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Lidocaine Patch

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721. Minor Surgery in Primary Care - Procedures Under a Direct Enhanced Service

for cautery but should not be used with cryotherapy. Lidocaine 1% is the most commonly used local anaesthetic and it can be used for these procedures. It is most conveniently administered using a dental syringe with a fine dental needle and cartridges made for the syringe. A lidocaine/adrenaline (epinephrine) mixture is often used. This prolongs the duration of action and increases the total dose that can be used; however, its greatest asset is that it induces vasoconstriction and so reduces bleeding (...) . It must not be used on fingers, toes or the penis. If analgesia is required on a mucous membrane it is possible to apply lidocaine directly via a piece of gauze and this numbs the surface so that injection is less painful. It does not cross the horny barrier of keratinised epithelium in the skin and so is of no use to numb skin. For topical use, a 2% or 4% solution is acceptable but otherwise a maximum of 1% is recommended. Remember that after injection of local anaesthetic it is necessary to allow

2008 Mentor

722. Minor Surgery in Primary Care - Basic Procedures

not be used with cryotherapy. Lidocaine 1% is the most commonly used local anaesthetic and it can be used for these procedures. It is most conveniently administered using a dental syringe with a fine dental needle and cartridges made for the syringe. A lidocaine/adrenaline (epinephrine) mixture is often used. This prolongs the duration of action and increases the total dose that can be used; however, its greatest asset is that it induces vasoconstriction and so reduces bleeding. It must not be used (...) on fingers, toes or the penis. If analgesia is required on a mucous membrane it is possible to apply lidocaine directly via a piece of gauze and this numbs the surface so that injection is less painful. It does not cross the horny barrier of keratinised epithelium in the skin and so is of no use to numb skin. For topical use, a 2% or 4% solution is acceptable but otherwise a maximum of 1% is recommended. Remember that after injection of local anaesthetic it is necessary to allow a few minutes

2008 Mentor

723. Chronic Pain Syndrome

in addition to non-pharmacological treatments. Topical NSAIDs should be considered in the treatment of patients with chronic pain from musculoskeletal conditions, particularly for patients who cannot tolerate oral NSAIDs. Topical capsaicin patches should be considered in the treatment of patients with peripheral neuropathic pain when first-line pharmacological therapies have been ineffective or not tolerated. (This is from SIGN guidance for chronic pain - NICE guideline on neuropathic pain advises (...) this is only used under specialist advice, although it gives capsaicin cream as an option [ ] .) Topical lidocaine should be considered for the treatment of patients with postherpetic neuralgia if first-line pharmacological therapies have been ineffective. Topical rubefacients should be considered for the treatment of pain in patients with musculoskeletal conditions if other pharmacological therapies have been ineffective. Opioids Over recent years there has been a significant increase in prescribing

2008 Mentor

724. Shingles

strong analgesia if there is pain. First-line treatments include paracetamol (with or without codeine) and non steroidal anti-inflammatory drugs (NSAIDs). Tricyclic antidepressants, gabapentin, pregabalin, steroids and opioids are options used to reduce acute pain where the first-line treatments fail. Topical analgesia with lidocaine patches has also been shown to be of benefit in the acute stage as well as for PHN. They must be applied to intact skin, not to the area of the rash. If the pain (...) acute, neuritic pain in this phase. A few have severe pain without any eruption, called zoster sine herpete. Young adults and children are most likely to be free of pain. Crust formation and drying occurs over 7 to 10 days and is followed by resolution at 14 to 21 days. Patients are infectious (resulting infection is chickenpox) until lesions have dried. In the eruptive phase the rash first appears as a patch of erythematous, swollen plaques with clusters of small vesicles. This eruption

2008 Mentor

725. Postherpetic Neuralgia

a burning sensation with topical capsaicin then the cream can be mixed with either glyceryl trinitrate (GTN) paste or Emla® cream. Topical lidocaine 5% patches can be considered if oral or other topical treatment is not suitable or is not tolerated. They are not recommended as first-line treatment. They should be applied for 12 hours and then removed for 12 hours. The 5% lidocaine medicated plaster has been shown to be as effective as systemic pregabalin in PHN but with an improved tolerability profile (...) be given (to a maximum of 300 mg bd) if there are side-effects, such as sedation or ataxia, with gabapentin. Strong opioids can provide similar pain relief to tricyclic antidepressants but can be associated with more side-effects. Topical capsaicin (0.075%) patch can be used topically if other treatments have not worked, are not appropriate or at a patient's request. [ ] The skin needs to have healed completely. There can sometimes be a four-week delay before benefit is felt. If patients experience

2008 Mentor

726. Peyronie's Disease

of dexamethasone, verapamil and/or orgotein and lidocaine. The evidence base supporting the effectiveness of this method is equivocal. There appear to be no significant adverse effects apart from mild, local erythema. Surgical Careful selection, patient education and discussion of patient expectation help to improve satisfaction post-surgery. Issues to be discussed should include the aims and risks of surgery, the risks of penile shortening, the risk of recurrent curvature, the possibility of knots (...) lengthening surgical procedure based on a ventro-dorsal incision of the tunica albuginea, penile prosthesis implantation and double dorsal-ventral patch grafting with porcine small intestinal submucosa. [ ] Carbon dioxide laser: this has been used to good effect in some cases to thin the plaque. Prognosis PD rarely resolves completely. Studies suggest that without treatment, 13% of patients have a diminution or complete resolution of pain with time. One half of the remainder has progressive disease

2008 Mentor

727. Oral Ulceration

(leukoplakia) or red lesions (erythroplakia): white patches carry a 5% risk of malignancy and red lesions are malignant until proven otherwise (50% risk). Spread occurs via the submandibular and cervical lymph nodes; these will be involved on presentation in 30% of patients. These often present as slow-growing, painless, non-healing ulcers with raised borders, usually on the lateral aspect of the tongue, the floor of the mouth or on the soft palate. Irradiation ulcers Ulceration occurs either acutely (...) such as pemphigus vulgaris. Oral thrush is a potential side-effect of treatment. Local analgesics These have a limited role, as short duration of action precludes good maintenance of analgesia throughout the day. They are mainly indicated for intolerable and intractable pain of chronic ulceration (such as with major aphthae). Options include: Local anaesthetic: lidocaine 5% ointment, lozenges or spray containing a local anaesthetic are available to apply to the ulcer. Care must be taken not to produce

2008 Mentor

728. Advances in neuropathic pain: diagnosis, mechanisms, and treatment recommendations. Full Text available with Trip Pro

Advances in neuropathic pain: diagnosis, mechanisms, and treatment recommendations. Chronic neuropathic pain, caused by lesions in the peripheral or central nervous system, comes in many forms. We describe current approaches to the diagnosis and assessment of neuropathic pain and discuss the results of recent research on its pathophysiologic mechanisms. Randomized controlled clinical trials of gabapentin, the 5% lidocaine patch, opioid analgesics, tramadol hydrochloride, and tricyclic

2003 Archives of Neurology

729. Treatment and prevention of postherpetic neuralgia. Full Text available with Trip Pro

Treatment and prevention of postherpetic neuralgia. There have been 4 recent major advances in the treatment of postherpetic neuralgia (PHN) that are based on the results of randomized, controlled trials. These advances are the demonstrations that gabapentin, the lidocaine patch 5%, and opioid analgesics are efficacious in patients with PHN, and the report that nortriptyline and amitriptyline provide equivalent analgesic benefits for patients with PHN but that nortriptyline is better tolerated

2003 Clinical Infectious Diseases

730. Assessment of differential blockade by amitriptyline and its N-methyl derivative in different species by different routes. (Abstract)

of amitriptyline and its quaternary ammonium derivative in rats and sheep.The Na+ channel-blocking properties of N-methyl amitriptyline were determined with the patch clamp technique in cultured GH(3) cells. Various functions (motor, nociception, proprioception-ataxia) were compared in rats (spinal and sciatic nerve blockade) and sheep (spinal blockade) with amitriptyline, N-methyl amitriptyline, lidocaine, and bupivacaine (partially from historical data).In vitro testing revealed N-methyl amitriptyline (...) time points. Sheep data for lidocaine and bupivacaine seemed to be more comparable to the clinical experience in humans than did rat data.Amitriptyline and N-methyl amitriptyline are potent Na+ channel blockers and show greater differential blockade in sheep than in rats. This differential blockade in sheep is greater than that produced by lidocaine or bupivacaine.

2003 Anesthesiology

731. Local anesthetics potently block a potential insensitive potassium channel in myelinated nerve Full Text available with Trip Pro

Local anesthetics potently block a potential insensitive potassium channel in myelinated nerve Effects of some local anesthetics were studied in patch clamp experiments on enzymatically demyelinated peripheral amphibian nerve fibers. Micromolar concentrations of external bupivacaine depolarized the excised membrane considerably. The flicker K+ channel was found to be the most sensitive ion channel to local anesthetics in this preparation. Half-maximum inhibiting concentrations (IC50 (...) ) for extracellular application of bupivacaine, ropivacaine, etidocaine, mepivacaine, lidocaine, and QX-314 were 0.21, 4.2, 8.6, 56, 220, and > 10,000 microM, respectively. The corresponding concentration-effect curves could be fitted under the assumption of a 1:1 reaction. Application from the axoplasmic side resulted in clearly lower potencies with IC50 values of 2.1, 6.6, 16, 300, 1,200, and 1,250 microM, respectively. The log(IC50)-values of the local anesthetics linearly depended on the logarithm

1995 The Journal of general physiology

732. Enhancement of delayed-rectifier potassium conductance by low concentrations of local anaesthetics in spinal sensory neurones Full Text available with Trip Pro

Enhancement of delayed-rectifier potassium conductance by low concentrations of local anaesthetics in spinal sensory neurones Combining the patch-clamp recordings in slice preparation with the 'entire soma isolation' method we studied action of several local anaesthetics on delayed-rectifier K(+) currents in spinal dorsal horn neurones. Bupivacaine, lidocaine and mepivacaine at low concentrations (1 - 100 microM) enhanced delayed-rectifier K(+) current in intact neurones within the spinal cord

2002 British journal of pharmacology

733. Nonselective Suppression of Voltage-gated Currents by Odorants in the Newt Olfactory Receptor Cells Full Text available with Trip Pro

Nonselective Suppression of Voltage-gated Currents by Odorants in the Newt Olfactory Receptor Cells Effects of odorants on voltage-gated ionic channels were investigated in isolated newt olfactory receptor cells by using the whole cell version of the patch-clamp technique. Under voltage clamp, membrane depolarization to voltages between -90 mV and +40 mV from a holding potential (Vh) of -100 mV generated time- and voltage-dependent current responses; a rapidly (< 15 ms) decaying initial inward (...) at 0.1 mM. These phenomena are similar to the suppressive effects of local anesthetics (lidocaine and benzocaine) on INa in various preparations, suggesting that both types of suppression are caused by the same mechanism. The nonselective blockage of ionic channels observed here is consistent with the previous notion that the suppression of the transduction current by odorants is due to the direst blockage of transduction channels.

1997 The Journal of general physiology

734. Lamotrigine in Treating Peripheral Neuropathy Caused by Chemotherapy in Patients With Cancer

reuptake inhibitors allowed Monoamine oxidase inhibitors Opioid analgesics Anticonvulsants (e.g., gabapentin, topiramate, valproic acid, or clonazepam) Adjuvant analgesics (e.g., mexiletine) Prior nonsteroidal anti-inflammatory drugs allowed Topical analgesics (e.g., lidocaine gel or patch) to the affected area Amifostine More than 30 days since prior investigational agents for pain control No other concurrent investigational agents for pain control Contacts and Locations Go to Information from

2003 Clinical Trials

735. Gabapentin in Treating Peripheral Neuropathy in Cancer Patients Undergoing Chemotherapy

concurrent adjuvant analgesic (e.g., anticonvulsant, clonazepam, or mexiletine)* No concurrent topical analgesics (e.g., lidocaine gel or lidocaine patch)* No concurrent amifostine No concurrent investigational agent for pain control NOTE: * For pain or symptoms due to chemotherapy-induced peripheral neuropathy Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information

2001 Clinical Trials

736. Transdermal scopolamine decreases nausea and vomiting following cesarean section in patients receiving epidural morphine. (Abstract)

Transdermal scopolamine decreases nausea and vomiting following cesarean section in patients receiving epidural morphine. The authors evaluated the antiemetic properties of transdermal scopolamine (TDS) in healthy patients undergoing elective cesarean section and receiving epidural morphine for postoperative analgesia. Prior to administration of anesthesia, 203 patients had either TDS or a placebo study patch applied behind one ear. All patients were hydrated with lactated Ringer's solution iv (...) and given 2.0% lidocaine with 1:200,000 epinephrine epidurally for surgical anesthesia. Following delivery of the infant, 4 mg of morphine sulphate was injected through the epidural catheter. After the operation patients were evaluated by "blinded" observers at 2, 4, 6, 8, 10, 24, and 48 h for nausea, vomiting, retching, pain relief, itching, and adverse effects. In addition, medications received were noted. No differences were found between the groups in terms of severity or incidence of pain

1989 Anesthesiology

737. Pain perception and effectiveness of the eutectic mixture of local anesthetics in children undergoing venipuncture. Full Text available with Trip Pro

Pain perception and effectiveness of the eutectic mixture of local anesthetics in children undergoing venipuncture. The emulsion of lidocaine and prilocaine (EMLA) is effective in preventing the pain of venipuncture in children. It is therefore important to identify children who could benefit the most from EMLA. We studied the safety and feasibility of two methods of application of EMLA (patch and cream) in a randomized, open-label trial of EMLA patch versus EMLA cream in 160 children (...) with chronic diseases undergoing venipuncture. EMLA patch or cream was applied 60 to 120 min before puncture. Pain was assessed by the children using a visual analogue score. Children also scored the pain of their last puncture and the pain of removing the tape. EMLA patch and cream had similar efficacy (visual analogue scores for the venipuncture were 8.5 +/- 16 and 9.5 +/- 17 out of 100, respectively). Side effects occurred in similar frequencies in the two groups. Adhesiveness of the patch was less

1992 Pediatric research Controlled trial quality: uncertain

738. Postdural puncture headache after spinal anaesthesia in young orthopaedic outpatients using 27-g needles. Full Text available with Trip Pro

arthroscopy under spinal anaesthesia were randomly assigned to receive spinal anaesthesia with hyperbaric lidocaine 5% using either a Quincke or a Whitacre 27-G needle. Twenty patients choosing general anaesthesia formed a comparative group. Using a previously validated questionnaire, the incidence and nature of PDPH were evaluated by telephone three to five days after surgery by an anaesthetist unaware of the anaesthetic technique used. Once all data were collected, an anaesthetist not involved (...) in the study determined in a blinded fashion which headaches were likely to be PDPH. Grading and classification of headaches were based on several criteria: postural nature, duration, intensity and confinement to bed.The overall incidence of PDPH in both spinal groups was 9.3%. The incidence in women, 20.4%, was higher than in men, 5.5%, (P < 0.05). Only one patient required a blood patch. Both types of needle were comparable with respect to the incidence, severity and duration of PDPH, number of dural

1998 Canadian journal of anaesthesia = Journal canadien d'anesthesie Controlled trial quality: uncertain

739. Evaluation of a transoral delivery system for topical anesthesia. (Abstract)

Evaluation of a transoral delivery system for topical anesthesia. The development of bioadhesives has allowed for the creation of a novel transoral topical anesthesia delivery system used to alleviate pain by needlestick injections and select dental procedures.Sixty subjects evaluated the effectiveness of a lidocaine-containing bioadhesive patch, or L-BP, to alleviate pain caused by needlesticks, or Ns, with or without injection, and with scaling and root planing, or Sc/RP, instrumentation (...) the subjects' perception of pain caused by Ns and Sc/RP when compared directly with B-G (P < .01). The resultant tissue anesthesia by L-BP significantly reduced pain to Ns with or without anesthetic injection using 25- and 27-gauge needles. However, Ns in conjunction with anesthetic injections generated significantly greater pain than that caused by Ns alone (P < .01). VPS score differences between 25- and 27-gauge needles were not found.This study found that a lidocaine-containing bioadhesive system

2001 Journal of the American Dental Association Controlled trial quality: uncertain

740. Clinical evaluation and comparison of 2 topical anesthetics for pain caused by needle sticks and scaling and root planing. (Abstract)

Clinical evaluation and comparison of 2 topical anesthetics for pain caused by needle sticks and scaling and root planing. Pain generated by needle sticks (Ns) for the delivery of local anesthetic and/or scaling and root planing (SRP) instrumentation is commonly addressed by the use of topical anesthetics, such as a benzocaine-gel preparation (BGP). Pain suppression following such use has been highly variable. Development of medicine-containing patches and adhesives for intraoral use have led (...) to a new approach for topical anesthesia in the form of a transoral lidocaine delivery system (LDS). The purpose of this double-blind study was to evaluate the efficacy of the LDS and also to compare LDS with BGP for pain suppression to Ns and SRP.One group of 20 subjects randomly received in both maxillary and mandibular molar-bicuspid areas LDS or BGP on one side and non-anesthetic control on the other side. A second group of 20 subjects compared the effectiveness of LDS directly with BGP in molar

2001 Journal of periodontology Controlled trial quality: uncertain

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