Topical Lidocaine in the Treatment of Partial-Thickness Burns

Brofeldt, Bo Tomas; Cornwell, Petrea; Doherty, Derek G.; Batra, Kumar Kunnal; Gunther, R. A.

doi:10.1097/00004630-198901000-00009

Cited by 51 publications

(17 citation statements)

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“…After 2 mg/ml intravenous administration, the peak plasma concentration of lidocaine reached 1.5-1.9 g/ml (6 -8 M) within 15 min (45). Similar plasma concentrations were obtained after topical application of lidocaine (1 mg/cm 2 ) in partial thickness burns (7). In this study, the suppressive effects of lidocaine appeared at a higher plasma concentration than is observed in the clinical setting in humans.…”

Section: Discussionsupporting

confidence: 80%

Lidocaine depresses splenocyte immune functions following trauma-hemorrhage in mice

Kawasaki¹,

Choudhry²,

Schwacha³

et al. 2006

American Journal of Physiology-Cell Physiology

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Traumatic and/or surgical injury as well as hemorrhage induces profound suppression of cellular immunity. Although local anesthetics have been shown to impair immune responses, it remains unclear whether lidocaine affects lymphocyte functions following trauma-hemorrhage (T-H). We hypothesized that lidocaine will potentiate the suppression of lymphocyte functions after T-H. To test this, we randomly assigned male C3H/HeN (6–8 wk) mice to sham operation or T-H. T-H was induced by midline laparotomy and ∼90 min of hemorrhagic shock (blood pressure 35 mmHg), followed by fluid resuscitation (4× shed blood volume in the form of Ringer lactate). Two hours later, the mice were killed and splenocytes and bone marrow cells were isolated. The effects of lidocaine on concanavalin A-stimulated splenocyte proliferation and cytokine production in both sham-operated and T-H mice were assessed. The effects of lidocaine on LPS-stimulated bone marrow cell proliferation and cytokine production were also assessed. The results indicate that T-H suppresses cell proliferation, Th1 cytokine production, and MAPK activation in splenocytes. In contrast, cell proliferation, cytokine production, and MAPK activation in bone marrow cells were significantly higher 2 h after T-H compared with shams. Lidocaine depressed immune responses in splenocytes; however, it had no effect in bone marrow cells in either sham or T-H mice. The enhanced immunosuppressive effects of lidocaine could contribute to the host's enhanced susceptibility to infection following T-H.

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Section: Discussionsupporting

confidence: 80%

Lidocaine depresses splenocyte immune functions following trauma-hemorrhage in mice

Kawasaki¹,

Choudhry²,

Schwacha³

et al. 2006

American Journal of Physiology-Cell Physiology

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“…Topical analgesic techniques, such as lignocaine (Brofeldt et al, 1989 Level IV) or morphineinfused silver sulfadiazine cream (Long et al, 2001 Level IV) may be effective, however a topical gel dressing containing morphine was no more effective than other gel dressing in reducing burn injury pain in the emergency department (Welling, 2007 Level II).…”

Section: Short-acting Opioids Such As Fentanyl (Prakash Et Al 2004mentioning

confidence: 99%

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Cohen

Smit

Andrianopoulos³

et al. 2017

Medical Journal of Australia

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Objectives: This study aimed to assess analgesia provided by acupuncture, alone or in combination with pharmacotherapy, to patients presenting to emergency departments with acute low back pain, migraine or ankle sprain. Design: A pragmatic, multicentre, randomised, assessor‐blinded, equivalence and non‐inferiority trial of analgesia, comparing acupuncture alone, acupuncture plus pharmacotherapy, and pharmacotherapy alone for alleviating pain in the emergency department. Setting, participants: Patients presenting to emergency departments in one of four tertiary hospitals in Melbourne with acute low back pain, migraine, or ankle sprain, and with a pain score on a 10‐point verbal numerical rating scale (VNRS) of at least 4. Main outcome measures: The primary outcome measure was pain at one hour (T1). Clinically relevant pain relief was defined as achieving a VNRS score below 4, and statistically relevant pain relief as a reduction in VNRS score of greater than 2 units. Results: 1964 patients were assessed between January 2010 and December 2011; 528 patients with acute low back pain (270 patients), migraine (92) or ankle sprain (166) were randomised to acupuncture alone (177 patients), acupuncture plus pharmacotherapy (178) or pharmacotherapy alone (173). Equivalence and non‐inferiority of treatment groups was found overall and for the low back pain and ankle sprain groups in both intention‐to‐treat and per protocol (PP) analyses, except in the PP equivalence testing of the ankle sprain group. 15.6% of patients had clinically relevant pain relief and 36.9% had statistically relevant pain relief at T1; there were no between‐group differences. Conclusion: The effectiveness of acupuncture in providing acute analgesia for patients with back pain and ankle sprain was comparable with that of pharmacotherapy. Acupuncture is a safe and acceptable form of analgesia, but none of the examined therapies provided optimal acute analgesia. More effective options are needed. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12609000989246.

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“…Topical 5% lidocaine cream applied to partial thickness burn wound at a concentration of 1 mg/cm 2 (maximum area treated being 28% TBSA) provides significant pain relief for up to 4-6 h without associated systemic side effects [59]. Intravenous lidocaine, 1 mg/kg as a bolus, followed by infusion at a rate of 40 µg/kg/min has been shown to inhibit burn pain for up to 3 days [60].…”

Section: Local Anestheticsmentioning

confidence: 99%

Analgesia and sedation for children undergoing burn wound care

Bayat

Ramaiah

Bhananker

2010

Expert Review of Neurotherapeutics

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Standard care of burn wounds consists of cleaning and debridement (removing devitalized tissue), followed by daily dressing changes. Children with burns undergo multiple, painful and anxiety-provoking procedures during wound care and rehabilitation. The goal of procedural sedation is safe and efficacious management of pain and emotional distress, requiring a careful and systematic approach. Achieving the best results needs understanding of the mechanisms of pain and the physiologic changes in burn patients, frequent evaluation and assessment of pain and anxiety, and administration of suitable pharmacological and nonpharmacological therapies. Pharmacological therapies provide the backbone of analgesia and sedation for procedural pain management. Opioids provide excellent pain control, but they must be administered judiciously due to their side effects. Sedative drugs, such as benzodiazepines and propofol, provide excellent sedation, but they must not be used as a substitute for analgesic drugs. Ketamine is increasingly used for analgesia and sedation in children as a single agent or an adjuvant. Nonpharmacological therapies such as virtual reality, relaxation, cartoon viewing, music, massage and hypnosis are necessary components of procedural sedation and analgesia for children. These can be combined with pharmacological techniques and are used to limit the use of drugs (and hence side effects), as well as to improve patient participation and satisfaction. In this article, we review the pathophysiologic changes associated with major thermal injury in children, the options available for sedation and analgesia for wound care procedures in these children and our institutional guidelines for procedural sedation.

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Topical Lidocaine in the Treatment of Partial-Thickness Burns

Cited by 51 publications

References 0 publications

Lidocaine depresses splenocyte immune functions following trauma-hemorrhage in mice

Lidocaine depresses splenocyte immune functions following trauma-hemorrhage in mice

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Analgesia and sedation for children undergoing burn wound care

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