Absorption of lidocaine following topical application in microvascular procedures on rabbits

Hou, Sheng‐Mou; Liu, Tang‐Kue; Yu, Hsiu‐Ying

doi:10.1002/jor.1100090410

Cited by 12 publications

(14 citation statements)

References 16 publications

(8 reference statements)

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“…2 It is characterized by wide availability, low cost, and rapid spasmolytic and antispasmodic effect. 5,11 In addition, despite quick tissue penetration, 5 large topical doses lead to negligible serum levels. 12 In this study, dilated arteries in the delayed group did not dilate further when exposed to 2% lidocaine, suggesting that maximum vasodilation had already been achieved 24 hours earlier by hydrostatic dilation.…”

Section: Discussionmentioning

confidence: 98%

“…4 Pharmacological agents, such as lidocaine, are less traumatic but do not always promote vasodilatation to the desired extent. 5 Even under the best of circumstances, simple dissection and exposure of the rat femoral vessels can lead to denudation of the intima and ischemic lesions of the tunica media. This damage may be caused by removal of the vasa vasorum during the dissection.…”

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confidence: 99%

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The Acute and Delayed Effects of Hydrostatic Dilation on Rat Femoral Arteries

Kakoulidis¹,

Papanicolaou²,

Cobbs³

et al. 2004

Annals of Plastic Surgery

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The technique of intraoperative vessel dilation is sometimes used to facilitate microvascular anastomosis and prevent vasospasm. Although this technique is not new, its application has not gained widespread acceptance mainly due to concerns raised about potential damage to the vessels acutely and during the postoperative period, leading to decreased vessel patency. The goal of this study was to determine the acute and delayed histologic effects of hydrostatic dilation on rat femoral arteries and to compare the response of dilated arteries to vasodilating and vasoconstricting agents. The femoral arteries in 22 rats were used in 2 experimental groups; 9 in the acute group and 13 in the delayed group. Six animals served as controls. After the vessels were exposed, a microcatheter was inserted into a segment of the vessel that had been isolated between 2 vessel clamps. Saline was infused into the artery until a pressure of 300 mm Hg was attained and then maintained for 60 seconds. In the acute group, the animals were euthanized at the end of the dilation, while in the delayed group the animals were euthanized 24 hours later. Hydrostatic dilation of rat femoral arteries was found to increased vessel diameter acutely, with subsequent relief and prevention of vasospasm during the ensuing 24 hours. Histologically, there was no increased damage of the vessel walls in the dilated vessels compared with control vessels. Based on the data reported in this study, hydrostatic dilation of rat microvessels appears to be safe and may be used to technically facilitate microanastomoses and decrease vasospasm.

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Section: Discussionmentioning

confidence: 98%

mentioning

confidence: 99%

The Acute and Delayed Effects of Hydrostatic Dilation on Rat Femoral Arteries

Kakoulidis¹,

Papanicolaou²,

Cobbs³

et al. 2004

Annals of Plastic Surgery

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“…The effectiveness of lidocaine is known to be strongly related to its concentration. [7][8][9][10] It has been reported that 20% lidocaine is the optimal concentration. 4,7 On the other hand, the occurrence of clinical toxicity has been reported when high-concentration lidocaine is directly applied on a vessel.…”

Section: Discussionmentioning

confidence: 99%

“…4,7 On the other hand, the occurrence of clinical toxicity has been reported when high-concentration lidocaine is directly applied on a vessel. 10 Beekman and Persisting effect of lidocaine application immediately after surgery.…”

Section: Discussionmentioning

confidence: 99%

A Novel Approach for Preventing the Development of Persistent Vasospasms after Microsurgery for the Extremities: Intermittent Topical Lidocaine Application

Yokoyama¹,

Tosa²,

Kadomatsu³

et al. 2009

J reconstr Microsurg

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Vasospasm is often encountered after harvesting the recipient artery in tissue transfer surgery, particularly in the extremities. Further, after anastomosis, thrombosis is a major complication arising due to vasoconstriction. Therefore, we decided to apply lidocaine topically on the recipient artery to prevent postoperative vasospasm. We had applied lidocaine topically on the recipient artery in seven patients with persistent vasospasm before the completion of the surgery. After surgery, 0.2 mL lidocaine (4%) was directly applied on the vascularized region every 15 minutes for the first 3 hours, every 30 minutes for the next 3 hours, and every 1 hour for the next 18 hours. Although four patients experienced a disturbance in the blood flow immediately after the surgery, they showed improvements after lidocaine application. In three of these four patients, vasospasm was also suspected to occur at 15 minutes after the surgery; however, topical application of lidocaine was found to be effective in these patients. Thrombosis was not observed in any case. We believe that if the site of lidocaine application is appropriate, even a small dose of low-concentration lidocaine (4%) can produce an adequate effect. Moreover, the intervals between lidocaine applications should be carefully considered.

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“…Systemic absorption of the topically applied lidocaine is rapid, with a peak occurring at 5 to 15 minutes 9 . The perivascular tissue is regarded as the most important site of absorption 9 . This may be a result of the mixing of lidocaine with blood at the anastomosis and slower blood flow at this site 9 .…”

Section: Discussionmentioning

confidence: 99%

The use of lidocaine in microvascular reconstruction

Chafin

Wax

Johnstone

et al. 1997

Otolaryngol.--head neck surg.

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Vasospasm is known to have an adverse effect on the survival of free tissue transfers. Prolonged vasoconstriction decreases blood flow to the flap and promotes thrombosis at the anastomotic site. Because of its wide availability and rapid effect, topically applied lidocaine is used by many surgeons to prevent and correct vasospasm. Mucosal absorption of lidocaine is known to be rapid. Absorption by the surgical bed during microvascular reconstruction has not previously been determined. We had three specific aims: (1) to determine whether systemic absorption occurs, (2) if so, to determine the degree of absorption, and (3) to determine whether the type of reconstruction affects the degree of absorption. Twelve consecutive patients were entered into the study, four in a myocutaneous reconstructive group and eight in a fasciocutaneous group. Baseline serum lidocaine levels were drawn. After the initial application of lidocaine, levels were drawn every 30 minutes. Final levels were drown 120 minutes after the last application. The total amount of lidocaine used ranged from 720 mg to 2600 mg. Application ranged from 7.5 mg/minute to 34.7 mg/minute (2 to 9 times the estimated toxic dose of 4 mg/minute for a patient weighing 70 kg). Results ranged from undetectable (<0.5 μg/ml) to minimal therapeutic levels (1.6 μg/ml). Toxic levels (>6.0 μg/ml) were not encountered. Significant ( p < 0.05) differences were found between the fasciocutaneous group, which generally had no detectable serum levels, and the myocutaneous group, which had detectable subtherapeutic to minimally therapeutic levels. Doses considered toxic by intravenous or mucous membrane application may safely be applied topically. Greater absorption was found in the myocutaneous group, which is believed to be a result of the richer absorption surface provided by the muscular tissue. (Otolaryngol Head Neck Surg 1997;117:93–8.)

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Absorption of lidocaine following topical application in microvascular procedures on rabbits

Cited by 12 publications

References 16 publications

The Acute and Delayed Effects of Hydrostatic Dilation on Rat Femoral Arteries

The Acute and Delayed Effects of Hydrostatic Dilation on Rat Femoral Arteries

A Novel Approach for Preventing the Development of Persistent Vasospasms after Microsurgery for the Extremities: Intermittent Topical Lidocaine Application

The use of lidocaine in microvascular reconstruction

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