1
|
Xia Y, Xu K, Luo M, Li Z, He S, Gong T, Zhang Z, Deng L. A Bilayer Microneedle for Modulated Sequential Release of Adrenaline and Lidocaine for Prolonged Local Anesthesia. ACS APPLIED BIO MATERIALS 2024; 7:1229-1239. [PMID: 38254256 DOI: 10.1021/acsabm.3c01128] [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] [Indexed: 01/24/2024]
Abstract
Chronic pain emerges as a major global health issue, significantly impacting individuals' health and quality of life. In this study, we designed a bilayer microneedle loaded with lidocaine nanocomposites in the inner layer and adrenaline (Adr) in the outer layer (HCP MNs) for modulated sequential release to achieve prolonged local anesthesia. The obtained HCP MNs featured an intact structure with adequate mechanical strength for efficient skin penetration. The bilayer structure of MNs was evidenced by loading two fluorescent dyes in each layer. Furthermore, these HCP MNs were capable of inducing rapid as well as prolonged local anesthetic effects in guinea pigs. Hence, the bilayer MN coloaded with Adr and lidocaine nanocomposite serves as a promising transdermal delivery platform for chronic pain management.
Collapse
Affiliation(s)
- Yunli Xia
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610041, China
| | - Ke Xu
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610041, China
| | - Maoqi Luo
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610041, China
| | - Zeya Li
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610041, China
| | - Siwuxie He
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610041, China
| | - Tao Gong
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610041, China
| | - Zhirong Zhang
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610041, China
| | - Li Deng
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610041, China
| |
Collapse
|
2
|
Tirupathi SP, Rajasekhar S. Effect of warming local anesthesia solutions before intraoral administration in dentistry: a systematic review. J Dent Anesth Pain Med 2020; 20:187-194. [PMID: 32934984 PMCID: PMC7470999 DOI: 10.17245/jdapm.2020.20.4.187] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/02/2020] [Accepted: 07/09/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The aim of the present systematic review was to evaluate and compare the efficacy of warmed and unwarmed local anesthesia solutions in reduction of pain during intraoral injection administration. METHODS PubMed, Ovid SP, and Cochrane Central Register of Controlled Trials were searched from publication years 1990 to 2020 with relevant MeSH terms. Studies were screened by titles and abstracts, followed by full-texts evaluation of the included studies. RESULTS A total of four studies were included in the systematic review. Outcomes evaluated were subjective and objective pain during administration of the warmed local anesthesia solution in comparison with the unwarmed local anesthesia solution. Among the four studies that evaluated the self-reported pain score, three studies showed significantly lower pain scores associated with warmed local anesthesia. Only two studies evaluated the observed pain score, and both of them reported a significantly lower pain reaction with the warmed local anesthesia solution. CONCLUSION Within the limits of this systematic review, warming the local anesthesia solution to body temperature (37℃) before administration seemed to reduce the discomfort during intraoral local anaesthesia administration, and more high-quality studies should be carried out to validate the same.
Collapse
Affiliation(s)
- Sunny Priyatham Tirupathi
- Department of Pedodontics & Preventive Dentistry, Malla Reddy Institute of Dental Sciences, Hyderabad Telangana, India
| | - Srinitya Rajasekhar
- Department of Pedodontics & Preventive Dentistry, Malla Reddy Dental College for Women, Hyderabad, Telangana, India
| |
Collapse
|
3
|
Ulu M, Etöz OA, Demirbaş AE, Çanakçı FGY, Akçay H. Yirmi yaş dişi çekimi öncesinde ısıtılmış lokal anestezik solüsyonun ağrı ve anestezi süresine etkisi. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.481120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
|
4
|
Aravena PC, Barrientos C, Troncoso C, Coronado C, Sotelo-Hitschfeld P. Effect of warming anesthetic on pain perception during dental injection: a split-mouth randomized clinical trial. Local Reg Anesth 2018; 11:9-13. [PMID: 29503582 PMCID: PMC5826251 DOI: 10.2147/lra.s147288] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The purpose of this study is to determine the effectiveness of warming anesthesia on the control of the pain produced during the administration of dental anesthesia injection and to analyze the role of Transient Receptor Potential Vanilloid-1 nociceptor channels in this effect. PATIENTS AND METHODS A double-blind, split-mouth randomized clinical trial was designed. Seventy-two volunteer students (22.1±2.45 years old; 51 men) from the School of Dentistry at the Universidad Austral de Chile (Valdivia, Chile) participated. They were each administered 0.9 mL of lidocaine HCl 2% with epinephrine 1:100,000 (Alphacaine®) using two injections in the buccal vestibule at the level of the upper lateral incisor teeth. Anesthesia was administered in a hemiarch at 42°C (107.6°F) and after 1 week, anesthesia was administered by randomized sequence on the contralateral side at room temperature (21°C-69.8°F) at a standardized speed. The intensity of pain perceived during the injection was compared using a 100 mm visual analog scale (VAS; Wilcoxon test p<0.05). RESULTS The use of anesthesia at room temperature produced an average VAS for pain of 35.3±16.71 mm and anesthesia at 42°C produced VAS for pain of 15±14.67 mm (p<0.001). CONCLUSION The use of anesthesia at 42°C significantly reduced the pain during the injection of anesthesia compared to its use at room temperature during maxillary injections. The physiological mechanism of the temperature on pain reduction could be due to a synergic action on the permeabilization of the Transient Receptor Potential Vanilloid-1 channels, allowing the passage of anesthetic inside the nociceptors.
Collapse
Affiliation(s)
- Pedro Christian Aravena
- Department of Dentistry, Universidad Austral de Chile, Valdivia, Chile
- Department of Dental Implant Surgery, São Leopoldo Mandic School and Dental Institute, Campinas, SP, Brazil
| | - Camila Barrientos
- Department of Dentistry, Universidad Austral de Chile, Valdivia, Chile
| | - Catalina Troncoso
- Department of Dentistry, Universidad Austral de Chile, Valdivia, Chile
| | - Cesar Coronado
- Faculty of Health Science, School of Medicine, Universidad Autónoma de Chile, Santiago, Chile
| | - Pamela Sotelo-Hitschfeld
- Department of Center for Interdisciplinary Studies on Nervous System (CISNe), Universidad Austral de Chile, Valdivia, Chile
| |
Collapse
|
5
|
Yeo G, Gupta A, Ding G, Skerman H, Khatun M, Melsom D. Pain Levels after Local Anaesthetic with or without Hyaluronidase in Carpal Tunnel Release: A Randomised Controlled Trial. Adv Orthop 2015; 2015:784329. [PMID: 26587288 PMCID: PMC4637433 DOI: 10.1155/2015/784329] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 10/15/2015] [Indexed: 01/06/2023] Open
Abstract
Purpose. Hyaluronidase is an enzyme that temporarily liquefies the interstitial barrier, allowing easy dispersal of local anaesthetic through cleavage of tissue planes. This prospective, blinded, randomised controlled study investigates the utility of adding hyaluronidase to local anaesthetic in the setting of carpal tunnel release. Methods. 70 consecutive carpal tunnel release patients were recruited and randomised into a control group only receiving local anaesthetic and a hyaluronidase group receiving both hyaluronidase and local anaesthetic. Pain scores were rated using the visual analogue scale (VAS) by patients immediately after local anaesthetic injection and again immediately after the carpal tunnel release. Results. Preoperative VAS scores, taken after local anaesthetic injection, were greater than postoperative VAS scores. Postoperative VAS scores were significantly lower in the hyaluronidase group and tourniquet times were significantly shorter in the hyaluronidase group. Conclusion. Hyaluronidase addition to local anaesthetic in carpal tunnel release resulted in significant reductions in operative time and pain immediately after operation.
Collapse
Affiliation(s)
- G. Yeo
- Royal Brisbane Hospital, Australia
| | | | | | | | | | | |
Collapse
|
6
|
Aravena P, Barrientos C, Troncoso C. Effect of warming anesthetic solutions in injection pain during dental anesthesia. A Randomized clinical trial. JOURNAL OF ORAL RESEARCH 2015. [DOI: 10.17126/joralres.2015.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
7
|
Cepeda MS, Tzortzopoulou A, Thackrey M, Hudcova J, Arora Gandhi P, Schumann R. WITHDRAWN: Adjusting the pH of lidocaine for reducing pain on injection. Cochrane Database Syst Rev 2015; 2015:CD006581. [PMID: 25993661 PMCID: PMC10641661 DOI: 10.1002/14651858.cd006581.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
May 2015 This review was originally published in 2010 and at that time complied with Cochrane’s Commercial Sponsorship Policy. The Commercial Sponsorship policy was updated in 2014 (http://community.cochrane.org/organisational‐policy‐manual/appendix‐5‐commercial‐sponsorship‐policy ). This review is no longer compliant with that policy. The non conflicted members of the original team of authors have decided not to update the review. We have therefore decided to withdraw the review and seek new authors to update it The editorial group responsible for this previously published document have withdrawn it from publication.
Collapse
Affiliation(s)
- M Soledad Cepeda
- Johnson & Johnson Pharmaceutical Research and DevelopmentPharmacoepidemiologyPO BOX 200, M/S K304TitussvilleNJUSA08560
| | - Aikaterini Tzortzopoulou
- Tufts Medical CenterDepartment of Anesthesiology800 Washington streetBostonMassachusettsUSA02111
| | - Michael Thackrey
- University of California, San FranciscoFamily and Community MedicineFamily Health Center995 Potrero Avenue, Ward 83San FranciscoCaliforniaUSA94110
| | - Jana Hudcova
- Lahey ClinicDepartment of Surgical Critical Care41 Mall RoadBurlingtonMassachusettsUSA01805
| | - Preeti Arora Gandhi
- Tufts Medical CenterDepartment of Anesthesiology800 Washington streetBostonMassachusettsUSA02111
| | - Roman Schumann
- Tufts Medical CenterDepartment of Anesthesiology800 Washington streetBostonMassachusettsUSA02111
| | | |
Collapse
|
8
|
Abstract
Local anaesthetic techniques are increasingly popular for ophthalmic surgery. It is now being provided mainly by anaesthesiologists and varies from an akinetic injection technique to a non-akinetic topical technique. Each technique has its own risk/benefit profile, and proven to be highly successful if performed correctly. The choice of the technique should be individualized based upon specific needs of the patient, the nature and extent of eye surgery, and the anaesthesiologist's and surgeon's preferences and skill. This review article attempts to outline the orbital anatomy, discuss the commonly used agents, current method of pre-operative preparation, available clinical techniques and their inherent complications.
Collapse
Affiliation(s)
- VV Jaichandran
- Department of Anaesthesiology, Medical Research Foundation, Sankara Nethralaya, 41/18, College Road, Nungambakkam, Chennai, Tamil Nadu, India
| |
Collapse
|
9
|
Zawar S. Alkalinization in peribulbar anesthesia for surgery on inflamed eye. Indian J Ophthalmol 2011; 59:266. [PMID: 21586867 PMCID: PMC3120265 DOI: 10.4103/0301-4738.81044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
10
|
Hogan ME, vanderVaart S, Perampaladas K, Machado M, Einarson TR, Taddio A. Systematic review and meta-analysis of the effect of warming local anesthetics on injection pain. Ann Emerg Med 2011; 58:86-98.e1. [PMID: 21316812 DOI: 10.1016/j.annemergmed.2010.12.001] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 11/23/2010] [Accepted: 12/01/2010] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE Local anesthetics are the main class of analgesics used for pain management during laceration repair and other minor surgeries; however, they are administered by injection, which is painful. Warming local anesthetics has been proposed as a cost-free intervention that reduces injection pain. A systematic review of the effectiveness of this technique has not yet been undertaken. We determine the effectiveness of warming local anesthetics to reduce pain in adults and children undergoing local anesthetic infiltration into intradermal or subcutaneous tissue. METHODS We used published articles from MEDLINE (1950 to June 2010), EMBASE (1980 to June 2010), CINAHL (1982 to June 2010), the Cochrane Library (second quarter 2010), International Pharmaceutical Abstracts (1970 to June 2010), and ProQuest Dissertations and Theses database (1938 to June 2010). We included studies with randomized or pseudorandomized designs and healthy subjects or patients receiving subcutaneous or intradermal injection of local anesthetics that were warmed (body temperature) or not (room temperature). Studies of regional anesthesia and intraarticular, spinal, or periorbital administration of local anesthetics were excluded. Data were extracted onto predesigned forms and verified by 2 reviewers. Quality was assessed with the Cochrane risk of bias tool. The primary outcome was self-reported pain as assessed by a visual analog or numeric rating scale. Data were combined with mean differences with 95% confidence intervals (CIs) by using a random-effects model. RESULTS Twenty-nine studies were retrieved for close examination and 19 studies met inclusion criteria. A total of 18 studies with 831 patients could be included in a meta-analysis. Seventeen studies had an unclear risk of bias and 1 had a high risk of bias. A mean difference of -11 mm (95% CI -14 to -7 mm) on a 100-mm scale was found in favor of warming local anesthetics. Subgroup analysis of 8 studies investigating the effect of warming on buffered local anesthetics yielded similar results: -7 mm (95% CI -12 to -3 mm). CONCLUSION Warming local anesthetics leads to less pain during injection and therefore should be done before administration.
Collapse
Affiliation(s)
- Mary-Ellen Hogan
- Graduate Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
11
|
Cepeda MS, Tzortzopoulou A, Thackrey M, Hudcova J, Arora Gandhi P, Schumann R. Adjusting the pH of lidocaine for reducing pain on injection. Cochrane Database Syst Rev 2010:CD006581. [PMID: 21154371 DOI: 10.1002/14651858.cd006581.pub2] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Lidocaine administration produces pain due to its acidic pH. OBJECTIVES The objective of this review was to determine if adjusting the pH of lidocaine had any effect on pain resulting from non-intravascular injections in adults and children. We tested the hypothesis that adjusting the pH of lidocaine solution to a level closer to the physiologic pH reduces this pain. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, to June 2010); Ovid MEDLINE (1966 to June 2010); EMBASE (1988 to June 2010); LILACS (1982 to June 2010); CINAHL (1982 to June 2010); ISI Web of Science (1999 to June 2010); and abstracts of the meetings of the American Society of Anesthesiologists (ASA). We checked the full articles of selected titles. We did not apply any language restrictions. SELECTION CRITERIA We included double-blinded, randomized controlled trials that compared pH-adjusted lidocaine with unadjusted lidocaine. We evaluated pain at the injection site, satisfaction and adverse events. We excluded studies in healthy volunteers. DATA COLLECTION AND ANALYSIS We separately analysed parallel-group and crossover trials; trials that evaluated lidocaine with or without epinephrine; and trials with pH-adjusted lidocaine solutions < 7.35 and ≥ 7.35. To explain heterogeneity, we separately analysed studies with a low and higher risk of bias due to the level of allocation concealment; studies that employed a low and a higher volume of injection; and studies that used lidocaine for different types of procedures. MAIN RESULTS We included 23 studies of which 10 had a parallel design and 13 were crossover studies. Eight of the 23 studies had moderate to high risk of bias due to the level of allocation concealment.Pain associated with the infiltration of buffered lidocaine was less than the pain associated with infiltration of unbuffered lidocaine in both parallel and crossover trials. In the crossover studies, the difference was -1.98 units (95% confidence interval (CI) -2.62 to -1.34) and in the parallel-group studies it was -0.98 units (95% CI -1.49 to -0.47) on a 0 to 10 scale. The magnitude of the pain decrease associated with buffered lidocaine was larger when the solution contained epinephrine. The risk of bias, volume of injection, and type of procedure failed to explain the heterogeneity of the results.Patients preferred buffered lidocaine (odds ratio 3.01, 95% CI 2.19 to 4.15). No adverse events or toxicity were reported. AUTHORS' CONCLUSIONS Increasing the pH of lidocaine decreased pain on injection and augmented patient comfort and satisfaction.
Collapse
Affiliation(s)
- M Soledad Cepeda
- Pharmacoepidemiology, Johnson & Johnson Pharmaceutical Research and Development, PO BOX 200, M/S K304, Titussville, NJ, USA, 08560
| | | | | | | | | | | |
Collapse
|