Plasma Lidocaine Concentrations After Caudal, Lumbar Epidural, Axillary Block, and Intravenous Regional Anesthesia

Mazze, Richard I.; Dunbar, Ronald W.

doi:10.1097/00000542-196609000-00007

Cited by 55 publications

(13 citation statements)

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“…The highest concentration recorded was 2.83 lg/ml at 15 min after infiltration. In a study by Mazze et al [18] symptoms and signs of lidocaine toxicity appeared at venous levels of 5 lg/ml or more, which is higher than our highest recorded level. Our results demonstrate no early peak at 1 min in any patient, which could have occurred from direct intravascular administration, which could be a factor in the safety of our procedure.…”

Section: Discussioncontrasting

confidence: 62%

An assessment of the clinical utility of transperineal urethrosphincteric block (TUSB) in outpatient rigid cystoscopy: a single-blind, randomized study

et al. 2008

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Section: Discussioncontrasting

confidence: 62%

An assessment of the clinical utility of transperineal urethrosphincteric block (TUSB) in outpatient rigid cystoscopy: a single-blind, randomized study

et al. 2008

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“…However, in clinical practice the doses required for cervical and thoracic epidural anaesthesia are generally smaller than those needed for lumbar epidural anaesthesia (Bromage 1978), and consequently higher concentrations should be anticipated after lumbar injection. Concentrations after caudal injection generally exceed those after lumbar administration, both because of the higher dose requirements and because the absorption from the caudal epidural space is faster, as has been demonstrated with mepivacaine and etidocaine (Lund et al 1975;Tucker et al 1972), but not with lignocaine (Mazze & Dunbar 1966). Injection in the thoracic or cervical region is rarely, if ever, used for spinal anaesthesia.…”

Section: Site Of Injectionmentioning

confidence: 99%

Clinical Pharmacokinetics of Epidural and Spinal Anaesthesia

Burm

1989

Clinical Pharmacokinetics

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Epidural and spinal anaesthesia results from the interaction of local anaesthetics with nerve structures, primarily those located within the subarachnoid space. Local anaesthetics can reach the sites of action along various distribution pathways. Uptake into extraneural tissues (in particular epidural fat) and systemic absorption compete with neural tissue distribution and thereby affect the clinical potency and duration of action. Consequently, epidural doses must be much higher than spinal doses. The systemic absorption of lignocaine (lidocaine), bupivacaine and etidocaine following lumbar epidural administration has been shown to be biphasic, with a rapid initial absorption phase followed by a much slower absorption phase. Initial absorption rates of lignocaine and bupivacaine following subarachnoid injection are much slower, but the late absorption rates are similar to those after epidural administration. The tissue distribution characteristics of various amide-type agents are similar, because more extensive plasma binding offsets the greater tissue affinity of the more lipophilic compounds bupivacaine and etidocaine. The amide-type agents are predominantly eliminated by hepatic metabolism, except prilocaine, which is also metabolised elsewhere in the body. Ester-type agents are rapidly hydrolysed in blood and liver and are eliminated much faster than amide-type agents. The blood concentrations attained depend primarily upon the dose administered. The addition of adrenaline (epinephrine) reduces the peak plasma drug concentrations; similarly, the age of the patient, disease states and drug interactions may alter the pharmacokinetics to various extents. Because of the low dose requirements, systemic toxicity is not a problem during spinal anaesthesia. During epidural anaesthesia, however, the safety margin is relatively small, and systemic toxicity is very likely to occur after inadvertent intravascular injection of an epidural dose.

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“…The low incidence of central nervous sy stem and cardiovascular effects is, according to Knapp and Weinberg (1967), due to the rapid tissue uptake of the drug from the blood. Mazze & Dunbar (1966) have shown in man that with intravenous regional anaesthesia the plasma concentration of the drug is actually less than with conventional axillary block. Foldes et al (1960) also found that the blood levels of the drug after release of the tourniquet were much lower than those associated with central nervous system toxicity.…”

Section: Techniquementioning

confidence: 99%

Serum Complement (C3) in Leprosy

Shwe¹

1971

Leprosy Review

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In troductionThe production of surgical analgesia in the limbs by intravenous injection of a local anaesthetic, was introduced by Bier (1908). The procedure involves exsanguination of the extremity by elevation and compression, and the application of a tourniquet. The anaesthetic solution, which is injected into the vein , diffuses into the tissue and blocks the nerve endings. TechniqueA sphygmomanometer cuff is placed high on the upper arm of the limb to be operated on, and the hand is prepared and draped . A Mitchell's needle is then introduced into a prominent vein on the dorsum of the hand, the arm is elevated for 5 min, and if necessary the extremity is exsanguinated with a sterile Esmarch bandage. The sphygmomanometer cuff is inflated to a pressure of 220 mmHg, and 15 ml of 1 % Xylo caine solution is injected through the needle . We prefer Xylocaine solution to procaine because it seems to diffuse more easily across the endothelium. Some anaesthetists apply two tourniquets on the arm in an attempt to avoid discomfort, since the pressure of the tourniquet is felt by the patient after about 50 min . At the end of the operation the tourniquet is released intermittently in order to allow the drug from the exsanguinated area to enter the sy stemic circulation slowly . Too rapid a release may produce a generalized response resulting from flooding of the tissues with anaesthetic solution.During the past 5 years, of the 1472 operations performed on the hand at this institution, regional anaesthesia was used in 1124 cases; 80% of the operations were for tendon transplantation, and the remainder were for fractures and other injuries. Plantaris tendon required as graft for tendon transplant was removed under Trilene anaesthesia. Four wrist fu sions, and several reductions of fractures of the forearm bones, both open and closed, were also performed under intravenous regional anaesthesia. Since the anaesthesia lasts for about 15 min after the tourniquet is deflated, this was done before th e skin sutures were inserted.With good technique, 100% success rate is achieved ; our failures were due to a leaking tourniquet. Out of this large series, systemic response has occurred on a few occasions only. In one case the patient developed convulsions and

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Plasma Lidocaine Concentrations After Caudal, Lumbar Epidural, Axillary Block, and Intravenous Regional Anesthesia

Cited by 55 publications

References 0 publications

An assessment of the clinical utility of transperineal urethrosphincteric block (TUSB) in outpatient rigid cystoscopy: a single-blind, randomized study

An assessment of the clinical utility of transperineal urethrosphincteric block (TUSB) in outpatient rigid cystoscopy: a single-blind, randomized study

Clinical Pharmacokinetics of Epidural and Spinal Anaesthesia

Serum Complement (C3) in Leprosy

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