Pharmacokinetics and pharmacodynamics of lignocaine: A review

Weinberg, Laurence; Peake, Benjamin; Tan, Chong Oon; Nikfarjam, Mehrdad

doi:10.5313/wja.v4.i2.17

Cited by 121 publications

(124 citation statements)

References 96 publications

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“…У Швеції 40-х років 1/3 операцій виконувалася під місцевою анестезією новокаїном [1]. Однак новокаїнова анестезія була небезпечним методом знеболювання, що у великому відсотку випадків було пов'язано з алергічними реакціями і впливом великих доз новакаїну на системну гемодинаміку [2].…”

Section: вступunclassified

Лидокаин В Мультимодальной Анестезии: Сегодняшняя Панацея Или Новое Модное Направление?

Лоскутов¹,

Danchyna²,

Kolesnykov³

et al. 2021

ЕМ

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Работа посвящена исследованию действия и эффективности методики малоопиоидной анестезии с использованием внутривенного лидокаина в кардиохирургии. В исследование вошли 28 пациентов в возрасте 69,5 ± 6,2 года, которым было выполнено аортокоронарное шунтирование с искусственным кровообращением. Все пациенты были прооперированы в условиях эндотрахеального наркоза. Индукция включала пропофол (1,52 ± 0,05 мг/кг), фентанил (1,46 ± 0,38 мкг/кг), лидокаин 1 мг/кг, пипекурония бромид (0,08 мг/кг). Поддержание анестезии: севофлуран (1,5–2 МАК), кетамин (0,5 мг/кг— однократно перед разрезом), лидокаин непрерывной инфузией (1,5–2 мг/кг/ч), магнезии сульфат в/в (30 мг/кг). Средний уровень оценки боли по визуальной аналоговой шкале составлял 4,6 ± 1,2 балла. Максимальную интенсивность боли в 1-е сутки отмечали 27,8 % пациентов, средней и малой интенсивности — 72,2 %. Предложенная методика малоопиоидной анестезии с внутривенным лидокаином обеспечивала адекватный анальгезирующий эффект и позволила отказаться от интраоперационного применения рутинных доз фентанила при выполнении кардиохирургических операций, что подтверждается отсутствием гемодинамических и эндокринно-метаболических сдвигов при ее использовании.

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Section: вступunclassified

Лидокаин В Мультимодальной Анестезии: Сегодняшняя Панацея Или Новое Модное Направление?

Лоскутов¹,

Danchyna²,

Kolesnykov³

et al. 2021

ЕМ

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“…Intravenous lidocaine for postoperative pain has been proposed after a number of surgical procedures (16,17) due to its mechanisms of action (sodium channel blocker, anti-inflammatory, reduction in the pro- (Table). Pharmacokinetic studies described a therapeutic range between 0.5-5.0 mcg/mL (20), which is correlated with a bolus of 1-2 mg/kg, followed by P u b l i c a c i ó n a n t i c i p a d a .…”

Section: Introductionmentioning

confidence: 99%

“…Lidocaine undergoes hepatic metabolism through cytochrome P450 3A4 isoenzyme, by oxidative N-dealkylation, producing monoethylglycinexylidide (MEGX) and subsequently glycine xylidine (GX), which are active metabolites with pharmacological activity comparable to lidocaine. This metabolism depends on the hepatic blood flow, and elimination is renal considering that less than 10% of the drug is excreted in non-metabolized form (20,22,23). It is worth noting that the lungs contribute to metabolism, since about 40% of lidocaine administered is subject to pulmonary extraction; this is an efficient mechanism because the total cardiac output goes through pulmonary circulation, and pulmonary pH is lower than plasmatic pH, which facilitates its passage (22).…”

Section: Introductionmentioning

confidence: 99%

“…It also has other mechanisms such as blockade of presynaptic muscarinic, dopamine and NMDA receptors, and substance P reduction, decreasing neuronal activity and spreading the stimulus to the spinal cord (20,21) Anti-inflammatory properties have been described, while a direct effect has been found in vitro on granulocytes, macrophages and polymorphonuclear cells function, as well as a decrease in the release of inflammatory mediators such as Leukotriene B4, an inducer of tissue edema in inflammatory processes, and Interleukin-1, which acts as a phagocytosis, degranulation and chemotaxis activator(20). In vivo, reports show that there is an effect on the release of thromboxane B2 with decreased activity on platelet aggregation and reduction of histamine release by mast cells, as well as inhibition of oxygen free radical formation because of interference at the mitochondrial level, facilitated by its ability to interact with proteins and membrane phospholipids(20). The plasma peak is independent of the route of administration and occurs within 20-30 minutes(20).…”

mentioning

confidence: 99%

“…In vivo, reports show that there is an effect on the release of thromboxane B2 with decreased activity on platelet aggregation and reduction of histamine release by mast cells, as well as inhibition of oxygen free radical formation because of interference at the mitochondrial level, facilitated by its ability to interact with proteins and membrane phospholipids(20). The plasma peak is independent of the route of administration and occurs within 20-30 minutes(20). The volume of distribution is 0.6-4.5 L/kg.…”

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confidence: 99%

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Use of systemic lidocaine for postoperative acute pain management in single-lung transplantation: Case report

2020

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Introduction: Lung transplantation is associated with severe pain, which can delay recovery. Systemic lidocaine has useful analgesic properties for managing acute pain, however little is known on its use after lung transplantation. Due to pharmacological alterations during the postoperative period, the use of analgesics implies a demanding process to avoid toxicity, so lidocaine may play a role in this scenario. In this sense, the purpose of this case report is to present the use of systemic lidocaine as an option for the management of acute pain when other analgesics have failed to do so.Case presentation: The case of a male patient with acute pain in the postoperative period of single-lung transplantation is presented. Opioids and non-opioid analgesics showed limited efficacy, so the systematic administration of lidocaine was decided. Systemic lidocaine was effective for pain control, functional recovery and opioid decrease during the postoperative period.Conclusions: Systemic lidocaine was a useful drug for postoperative pain management in lung transplantation, since it allowed adequate analgesia and lung function recovery with decreased use of opioids. This drug may be a component of multimodal analgesia in selected patients when other options have failed; however its routine use is not recommended.

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Intravenous Lidocaine for Gut Function Recovery in Colonic Surgery

Paterson,

Vadiveloo,

Innes

et al. 2024

JAMA

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ImportanceDespite the recovery advantages of minimally invasive surgical techniques, delayed return of gut function after colectomy is a common barrier to timely discharge from hospital.ObjectiveTo evaluate the effect of 2% perioperative intravenous lidocaine infusion on return of gut function after elective minimally invasive colon resection.Design, Setting, and ParticipantsThe ALLEGRO trial was a randomized, placebo-controlled, double-blind trial conducted in 27 UK hospitals. A total of 590 adults scheduled for elective minimally invasive colon resection for benign or malignant disease were randomized 1:1 to 2% intravenous lidocaine or saline placebo. Enrollment occurred from August 13, 2018, to April 11, 2023, with a pause in recruitment from March 20, 2020, through July 6, 2020; final follow-up was on August 10, 2023.InterventionsThe intervention patients received 2% intravenous lidocaine administered as 1.5-mg/kg bolus at induction of anesthesia followed by 1.5 mg/kg/h for 6 or 12 hours. Control patients received 0.9% saline placebo for 6 or 12 hours.Main Outcomes and MeasuresThe primary outcome was the proportion of patients with return of gut function at 72 hours after surgery, defined by the GI-3 composite end point of tolerating diet (ingestion of food and drink without significant nausea or vomiting for 3 consecutive meals) and passage of flatus or stool. There were 11 secondary outcomes, including time to GI-3 recovery, time to GI-2 recovery (tolerance of oral diet and passage of stool), prolonged postoperative ileus, postoperative nausea and vomiting score, Overall Benefit of Analgesia Score, postoperative opioid consumption, Quality of Recovery–15, quality of life (EuroQol 5-Dimension 5-Level), enhanced recovery protocol adherence, time to meeting medically defined criteria for discharge, and time to patient self-assessed readiness for discharge.ResultsThe trial enrolled 590 patients (295 intervention, 295 control); after 33 postrandomization exclusions, 557 patients were included (279 intervention, 278 control; 249 female patients [44.7%]; mean [SD] age, 66 [10.9] years); 532 (96%) received the randomized treatment. Return of gut function as defined by the GI-3 composite outcome was achieved at 72 hours by 160 patients (57.3%) in the intravenous lidocaine group vs 164 patients (59.0%) in the placebo group (adjusted absolute difference, −1.9% [95% CI, −8.0% to 4.2%]; relative risk, 0.97 [95% CI, 0.88 to 1.07]). There was no significant difference between the intervention and control groups in any of the 11 secondary end points.Conclusions and RelevanceAmong patients undergoing elective minimally invasive colon resection, perioperative administration of 2% intravenous lidocaine did not improve return of gut function at 72 hours.Trial Registrationisrctn.org Identifier: ISRCTN52352431

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Pharmacokinetics and pharmacodynamics of lignocaine: A review

Cited by 121 publications

References 96 publications

Лидокаин В Мультимодальной Анестезии: Сегодняшняя Панацея Или Новое Модное Направление?

Лидокаин В Мультимодальной Анестезии: Сегодняшняя Панацея Или Новое Модное Направление?

Use of systemic lidocaine for postoperative acute pain management in single-lung transplantation: Case report

Intravenous Lidocaine for Gut Function Recovery in Colonic Surgery

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