Intra‐articular administration of lidocaine in anaesthetized dogs: pharmacokinetic profile and safety on cardiovascular and nervous systems

Abstract

The intra-articular administration of lidocaine is a frequent practice in human orthopaedic surgical procedures, but an eventual absorption of the drug into the bloodstream can lead to toxicity, mainly concerning the central nervous system and the cardiovascular systems. The purpose of this study was to determine the pharmacokinetic profile and the safety, in terms of cardiovascular and CNS toxicity, of lidocaine after intra-articular administration to anesthetized dogs undergoing arthroscopy. Lidocaine 2% was administered to eight dogs before surgery in differing amounts, depending on the volume of the joints involved, and blood samples were taken at predetermined time points. The maximum serum concentration of lidocaine ranged from 0.50 to 3.01 μg/mL (mean ± SD: 2.18 ± 0.91 μg/mL), and the time to reach it was 28.75 ± 15.74 min. No signs of cardiac toxicity were detected during the entire procedure, and possible signs of CNS toxicity were masked by the anaesthesia. However, concentrations reported in literature as responsible for neurotoxicity in dog were achieved in three of eight investigated subjects. Pending further studies, veterinarians should consider the possibility of side effects occurring following the intra-articular administration of local anaesthetics.

Intra-articular administration of lidocaine plus adrenaline in dogs: Pharmacokinetic profile and evaluation of toxicity in vivo and in vitro

“…This value is approximately half of that observed in a similar study (2.18 ± 0.91 µg/mL; Di Salvo et al, 2014), where 2% lidocaine was administered by the IA route without the addition of adrenaline. Narchi et al (1992) also observed a reduction in the C max to approximately half after the intraperitoneal administration of a solution of 0.5% lidocaine plus adrenaline (1:800,000 and 1:320,000), compared to the values obtained after the administration of lidocaine alone.…”

“…The results showed that the maximum concentration of lidocaine reached was 2.188 µg/mL, which was lower than that indicated by Lemo et al (2007) as responsible for the appearance of neurotoxic effects. In the study conducted by Di Salvo et al (2014) with lidocaine alone concentrations > 2.7 ± 1.1 µg/mL were reached. As that study was conducted using the same protocol as the present study (the only difference was the presence or the absence of adrenaline) it is possible to postulate that the addition of adrenaline, which slows the absorption of lidocaine, does not allow blood concentrations high enough to cause neurological adverse effects.…”

“…Its absorption into the systemic circulation may cause cardiovascular and neurological toxic effects depending on the peak concentrations (Schulman and Strichartz, 2012). After IA administration of lidocaine 2%, Di Salvo et al (2014) observed no signs of toxicity as regards the cardiovascular and nervous system but treated dogs were under anaesthesia, which could have masked the possible neurotoxic effects. These authors observed a rapid absorption of lidocaine from the joint and, in some dogs, the peak drug concentrations were higher than those considered by Lemo et al (2007) to be responsible for neurotoxic effects in dogs (2.7 µg/mL).…”

Synoviology: a new chapter entitled to joints care

“…4 Anti-inflammatory and analgesics drugs are a classic, acute phase therapeutic resource, with a very old history of fast and long acting corticosteroids with facultative addition of lidocaine or other derivatives. Lidocaine, a local anesthetic was originally used to prevent the needle sticking pain of skin, subdermal layers, and synovial membrane (5). Finally, once spread into the joint cavity, it allows painless immediate motility and earlier functional recovery.…”

“…Finally, once spread into the joint cavity, it allows painless immediate motility and earlier functional recovery. 5 Furthermore, local anesthetics induce chondrocyte and synovial cell apoptosis. Ropivacaine and bupivacaine had limited toxicity in human mesenchymal stem cells, but lidocaine has shown to reduce mesenchymal stem cell viability.…”