1
|
Zhao M, Zhou M, Lu P, Wang Y, Zeng R, Liu L, Zhu S, Kong L, Zhang J. Local anesthetic delivery systems for the management of postoperative pain. Acta Biomater 2024; 181:1-18. [PMID: 38679404 DOI: 10.1016/j.actbio.2024.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 03/29/2024] [Accepted: 04/23/2024] [Indexed: 05/01/2024]
Abstract
Postoperative pain (POP) is a major clinical challenge. Local anesthetics (LAs), including amide-type LAs, ester-type LAs, and other potential ion-channel blockers, are emerging as drugs for POP management because of their effectiveness and affordability. However, LAs typically exhibit short durations of action and prolonging the duration by increasing their dosage or concentration may increase the risk of motor block or systemic local anesthetic toxicity. In addition, techniques using LAs, such as intrathecal infusion, require professional operation and are prone to catheter displacement, dislodgement, infection, and nerve damage. With the development of materials science and nanotechnology, various LAs delivery systems have been developed to compensate for these disadvantages. Numerous delivery systems have been designed to continuously release a safe dose in a single administration to ensure minimal systemic toxicity and prolong pain relief. LAs delivery systems can also be designed to control the duration and intensity of analgesia according to changes in the external trigger conditions, achieve on-demand analgesia, and significantly improve pain relief and patient satisfaction. In this review, we summarize POP pathways, animal models and methods for POP testing, and highlight LAs delivery systems for POP management. STATEMENT OF SIGNIFICANCE: Postoperative pain (POP) is a major clinical challenge. Local anesthetics (LAs) are emerging as drugs for POP management because of their effectiveness and affordability. However, they exhibit short durations and toxicity. Various LAs delivery systems have been developed to compensate for these disadvantages. They have been designed to continuously release a safe dose in a single administration to ensure minimal toxicity and prolong pain relief. LAs delivery systems can also be designed to control the duration and intensity of analgesia to achieve on-demand analgesia, and significantly improve pain relief and patient satisfaction. In this paper, we summarize POP pathways, animal models, and methods for POP testing and highlight LAs delivery systems for POP management.
Collapse
Affiliation(s)
- Mingxu Zhao
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Key Laboratory of Anesthesia and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, 230032, China; Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230031, China
| | - Mengni Zhou
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230032, China
| | - Pengcheng Lu
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Key Laboratory of Anesthesia and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, 230032, China
| | - Ying Wang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Key Laboratory of Anesthesia and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, 230032, China
| | - Rong Zeng
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230031, China
| | - Lifang Liu
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230031, China
| | - Shasha Zhu
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230032, China.
| | - Lingsuo Kong
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230031, China.
| | - Jiqian Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Key Laboratory of Anesthesia and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, 230032, China.
| |
Collapse
|
2
|
Lee J, Currow D, Lovell M, Phillips JL, McLachlan A, Ritchie M, Brown L, Fazekas B, Aggarwal R, Seah D, Sheehan C, Chye R, Noble B, McCaffrey N, Aggarwal G, George R, Kow M, Ayoub C, Linton A, Sanderson C, Mittal D, Rao A, Prael G, Urban K, Vandersman P, Agar M. Lidocaine for Neuropathic Cancer Pain (LiCPain): study protocol for a mixed-methods pilot study. BMJ Open 2023; 13:e066125. [PMID: 36810169 PMCID: PMC9945039 DOI: 10.1136/bmjopen-2022-066125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION Many patients experience unrelieved neuropathic cancer-related pain. Most current analgesic therapies have psychoactive side effects, lack efficacy data for this indication and have potential medication-related harms. The local anaesthetic lidocaine (lignocaine) has the potential to help manage neuropathic cancer-related pain when administered as an extended, continuous subcutaneous infusion. Data support lidocaine as a promising, safe agent in this setting, warranting further evaluation in robust, randomised controlled trials. This protocol describes the design of a pilot study to evaluate this intervention and explains the pharmacokinetic, efficacy and adverse effects evidence informing the design. METHODS AND ANALYSIS A mixed-methods pilot study will determine the feasibility of an international first, definitive phase III trial to evaluate the efficacy and safety of an extended continuous subcutaneous infusion of lidocaine for neuropathic cancer-related pain. This study will comprise: a phase II double-blind randomised controlled parallel-group pilot of subcutaneous infusion of lidocaine hydrochloride 10% w/v (3000 mg/30 mL) or placebo (sodium chloride 0.9%) over 72 hours for neuropathic cancer-related pain, a pharmacokinetic substudy and a qualitative substudy of patients' and carers' experiences. The pilot study will provide important safety data and help inform the methodology of a definitive trial, including testing proposed recruitment strategy, randomisation, outcome measures and patients' acceptability of the methodology, as well as providing a signal of whether this area should be further investigated. ETHICS AND DISSEMINATION Participant safety is paramount and standardised assessments for adverse effects are built into the trial protocol. Findings will be published in a peer-reviewed journal and presented at conferences. This study will be considered suitable to progress to a phase III study if there is a completion rate where the CI includes 80% and excludes 60%. The protocol and Patient Information and Consent Form have been approved by Sydney Local Health District (Concord) Human Research Ethics Committee 2019/ETH07984 and University of Technology Sydney ETH17-1820. TRIAL REGISTRATION NUMBER ANZCTR ACTRN12617000747325.
Collapse
Affiliation(s)
- Jessica Lee
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney Faculty of Health, Broadway, New South Wales, Australia
- Concord Centre for Palliative Care, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - David Currow
- University of Wollongong Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
| | - Melanie Lovell
- Greenwich Palliative and Supportive Care Services, HammondCare, Sydney, New South Wales, Australia
- Northern Clinical School, The University of Sydney, St Leonards, New South Wales, Australia
| | - Jane L Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney Faculty of Health, Broadway, New South Wales, Australia
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Andrew McLachlan
- Sydney Pharmacy School, The University of Sydney, Sydney, New South Wales, Australia
| | - Megan Ritchie
- Concord Centre for Palliative Care, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Linda Brown
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney Faculty of Health, Broadway, New South Wales, Australia
| | - Belinda Fazekas
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney Faculty of Health, Broadway, New South Wales, Australia
| | - Rajesh Aggarwal
- Palliative Care, Bankstown Hospital, Bankstown, New South Wales, Australia
| | - Davinia Seah
- Palliative Care, St Vincent's Health Australia Ltd, Sydney, New South Wales, Australia
| | - Caitlin Sheehan
- Palliative Care, Calvary Health Care, Kogarah, New South Wales, Australia
| | - Richard Chye
- Palliative Care, St Vincent's Health Australia Ltd, Sydney, New South Wales, Australia
| | - Beverly Noble
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney Faculty of Health, Broadway, New South Wales, Australia
| | - Nikki McCaffrey
- Deakin Health Economics, Deakin University School of Health and Social Development, Burwood, Victoria, Australia
| | - Ghauri Aggarwal
- Concord Centre for Palliative Care, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Rachel George
- Pharmacy, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Marian Kow
- Pharmacy, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Chadi Ayoub
- Cardiology, Mayo Clinic Scottsdale, Scottsdale, Arizona, USA
| | - Anthony Linton
- Concord Cancer Centre, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | | | - Dipti Mittal
- Concord Centre for Palliative Care, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Angela Rao
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney Faculty of Health, Broadway, New South Wales, Australia
- Palliative Care, Calvary Health Care, Kogarah, New South Wales, Australia
| | - Grace Prael
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney Faculty of Health, Broadway, New South Wales, Australia
| | - Katalin Urban
- Palliative Care, Northern New South Wales Local Health Network, Lismore, New South Wales, Australia
| | - Priyanka Vandersman
- Research Centre for Palliative Care Death & Dying, Flinders University, Adelaide, South Australia, Australia
| | - Meera Agar
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney Faculty of Health, Broadway, New South Wales, Australia
- Palliative Care, Sydney South West Area Health Service, Liverpool, New South Wales, Australia
| |
Collapse
|
3
|
Weinschenk S, Benrath J, Kessler E, Strowitzki T, Feisst M. Therapy With Local Anesthetics to Treat Vulvodynia. A Pilot Study. Sex Med 2022; 10:100482. [PMID: 35063914 PMCID: PMC9023246 DOI: 10.1016/j.esxm.2021.100482] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/05/2021] [Accepted: 12/14/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Vulvodynia (chronic vulvar pain) is a sexually debilitating disorder with a prevalence of ∼10%. Aim To investigate the effectiveness of therapy with local anesthetics (TLA) in women with severe vulvodynia, we conducted a prospective, non-controlled observational study. Methods 45 patients with severe chronic vulvodynia (primary and secondary vulvodynia, 0–10 numeric analogue scale (NAS) ≥6, median 7.9, duration ≥6 months, median 65.2 months) in an outpatient practice in Germany were treated with TLA in 3–12 sessions using procaine 1% as local anesthetic. Effectiveness was analyzed with Wilcoxon signed rank tests and Wilcoxon rank sum tests. Outcomes Therapeutic success as a reduction of pain to ≤4 NAS lasting for ≥6 months after end of therapy. Results TLA successfully reduced vulvodynia in 36 of 45 patients (80 %, responders). The NAS reduction was from 7.9 to 2.4 (P < .001). Even patients denominated as non-responders experienced a significant reduction in NAS (P = .03). In responders, long-term success was observed for 6.8–125 months (median 24.1 months). No adverse events occurred. Clinical Translation A promising new treatment for a hard-to-treat chronic female pain disorder. Strengths and Limitations Limitation: Monocentric, non-controlled observational design; Strength: the high number of patients treated. Conclusion The high success rate of TLA in this investigation offers new perspectives on the etiology of vulvodynia as a complex pain syndrome affecting several nerves of the pelvic floor, and also provides early insight into the effectiveness of TLA in women with vulvodynia. Weinschenk S, Benrath J, Kessler E, et al. Therapy With Local Anesthetics to Treat Vulvodynia. A Pilot Study. Sex Med 2022;10:100482.
Collapse
Affiliation(s)
- Stefan Weinschenk
- Outpatient practice Weinschenk & Scherer, Karlsruhe, Germany; Deprtment of Gynecological Endocrinology and Fertility Disorders, Women's Hospital, Heidelberg University, Germany; the Heidelberg University Neural Therapy Education and Research (HUNTER) Group (www.hunter-heidelberg.com.
| | - Justus Benrath
- Clinic of Anesthesiology and Intensive Care, Pain Centre, University Clinic, Mannheim, Germany; the Heidelberg University Neural Therapy Education and Research (HUNTER) Group (www.hunter-heidelberg.com
| | | | - Thomas Strowitzki
- Deprtment of Gynecological Endocrinology and Fertility Disorders, Women's Hospital, Heidelberg University, Germany
| | - Manuel Feisst
- Institute of Medical Biometry and Informatics; Heidelberg University, Heidelberg, Germany; the Heidelberg University Neural Therapy Education and Research (HUNTER) Group (www.hunter-heidelberg.com
| |
Collapse
|
4
|
Weinschenk S, Weiss C, Benrath J, von Baehr V, Strowitzki T, Feißt M. Anti-Inflammatory Characteristics of Local Anesthetics: Inhibition of TNF-α Secretion of Lipopolysaccharide-Stimulated Leucocytes in Human Blood Samples. Int J Mol Sci 2022; 23:ijms23063283. [PMID: 35328706 PMCID: PMC8949497 DOI: 10.3390/ijms23063283] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 02/04/2023] Open
Abstract
Background. Local anesthetics (LAs) have potent anti-inflammatory properties. Inflammatory down-regulation is crucial in diseases with overactive immune reactions, such as acute respiratory distress syndrome (ARDS) and chronic inflammation. We investigated the influence of four LAs, procaine, lidocaine, mepivacaine, and bupivacaine, on the reduction of tumor necrosis factor-alpha (TNF-α) secretion in lipopolysaccharide (LPS)-activated human leucocytes. Methods. Blood samples of 28 individuals were stimulated with LPS. The reduction of TNF-α production by each of the four LAs added (0.5 mg/mL) was measured and correlated with biometric variables. A response was defined as reduction to <85% of initial levels. Results. All four LAs down-regulated the TNF-α secretion in 44−61%: Bupivacaine (44.4%), lidocaine (61.5%), mepivacaine (44.4%), and procaine (50% of the individuals, “responders”). The TNF-α secretion was reduced to 67.4, 68.0, 63.6, and 67.1% of the initial values in responders. The effects in both patients and healthy persons were the same. Interindividual responses to LAs were not correlated with the duration or type of complaints, basal TNF-α serum level, sex, BMI, or age of responders. Conclusions. Four clinically relevant LAs (amid-LA and ester-LA) attenuate the inflammatory response provoked by LPS. They are potential candidates for drug repositioning in treating overactive immune reactions and chronic inflammation.
Collapse
Affiliation(s)
- Stefan Weinschenk
- Department of Gynecological Endocrinology and Fertility Disorders, Women’s Hospital, University of Heidelberg, D-69120 Heidelberg, Germany;
- Correspondence:
| | - Carsten Weiss
- Institute of Biological and Chemical Systems, Biological Information Processing, Karlsruhe Institute of Technology (KIT), Campus North, D-76133 Karlsruhe, Germany;
| | - Justus Benrath
- Pain Clinic, Mannheim University Hospital, Faculty of Heidelberg University, D-68167 Mannheim, Germany;
| | - Volker von Baehr
- Institute of Medical Diagnostics, Nicolaistraße 22, D-12247 Berlin, Germany;
| | - Thomas Strowitzki
- Department of Gynecological Endocrinology and Fertility Disorders, Women’s Hospital, University of Heidelberg, D-69120 Heidelberg, Germany;
| | - Manuel Feißt
- Institute of Medical Biometry (IMBI), Heidelberg University, Im Neuenheimer Feld 130.3, D-69120 Heidelberg, Germany;
| |
Collapse
|
5
|
Bupivacaine reduces GlyT1 expression by potentiating the p-AMPKα/BDNF signalling pathway in spinal astrocytes of rats. Sci Rep 2022; 12:1378. [PMID: 35082359 PMCID: PMC8792009 DOI: 10.1038/s41598-022-05478-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/12/2022] [Indexed: 12/17/2022] Open
Abstract
Bupivacaine, a local anaesthetic, is widely applied in the epidural or subarachnoid space to clinically manage acute and chronic pain. However, the underlying mechanisms are complex and unclear. Glycine transporter 1 (GlyT1) in the spinal cord plays a critical role in various pathologic pain conditions. Therefore, we sought to determine whether bupivacaine exerts its analgesic effect by regulating GlyT1 expression and to determine the underlying mechanisms of regulation. Primary astrocytes prepared from the spinal cord of rats were treated with bupivacaine. The protein levels of GlyT1, brain-derived neurotrophic factor (BDNF) and phosphorylated adenosine 5′-monophosphate (AMP)-activated protein kinase α (p-AMPKα) were measured by western blotting or immunofluorescence. In addition, 7,8-dihydroxyflavone (7,8-DHF, BDNF receptor agonist) and AMPK shRNA were applied to verify the relationship between the regulation of GlyT1 by bupivacaine and the p-AMPKα/BDNF signalling pathway. After treatment with bupivacaine, GlyT1 expression was diminished in a concentration-dependent manner, while the expression of BDNF and p-AMPK was increased. Moreover, 7,8-DHF decreased GlyT1 expression, and AMPK knockdown suppressed the upregulation of BDNF expression by bupivacaine. Finally, we concluded that bupivacaine reduced GlyT1 expression in spinal astrocytes by activating the p-AMPKα/BDNF signalling pathway. These results provide a new mechanism for the analgesic effect of intrathecal bupivacaine in the treatment of acute and chronic pain.
Collapse
|
6
|
Therapie mit Lokalanästhetika in Endokrinologie und Gynäkologie. GYNAKOLOGISCHE ENDOKRINOLOGIE 2022. [DOI: 10.1007/s10304-021-00428-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
7
|
Hasan D, Shono A, van Kalken CK, van der Spek PJ, Krenning EP, Kotani T. A novel definition and treatment of hyperinflammation in COVID-19 based on purinergic signalling. Purinergic Signal 2021; 18:13-59. [PMID: 34757513 PMCID: PMC8578920 DOI: 10.1007/s11302-021-09814-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 07/18/2021] [Indexed: 12/15/2022] Open
Abstract
Hyperinflammation plays an important role in severe and critical COVID-19. Using inconsistent criteria, many researchers define hyperinflammation as a form of very severe inflammation with cytokine storm. Therefore, COVID-19 patients are treated with anti-inflammatory drugs. These drugs appear to be less efficacious than expected and are sometimes accompanied by serious adverse effects. SARS-CoV-2 promotes cellular ATP release. Increased levels of extracellular ATP activate the purinergic receptors of the immune cells initiating the physiologic pro-inflammatory immune response. Persisting viral infection drives the ATP release even further leading to the activation of the P2X7 purinergic receptors (P2X7Rs) and a severe yet physiologic inflammation. Disease progression promotes prolonged vigorous activation of the P2X7R causing cell death and uncontrolled ATP release leading to cytokine storm and desensitisation of all other purinergic receptors of the immune cells. This results in immune paralysis with co-infections or secondary infections. We refer to this pathologic condition as hyperinflammation. The readily available and affordable P2X7R antagonist lidocaine can abrogate hyperinflammation and restore the normal immune function. The issue is that the half-maximal effective concentration for P2X7R inhibition of lidocaine is much higher than the maximal tolerable plasma concentration where adverse effects start to develop. To overcome this, we selectively inhibit the P2X7Rs of the immune cells of the lymphatic system inducing clonal expansion of Tregs in local lymph nodes. Subsequently, these Tregs migrate throughout the body exerting anti-inflammatory activities suppressing systemic and (distant) local hyperinflammation. We illustrate this with six critically ill COVID-19 patients treated with lidocaine.
Collapse
Affiliation(s)
| | - Atsuko Shono
- Department of Anaesthesiology and Critical Care Medicine, School of Medicine, Showa University, Tokyo, 142-8666, Japan
| | | | - Peter J van der Spek
- Department of Pathology & Clinical Bioinformatics, Erasmus MC, Erasmus Universiteit Rotterdam, 3015 CE, Rotterdam, The Netherlands
| | | | - Toru Kotani
- Department of Anaesthesiology and Critical Care Medicine, School of Medicine, Showa University, Tokyo, 142-8666, Japan
| |
Collapse
|
8
|
Hung KC, Chu CC, Hsing CH, Chang YP, Li YY, Liu WC, Chen IW, Chen JY, Sun CK. Association between perioperative intravenous lidocaine and subjective quality of recovery: A meta-analysis of randomized controlled trials. J Clin Anesth 2021; 75:110521. [PMID: 34547603 DOI: 10.1016/j.jclinane.2021.110521] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/21/2021] [Accepted: 09/13/2021] [Indexed: 12/16/2022]
Abstract
STUDY OBJECTIVE To evaluate the impact of perioperative intravenous lidocaine on the quality of recovery (QoR) following surgery. DESIGN Meta-analysis of randomized controlled trials (RCTs). SETTING Postoperative care. INTERVENTION Intravenous lidocaine during perioperative period. PATIENTS Adults undergoing surgery under general anesthesia. MEASUREMENTS The primary outcome was postoperative QoR measured with QoR-40 questionnaire, while the secondary outcomes included five individual dimensions (i.e., emotional, state, physical comfort, psychological support, physical independence, and pain) of QoR-40, intraoperative opioid consumption, and risk of chronic postsurgical pain (CPSP). MAIN RESULTS Medline, Cochrane Library, Google scholar, and EMBASE databases were searched from inception to June 2021. Fourteen RCTs involving 1148 patients in total undergoing elective surgery published from 2012 to 2021 were included. QoR-40 scores were evaluated at postoperative 24 h (12 trials), 72 h (one trial), and Day 5 (one trial), respectively. Pooled results revealed significantly higher global [mean difference (MD) = 9.65, 95% confidence interval (CI): 6.33 to 12.97; I2 = 97%; 13 RCTs; n = 1085] and individual dimension QoR-40 scores in the lidocaine group than those in placebo group. Subgroup analysis demonstrated no significant impact of the type of surgery, age, gender, surgical time, anesthetic technique, lidocaine dosage, and time of assessment on global QoR-40 scores. The use of intravenous lidocaine was associated with a significant reduction in intraoperative remifentanil consumption compared with that in the placebo group (standardized MD = -0.91, 95%CI: -1.32 to -0.51; I2 = 86%; 10 RCTs; n = 799). There was no difference in risk of CPSP between the two groups [relative risk (RR) = 0.65, 95%CI: 0.33 to 1.25; I2 = 58%; 4 RCTs; n = 309]. CONCLUSION Our results verified the efficacy of intravenous lidocaine for enhancing postoperative quality of recovery by using a validated subjective tool and reducing intraoperative remifentanil consumption in patients receiving elective surgery under general anesthesia. Further studies are warranted to verify its efficacy in the acute care setting.
Collapse
Affiliation(s)
- Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan
| | - Chin-Chen Chu
- Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan
| | - Chung-Hsi Hsing
- Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan; Department of Medical Research, Chi-Mei Medical Center, Tainan city, Taiwan
| | - Yang-Pei Chang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Yu Li
- Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan
| | - Wei-Cheng Liu
- Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan
| | - I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan
| | - Jen-Yin Chen
- Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, Kaohsiung city, Taiwan; College of Medicine, I-Shou University, Kaohsiun cityg, Taiwan.
| |
Collapse
|
9
|
Grage SL, Culetto A, Ulrich AS, Weinschenk S. Membrane-Mediated Activity of Local Anesthetics. Mol Pharmacol 2021; 100:502-512. [PMID: 34475108 DOI: 10.1124/molpharm.121.000252] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/19/2021] [Indexed: 01/06/2023] Open
Abstract
The activity of local anesthetics (LAs) has been attributed to the inhibition of ion channels, causing anesthesia. However, there is a growing body of research showing that LAs act on a wide range of receptors and channel proteins far beyond simple analgesia. The current concept of ligand recognition may no longer explain the multitude of protein targets influenced by LAs. We hypothesize that LAs can cause anesthesia without directly binding to the receptor proteins just by changing the physical properties of the lipid bilayer surrounding these proteins and ion channels based on LAs' amphiphilicity. It is possible that LAs act in one of the following ways: They 1) dissolve raft-like membrane microdomains, 2) impede nerve impulse propagation by lowering the lipid phase transition temperature, or 3) modulate the lateral pressure profile of the lipid bilayer. This could also explain the numerous additional effects of LAs besides anesthesia. Furthermore, the concepts of membrane-mediated activity and binding to ion channels do not have to exclude each other. If we were to consider LA as the middle part of a continuum between unspecific membrane-mediated activity on one end and highly specific ligand binding on the other end, we could describe LA as the link between the unspecific action of general anesthetics and toxins with their highly specific receptor binding. This comprehensive membrane-mediated model offers a fresh perspective to clinical and pharmaceutical research and therapeutic applications of local anesthetics. SIGNIFICANCE STATEMENT: Local anesthetics, according to the World Health Organization, belong to the most important drugs available to mankind. Their rediscovery as therapeutics and not only anesthetics marks a milestone in global pain therapy. The membrane-mediated mechanism of action proposed in this review can explain their puzzling variety of target proteins and their thus far inexplicable therapeutic effects. The new concept presented here places LAs on a continuum of structures and molecular mechanisms in between small general anesthetics and the more complex molecular toxins.
Collapse
Affiliation(s)
- Stephan L Grage
- Institute of Biological Interfaces (IBG-2), Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany (S.L.G., A.C., A.S.U.); Institute of Organic Chemistry, KIT, Karlsruhe, Germany (A.C., A.S.U.); Women's Hospital, Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg, Germany (S.W.); and The HUNTER Group, Heidelberg University, Women's Hospital, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany, Heidelberg University, Women's Hospital, Neural Therapy Education & Research Group (S.W.)
| | - Anke Culetto
- Institute of Biological Interfaces (IBG-2), Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany (S.L.G., A.C., A.S.U.); Institute of Organic Chemistry, KIT, Karlsruhe, Germany (A.C., A.S.U.); Women's Hospital, Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg, Germany (S.W.); and The HUNTER Group, Heidelberg University, Women's Hospital, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany, Heidelberg University, Women's Hospital, Neural Therapy Education & Research Group (S.W.)
| | - Anne S Ulrich
- Institute of Biological Interfaces (IBG-2), Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany (S.L.G., A.C., A.S.U.); Institute of Organic Chemistry, KIT, Karlsruhe, Germany (A.C., A.S.U.); Women's Hospital, Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg, Germany (S.W.); and The HUNTER Group, Heidelberg University, Women's Hospital, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany, Heidelberg University, Women's Hospital, Neural Therapy Education & Research Group (S.W.)
| | - Stefan Weinschenk
- Institute of Biological Interfaces (IBG-2), Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany (S.L.G., A.C., A.S.U.); Institute of Organic Chemistry, KIT, Karlsruhe, Germany (A.C., A.S.U.); Women's Hospital, Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg, Germany (S.W.); and The HUNTER Group, Heidelberg University, Women's Hospital, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany, Heidelberg University, Women's Hospital, Neural Therapy Education & Research Group (S.W.)
| |
Collapse
|
10
|
Rey Novoa M, Muñoz-Sellart M, Catalán Soriano M, Vinyes D. Treatment of Localized Vulvar Pain with Neural Therapy: A Case Series and Literature Review. Complement Med Res 2021; 28:571-577. [PMID: 33845481 DOI: 10.1159/000514945] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 01/27/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Localized vulvar pain (LVP) is a common condition among fertile women, with physical and psychosexual implications. Treatment is complex with limited benefits. Neural therapy is a regulatory therapy that uses injections of local anesthetics in low concentrations in specific points to treat different conditions. CASE PRESENTATION We present the cases of 5 women, ages 33-44 years, with LVP treated with procaine 0.5% injections in painful points. Complete relief from pain occurred in 2 patients, and significant improvement in 3. Only 1 or 2 sessions were required. Initial VAS score was ≥70 and decreased to ≤30 after the intervention. The improvement was maintained over time, with a minimum follow-up period of 6 months. None of the patients were able to have sex or use tampons due to pain, but they were able to resume after the intervention. CONCLUSIONS In this case series, local injections of procaine showed a favorable outcome. Future randomized clinical trials could help elucidate the role of this intervention in LVP.
Collapse
Affiliation(s)
- Modesto Rey Novoa
- Department of Obstetrics and Gynecology, Hospital Universitario de Burgos, Burgos, Spain.,Campus Docent de Sant Joan de Déu, Barcelona, Spain
| | - Montserrat Muñoz-Sellart
- Campus Docent de Sant Joan de Déu, Barcelona, Spain.,Neural Therapy Research Foundation, Barcelona, Spain.,Institute of Neural Therapy and Regulatory Medicine, Sabadell, Barcelona, Spain
| | - Marta Catalán Soriano
- Campus Docent de Sant Joan de Déu, Barcelona, Spain.,Department of Obstetrics and Gynecology, Hospital del Vendrell, Tarragona, Spain
| | - David Vinyes
- Campus Docent de Sant Joan de Déu, Barcelona, Spain.,Neural Therapy Research Foundation, Barcelona, Spain.,Institute of Neural Therapy and Regulatory Medicine, Sabadell, Barcelona, Spain
| |
Collapse
|
11
|
Furutani K, Tobita T, Ishii H, Deguchi H, Mitsuma Y, Kamiya Y, Baba H. Epidural Administration of Ropivacaine Reduces the Amplitude of Transcranial Electrical Motor-Evoked Potentials: A Double-Blinded, Randomized, Controlled Trial. Anesth Analg 2021; 132:1092-1100. [PMID: 33060493 DOI: 10.1213/ane.0000000000005236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND An epidurally administered local anesthetic acts primarily on the epidural nerve roots and can act directly on the spinal cord through the dural sleeve. We hypothesized that epidurally administered ropivacaine would reduce the amplitude of transcranial electrical motor-evoked potentials by blocking nerve conduction in the spinal cord. Therefore, we conducted a double-blind, randomized, controlled trial. METHODS Thirty adult patients who underwent lung surgery were randomly allocated to 1 of 3 groups, based on the ropivacaine concentration: the 0.2% group, the 0.375% group, and the 0.75% group. The attending anesthesiologists, neurophysiologists, and patients were blinded to the allocation. The epidural catheter was inserted at the T5-6 or T6-7 interspace by a paramedian approach, using the loss of resistance technique with normal saline. General anesthesia was induced and maintained using propofol and remifentanil. Transcranial electrical motor-evoked potentials were elicited by a train of 5 pulses with an interstimulus interval of 2 milliseconds by using a constant-voltage stimulator and were recorded from the tibialis anterior muscle. Somatosensory-evoked potentials (SSEPs) were evoked by electrical tibial nerve stimulation at the popliteal fossa. After measuring the baseline values of these evoked potentials, 10 mL of epidural ropivacaine was administered at the 0.2%, 0.375%, or 0.75% concentration. The baseline amplitudes and latencies recorded before administering ropivacaine were defined as 100%. Our primary end point was the relative amplitude of the motor-evoked potentials at 60 minutes after the epidural administration of ropivacaine. We analyzed the amplitudes and latencies of these evoked potentials by using the Kruskal-Wallis test and used the Dunn multiple comparison test as the post hoc test for statistical analysis. RESULTS The data are expressed as the median (interquartile range). Sixty minutes after epidurally administering ropivacaine, the motor-evoked potential amplitude was lower in the 0.75% group (7% [3%-18%], between-group difference P < .001) and in the 0.375% group (52% [43%-59%]) compared to that in the 0.2% group (96% [89%-105%]). The latency of SSEP was longer in the 0.75% group compared to that in the 0.2% group, but the amplitude was unaffected. CONCLUSIONS Epidurally administered high-dose ropivacaine lowered the amplitude of motor-evoked potentials and prolonged the onset latencies of motor-evoked potentials and SSEPs compared to those in the low-dose group. High-dose ropivacaine can act on the motor pathway through the dura mater.
Collapse
Affiliation(s)
- Kenta Furutani
- From the Department of Anesthesiology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Toshiyuki Tobita
- Department of Anesthesiology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Hideaki Ishii
- Department of Anesthesiology, Nagaoka Chuo General Hospital, Nagaoka City, Japan
| | - Hiroyuki Deguchi
- From the Department of Anesthesiology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Yusuke Mitsuma
- From the Department of Anesthesiology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Yoshinori Kamiya
- From the Department of Anesthesiology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Hiroshi Baba
- From the Department of Anesthesiology, Niigata University Medical and Dental Hospital, Niigata, Japan
| |
Collapse
|
12
|
Balevi Batur E, Atan T. Neural therapy for fibromyalgia: Myth or improving quality of life? Int J Clin Pract 2021; 75:e13719. [PMID: 32955788 DOI: 10.1111/ijcp.13719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/11/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Fibromyalgia is a common rheumatic disease, which is thought to be a neuroendocrine dysregulation disorder. Patients' quality of life (QOL) is severely affected by this disease. Though neural therapy, as a treatment option, attempts to correct the underlying neuroendocrine dysfunction, yet there is no proven evidence of its effect on this disease. The present study aimed to evaluate the effectiveness of neural therapy on pain and functionality in patients with fibromyalgia. METHODS The study was a 1-year retrospective cohort study and held in physical medicine and rehabilitation clinics. A total of 60 female patients diagnosed with fibromyalgia were included. Sixty female patients with fibromyalgia were included in this study. Patients were divided into two groups; the first group (n = 30) received neural therapy, the second group (n = 30) received conventional physical therapy and each of the two groups received the same home exercise (stretching, strengthening and aerobic exercises) programme for four weeks. The primer outcomes were visual analogue scale (VAS), Short Form-36 (SF-36) and Fibromyalgia Impact Questionnaire (FIQ) scores after the treatment. RESULTS The social functioning score exhibited a significant improvement only in the intra-group comparison of the neural therapy group (P < .001). However, after treatment, the VAS, FIQ and all the SF-36 parameters, except role limitations because of physical health, were detected to be significantly improved in the neural therapy group compared with the exercise group (P < .001). CONCLUSIONS Neural therapy may be an effective alternative treatment for improving the QOL in patients with fibromyalgia.
Collapse
Affiliation(s)
- Elif Balevi Batur
- Department of Physical Medicine and Rehabilitation, Selçuk University Faculty of Medicine, Konya, Turkey
| | - Tuğba Atan
- Department of Physical Medicine and Rehabilitation, Hitit University Faculty of Medicine, Çorum, Turkey
| |
Collapse
|
13
|
Topical Treatments and Their Molecular/Cellular Mechanisms in Patients with Peripheral Neuropathic Pain-Narrative Review. Pharmaceutics 2021; 13:pharmaceutics13040450. [PMID: 33810493 PMCID: PMC8067282 DOI: 10.3390/pharmaceutics13040450] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 12/25/2022] Open
Abstract
Neuropathic pain in humans results from an injury or disease of the somatosensory nervous system at the peripheral or central level. Despite the considerable progress in pain management methods made to date, peripheral neuropathic pain significantly impacts patients' quality of life, as pharmacological and non-pharmacological methods often fail or induce side effects. Topical treatments are gaining popularity in the management of peripheral neuropathic pain, due to excellent safety profiles and preferences. Moreover, topical treatments applied locally may target the underlying mechanisms of peripheral sensitization and pain. Recent studies showed that peripheral sensitization results from interactions between neuronal and non-neuronal cells, with numerous signaling molecules and molecular/cellular targets involved. This narrative review discusses the molecular/cellular mechanisms of drugs available in topical formulations utilized in clinical practice and their effectiveness in clinical studies in patients with peripheral neuropathic pain. We searched PubMed for papers published from 1 January 1995 to 30 November 2020. The key search phrases for identifying potentially relevant articles were "topical AND pain", "topical AND neuropathic", "topical AND treatment", "topical AND mechanism", "peripheral neuropathic", and "mechanism". The result of our search was 23 randomized controlled trials (RCT), 9 open-label studies, 16 retrospective studies, 20 case (series) reports, 8 systematic reviews, 66 narrative reviews, and 140 experimental studies. The data from preclinical studies revealed that active compounds of topical treatments exert multiple mechanisms of action, directly or indirectly modulating ion channels, receptors, proteins, and enzymes expressed by neuronal and non-neuronal cells, and thus contributing to antinociception. However, which mechanisms and the extent to which the mechanisms contribute to pain relief observed in humans remain unclear. The evidence from RCTs and reviews supports 5% lidocaine patches, 8% capsaicin patches, and botulinum toxin A injections as effective treatments in patients with peripheral neuropathic pain. In turn, single RCTs support evidence of doxepin, funapide, diclofenac, baclofen, clonidine, loperamide, and cannabidiol in neuropathic pain states. Topical administration of phenytoin, ambroxol, and prazosin is supported by observational clinical studies. For topical amitriptyline, menthol, and gabapentin, evidence comes from case reports and case series. For topical ketamine and baclofen, data supporting their effectiveness are provided by both single RCTs and case series. The discussed data from clinical studies and observations support the usefulness of topical treatments in neuropathic pain management. This review may help clinicians in making decisions regarding whether and which topical treatment may be a beneficial option, particularly in frail patients not tolerating systemic pharmacotherapy.
Collapse
|
14
|
Bi Y, Ye Y, Ma J, Tian Z, Zhang X, Liu B. Effect of perioperative intravenous lidocaine for patients undergoing spine surgery: A meta-analysis and systematic review. Medicine (Baltimore) 2020; 99:e23332. [PMID: 33235097 PMCID: PMC7710210 DOI: 10.1097/md.0000000000023332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Perioperative intravenous lidocaine has been reported to have analgesic and opioid-sparing effects in many kinds of surgery. Several studies have evaluated its use in the settings of spine surgery. The aim of the study is to examine the effect of intravenous lidocaine in patients undergoing spine surgery. METHODS We performed a quantitative systematic review. Databases of PubMed, Medline, Embase database and Cochrane library were investigated for eligible literatures from their establishments to June, 2019. Articles of randomized controlled trials that compared intravenous lidocaine to a control group in patients undergoing spine surgery were included. The primary outcome was postoperative pain intensity. Secondary outcomes included postoperative opioid consumption and the length of hospital stay. RESULT Four randomized controlled trials with 275 patients were included in the study. postoperative pain compared with control was reduced at 6 hours after surgery (WMD -0.50, 95%CI, -0.76 to -0.25, P < .001), at 24 hours after surgery (WMD -0.50, 95%CI, -0.70 to -0.29, P < .001) and at 48 hours after surgery (WMD -0.57, 95%CI, -0.96 to -0.17, P = .005). The effect of intravenous lidocaine on postoperative opioid consumption compared with control revealed a significant effect (WMD -15.36, 95%CI, -21.40 to -9.33 mg intravenous morphine equivalents, P < .001). CONCLUSION This quantitative analysis of randomized controlled trials demonstrated that the perioperative intravenous lidocaine was effective for reducing postoperative opioid consumption and pain in patients undergoing spine surgery. The intravenous lidocaine should be considered as an effective adjunct to improve analgesic outcomes in patients undergoing spine surgery. However, the quantity of the studies was very low, more research is needed.
Collapse
Affiliation(s)
| | - Yu Ye
- Department of Anesthesiology
| | - Jun Ma
- Department of Anesthesiology
| | | | | | - Bin Liu
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
15
|
Licina A, Silvers A. Perioperative intravenous lignocaine infusion for postoperative pain control in patients undergoing surgery of the spine: protocol for a systematic review and meta-analysis. BMJ Open 2020; 10:e036908. [PMID: 33051233 PMCID: PMC7554463 DOI: 10.1136/bmjopen-2020-036908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Intravenous lignocaine is an amide local anaesthetic known for its analgesic, antihyperalgesic and anti-inflammatory properties. Administration of intravenous lignocaine has been shown to enhance perioperative recovery parameters. This is the protocol for a systematic review which intends to summarise the evidence base for perioperative intravenous lignocaine administration in patients undergoing spinal surgery. METHODS AND ANALYSIS Our primary outcomes include: postoperative pain scores at rest and movement at predefined early, intermediate and late time points and adverse events. Other outcomes of interest include perioperative opioid consumption, composite morbidity, surgical complications and hospital length of stay. We will include randomised controlled trials, which compared intravenous lignocaine infusion vs standard treatment for perioperative analgesia. We will search electronic databases from inception to present; MEDLINE, EMBASE and Cochrane Library (Cochrane Database of Systematic Reviews and CENTRAL). Two team members will independently screen all citations, full-text articles and abstract data. The individual study risk of bias will be appraised using the Cochrane risk of bias tool. We will obtain a risk ratio or mean difference (MD) from the intervention and control group event rates based on the nature of data. We will correct for the variable measurement tools by using the standardised MD (SMD). We will use a random-effects model to synthesise data. We will conduct five subgroup analysis: major versus minor surgery, emergency versus elective surgery, patients with chronic pain conditions versus patients without, duration of lignocaine infusion and adult versus paediatric. Confidence in cumulative evidence for will be classified according to the Grading of Recommendations, Assessment, Development and Evaluation system. We will construct summary of findings tables supported detailed evidence profile tables for predefined outcomes. ETHICS AND DISSEMINATION Formal ethical approval is not required as primary data will not be collected. The results will be disseminated through a peer-reviewed publication. PROSPERO REGISTRATION NUMBER CRD420201963314.
Collapse
Affiliation(s)
- Ana Licina
- Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
| | | |
Collapse
|
16
|
Yue H, Zhou M, Lu Y, Chen L, Cui W. Effect of Intravenous Lidocaine on Postoperative Pain in Patients Undergoing Intraspinal Tumor Resection: Study Protocol for a Prospective Randomized Controlled Trial. J Pain Res 2020; 13:1401-1410. [PMID: 32606906 PMCID: PMC7297458 DOI: 10.2147/jpr.s249359] [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: 02/11/2020] [Accepted: 05/26/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose Patients undergoing intraspinal tumor resection usually experience severe acute pain, delaying postoperative rehabilitation, and increasing incidence of chronic pain. Recently, an increasing number of studies have found that low-dose intravenous lidocaine infusion during and/or after surgery can reduce opioid usage and the incidence of related side effects, inhibit hyperalgesia and promote recovery. Thus far, no studies have evaluated the analgesic effect and safety of perioperative intravenous lidocaine infusion for intraspinal tumor resection, especially the long-term analgesic effects of patient-controlled analgesia (PCA) with lidocaine during the first postoperative 48 hours. This study tests the hypothesis that intra- and postoperative systemic lidocaine infusion for patients undergoing intraspinal tumor resection can relieve postoperative acute or chronic pain and reduce the opioid dosage and incidence of related side effects without other problems. Study Design and Methods This is a prospective, randomized, placebo-controlled, and double-blinded study. In total, 180 participants scheduled for intraspinal tumor resection will be randomly divided into lidocaine and placebo groups. The lidocaine group will be administered lidocaine intravenously during anesthesia and postoperative pain management during the first 48 postoperative hours; the placebo group will be administered normal saline at the same volume, infusion rate, and timing. The primary outcome will be the postoperative visual analog scale (VAS) score. Secondary outcomes will be postoperative cumulative sufentanil consumption, indicators of postoperative recovery, and the incidence of perioperative adverse events. Discussion This study investigates the effect of continuous intravenous lidocaine infusion on postoperative sufentanil consumption and VAS scores. The findings will provide a new strategy of anesthesia and analgesia management for intraspinal tumor resection.
Collapse
Affiliation(s)
- Hongli Yue
- Department of Anesthesiology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Man Zhou
- Department of Anesthesiology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yu Lu
- Department of Anesthesiology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Liang Chen
- Department of Anesthesiology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Weihua Cui
- Department of Anesthesiology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, People's Republic of China
| |
Collapse
|
17
|
Assessment of the Effect of Perioperative Venous Lidocaine on the Intensity of Pain and IL-6 Concentration After Laparoscopic Gastroplasty. Obes Surg 2020; 30:3912-3918. [PMID: 32533519 DOI: 10.1007/s11695-020-04748-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/22/2020] [Accepted: 05/28/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Opioids are associated with sedation and respiratory depression. The primary objective of this study was to assess pain intensity after gastric bypass with lidocaine. The secondary objective was to assess the IL-6 concentration, consumption of morphine, time to morphine request, time to extubation, and side effects. METHODS Sixty patients aged 18 to 60 years, with ASA (American Society of Anesthesiologists) scores of 2 or 3, who underwent bariatric surgery were allocated to two groups. Patients in group 1 were administered lidocaine (1.5 mg/kg) 5 min before the induction of anesthesia, and group 2 was administered 0.9% saline solution in an equal volume. Subsequently, lidocaine (2 mg/kg/h) or 0.9% saline was infused during the entire surgical procedure. Anesthesia was performed with fentanyl (5 μg/kg), propofol, rocuronium, and sevoflurane. Postoperative patient-controlled analgesia was provided with morphine. The following were evaluated: pain intensity, IL-6, 24-h consumption of morphine, time to the morphine request, time to extubation, and adverse effects. RESULTS The lidocaine group had a lower pain intensity than the saline group for up to 1 h, with no differences between groups in IL-6 and time to extubation. The lidocaine group consumed less morphine within 24 h, had a longer time until the first supplemental morphine request, and had a lower incidence of nausea. CONCLUSIONS Lidocaine reduced the intensity of early postoperative pain, incidence of nausea, and consumption of morphine within 24 h and increased time to the first morphine request, without reducing the plasma concentrations of IL-6.
Collapse
|
18
|
Ghimire A, Subedi A, Bhattarai B, Sah BP. The effect of intraoperative lidocaine infusion on opioid consumption and pain after totally extraperitoneal laparoscopic inguinal hernioplasty: a randomized controlled trial. BMC Anesthesiol 2020; 20:137. [PMID: 32493276 PMCID: PMC7268281 DOI: 10.1186/s12871-020-01054-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/25/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND As a component of multimodal analgesia, the administration of systemic lidocaine is a well-known technique. We aimed to evaluate the efficacy of lidocaine infusion on postoperative pain-related outcomes in patients undergoing totally extraperitoneal (TEP) laparoscopies inguinal hernioplasty. METHODS In this randomized controlled double-blind study, we recruited 64 patients to receive either lidocaine 2% (intravenous bolus 1.5 mg. kg - 1 followed by an infusion of 2 mg. kg- 1. h- 1), or an equal volume of normal saline. The infusion was initiated just before the induction of anesthesia and discontinued after tracheal extubation. The primary outcome of the study was postoperative morphine equivalent consumption up to 24 h after surgery. Secondary outcomes included postoperative pain scores, nausea/vomiting (PONV), sedation, quality of recovery (scores based on QoR-40 questionnaire), patient satisfaction, and the incidence of chronic pain. RESULTS The median (IQR) cumulative postoperative morphine equivalent consumption in the first 24 h was 0 (0-1) mg in the lidocaine group and 4 [1-8] mg in the saline group (p < 0.001). Postoperative pain intensity at rest and during movement at various time points in the first 24 h were significantly lower in the lidocaine group compared with the saline group (p < 0.05). Fewer patients reported PONV in the lidocaine group than in the saline group (p < 0.05). Median QoR scores at 24 h after surgery were significantly better in the lidocaine group (194 (194-196) than saline group 184 (183-186) (p < 0.001). Patients receiving lidocaine were more satisfied with postoperative analgesia than those receiving saline (p = 0.02). No difference was detected in terms of postoperative sedation and chronic pain after surgery. CONCLUSIONS Intraoperative lidocaine infusion for laparoscopic TEP inguinal hernioplasty reduces opioid consumption, pain intensity, PONV and improves the quality of recovery and patient satisfaction. TRIAL REGISTRATION ClinicalTrials.gov- NCT02601651. Date of registration: November 10, 2015.
Collapse
Affiliation(s)
- Anup Ghimire
- Department of Anesthesiology, Nepal Mediciti Hospital, Lalitpur, Nepal
| | - Asish Subedi
- Department of Anesthesiology & Critical Care Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal.
| | - Balkrishna Bhattarai
- Department of Anesthesiology & Critical Care Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Birendra Prasad Sah
- Department of Anesthesiology & Critical Care Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
| |
Collapse
|
19
|
Abstract
For decades local anesthetics have proven to be safe and effective drugs in the clinical practice, crucially promoting the enormous achievements in regional anesthesia. Meanwhile, it is a well-known fact that local anesthetics are much more than just "simple" sodium channel blockers. They also interact with numerous other ion channels and subcellular structures, enhancing nerve blockade and resulting in systemic "alternative" effects, which can sometimes even be clinically used. By the simultaneous administration of various adjuvants (e.g., opioids, corticosteroids and α2-receptor agonists) attempts are made to prolong the time of action of local anesthetics after a single administration in order to achieve the best possible improvement in postoperative analgesia. In this context, ultralong-acting local anesthetics, such as liposomal bupivacaine, which at least theoretically can provide a sensory nerve block for several days, have been developed and clinically introduced. The coming years will show whether these approaches will develop into genuine alternatives to the personnel and cost-intensive continuous nerve blockades.Local anesthetic-induced systemic toxicity is meanwhile rare but still a potentially life-threatening event, frequently resulting from accidental intravascular injection or extensive systemic resorption. Consequently, slow and fractional application of these agents with intermittent aspiration helps to prevent toxic sequelae. If toxic symptoms occur, however, the intravenous infusion of 20% lipid solutions in addition to basic treatment measures can enhance the success of treatment.
Collapse
Affiliation(s)
- W Zink
- Klinik für Anästhesiologie, Operative Intensivmedizin und Notfallmedizin, Klinikum der Stadt Ludwigshafen am Rhein, Bremserstr 79, 67063, Ludwigshafen, Deutschland.
| | - T Steinfeldt
- Klinik für Anästhesiologie und operative Intensivmedizin, Diakonieklinikum Schwäbisch Hall, Schwäbisch Hall, Deutschland
| | - T Wiesmann
- Klinik für Anästhesie und Intensivtherapie, Philipps Universität Marburg, Marburg, Deutschland
| |
Collapse
|
20
|
Bailey MA, Toner AJ, Corcoran TB. A survey of perioperative intravenous lidocaine use by anaesthetists in Australia and New Zealand. Anaesth Intensive Care 2020; 48:53-58. [DOI: 10.1177/0310057x19889367] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Perioperative intravenous lidocaine administration by anaesthetists is purported to confer a variety of benefits across a range of surgical procedures. It remains unclear whether the available evidence regarding efficacy and safety is sufficient to influence Australasian practice broadly, and whether significant barriers to uptake exist. We therefore conducted a survey of Fellows of the Australian and New Zealand College of Anaesthetists to evaluate patterns of lidocaine use, and perceptions relating to benefit and safety. Of 979 survey invitations, 295 (30.1%) responded. Of these, 51.9% of anaesthetists incorporate lidocaine administration into their practice. Amongst users, the most common indication is open abdominal or pelvic surgery (88.9%), with the principal intent of reducing acute pain and opioid use (both 92.2%). Only 51% perceive lidocaine to have a role in the prevention of chronic post-surgical pain, and less than a third administer it for operations strongly linked to this condition. Nearly all (91%) users deliver the drug by intraoperative bolus and infusion, with the majority using doses between 1.0 and 1.5 mg/kg for both the bolus and the hourly infusion rate. When parallel local anaesthetic techniques are employed, 44.4% restrict the dose, 37.3% turn the lidocaine infusion off first and 15.7% make no modifications. Most respondents terminate infusions by the end of surgery (52.3%) or in the post-anaesthesia care unit (26.8%). Few deliver postoperative infusions without electrocardiographic monitoring (5.9%). There were no reports of life-threatening events. The dichotomy in Australasian use of perioperative lidocaine revealed by this survey confirms that large multicentre trials are now required to guide practice accurately.
Collapse
Affiliation(s)
- Martin A Bailey
- Department of Anaesthesia and Intensive Care Medicine, Taranaki Base Hospital, New Plymouth, New Zealand
| | - Andrew J Toner
- Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Australia
| | - Tomas B Corcoran
- Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Australia
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
- Raine Foundation/WA Health Department, Nedlands, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
21
|
Hermanns H, Hollmann MW, Stevens MF, Lirk P, Brandenburger T, Piegeler T, Werdehausen R. Molecular mechanisms of action of systemic lidocaine in acute and chronic pain: a narrative review. Br J Anaesth 2019; 123:335-349. [DOI: 10.1016/j.bja.2019.06.014] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 06/03/2019] [Accepted: 06/03/2019] [Indexed: 02/07/2023] Open
|
22
|
Wang T, Liu H, Sun JH, Wang L, Zhang JY. Efficacy of intravenous lidocaine in improving post-operative nausea, vomiting and early recovery after laparoscopic gynaecological surgery. Exp Ther Med 2019; 17:4723-4729. [PMID: 31086606 DOI: 10.3892/etm.2019.7497] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 02/28/2019] [Indexed: 12/15/2022] Open
Abstract
Post-operative nausea and vomiting (PONV) is a major peri-operative complication. It has numerous adverse consequences that seriously affect the post-operative recovery of patients. The aim of the present study was to investigate the efficacy of intravenous lidocaine in improving PONV and recovery after laparoscopic gynaecological surgery. A total of 40 patients were randomly assigned to 2 groups: Group L (lidocaine group) and Group C (control group). The patients in Group L received intravenous lidocaine throughout the operation, while patients in Group C were given a saline infusion. Vital signs, recovery time, extubation time, dosage of remifentanil, first flatus time and defecation time of each patient were recorded. The incidence of PONV after surgery was also recorded. The recovery of the patients was evaluated by using the quality of recovery score (QoR-40). The total dose of remifentanil was significantly lower in Group L (P<0.05). However, the recovery time and extubation time were shorter in Group C (P<0.05). The first flatus time and defecation time were longer in Group C (P<0.05). The mean arterial pressure and heart rate in Group L were lower and more stable (P<0.05). At 6 h after surgery, the incidence of PONV was significantly lower in Group L vs. that in Group C (P<0.05). The QoR-40 score in Group C was significantly lower at 1 and 3 days after the operation compared with that in Group C (P<0.05). In conclusion, intravenous lidocaine administered to patients undergoing laparoscopic gynaecological surgery may reduce PONV and supports their early recovery [trial registration number in Chinese Clinical Trial Registry: ChiCTR-IOR-17010782 (March 5, 2017)].
Collapse
Affiliation(s)
- Tao Wang
- Department of Anesthesia, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu 225000, P.R. China
| | - Hui Liu
- Department of Endocrinology, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu 225000, P.R. China
| | - Jian Hong Sun
- Department of Anesthesia, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu 225000, P.R. China
| | - Lin Wang
- Department of Anesthesia, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu 225000, P.R. China
| | - Jian You Zhang
- Department of Anesthesia, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu 225000, P.R. China
| |
Collapse
|
23
|
Zhou S, Huang G, Chen G. Synthesis and biological activities of local anesthetics. RSC Adv 2019; 9:41173-41191. [PMID: 35540039 PMCID: PMC9076432 DOI: 10.1039/c9ra09287k] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 11/27/2019] [Indexed: 01/22/2023] Open
Abstract
Local anesthetics are mainly used in stomatology, ophthalmology, gynecology and surgery to temporarily relieve pain. Local anesthetics act on nerve endings or around nerve trunks, and are combined with specific sodium ion (Na+) channel sites on the nerve membrane. They can affect the membrane potential by reducing Na+ passage through sodium ion channels, thus blocking the generation and conduction of nerve impulses, reversibly blocking the generation and conduction of sensory nerve impulses. Local anesthetics are used for convenience in local surgical operations and treatments. Herein, we mainly review the research progress on local anesthetics and discuss the important aspects of design, synthesis and biological activity of various new compounds. Local anesthetics are mainly used in stomatology, ophthalmology, gynecology and surgery to temporarily relieve pain.![]()
Collapse
Affiliation(s)
- Shiyang Zhou
- Key Laboratory of Tropical Medicinal Resource Chemistry of Ministry of Education
- College of Chemistry and Chemical Engineering
- Hainan Normal University
- Haikou 571158
- China
| | - Gangliang Huang
- Active Carbohydrate Research Institute
- Chongqing Key Laboratory of Green Synthesis and Application
- College of Chemistry
- Chongqing Normal University
- Chongqing 401331
| | - Guangying Chen
- Key Laboratory of Tropical Medicinal Resource Chemistry of Ministry of Education
- College of Chemistry and Chemical Engineering
- Hainan Normal University
- Haikou 571158
- China
| |
Collapse
|
24
|
Weinschenk F, Dittrich R, Müller A, Lotz L, Beckmann MW, Weinschenk SW. Uterine contractility changes in a perfused swine uterus model induced by local anesthetics procaine, lidocaine, and ropivacaine. PLoS One 2018; 13:e0206053. [PMID: 30521531 PMCID: PMC6283528 DOI: 10.1371/journal.pone.0206053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 10/07/2018] [Indexed: 12/03/2022] Open
Abstract
Background Local anesthetics (LAs) are increasingly used as therapeutics due to their multiple molecular effects. They may be potential agents also in gynecology and reproductive medicine. The objective of this study was to investigate the contractility response of the perfused swine uterus to different concentrations of the LAs procaine, lidocaine, and ropivacaine. Methods and findings In an extracorporeal perfusion model with fresh swine uteri, effects of administered boli of these three LAs in concentrations of 0.1 mg/mL, 0.5 mg/mL and 1.0 mg/mL on uterine contractility and peristalsis were assessed using an intrauterine double-chip micro-catheter. A dose-dependent increase in intrauterine pressure (IUP) in the isthmus and corpus uteri was observed after the administration of the ester-LA procaine 0.1, 0.5, and 1.0%, which was not seen with lower concentrations, or buffer solution. An increase-decrease curve was found after increasing concentrations of the amide-LA lidocaine and ropivacaine, with an IUP plateau with 0.1 and 0.5%, and a decrease with 1% (p<0.01). All reactions were seen in both the isthmus and corpus uteri. The difference of the contractility pattern between ester- and amide-LA at 1% concentration was significant. Conclusion LAs dose-dependently modulate contractility in non-pregnant swine uteri. The amid-LAs lidocaine and ropivacaine reduce contractility in higher concentrations and may be used as therapeutics in disorders with increased uterine contractility, as dysmenorrhoea, endometriosis, and infertility. The multiple molecular effects of LAs may explain these effects. This in-vitro pilot study in vitro provides initial data for designing further studies to transfer the results onto humans.
Collapse
Affiliation(s)
- Fabian Weinschenk
- Department of Plastic, Reconstructive, Hand-, and Burn Surgery, StKM Klinikum Bogenhausen, Academic Teaching Hospital Technical University, Munich, Germany
- Department of Obstetrics and Gynecology, University Hospital Erlangen, Erlangen, Germany
| | - Ralf Dittrich
- Department of Obstetrics and Gynecology, University Hospital Erlangen, Erlangen, Germany
| | - Andreas Müller
- Department of Obstetrics and Gynecology, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Laura Lotz
- Department of Obstetrics and Gynecology, University Hospital Erlangen, Erlangen, Germany
| | - Matthias W. Beckmann
- Department of Obstetrics and Gynecology, University Hospital Erlangen, Erlangen, Germany
| | - Stefan W. Weinschenk
- Department of Gynecological Endocrinology and Fertility Disorders, University of Heidelberg, Heidelberg, Germany
- Outpatient OB/GYN Practice Weinschenk, Scherer & Colleagues, Karlsruhe, Germany
- Heidelberg University Neural Therapy Education and Research Group (The HUNTER Group), Heidelberg, Germany
- * E-mail:
| |
Collapse
|
25
|
Garcia-Pereira F. Epidural anesthesia and analgesia in small animal practice: An update. Vet J 2018; 242:24-32. [PMID: 30503540 DOI: 10.1016/j.tvjl.2018.09.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 11/15/2022]
Abstract
Epidural anesthesia is a commonly performed technique in both human and veterinary medicine. The technique is relatively simple following appropriate training and provides anesthesia and analgesia for acute and chronic pain. Several drug combinations have been administered by this route with variable success and duration. Multiple techniques to guide or confirm correct epidural needle placement are discussed in this article, as well as anatomical features of the epidural space, effect of drug volume and concentration, and adverse effects of the technique in small animal practice. This article is not an exhaustive review of the literature, but an update of some new findings over the last decade.
Collapse
Affiliation(s)
- F Garcia-Pereira
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, 2015 SW 16th Avenue, Gainesville, FL, 32610 USA.
| |
Collapse
|
26
|
Perioperative lidocaine infusions for the prevention of chronic postsurgical pain: a systematic review and meta-analysis of efficacy and safety. Pain 2018; 159:1696-1704. [DOI: 10.1097/j.pain.0000000000001273] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
27
|
|
28
|
Estebe JP. Intravenous lidocaine. Best Pract Res Clin Anaesthesiol 2017; 31:513-521. [DOI: 10.1016/j.bpa.2017.05.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 05/13/2017] [Accepted: 05/23/2017] [Indexed: 12/14/2022]
|
29
|
Li W, Ding L, Liu HM, You Q. Synthesis, biological evaluation, and molecular docking of ropivacaine analogs as local anesthetic agents. Med Chem Res 2017. [DOI: 10.1007/s00044-017-2118-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
30
|
Weinbroum AA. Postoperative hyperalgesia—A clinically applicable narrative review. Pharmacol Res 2017; 120:188-205. [DOI: 10.1016/j.phrs.2017.02.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/08/2017] [Accepted: 02/08/2017] [Indexed: 02/08/2023]
|
31
|
Connolly C, Madden SF, Buggy DJ, Gallagher HC. Expression of anaesthetic and analgesic drug target genes in excised breast tumour tissue: Association with clinical disease recurrence or metastasis. PLoS One 2017; 12:e0177105. [PMID: 28558008 PMCID: PMC5448742 DOI: 10.1371/journal.pone.0177105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 04/21/2017] [Indexed: 11/18/2022] Open
Abstract
Background Retrospective analyses suggest anaesthetic-analgesics technique during cancer surgery may affect recurrence/metastasis. This could involve direct effects of anaesthetic-analgesic drugs on cancer cells. While μ-opioid receptor over-expression in lung tumours is associated with greater metastasis, other anaesthetic-analgesic receptor targets in cancer recurrence/metastasis remain unexplored. Therefore, we evaluated the association between genetic expression of anaesthetic-analgesic receptor targets and recurrence/metastasis, using a repository of breast cancer gene expression and matching clinical data. Methods A list of 23 genes encoding for the most prominent anaesthetic-analgesic receptor targets was compiled. This was processed through BreastMark- an algorithm integrating gene expression data from ~17,000 samples and clinical data from >4,500 breast cancer samples. Gene expression data was dichotomized using disease-free survival (survival without recurrence) and distant disease-free survival (survival without metastasis) as end points. Hazard ratios were calculated by Cox-regression analysis. Enrichment for prognostic markers was determined by randomly choosing 23-member gene lists from all available genes, calculating how often >5 significant markers were observed and adjusting p-values for multiple testing. This was repeated 10,000 times and an empirical p-value calculated. Results Of 23 selected genes, 9 were significantly associated with altered rates of metastasis and 4 with recurrence on univariate analysis. Adjusting for multiple testing, 5 of these 9 genes remained significantly associated with metastasis, non with recurrence. This ratio of genes (5/23) was not significantly enriched for markers of metastasis (p = 0.07). Conclusion Several anaesthetic-analgesic receptor genes were associated with metastatic spread in breast cancer. Overall there was no significant enrichment in prognostic markers of metastasis, although a trend was observed.
Collapse
Affiliation(s)
- C. Connolly
- Dept. of Anaesthesia, Mater Misericordiae University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
- * E-mail: (CC); (DJB)
| | - S. F. Madden
- RCSI Population Health Sciences, Dept. of Psychology, Royal College of Surgeons, Dublin, Ireland
| | - D. J. Buggy
- Dept. of Anaesthesia, Mater Misericordiae University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
- Conway Institute for Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
- Outcomes Research Consortium, Cleveland Clinic, Cleveland, Ohio, United States of America
- * E-mail: (CC); (DJB)
| | - H. C. Gallagher
- Dept. of Anaesthesia, Mater Misericordiae University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
- Conway Institute for Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
| |
Collapse
|
32
|
Johnson RA, Kierski KR, Jones BG. Evaluation of gastric emptying time, gastrointestinal transit time, sedation score, and nausea score associated with intravenous constant rate infusion of lidocaine hydrochloride in clinically normal dogs. Am J Vet Res 2017; 78:550-557. [DOI: 10.2460/ajvr.78.5.550] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
33
|
Yuan Y, Sun Z, Chen Y, Zheng Y, Xie KL, He Y, Wang Z, Wang GL, Yu YH. Prevention of Remifentanil Induced Postoperative Hyperalgesia by Dexmedetomidine via Regulating the Trafficking and Function of Spinal NMDA Receptors as well as PKC and CaMKII Level In Vivo and In Vitro. PLoS One 2017; 12:e0171348. [PMID: 28182698 PMCID: PMC5300256 DOI: 10.1371/journal.pone.0171348] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 01/19/2017] [Indexed: 11/19/2022] Open
Abstract
Remifentanil-induced secondary hyperalgesia has been demonstrated in both animal experiments and clinical trials. Enhancement of N-methyl-D-aspartate (NMDA) receptor trafficking as well as protein kinase C (PKC) and calmodulin-dependent protein kinase II (CaMKII) have been reported to be involved in the induction and maintenance of central sensitization. In the current study, it was demonstrated that dexmedetomidine could prevent remifentanil-induced hyperalgesia (RIH) via regulating spinal NMDAR-PKC-Ca2+/ CaMKII pathway in vivo and in vitro. We firstly investigated the effect of dexmedetomidine, a highly selective α2-adrenergic receptor agonist, on mechanical and thermal hyperalgesia using a rat model of RIH. NMDA receptor subunits (NR1, NR2A and NR2B) expression and membrane trafficking as well as PKC and CaMKII expression in spinal cord L4-L5 segments were measured by Western blot analysis. The expression of NMDA receptor subunits (NR1, NR2A and NR2B) were also detected by immunohistochemistry. Further more, the effect of dexmedetomidine on NMDA receptor current amplitude and frequency in spinal cord slices were investigated by whole-cell patch-clamp recording. We found that remifentail infusion at 1.2 μg.kg-1.min-1 for 90 min caused mechanical and thermal hyperalgesia, up-regulated NMDA receptor subunits NR1 and NR2B expression in both membrane fraction and total lysate as well as increased PKC and CaMKII expression in spinal cord dorsal horn. Subcutaneously injection of dexmedetomidine at the dose of 50 μg/kg at 30 min before plantar incision significantly attenuated remifentanil-induced mechanical and thermal hyperalgesia from 2 h to 48 h after infusion, and this was associated with reversal of up-regulated NR1 and NR2B subunits in both membrane fraction and total lysate as well as increased PKC and CaMKII expression in spinal cord dorsal horn. Furthermore, remifentanil incubation increased amplitude and frequency of NMDA receptor-induced current in dorsal horn neurons, which was dose-dependently attenuated by dexmedetomidine. These results suggest that dexmedetomidine can significantly ameliorate RIH via modulating the expression, membrane trafficking and function of NMDA receptors as well as PKC and CaMKII level in spinal dorsal horn, which present useful insights into the mechanistic action of dexmedetomidine as a potential anti-hyperalgesic agents for treating RIH.
Collapse
Affiliation(s)
- Yuan Yuan
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Research Institute of Anesthesiology, Tianjin, China
| | - Zhe Sun
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Research Institute of Anesthesiology, Tianjin, China
| | - Yi Chen
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Research Institute of Anesthesiology, Tianjin, China
| | - Yuxin Zheng
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Research Institute of Anesthesiology, Tianjin, China
| | - Ke-liang Xie
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Research Institute of Anesthesiology, Tianjin, China
| | - Ying He
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Research Institute of Anesthesiology, Tianjin, China
| | - Zhifen Wang
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Research Institute of Anesthesiology, Tianjin, China
| | - Guo-lin Wang
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Research Institute of Anesthesiology, Tianjin, China
| | - Yong-hao Yu
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Research Institute of Anesthesiology, Tianjin, China
- * E-mail:
| |
Collapse
|
34
|
Tamam Y, Özdemir HH, Gedik A, Tamam C, Nazlıkul H. Efficacy of peripheral lidocaine application (neural therapy) in the treatment of neurogenic detrusor overactivity in multiple sclerosis patients. Neurourol Urodyn 2017; 36:1832-1838. [PMID: 28084625 DOI: 10.1002/nau.23191] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 11/15/2016] [Indexed: 12/28/2022]
Abstract
AIMS Many agents and treatments are used in the treatment of neurogenic detrusor overactivity (NDO) in MS patients, but no study has been conducted on the use of peripheric lidocaine (neural therapy-NT) on MS patients. We evaluated the effects of local administration of lidocaine on NDO in Multiple Sclerosis (MS) patients. METHODS For each patient local anesthetic lidocaine was injected at each session. Sessions were held once a week for 5 weeks. At each session, Th 10-L1, urogenital segment intradermal injections, Frankenhauser, and sacral epidural injections were given. The patients had clinical and urodynamic assessment 1 month before and 3, 9, and 12 months after NT. In addition, multiple sclerosis quality of life inventory (MSQL-54) and bladder control scale (BLCS) was performed for patients. RESULTS Twenty-eight patients were included in the study (8 males, 20 females). The patients' average age was 31.7 ± 8.1 years. The injection therapy significantly improved volume at first involuntary bladder contraction (FCV), maximal detrusor pression during filling (P det. max.), maximal cystometric bladder capacity (MCC) after 3 months. Also, the MSQL-54 and BLCS scores were improved with treatment. However, these improvements reached a maximum 3 months after treatment, but from the 9 month a regression was seen in the parameters, and after 12 months the findings were seen to be slightly above their basal levels. CONCLUSIONS These results suggest that NDO treatment in MS patients could be an effective treatment which is easy and has very few side effects, and is cost effective.
Collapse
Affiliation(s)
- Yusuf Tamam
- Department of Neurology, Dicle University Faculty of Medicine, Diyarbakir, Turkey
| | | | - Abdullah Gedik
- Department of Urology, Dicle University Faculty of Medicine, Diyarbakir, Turkey
| | | | | |
Collapse
|
35
|
Sun Y, Zhan L, Cheng X, Zhang L, Hu J, Gao Z. The Regulation of GluN2A by Endogenous and Exogenous Regulators in the Central Nervous System. Cell Mol Neurobiol 2016; 37:389-403. [PMID: 27255970 DOI: 10.1007/s10571-016-0388-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 05/25/2016] [Indexed: 12/25/2022]
Abstract
The NMDA receptor is the most widely studied ionotropic glutamate receptor, and it is central to many physiological and pathophysiological processes in the central nervous system. GluN2A is one of the two main types of GluN2 NMDA receptor subunits in the forebrain. The proper activity of GluN2A is important to brain function, as the abnormal regulation of GluN2A may induce some neuropsychiatric disorders. This review will examine the regulation of GluN2A by endogenous and exogenous regulators in the central nervous system.
Collapse
Affiliation(s)
- Yongjun Sun
- Department of Pharmacy, Hebei University of Science and Technology, Yuhua East Road 70, Shijiazhuang, 050018, People's Republic of China.,Hebei Research Center of Pharmaceutical and Chemical Engineering, Hebei University of Science and Technology, Shijiazhuang, 050018, People's Republic of China
| | - Liying Zhan
- Department of Pharmacy, Hebei University of Science and Technology, Yuhua East Road 70, Shijiazhuang, 050018, People's Republic of China
| | - Xiaokun Cheng
- North China Pharmaceutical Group New Drug Research and Development Co., Ltd, Shijiazhuang, 050015, People's Republic of China
| | - Linan Zhang
- Department of Pathophysiology, Hebei Medical University, Shijiazhuang, 050017, People's Republic of China
| | - Jie Hu
- School of Nursing, Hebei Medical University, Shijiazhuang, 050017, People's Republic of China
| | - Zibin Gao
- Department of Pharmacy, Hebei University of Science and Technology, Yuhua East Road 70, Shijiazhuang, 050018, People's Republic of China. .,Hebei Research Center of Pharmaceutical and Chemical Engineering, Hebei University of Science and Technology, Shijiazhuang, 050018, People's Republic of China. .,State Key Laboratory Breeding Base-Hebei Province Key Laboratory of Molecular Chemistry for Drug, Shijiazhuang, 050018, People's Republic of China.
| |
Collapse
|
36
|
van der Wal SEI, van den Heuvel SAS, Radema SA, van Berkum BFM, Vaneker M, Steegers MAH, Scheffer GJ, Vissers KCP. The in vitro mechanisms and in vivo efficacy of intravenous lidocaine on the neuroinflammatory response in acute and chronic pain. Eur J Pain 2015; 20:655-74. [PMID: 26684648 DOI: 10.1002/ejp.794] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2015] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The neuroinflammatory response plays a key role in several pain syndromes. Intravenous (iv) lidocaine is beneficial in acute and chronic pain. This review delineates the current literature concerning in vitro mechanisms and in vivo efficacy of iv lidocaine on the neuroinflammatory response in acute and chronic pain. DATABASES AND DATA TREATMENT We searched PUBMED and the Cochrane Library for in vitro and in vivo studies from July 1975 to August 2014. In vitro articles providing an explanation for the mechanisms of action of lidocaine on the neuroinflammatory response in pain were included. Animal or clinical studies were included concerning iv lidocaine for acute or chronic pain or during inflammation. RESULTS Eighty-eight articles regarding iv lidocaine were included: 36 in vitro studies evaluating the effect on ion channels and receptors; 31 animal studies concerning acute and chronic pain and inflammatory models; 21 clinical studies concerning acute and chronic pain. Low-dose lidocaine inhibits in vitro voltage-gated sodium channels, the glycinergic system, some potassium channels and Gαq-coupled protein receptors. Higher lidocaine concentrations block potassium and calcium channels, and NMDA receptors. Animal studies demonstrate lidocaine to have analgesic effects in acute and neuropathic pain syndromes and anti-inflammatory effects early in the inflammatory response. Clinical studies demonstrate lidocaine to have advantage in abdominal surgery and in some neuropathic pain syndromes. CONCLUSIONS Intravenous lidocaine has analgesic, anti-inflammatory and antihyperalgesic properties mediated by an inhibitory effect on ion channels and receptors. It attenuates the neuroinflammatory response in perioperative pain and chronic neuropathic pain.
Collapse
Affiliation(s)
- S E I van der Wal
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center (RUMC), Nijmegen, The Netherlands
| | - S A S van den Heuvel
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center (RUMC), Nijmegen, The Netherlands
| | - S A Radema
- Department of Medical Oncology, RUMC, Nijmegen, The Netherlands
| | - B F M van Berkum
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center (RUMC), Nijmegen, The Netherlands
| | - M Vaneker
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center (RUMC), Nijmegen, The Netherlands
| | - M A H Steegers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center (RUMC), Nijmegen, The Netherlands
| | - G J Scheffer
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center (RUMC), Nijmegen, The Netherlands
| | - K C P Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center (RUMC), Nijmegen, The Netherlands
| |
Collapse
|
37
|
Gomez-Brouchet A, Blaes N, Mouledous L, Fourcade O, Tack I, Francès B, Girolami JP, Minville V. Beneficial effects of levobupivacaine regional anaesthesia on postoperative opioid induced hyperalgesia in diabetic mice. J Transl Med 2015; 13:208. [PMID: 26136113 PMCID: PMC4488045 DOI: 10.1186/s12967-015-0575-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 06/16/2015] [Indexed: 12/26/2022] Open
Abstract
Background Diabetic neuropathy is one of the most common complications of diabetes and causes various problems in daily life. The aim of this study was to assess the effect of regional anaesthesia on post surgery opioid induced hyperalgesia in diabetic and non-diabetic mice. Methods Diabetic and non-diabetic mice underwent plantar surgery. Levobupivacaine and sufentanil were used before surgery, for sciatic nerve block (regional anaesthesia) and analgesia, respectively. Diabetic and non-diabetic groups were each randomly assigned to three subgroups: control, no sufentanil and no levobupivacaine; sufentanil and no levobupivacaine; sufentanil and levobupivacaine. Three tests were used to assess pain behaviour: mechanical nociception; thermal nociception and guarding behaviours using a pain scale. Results Sufentanil, alone or in combination with levobupivacaine, produced antinociceptive effects shortly after administration. Subsequently, sufentanil induced hyperalgesia in diabetic and non-diabetic mice. Opioid-induced hyperalgesia was enhanced in diabetic mice. Levobupivacaine associated to sufentanil completely prevented hyperalgesia in both groups of mice. Conclusion The results suggest that regional anaesthesia can decrease opioid-induced hyperalgesia in diabetic as well as in non-diabetic mice. These observations may be clinically relevant for the management of diabetic patients.
Collapse
Affiliation(s)
- Anne Gomez-Brouchet
- Service d'Anatomie Pathologique et Histologie-Cytologie, IUCT Oncopôle, 1 Avenue du Juliot Curie, 31059, Toulouse Cedex 9, France.
| | - Nelly Blaes
- Institute of Metabolic and Cardiovascular Diseases, I2MC, INSERM, U1048, Université Paul Sabatier, 31432, Toulouse, France.
| | - Lionel Mouledous
- CNRS, IPBS, Institut de Pharmacologie et de Biologie Structurale, 205 Route de Narbonne, 31077, Toulouse, France.
| | - Olivier Fourcade
- Department of Anaesthesiology and Intensive Care, Toulouse University Hospital, 31432, Toulouse, France.
| | - Ivan Tack
- Institute of Metabolic and Cardiovascular Diseases, I2MC, INSERM, U1048, Université Paul Sabatier, 31432, Toulouse, France.
| | - Bernard Francès
- Université de Toulouse, Centre de Recherches sur la Cognition Animale, CNRS, UMR 5169, Université Paul Sabatier, 118 Route de Narbonne, 31062, Toulouse, France.
| | - Jean-Pierre Girolami
- Institute of Metabolic and Cardiovascular Diseases, I2MC, INSERM, U1048, Université Paul Sabatier, 31432, Toulouse, France.
| | - Vincent Minville
- Department of Anaesthesiology and Intensive Care, Toulouse University Hospital, 31432, Toulouse, France. .,Institute of Metabolic and Cardiovascular Diseases, I2MC, INSERM, U1048, Université Paul Sabatier, 31432, Toulouse, France.
| |
Collapse
|
38
|
Abstract
NMDA receptors mediate excitatory neurotransmission in brain and spinal cord and play a pivotal role in the neurological disease state of chronic pain, which is caused by central sensitization. Bupivacaine is the indicated local anesthetic in caudal, epidural, and spinal anesthesia and is widely used clinically to manage acute and chronic pain. In addition to blocking Na(+) channels, bupivacaine affects the activity of many other channels, including NMDA receptors. Importantly, bupivacaine inhibits NMDA receptor-mediated synaptic transmission in the dorsal horn of the spinal cord, an area critically involved in central sensitization. We used recombinant NMDA receptors expressed in HEK293 cells and found that increasing concentrations of bupivacaine decreased channel open probability in GluN2 subunit- and pH-independent manner by increasing the mean duration of closures and decreasing the mean duration of openings. Using kinetic modeling of one-channel currents, we attributed the observed current decrease to two main mechanisms: a voltage-dependent "foot-in-the-door" pore block and an allosteric gating effect. Further, the inhibition was state-independent because it occurred to the same degree whether the drug was applied before or after glutamate stimulation and was mediated by extracellular and intracellular inhibitory sites, via hydrophilic and hydrophobic pathways. These results predict that clinical doses of bupivacaine would decrease the peak and accelerate the decay of synaptic NMDA receptor currents during normal synaptic transmission. These quantitative predictions inform possible applications of bupivacaine as preventative and therapeutic approaches in chronic pain.
Collapse
|
39
|
Okura D, Horishita T, Ueno S, Yanagihara N, Sudo Y, Uezono Y, Minami T, Kawasaki T, Sata T. Lidocaine Preferentially Inhibits the Function of Purinergic P2X7 Receptors Expressed in Xenopus Oocytes. Anesth Analg 2015; 120:597-605. [DOI: 10.1213/ane.0000000000000585] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
40
|
Ballas SK. Pathophysiology and principles of management of the many faces of the acute vaso-occlusive crisis in patients with sickle cell disease. Eur J Haematol 2014; 95:113-23. [PMID: 25288149 DOI: 10.1111/ejh.12460] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2014] [Indexed: 12/11/2022]
Abstract
Effective management of sickle cell pain entails a thorough understanding of its pathophysiology and the pharmacogenomics of the opioids used to manage it. In recent years, there has been significant progress along these two lines. At the pathophysiologic level, there is evidence that the severity and frequency of painful stimuli modulate their transmission at the level of the dorsal horn of the spinal cord. This modulation is achieved via two channels: the α-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) and NMDA receptors. Initially, the AMPA channel controls the transmission of stimuli of mild-moderate severity. Once the AMPA channel reaches its limit of membrane depolarization, the NMDA channel is activated and facilitates the transmission of painful stimuli in a progressive fashion leading to central sensitization and glial activation. At the level of pharmacogenomics, the metabolism of each opioid is patient-specific. Glucuronidation is unique for the metabolism of morphine, hydromorphone, and oxymorphone. The metabolism of all other opioids requires specific Cytochrome P450 (CYP) isoenzymes. The activity of each isoenzyme and the activity of the metabolites of each opioid vary among patients depending on their genetic makeup and coexistent environmental factors such as the use of other medications that may enhance or inhibit the CYP isoenzyme activity.
Collapse
Affiliation(s)
- Samir K Ballas
- Cardeza Foundation for Hematologic Research, Department of Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
41
|
|
42
|
Zhang L, Tanabe K, Yanagidate F, Kawasaki Y, Chen G, Dohi S, Iida H. Different effects of local anesthetics on extracellular signal-regulated kinase phosphorylation in rat dorsal horn neurons. Eur J Pharmacol 2014; 734:132-6. [DOI: 10.1016/j.ejphar.2014.03.048] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 03/14/2014] [Accepted: 03/26/2014] [Indexed: 01/03/2023]
|
43
|
Zhang L, Bose P, Warren RA. Dopamine preferentially inhibits NMDA receptor-mediated EPSCs by acting on presynaptic D1 receptors in nucleus accumbens during postnatal development. PLoS One 2014; 9:e86970. [PMID: 24784836 PMCID: PMC4006738 DOI: 10.1371/journal.pone.0086970] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 12/19/2013] [Indexed: 11/23/2022] Open
Abstract
Nucleus accumbens (nAcb), a major site of action of drugs of abuse and dopamine (DA) signalling in MSNs (medium spiny neurons), is critically involved in mediating behavioural responses of drug addiction. Most studies have evaluated the effects of DA on MSN firing properties but thus far, the effects of DA on a cellular circuit involving glutamatergic afferents to the nAcb have remained rather elusive. In this study we attempted to characterize the effects of dopamine (DA) on evoked glutamatergic excitatory postsynaptic currents (EPSCs) in nAcb medium spiny (MS) neurons in 1 to 21 day-old rat pups. The EPSCs evoked by local nAcb stimuli displayed both AMPA/KA and NMDA receptor-mediated components. The addition of DA to the superfusing medium produced a marked decrease of both components of the EPSCs that did not change during the postnatal period studied. Pharmacologically isolated AMPA/KA receptor-mediated response was inhibited on average by 40% whereas the isolated NMDA receptor-mediated EPSC was decreased by 90%. The effect of DA on evoked EPSCs were mimicked by the D1-like receptor agonist SKF 38393 and antagonized by the D1-like receptor antagonist SCH 23390 whereas D2-like receptor agonist or antagonist respectively failed to mimic or to block the action of DA. DA did not change the membrane input conductance of MS neurons or the characteristics of EPSCs produced by the local administration of glutamate in the presence of tetrodotoxin. In contrast, DA altered the paired-pulse ratio of evoked EPSCs. The present results show that the activation D1-like dopaminergic receptors modulate glutamatergic neurotransmission by preferentially inhibiting NMDA receptor-mediated EPSC through presynaptic mechanisms.
Collapse
Affiliation(s)
- Liming Zhang
- Centre de recherche Fernand-Seguin, University of Montreal, Montreal, Canada
- Department of Physiology, University of Montreal, Montreal, Canada
| | - Poulomee Bose
- Department of Psychiatry, University of Montreal, Montreal, Canada
| | - Richard A. Warren
- Centre de recherche Fernand-Seguin, University of Montreal, Montreal, Canada
- Department of Psychiatry, University of Montreal, Montreal, Canada
- * E-mail:
| |
Collapse
|
44
|
Haller Y, Gantenbein AR, Willimann P, Spahn DR, Maurer K. Systemic ropivacaine diminishes pain sensitization processes: a randomized, double-blinded, placebo-controlled, crossover study in healthy volunteers. Pain Ther 2014; 3:45-58. [PMID: 25135387 PMCID: PMC4108022 DOI: 10.1007/s40122-013-0021-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Indexed: 12/21/2022] Open
Abstract
Introduction Ropivacaine is a local anesthetic widely used for regional anesthesia. One of its advantages is low toxicity at plasma concentrations reached systemically during continuous peripheral or central nervous block. The objective of this study was to test the effect of systemic ropivacaine on pain, hyperalgesia, dynamic allodynia, and flare response. Methods This randomized, double-blinded, placebo-controlled, crossover study was carried out in at the Clinical Trials Centre, University of Zurich, Switzerland. Twenty healthy male volunteers were included in the study. Exclusion criteria were contraindications or hypersensitivity to local anesthetics, vulnerable subjects (intellectually or mental impaired), drug, alcohol or nicotine abuse, known peripheral neuropathies, diabetes mellitus and/or congestive heart disease. Ropivacaine and saline were infused intravenously during a subcutaneous electrical stimulation. The stimulation software adjusted the stimulus strength according to the rating on a numeric rating scale (NRS; 0–10) maintaining a NRS of 5. Areas of punctate hyperalgesia, dynamic allodynia, and flare response were measured before and after the infusion. Results The area of hyperalgesia increased significantly with saline (303 ± 380%, P < 0.05) and ropivacaine (186 ± 137%, P < 0.05). The area of allodynia (253 ± 299%, P < 0.05) and flare response (112 ± 24%, P < 0.05) increased only during the placebo infusion. Conclusion The results of this study imply that systemic ropivacaine may diminish pain sensitization processes. Electronic supplementary material The online version of this article (doi:10.1007/s40122-013-0021-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Yéri Haller
- Institute of Anaesthesiology, University Hospital of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | | | | | | | | |
Collapse
|
45
|
Effect of Intravenous Lidocaine on Postoperative Recovery of Patients Undergoing Mastectomy. Reg Anesth Pain Med 2014; 39:472-7. [DOI: 10.1097/aap.0000000000000140] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
46
|
Effect of Perioperative Intravenous Lidocaine Administration on Pain, Opioid Consumption, and Quality of Life after Complex Spine Surgery. Anesthesiology 2013; 119:932-40. [DOI: 10.1097/aln.0b013e318297d4a5] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Abstract
Background:
The authors tested the primary hypothesis that perioperative IV lidocaine administration during spine surgery (and in the postanesthesia care unit for no more than 8 h) decreases pain and/or opioid requirements in the initial 48 postoperative hours. Secondary outcomes included major complications, postoperative nausea and vomiting, duration of hospitalization, and quality of life.
Methods:
One hundred sixteen adults having complex spine surgery were randomly assigned to perioperative IV lidocaine (2 mg·kg−1·h−1) or placebo during surgery and in the postanesthesia care unit. Pain was evaluated with a verbal response scale. Quality of life at 1 and 3 months was assessed using the Acute Short-form (SF) 12 health survey. The authors initially evaluated multivariable bidirectional noninferiority on both outcomes; superiority on either outcome was then evaluated only if noninferiority was established.
Results:
Lidocaine was significantly superior to placebo on mean verbal response scale pain scores (P < 0.001; adjusted mean [95% CI] of 4.4 [4.2-4.7] and 5.3 [5.0-5.5] points, respectively) and significantly noninferior on mean morphine equivalent dosage (P = 0.011; 55 [36-84] and 74 [49-111] mg, respectively). Postoperative nausea and vomiting and the duration of hospitalization did not differ significantly. Patients given lidocaine had slightly fewer 30-day complications than patients given placebo (odds ratio [95% CI] of 0.91 [0.84–1.00]; P = 0.049). Patients given lidocaine had significantly greater SF-12 physical composite scores than placebo at 1 (38 [31–47] vs. 33 [27–42]; P = 0.002) and 3 (39 [31–49] vs. 34 [28–44]; P = 0.04) months, postoperatively.
Conclusion:
IV lidocaine significantly improves postoperative pain after complex spine surgery.
Collapse
|
47
|
Differential effects of peripheral versus central coadministration of QX-314 and capsaicin on neuropathic pain in rats. Anesthesiology 2012; 117:365-80. [PMID: 22739765 DOI: 10.1097/aln.0b013e318260de41] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Neuropathic pain is common and difficult to treat. Recently a technique was developed to selectively inhibit nociceptive inputs by simultaneously applying two drugs: capsaicin, a transient receptor potential vanilloid receptor-1 channel activator, and QX-314, a lidocaine derivative that intracellularly blocks sodium channels. We used this technique to investigate whether transient receptor potential vanilloid receptor 1-expressing nociceptors contribute to neuropathic pain. METHODS The rat chronic constriction injury model was used to induce neuropathic pain in order to test the analgesic effects of both peripheral (perisciatic) and central (intrathecal) administration of the QX-314/capsaicin combination. The Hargreaves and von Frey tests were used to monitor evoked pain-like behaviors and visual observations were used to rank spontaneous pain-like behaviors. RESULTS Perisciatic injections of the QX-314/capsaicin combination transiently increased the withdrawal thresholds by approximately 3-fold, for mechanical and thermal stimuli in rats (n = 6/group) with nerve injuries suggesting that peripheral transient receptor potential vanilloid receptor 1-expressing nociceptors contribute to neuropathic pain. In contrast, intrathecal administration of the QX-314/capsaicin combination did not alleviate pain-like behaviors (n = 5/group). Surprisingly, intrathecal QX-314 alone (n = 9) or in combination with capsaicin (n = 8) evoked spontaneous pain-like behaviors. CONCLUSIONS Data from the perisciatic injections suggested that a component of neuropathic pain was mediated by peripheral nociceptive inputs. The role of central nociceptive terminals could not be determined because of the severe side effects of the intrathecal drug combination. We concluded that only peripheral blockade of transient receptor potential vanilloid receptor 1-expressing nociceptive afferents by the QX-314/capsaicin combination was effective at reducing neuropathic allodynia and hyperalgesia.
Collapse
|
48
|
Grady MV, Mascha E, Sessler DI, Kurz A. The effect of perioperative intravenous lidocaine and ketamine on recovery after abdominal hysterectomy. Anesth Analg 2012; 115:1078-84. [PMID: 23011561 DOI: 10.1213/ane.0b013e3182662e01] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Perioperative ketamine infusion reduces postoperative pain; perioperative lidocaine infusion reduces postoperative narcotic consumption, speeds recovery of intestinal function, improves postoperative fatigue, and shortens hospital stay. However, it is unknown whether perioperative IV lidocaine and/or ketamine enhances acute functional recovery. We therefore tested the primary hypothesis that perioperative IV lidocaine and/or ketamine in patients undergoing open abdominal hysterectomy improves rehabilitation as measured by a 6-minute walk distance (6-MWD) on the second postoperative morning. METHODS Women having open hysterectomy were anesthetized with sevoflurane, followed by patient-controlled morphine. Patients were factorially randomized to one of the following groups: (1) lidocaine and placebo, (2) placebo and ketamine, (3) placebo and placebo, or (4) lidocaine and ketamine. Lidocaine was given as a bolus (1.5 mg/kg), followed by lidocaine infusion of 2 mg/kg/h for the first 2 hours, and then 1.2 mg/kg/h for 24 postoperative hours. Ketamine was given as a bolus (0.35 mg/kg), followed by ketamine infusion of 0.2 mg/kg/h for the first 2 hours, and then 0.12 mg/kg/h for 24 postoperative hours. The primary double-blind outcome was 6-MWD on the second postoperative morning; secondary outcomes included pain scores, opioid consumption, postoperative nausea and vomiting, and fatigue score. RESULTS The study was stopped after a planned interim analysis of 64 patients showed that lidocaine crossed the preplanned futility boundary, with mean ± SD of 202 ± 66 m versus 202 ± 73 m for lidocaine versus placebo, respectively, and mean difference (interim adjusted 97.5% confidence interval) of 0.93 m (-52, 54) (P = 0.96); the ketamine effect also crossed the futility boundary, with mean ± SD of 193 ± 77 m versus 210 ± 61 m for ketamine versus placebo, respectively, and mean difference (interim adjusted 97.5% confidence interval) of -11 m (-65, 44) (P = 0.54). No interaction between the 2 intervention effects was observed (P = 0.96). Neither intervention significantly influenced any of the secondary outcomes. CONCLUSION Our results do not support use of lidocaine or ketamine for improving 6-MWD on the second postoperative day after open hysterectomy.
Collapse
Affiliation(s)
- Martin V Grady
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH 44195, USA
| | | | | | | |
Collapse
|
49
|
LIU Z, LU H, HE G, MA H, WANG J. Non-steroidal anti-inflammatory drugs reduce the stress response during sevoflurane anesthesia. Acta Anaesthesiol Scand 2012; 56:890-5. [PMID: 22725648 DOI: 10.1111/j.1399-6576.2012.02730.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Non-steroidal anti-inflammatory drugs are analgesics commonly used for post-operative pain. However, their effect on dosages of inhaled anesthetics during surgery is unclear. We investigated the effect of flurbiprofen axetil and parecoxib sodium on the minimum alveolar concentration of sevoflurane required to blunt stress responses to skin incision under general anesthesia. METHODS One hundred and five adult patients were randomly allocated to four treatment groups, each receiving sevoflurane: control (sevoflurane only), lidocaine (1 mg/kg bolus, followed by continuous infusion of 20 μg/kg/min after intubation), Intravenous (IV) flurbiprofen (1 mg/kg before skin incision), and IV parecoxib (40 mg before skin incision). Following anesthetic induction and stabilization of end-tidal sevoflurane concentration, mean arterial blood pressure and heart rate were recorded 2 min before and at 5-min intervals after skin incision. The stable end-tidal sevoflurane concentration was calculated using an up-and-down method. RESULTS The minimum alveolar concentration of sevoflurane required to blunt the stress responses to skin incision in the control, lidocaine, flurbiprofen, and parecoxib groups was 4.63 ± 0.08%, 2.67 ± 0.08%, 3.33 ± 0.08%, and 3.80 ± 0.11%, respectively. These figures for the later three groups were all significantly less than that of the control group (P = 0.021, P = 0.037, and P = 0.011, respectively); that of the flurbiprofen group was significantly less than the parecoxib (P = 0.034). CONCLUSION The non-steroidal anti-inflammatory drugs flurbiprofen axetil and parecoxib sodium decreased the minimum alveolar concentration of sevoflurane required to blunt the stress response to skin incision during general anesthesia.
Collapse
Affiliation(s)
| | - H. LU
- Department of Anesthesiology; First Affiliated Hospital of China Medical University; Shenyang; China
| | - G. HE
- Department of Anesthesiology; First Affiliated Hospital of China Medical University; Shenyang; China
| | - H. MA
- Department of Anesthesiology; First Affiliated Hospital of China Medical University; Shenyang; China
| | - J. WANG
- Department of Anesthesiology; First Affiliated Hospital of China Medical University; Shenyang; China
| |
Collapse
|
50
|
NMDA receptors with incomplete Mg²⁺ block enable low-frequency transmission through the cerebellar cortex. J Neurosci 2012; 32:6878-93. [PMID: 22593057 DOI: 10.1523/jneurosci.5736-11.2012] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The cerebellar cortex coordinates movements and maintains balance by modifying motor commands as a function of sensory-motor context, which is encoded by mossy fiber (MF) activity. MFs exhibit a wide range of activity, from brief precisely timed high-frequency bursts, which encode discrete variables such as whisker stimulation, to low-frequency sustained rate-coded modulation, which encodes continuous variables such as head velocity. While high-frequency MF inputs have been shown to activate granule cells (GCs) effectively, much less is known about sustained low-frequency signaling through the GC layer, which is impeded by a hyperpolarized resting potential and strong GABA(A)-mediated tonic inhibition of GCs. Here we have exploited the intrinsic MF network of unipolar brush cells to activate GCs with sustained low-frequency asynchronous MF inputs in rat cerebellar slices. We find that low-frequency MF input modulates the intrinsic firing of Purkinje cells, and that this signal transmission through the GC layer requires synaptic activation of Mg²⁺-block-resistant NMDA receptors (NMDARs) that are likely to contain the GluN2C subunit. Slow NMDAR conductances sum temporally to contribute approximately half the MF-GC synaptic charge at hyperpolarized potentials. Simulations of synaptic integration in GCs show that the NMDAR and slow spillover-activated AMPA receptor (AMPAR) components depolarize GCs to a similar extent. Moreover, their combined depolarizing effect enables the fast quantal AMPAR component to trigger action potentials at low MF input frequencies. Our results suggest that the weak Mg²⁺ block of GluN2C-containing NMDARs enables transmission of low-frequency MF signals through the input layer of the cerebellar cortex.
Collapse
|