgesia in Calves

. The effect of sedatives and analgesics on heart rate, respiration rate and rectal temperature were observed. Heart rate and respiration rate significantly decreased during sedation with xylazine hydrochloride plus 2% lignocaine hydrochloride or 0.5% bupivacaine hydrochloride. A significantly decreased heart rate and respiration rate also found during sedation with diazepam plus 2% lignocaine hydrochloride or 0.5% bupivacaine hydrochloride. Two percent lignocaine hydrochloride showed short onset, rapid spreading and no side effect. Duration of analgesia was longer with 0.5 % bupivacaine hydrochloride (55.88±1.58 min in Group B and 48±11.25 min in Group D) compared to 2% lignocaine hydrochloride (39.60±5.77 min in Group A and 43.6±5.81 min in Group C). Xylazine hydrochloride showed short onset and long duration of sedation compared to diazepam. So for herniorraphy, xylazine hydrochloride can be used as a better sedative while 0.5 % bupivacaine hydrochloride can be used as a local analgesic for longer duration of action