Invasive treatment of chronic vertebral pain

Background. The need to find new effective treatments for chronic pain today is beyond doubt. Pain resistant to nonsteroidal analgesics and gabapentin stimulates the introduction of invasive treatments for chronic pain. Materials and methods. The efficacy of the combination of diclofenac and gabapentin with epidural administration of dexamethasone 8 mg and epidural neurolysis of 30% ethyl alcohol in 1% lidocaine solution was compared. Results. The combination of diclofenac and gabapentin, as well as the use of epidural glucocorticoids, has not shown sufficient efficacy. After the use of glucocorticoids, a long-term assessment on the visual analog scale was at the level of 3.5 points, which corresponded to the results of a one-time neurolysis. At 2 injections of the neurolytic mixture or more, the score on the visual analog scale was lower by 1.5 points compared to the results of glucocorticoid administration. After the 3rd stage of neurolysis, the lack of need for analgesics to correct vertebral pain is accompanied by a reliable absence of conversions to other methods of analgesia. Conclusions. The safety and efficacy of three-time epidural neurolysis with 30% ethyl alcohol in 1% lidocaine solution allow recommending this procedure to patients with chronic resistant vertebrogenic pain, especially in case of low efficacy and poor tolerability of nonsteroidal analgesics.

CHOICE OF THE OPTIMAL METHOD OF PERIOPERATIVE ANESTHESIA AT THORACOTOMIA

Introduction. Lung cancer occupy an advanced place among malignant neoplasms. It is more common in men aged 30 to 74 years. Almost all lung cancer patients need surgical treatment. Pulmonary dysfunction is caused by impaired evacuation of bronchial secretions, and the diaphragm dysfunction due to the pain. Postoperative pain is one of the main reasons for the development of complications. There are many methods of postoperative pain control, but the search for a better method is still ongoing.Objective. Improve results of perioperative analgesia in patients undergoing thoracotomy by choosing the optimal method of analgesia.Маterials and methods. 45 patients with lung cancer who underwent thoracotomy. Patients were randomized into 4 groups. Group A: according to the concept of pre-emptive analgesia, patients received 1000 mg of paracetamol intravenously 1 hour before incision, 50 mg of dexketoprofen intravenously and epidural analgesia: 40 mg of 2% lidocaine solution when placing a venous catheter, in the postoperative period - 2 mg / ml (3-7 ml / h) of ropivacaine. Group B: epidural analgesia: 40 mg of 2% lidocaine solution when placing a venous catheter, in the postoperative - 2 mg / ml (3-7 ml / h) ropivacaine. Group C: according to the concept of pre-emptive analgesia, patients received 1000 mg of paracetamol intravenously 1 hour before incision and of 50 mg of dexketoprofen intravenously. Group D: Without pre-emptive analgesia and epidural analgesia. The severity of the pain syndrome was assessed using a numerical rating scale (NRS) after 3, 6, 12, 24 and 32 hours.Results and discussion. No statistically significant differences were observed in the subgroups by age, body weight, duration of surgery and blood loss (p> 0.05). Patients in group A did not require additional morphine analgesia and reported lower pain intensity using NRS. After 32 hours, the data were significantly different from groups B, C, and D (p <0.05). There was no significant difference between groups B and C in the assessment of the NRS (p <0.05), but in the group C only one patient required additional morphine analgesia.Conclusion. The effectiveness of the combination of pre-emptive analgesia and epidural analgesia indicates sufficient level of analgesia in patients after lung surgery. A multimodal approach to perioperative analgesia for patients undergoing thoracic surgery without epidural analgesia reduces opioid use compared to epidural analgesia alone.

Intraoperative dynamics of interleukin-6 levels during planned coronary stenting with different approaches to analgesic sedation

The aim – to study the dynamics of the level of interleukin-6 (IL-6) under various drugs for analgesic sedation in the perioperative period of planned coronary stenting. Materials and methods. This study was conducted from September 2018 to March 2020 in 90 patients with coronary heart disease. Patients were evenly divided into three study groups, depending on the drugs that were used for intraoperative analgosedation. Group 1 – slow intravenous administration of 10 mg of diazepam solution and 100 μg of fentanyl solution for induction and repeated administration of these drugs in the same dose to maintain anesthesia during surgery; group 2 – slow intravenous administration of the solution of fentanyl 1.5 mg/kg per induction and 1.5 mg/kg for 1 h to maintain analgesia, propofol solution was used to maintain a certain level of sedation; group 3 – slow intravenous administration of 1 mg/kg of lidocaine solution for induction, for sedation – propofol solution as well. All patients underwent recanalization as planned. In our study, the main study parameter was the level of IL-6 at the beginning of surgery and 10 minutes after stent implantation. Results. When comparing operational indicators with the results that were obtained after stenting, in all groups, IL-6 indicators were lower than preoperative ones. The statistically significant difference between the studied index before surgery and 10 min after stent implantation was in the groups 2 and 3, in contrast to that in patients of the group 1: the level of IL-6 decreased to 30 % in group 2 (p = 0.005) and in group 3 (p = 0.001). Conclusions. The level of pro-inflammatory IL-6 in routine coronary artery stenting tends to decrease after stent placement, with lower rates under propofol solution usage as an anesthetic. At the same time, in group 3 (where nonopioid analgesia was used) the level of interleukin-6 at point 10 min after stent implantation was significantly lower than in first group. This fact might be explained by usage of lidocaine solution in patients of the third group. Key words: interleukin-6, planned coronary stenting, analgosedation, coronary heart disease.

Evaluation of Lidocaine and Metabolite Pharmacokinetics in Hyaluronic Acid Injection

Lidocaine-incorporated hyaluronic acid injection (LHA) is considered a promising way to increase patient compliance. Various reviews and analyses have been conducted to verify that the addition of lidocaine had no effect on the product quality of hyaluronic acid injections. However, possible pharmacokinetic (PK) alterations of lidocaine and its active metabolites, monoethylglycylxylidide (MEGX) and glycylxylidide (GX), in hyaluronic acid injection have not been studied so far. Thus, the objective of this study was to evaluate lidocaine and its metabolite PK after 0.3% lidocaine solution or LHA injection and to investigate any changes in PK profiles of lidocaine and its active metabolites. To do this, a novel bio-analytical method for simultaneous determination of lidocaine, MEGX, and GX in rat plasma was developed and validated. Then, plasma concentrations of lidocaine and its active metabolites MEGX and GX following subcutaneous (SC) injection of 0.3% lidocaine solution or LHA with 0.3–1% lidocaine in male Sprague-Dawley rats were successfully determined. The obtained data were used to develop a parent-metabolite pharmacokinetic (PK) model for LHA injection. The half-life, dose-normalized Cmax, and AUCinf of lidocaine after SC injection of lidocaine solution and LHA did not show statistically significant difference. The PK characteristics of lidocaine after LHA administration were best captured using a two-compartment model with combined first-order and transit absorption and its clearance described with Michaelis–Menten and first-order elimination kinetics. Two one-compartment models were consecutively added to the parent model for the metabolites. In conclusion, the incorporation of lidocaine in hyaluronic acid filler injection did not alter the chemical’s pharmacokinetic characteristics.

LIDOCAINE AS COMPONENT OF ANALGOSITION DURING CORONARY ARTERY STENTING

Minimally invasive techniques are one of the main methods for the diagnosis and treatment of coronary artery disease. Opiates are the main drugs that used for analgesia during interventional procedures, but their wide application is associated with a number of drawbacks. One of the ways to reduce the use of opiates is the concept of "multimodal anaesthesia", and one of its options is "no and low-opiate" anaesthesia. The aim of the presents study is to determine the main aspects of the lidocaine-based low and opiate-free anaesthesia during coronary artery stenting. 90 patients with coronary artery disease who underwent elective coronary artery stenting were included in the study. The patients were evenly divided into three groups, depending on the drugs used for intraoperative analgosedation. The first group (comparison) consisted of patients who received analgosedation with diazepam and fentanyl. For the non-opiate anaesthesia second group, the dosed lidocaine solution was the main component of analgesia. In order to study low-opiate analgesia based on the use of lidocaine, we formed the thirds group. Fentanyl was administered for analgesia induction, and lidocaine was administered intraoperatively to maintain the level of analgesia in combination with fentanyl infusion. For sedation, propofol was given in the target dose to achieve Level III by RAMSEY for the second and third groups. Intravenous use of lidocaine as a component of “low and no-opiate” anaesthesia is safe for coronary stenting operations. The study showed that the use of the above doses of lidocaine in comparison with traditional administration of opiates in assessing the parameters of external respiration, hemodynamics, and blood glucose and cortisol levels has a number of advantages and, at the same time, there are no negative effects typical for traditional anaesthesia. In comparison with the control group and the group of non-opiate anaesthesia, there are a smaller number of complaints of chest pain, drowsiness and numbness in the group of low-opiate anaesthesia in post-operative period.

DOES LIDOCAINE HAVE ANTIMICROBIAL EFFECTS AGAINST MAJOR PATHOGENS THAT INFECT WOUNDS? AN IN VITRO STUDY

Local anesthetics are commonly used in medicine and dentistryand have a low cost, but their action as a microbicidalagent is still controversial. This study aimed to evaluate the antimicrobial effects of lidocaine against bacteria thatmost commonly infect surgical wounds. We evaluated Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Proteus mirabilisand Enterococcus faecalis. The solutions tested were saline, chlorhexidine, lidocaine (solution and pure) and an antibioticsolution. The agar diffusion test was performedusingPetri dishes. The agar plates were made in duplicate and incubated in an oven at 37°C for 48h. Subsequently, the inhibition halos were measured.The plates tested with lidocaine (pure or solution) presented no inhibition halo. The antibiotic solution presented the largest inhibition halos for all the bacteria(p<0.05). Chlorhexidine formed an inhibition halo similar to that of the antibiotic solution for Escherichia coli(p>0.05). Lidocaine did not present an antimicrobial effect for any of thetested bacteria. However, the antibiotic solution and the chlorhexidine inhibited the growth of all bacteria.

A Combined Prilocaine-Lidocaine Tumescent Solution Has Lower Clinical Side Effects Compared With Lidocaine Only

In awake liposuction surgery, the extent of surgery that can be performed in a single session is limited to the toxic threshold levels of the anesthetic. Today, lidocaine is the most commonly used anesthetic. The purpose of this study was to evaluate the clinical safety of a combined prilocaine-lidocaine tumescent solution, and to compare its efficacy and safety to patients receiving lidocaine only. In this cross-sectional study, the efficacy and the occurrence of clinical side effects of a prilocaine-lidocaine tumescent solution were compared with a standard solution containing lidocaine only. All patients received the same dose of prilocaine-lidocaine (n = 142) and of lidocaine (n = 142), respectively. Both tumescent solutions provided similar and effective local anesthesia during lipoaspiration. There were significantly more early signs of toxicity (nausea, irritation, light-headedness, and tachycardia) in patients receiving the standard lidocaine solution. A tumescent solution containing both lidocaine and prilocaine reduces the occurrence of early signs of toxicity of 1 or both anesthetics. It is a safe solution, provided the surgeon has extensive knowledge of potential adverse effects, and the guidelines of care for liposuction are strictly followed.