Os opióides de curta duração e de alta potencia analgésica, como o fentanil, embora amplamente utilizados em cães, ainda são pouco empregados pela via epidural nesta espécie. O presente estudo teve como objetivo avaliar a associação do anestésico local lidocaína à morfina ou à combinação morfina-fentanil, pela via epidural. Foram analisados os efeitos cardiovasculares, respiratórios bem como a analgesia pós-operatória, em cães submetidos a cirurgia de joelho. Para tanto, 24 animais da espécie canina foram aleatoriamente divididos em 2 grupos. Todos os animais receberam acepromazina (0,05 mg/kg), foram induzidos com propofol (5 mg/kg) e mantidos em anestesia inalatória. Os animais do GRUPO I foram tratados com lidocaína (5mg/kg) associada a morfina (0,1mg/kg) e os animais do GRUPO II receberam, pela via epidural, a combinação lidocaína-morfina-fentanil, sendo este último na dose de 2µ/kg. Parâmetros como frequência cardíaca, respiratória, pressão arterial (sistólica, média e diastólica) foram mensurados, bem como pH e gases sanguíneos. Para a avaliação da analgesia foram utilizadas a escala Analógica-visual (EAV), a escala proposta por Lascelles, 1994 e a termoalgimetria. Amostras de sangue foram coletadas para posterior dosagem de cortisol e Interleucina-06. O período de avaliação imediata foi de 06 horas após a cirurgia, sendo os animais reavaliados no período de 24 horas após o procedimento. No tocante aos parâmetros cardiorrespiratórios os grupos se comportaram de maneira muito semelhante. Entretanto, pode-se observar que os animais tratados com a combinação lidocaína-fentanil-morfina apresentaram menor escore de dor quando avaliados pelas escalas do estudo no período pós-operatório. De fato verificou-se diferença significativa nos escores da EAV (p <0,05) nos tempos T180 e T360; na escala de Lascelles obteve-se diferença estatística nos tempos T180, T360 e T24h e na termoalgimetria houve diferença estatística nos tempos T180, T360 e T24h. A analgesia de resgate foi necessária em 3 animais do Grupo II, enquanto no Grupo I a necessidade desta medicação foi observada em 6 animais. Pode-se concluir, com os resultados obtidos, que a associação do fentanil no protocolo de anestesia epidural, promoveu adequada analgesia perioperatória, além de produzir um efeito sinérgico-residual, o que melhorou a analgesia pós-operatória, diminuindo a necessidade de analgesia de resgate. / Short duration opioids and high potency analgesics such as fentanyl, although widely used in dogs are seldom used for epidural anesthesia in this species. This study aimed to evaluate the association of lidocaine with morphine or morphine-fentanyl combination, epidurally. 24 dogs were randomly divided into two groups. All animals received acepromazine intramuscularlly (0.05 mg / kg), were induced with propofol (5 mg / kg) and maintained under inhalation anesthesia. The animals in group I were treated with lidocaine (5 mg / kg) combined with morphine (0.1 mg / kg) epidurally and the animals of group II received epidurally, the combination lidocaine-morphine-fentanyl, the latter at the dose of 2µ/kg. Parameters such as heart and respiratory rate, blood pressure (systolic, mean and diastolic), blood gases and pH were measured. For the assessment of analgesia were used visual-analogue scale (VAS), the scale proposed by Lascelles and thermoalgimetry. Blood samples were collected for later determination of cortisol and interleukin-06. The evaluation period was 06 hours after surgery, the animals were re-evaluated within 24 hours after the procedure. Except the cardiorespiratory parameters, the groups were similarly. However, was observed that animals treated with the combination lidocaine-fentanyl-morphine had lower pain scores in the postoperative period. In fact there were significant differences in VAS scores (p <0.05) at times T180 and T360; in Lascelles scores at times T180, T360 and T24h and there were no statistical diferences in thermoalgimetry at times T180, T360 and T24h. The rescue analgesia was required in three animals in Group II, and six animals in Group I. It can be concluded that the combination of fentanyl in epidural anesthesia protocol, promoted adequate perioperative analgesia, producing synergistic and residual effects, which improved postoperative analgesia.

Orientador: Gilberto De Nucci / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-25T22:09:32Z (GMT). No. of bitstreams: 1 RosaCastelli_Maisa_M.pdf: 2792033 bytes, checksum: 8d7ee3cc5a3af831f35e49968b355af5 (MD5) Previous issue date: 2014 / Resumo: A anestesia tópica é uma das estratégias mais usadas para minimizar a ansiedade, dor e o desconforto no local da inserção da agulha ou de procedimentos cirúrgicos. As formulações tópicas têm como objetivo promover a permeação no local de aplicação e obter um rápido início de ação. Para tanto, é necessário que a permeação cutânea atravesse de forma efetiva as camadas dérmicas, principalmente o estrato córneo. Os sistemas de liberação de fármacos representam uma parcela importante dentre as estratégias de otimização terapêutica, tendo como objetivo a manipulação racional do perfil farmacológico das drogas e, concomitantemente, seus índices terapêuticos. Os sistemas de liberação nanoestruturados, ou nanocarreadores, podem ser empregados para a melhora de distintos caracteristicas: solubilidade, biodistribuição, biocompatibilidade, biodegradabilidade e liberação da droga. São estruturas com escala nanométrica, com tamanho variando de 1 a 100 nanometros. O objetivo deste trabalho foi a caracterização morfológica das nanocápsulas poliméricas que compõem o nanoanestésico e o desenvolvimento clínico do nanoanestésico, compreendendo a avaliação de eficácia e de segurança do produto. O nanoanestésico é um hidrogel composto pela mistura eutética de 2.5% de lidocaína e 2.5% de prilocaína. Metade desta concentração está nanoencapsulada, enquanto que o restante do ativo encontra-se livre no gel, através dos respectivos sais cloridratos. A suspensão de nanocápsulas foi analisada através de microscopia eletrônica de transmissão e foram identificadas estruturas correspondentes com as nanocápsulas poliméricas e com tamanhos condizentes ao esperado a partir dos dados de diâmetro médio proveniente do Espalhamento de Luz Dinâmico. O produto final, o nanoanestésico, foi analisado a partir da técnica de criofratura e também foram identificas estruturas correspondentes as nanocápsulas em meio ao hidrogel. Foi realizado o desenvolvimento clínico do nanoanestésico, compreendendo a avaliação do perfil farmacocinético (n=8 voluntários) e estudos de eficácia (n= 100 voluntários). O nanoanestésico atinge concentrações plasmáticas seguras de lidocaína e prilocaína: 6,5 ng.mL-1 e 1,7 ng.mL-1, respectivamente. Verificou-se também que o nanoanestésico possui eficácia não inferior ao EMLA® (Aztrazeneca) quando comparado após 1 (uma) hora de permanência sobre a pele e submetido a estimulo doloroso de inserção de agulha de venopunção. Além disso, de forma controlada por placebo, os voluntários foram submetidos a um estimulo doloroso em tempos inferiores a 1 hora e verificou-se que o nanoanestésico apresenta eficácia significativa a partir de 10 minutos da aplicação. Os resultados obtidos demonstram que o nanoanestésico pode ser uma alternativa dentre os anestésicos tópicos já estabelecidos no mercado e otimizar os procedimentos nos quais ele é necessário / Abstract: Topical anesthetic is the most used strategy to minimize anxiety, pain and local discomfort on the site of needle stick. The topical formulations aim to promote permeation on the application site and obtain a rapid onset of action. To achieve this, the skin permeation must cross the layers of skin, mainly the stratum corneum. Drug delivery systems are an important part of therapy optimization strategies, which target to improve the drug pharmacological profile and its therapeutic ratio. The nanostructured systems, like polymeric nanocapsules, may be used to improve a many features: solubility, biodistribution and drug release. They are nanoscale structures, with size ranging from 1 to 100 nanometers. This present study comprised morphologic characterization of polymeric nanocapsules which compose the nanoanesthetic and its clinical development with evaluation of efficacy and safety. The nanoanesthetic is a hydrogel with 2.5% lidocaine and 2.5% prilocaine, which are 50% of the active products in polymeric nanocapsules. The remaining 50% of the drugs are in the form of their chloridrate salts. The suspension of nanocapsules was examined by Transmission Electron Microscopy (TEM) and the identified structures correspond to the polymer nanocapsule and the size results matched the expected Dynamic Light Scattering data. The finished product, the nanoanesthetic, was evaluated by cryofracture, and the polymeric nanocapsules were observed. The clinical development was performed with pharmacokinetics profile (n= 8 healthy volunteers) and efficacy study (n=100 healthy volunteers). The nanoanesthesic security reaches plasmatic concentrations of lidocaine and prilocaine: 6,5 ng.mL-1 e 1,7 ng.mL-1, respectively. EMLA® (Astrazeneca) and the nanoanesthetic were left on the skin for one hour, and then exposed to needle insertion. It was observed that the nanoanesthetic efficacy is not lower than EMLA® product. Beyond that, a placebo-controlled study was performed. The volunteers were submitted to a painful stimulus for periods shorter than one hour and it was verified that the nanoanesthetic has a significant efficacy after 10 minutes of application. The results showed that the nanoanesthetic can be an alternative as a topical anesthetics among the ones that have already been commercialized in the market and it can also optimize the procedures in which it is needed / Mestrado / Farmacologia / Mestra em Farmacologia

Des études cliniques rétrospectives ont suggéré un effet protecteur de l’anesthésie locorégionale contre les récidives après chirurgie carcinologique, donnant une nouvelle dimension à la prise en charge de la douleur périopératoire. Le premier objectif de ce travail était de montrer les effets antitumoraux directs de la lidocaïne, un anesthésique local couramment utilisé en pratique clinique. L’impact de la lidocaïne a été mesuré in vitro sur la viabilité, la prolifération et la migration de plusieurs lignées humaines de cellules de cancer du sein, ainsi qu’in vivo sur la progression métastatique péritonéale de cellules triple négatives. Le second objectif était de déterminer par quels mécanismes moléculaires la lidocaïne exerçait cette action antitumorale. Des approches globales par analyses transcriptomiques et métabolomiques ont mis en exergue de nouvelles hypothèses mécanistiques, en particulier relatives à des modifications de la composition lipidique des membranes cellulaires. Enfin une approche par gène candidat a suggéré un mode d’action de la lidocaïne indépendant du canal sodique voltage-dépendant. / Retrospective clinical studies have suggested a protective effect of regional anesthesia against recurrences after cancer surgery, bringing the management of perioperative pain to a new level. Prospective studies are underway to support these results. The first objective of this work was to show the direct antitumor effect of lidocaine, a local anesthetic commonly used in clinical practice. The impact of lidocaine was measured in vitro on viability, proliferation and migration of several human breast cancer cell lines, as well as in vivo on the metastatic peritoneal progression of triple negative cells. The second objective was to determine by which molecular mechanisms lidocaine exerts this antitumor action. Global approaches by transcriptomic and metabolomic analyses have highlighted new mechanistic hypotheses, notably in relation to the lipid composition of cell membrane. Finally, a candidate gene approach suggested that the mode of action of lidocaine is independent of the voltage-gated sodium channel.

The metabolism of lignocaine to monoethylglycinexylidide has been found useful as an indicator of hepatic function in association with liver transplantation. It has been postulated that this might be due to the common effect of hypoxic damage on liver function and lignocaine metabolism. The aim of this work was to establish whether hepatic lignocaine elimination was impaired by hypoxia and whether lignocaine extraction ratio and clearance could be used as an indicator of hepatic function. This was studied using the isolated pig liver perfused via the hepatic artery and portal vein. To establish whether the pig liver could be used as a possible human model for this investigation and whether lignocaine had any detrimental effects on liver function and blood flow in vivo, hepatic lignocaine elimination and the effects of lignocaine administration on hepatic function and blood flow were studied in the anaesthetized pig, surgically prepared to allow sampling across the liver and direct hepatic blood flow measurement. Hepatic lignocaine elimination was then studied in the isolated perfused liver to determine whether this was similar to that found in vivo. The definitive studies required preliminary investigations not available from the literature to determine the feasibility of comparing in vivo and ex vivo hepatic function using the same liver. In addition, by studying the decay of lignocaine after bolus dose administration the necessary pharmacokinetic parameters to achieve similar constant hepatic affluent lignocaine concentrations in vivo and in the isolated preparation could be determined. The preliminary investigations showed that a sequential experiment using the same liver to compare in vivo and ex vivo function was inappropriate as the energy state of isolated perfused livers previously studied in vivo was significantly different from that in livers perfused immediately. The decay of lignocaine after a bolus dose in vivo and ex vivo could be described by a two-compartment open model and in both preparations the derived pharmacokinetic parameters from this analysis were used to achieve similar constant hepatic affluent concentrations over the study period used to determine hepatic lignocaine elimination. Lignocaine extraction ratio by the in situ pig liver was similar to that reported in man and together with hepatic clearance and intrinsic clearance was similar to that determined in the isolated state when different livers were used for this comparison. There was no detrimental effect of lignocaine administration on hepatic function and blood flow In vivo. Lignocaine extraction ratio and clearance and monoethylglycinexylidide formation were significantly impaired in livers subjected to hypoxia. Lignocaine elimination correlated strongly with hepatic cellular ATP, energy charge and ATP/ ADP ratio as well as with hepatic potassium release but less strongly with aspartate aminotransferase release when this relationship was tested using the combined data from hypoxic and normoxic livers ex vivo. These correlations were positive for hepatic adenine nucleotide status and negative for hepatic potassium and aspartate aminotransferase release. Neither hepatic alanine aminotransferase release nor lactate utilization were significantly affected by hypoxia. Lignocaine extraction ratio, hepatic oxygen consumption, ATP content, bile flow and potassium release were shown to be equivalent, more highly sensitive, and earlier indicators of hypoxic hepatic injury than hepatic aspartate aminotransferase release in the isolated perfused pig liver.

Background: Multimodal analgesia in rib fractures (RFs) is designed to maximize pain control while minimizing narcotics. Prior research with intravenous lidocaine (IVL) efficacy produced conflicting results. We hypothesized IVL infusion reduces opioid utilization and pain scores. Methods: A retrospective review of RF patients at an ACS-verified Level I trauma center from April 2018 to 2/2020 was conducted. Patients (pts) stratified as receiving IVL vs no IVL. Initial lidocaine dose: 1 mg/kg/hr with a maximum of 3 mg/kg/hr. Duration of infusion: 48 h. Pain quantified by the Stanford Pain Score system (PS). Bivariate and multivariate analyses of variables were performed on SPSS, version 21 (IBM Corp). Results: 414 pts met inclusion criteria: 254 males and 160 females. The average age for the non-IVL = 67.4 ± 15.2 years vs IVL = 58.3 ± 17.1 years (P <.001). There were no statistically significant differences between groups for ISS, PS for initial 48 h, and ICU length of stay (LOS). There was a difference in morphine equivalents per hour: non-IVL = 1.25 vs IVL = 1.72 (P =.004) and LOS non-IVL = 10.2+/−7.6 vs IVL = 7.82+/−4.94. By analyzing IVL pts in a crossover comparison before and after IVL, there was reduction in opiates: 3.01 vs 1.72 (P <.001) and PS: 7.0 vs 4.9 (P <.001). Stanford Pain Score system reduction in the IVL = 48.3 ± 23.9%, but less effective in narcotic dependency (27 ± 22.9%, P =.035); IVL pts had hospital cost reduction: $82,927 vs $118,202 (P <.01). Discussion: In a crossover analysis, IVL is effective for reduction of PS and opiate use and reduces hospital LOS and costs. Patient age may confound interpretation of results. Our data support IVL use in multimodal pain regimens. Future prospective study is warranted.

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Yes / Ionic systems with enhanced proton conductivity are widely viewed as promising electrolytes in fuel cells and batteries. Nevertheless, a major challenge toward their commercial applications is determination of the factors controlling the fast proton hopping in anhydrous conditions. To address this issue, we have studied novel proton-conducting materials formed via a chemical reaction of lidocaine base with a series of acids characterized by a various number of proton-active sites. From ambient and high pressure experimental data, we have found that there are fundamental differences in the conducting properties of the examined salts. On the other hand, DFT calculations revealed that the internal proton hopping within the cation structure strongly affects the pathways of mobility of the charge carrier. These findings offer a fresh look on the Grotthuss-type mechanism in protic ionic glasses as well as provide new ideas for the design of anhydrous materials with exceptionally high proton conductivity.