Effectiveness of local anesthesia with lidocaine in chronic opium abusers

Abstract

Context:It had been demonstrated that chronic opium abusers have lower pain thresholds compared with than non-abusers.Aims:This study aimed to compare the required dose of lidocaine, a common local anesthetic drug, with regard to the onset of anesthesia in opium abusers with that in non-abusers undergoing similar suturing of minor hand lacerations.Materials and Methods:In this study, 109 opium abusers and 91 non-abusers underwent similar suturing for hand lacerations known as digital block. We explained the patients that their case records would remain confidential and admitting to any history of opioid abuse could assist in alleviating any pain associated with the procedure.Results:There was no statistically significant difference between the two groups with regard to age, gender, and cause of injury (P > 0.05). We found a significantly longer duration of onset of analgesia in nonopioid abusers (5.42 ± 1.93 min) than that in abusers (10.30 ± 1.79 min) (P < 0.001). In addition, the lidocaine dose administered to abusers (6.67 ± 1.21 ml) was higher (4.07 ± 1.26) as well as statistically significant (P < 0.001) than that in non-abusers.Conclusion:The findings from this study suggest a longer duration of onset of anesthesia and requirement of a higher lidocaine dose in opium abusers compared with nonopioid abuser. Moreover, chronic opium abusers (4-5 years) experienced significantly higher time of onset of anesthesia compared with nonchronic abusers. This outcome may be useful in selecting a more suitable local anesthetic protocol in such patients.

Opioid-induced Loss of Local Anesthetic Potency in the Rat Sciatic Nerve

“…Lastly, the loss of LA potency was blocked by naloxone, but not naloxone methiodide. These results suggest the apparent decrease in LA potency observed in opioid tolerant patients, most clearly documented by Hashemian and colleagues 5 , may be due, at least in part, to a decrease in the potency of LA-induced peripheral nerve block.…”

Updates in emergency department laceration management

“…One randomized controlled trial compared the efficacy of a single subcutaneous palmar injection (introduced vertically through the distal joint line of the metacarpophalangeal joint) versus the traditional 2 injection technique and found similar results in terms of pain control and time of anesthesia onset [33]. An observational case control study found that patients with a history of opioid abuse who underwent digital block required a higher total amount of local anesthetic, and the time to anesthesia onset was longer [34]. In light of the current opioid epidemic, it is important to recognize that many of our patients who are opioid tolerant may require more anesthetic and take longer to achieve adequate anesthesia when receiving digital nerve blocks.…”

Multimodal Analgesia: Polypharmacy in Pain Relief or Rational Use of Non-Steroidal Anti-Inflammatory Drugs to Prevent Pain Chronicity

“…В последнее время было доказано повышение риска метастазирования и рецидивов злокачественных новообразований на фоне послеоперационного обезболивания опиоидами. Также следует отметить, что опиоиды способны снижать эффективность местных анестетиков [23,24].…”