Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942005000300005
Brazilian Journal of Anesthesiology
Scientific Article

Latência da lidocaína a 1% para anestesia infiltrativa da pele

Onset of 1% lidocaine for skin infiltrative anesthesia

Gustavo Paiva Almeida; Gustavo Luchi Boos; Tiago Gayer de Alencar; Getúlio Rodrigues de Oliveira Filho

http://dx.doi.org/10.1590/S0034-70942005000300005 Braz J Anesthesiol, vol.55, n3, p.284-288, 2005
PDF Português
PDF English
Downloads: 0
Views: 1024

Resumo

JUSTIFICATIVA E OBJETIVOS: As latências T50 e T95 correspondem às medianas dos intervalos entre o término da infiltração da pele e subcutâneo com anestésico local e a ocorrência de estímulo nóxico, que garantem insensibilidade em 50% e em 95% dos pacientes, respectivamente. Este estudo avaliou o T50 e o T95 da infiltração de lidocaína a 1% para punção da pele da região lombar. MÉTODO: O estudo foi prospectivo seguindo a técnica de alocação seqüencial dependente da resposta do paciente anterior, incluindo 25 pacientes submetidos a bloqueios subaracnóideos com agulha de Quincke 25G. Lidocaína a 1%, 3 mL, foi infiltrada na pele e subcutâneo de L3-L4 ou L4-L5, com agulha de 10 mm 25G. Os intervalos de tempo decorridos entre o término da infiltração e a punção com agulha de Quincke 25G foram estabelecidos em escala logarítmica. O intervalo inicial foi de 30 segundos. Os intervalos subseqüentes dependeram da resposta do paciente anterior. Caso o paciente referisse ter sentido a punção da pele com a agulha de Quincke, o tempo de espera era aumentado para o tempo imediatamente superior no paciente seguinte. Caso contrário, era diminuído para o intervalo imediatamente inferior. O T50 e o T95 foram calculados pelas fórmulas de Dixon e Massey. RESULTADOS: As medianas (limites de 95% de confiança) do T50 e do T95 foram 25 segundos (20 - 31 segundos) e 53 segundos (33 - 85 segundos), respectivamente. CONCLUSÕES: Para obter anestesia da pele da região lombar para punção subaracnóidea em 95% dos pacientes, utilizando anestesia infiltrativa com 3 mL de lidocaína a 1%, deve-se aguardar de 33 a 85 segundos entre o término da infiltração e a punção.

Palavras-chave

COMPLICAÇÕES, Dor, TÉCNICAS ANESTÉSICAS, Infiltrativa

Abstract

BACKGROUND AND OBJECTIVES: Minimum T50 and T95 onsets are the medians of time intervals between end of skin and subcutaneous tissue infiltration with local anesthetics and a painful stimulation, which are associated to no pain in 50% and 95% of patients, respectively. This study has evaluated T50 and T95 of subcutaneous 1% lidocaine for lumbar skin puncture. METHODS: This was a prospective study with sequential allocation depending on the response of previous patient (Dixon and Massey's up-down method) involving 25 patients submitted to spinal blocks with 25G Quincke needle. Skin and subcutaneous tissue were infiltrated with 3 mL of 1% lidocaine in L3-L4 or L4-L5 interspace with 10 mm 25G needle. Time elapsed between the end of infiltration and 25G Quincke needle puncture was established in logarithmic scale. Initial interval was 30 seconds. Subsequent intervals depended on previous patient's response. If the patient referred pain at 25G Quincke needle puncture, the next patient was allocated to the immediately longer interval; otherwise, the next patient would be allocated to the immediately shorter interval. Dixon and Massey's formulas were applied to calculate T50 and T95. RESULTS: Medians (95% confidence limits) of T50 and T95 were 25 seconds (20-31 seconds) and 53 seconds (33-85 seconds), respectively. CONCLUSIONS: To obtain lumbar skin anesthesia before lumbar puncture in 95% of patients, one should wait 33 to 85 seconds after the end of subcutaneous infiltration of 3 mL of 1% plain lidocaine.

Keywords

ANESTHETIC TECHNIQUES, Infiltrative, COMPLICATIONS, Pain

Referências

Theriault E, Diamond J. Nociceptive cutaneous stimuli evoke localized contractions in a skeletal muscle. J Neurophysiol. 1988;60:446-462.

Zedka M, Prochazka A, Knight B. Voluntary and reflex control of human back muscles during induced pain. J Physiol. 1999;520:591-604.

De Filho GR, Gomes HP, da Fonseca MH. Predictors of successful neuraxial block: a prospective study. Eur J Anaesthesiol. 2002;19:447-451.

De Oliveira Filho GR, Garcia JHS, Gomes HP. Predicting the successful identification of the epidural or the subarachnoid spaces at the first attempt: a prospective study. Eur J Anaesthesiol. 2001;21(^s18):82-83.

Prien T. Intradermal anaesthesia: comparison of several compounds. Acta Anaesthesiol Scand. 1994;38:805-807.

Dixon WJ, Massey FJ. Introduction to Statistical Analysis. 1983:428-439.

Rowlingson JC, Murphy TM. Chronic Pain in Anesthesia. Anesthesia. 2000:2352-2376.

Berde   CB, Strichartz GR. Local Anesthetics in Anesthesia. Anesthesia. 2000:491-521.

Morris RW, Whish DK. A controlled trial of pain on skin infiltration with local anaesthetics. Anaesth Intensive Care. 1984;12:113-114.

Morris R, McKay W, Mushlin P. Comparison of pain associated with intradermal and subcutaneous infiltration with local anesthetic solutions. Anesth Analg. 1987;66:1180-1182.

Nuttall GA, Barnett MR, Smith RL. Establishing intravenous access: a study of local anesthetic efficacy. Anesth Analg. 1993;77:950-953.

McKay W, Morris R, Mushlin P. Sodium bicarbonate attenuates pain on skin infiltration with lidocaine, with or without epinephrine. Anesth Analg. 1987;66:572-574.

Palmon SC, Lloyd AT, Kirsch JR. The effect of needle gauge and lidocaine pH on pain during intradermal injection. Anesth Analg. 1998;86:379-381.

Marica LS, O'Day T, Janosky JE. Chloroprocaine is less painful than lidocaine for skin infiltration anesthesia. Anesth Analg. 2002;94:351-354.

Steinbrook RA, Hughes N, Fanciullo G. Effects of alkalinization of lidocaine on the pain at skin infiltration and intravenous catheterization. J Clin Anesth. 1993;5:456-458.

Mader TJ, Playe SJ, Garb JL. Reducing the pain of local anesthetic infiltration: warming and buffering have a synergistic effect. Ann Emerg Med. 1994;23:550-554.

Skidmore RA, Patterson JD, Tomsick RS. Local anesthetics. Dermatol Surg. 1996;22:511-522.

Fitton AR, Ragbir M, Milling MA. The use of pH adjusted lignocaine in controlling operative pain in the day surgery unit: a prospective, randomised trial. Br J Plast Surg. 1996;49:404-408.

Bonica JJ, Bucley FP. Regional Analgesia with Local Anesthetics in Management of Pain. Management of Pain. 1990:1890-1891.

5dd7cd9a0e8825912e13f286 rba Articles
Links & Downloads
2352-2291 (Eletrônico) 0104-0014 (Impresso)
Braz J Anesthesiol ©2024 Todos os direitos reservados.

Braz J Anesthesiol

Share this page
Page Sections