Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942008000300011
Brazilian Journal of Anesthesiology
Review Article

Mecanismos envolvidos na analgesia da lidocaína por via venosa

Mechanisms of analgesia of intravenous lidocaine

Gabriela Rocha Lauretti

Downloads: 0
Views: 702

Resumo

JUSTIFICATIVA E OBJETIVOS: A lidocaína é utilizada por via venosa desde a década de 1960 para diversas finalidades. Seu mecanismo de ação multimodal foi o objetivo principal dessa revisão. CONTEÚDO: Foram revisados mecanismos de ação divergentes do clássico bloqueio do canal de Na+, a ação diferencial da lidocaína venosa na sensibilização central, sua ação analgésica e citoprotetora, assim como as diferentes doses da lidocaína utilizadas por via venosa. CONCLUSÕES: A ação analgésica final da lidocaína por via venosa reflete seu aspecto multifatorial de ação. Em relação à sensibilização central, sugere-se uma ação anti-hiperalgésica periférica da lidocaína na dor somática e central na dor neuropática, com resultante bloqueio da hiperexcitabilidade central. A dose por via venosa não deve exceder a concentração plasmática tóxica de 5 µg.mL-1, sendo consideradas seguras doses inferiores 5 mg.kg-1, administradas lentamente (30 minutos), com monitoração.

Palavras-chave

ANALGESIA, ANALGESIA, ANALGESIA

Abstract

BACKGROUND AND OBJECTIVES: Intravenous lidocaine has been used for several indications since the decade of 1960. Its multimodal mechanism of action was the objective of this review. CONTENTS: Mechanisms of action that diverge from the classical Na+ channel blockade, the differential action of intravenous lidocaine in central sensitization, and the analgesic and cytoprotective actions, as well as the different doses of intravenous lidocaine were reviewed. CONCLUSIONS: The final analgesic action of intravenous lidocaine is a reflection of its multifactorial action. It has been suggested that its central sensitization is secondary to a peripheral anti-hyperalgic action on somatic pain and central on neuropathic pain, which result on the blockade of central hyperexcitability. The intravenous dose should not exceed the toxic plasma concentration of 5 µg.mL-1; doses smaller than 5 mg.kg-1, administered slowly (30 minutes), under monitoring, are considered safe.

Keywords

ANALGESIA, ANALGESIA, ANALGESIA

References

Rawm WE Jr, Strother WF, Crump . The effects of anesthetics upon the ear: IV. Lidocaine hydrochloride. Ann Otol Rhinol Laryngol. 1962;71:116-123.

Nicholson BD. Evaluation and treatment of central pain syndromes. Neurology. 2004;62:30-66.

Thomas J, Kronenberg R, Cox MC. Intravenous lidocaine relieves severe pain: results of an inpatient hospice chart review. J Palliat Med. 2004;7:660-667.

Wood JN, Boorman JP, Okuse K. Voltage-gated sodium channels and pain pathways. J Neurobiol. 2004;61:55-71.

Kalso E. Sodium channel blockers in neuropathic pain. Curr Pharm Des. 2005;11:3005-3011.

Osawa Y, Oda A, Iida H. The effects of class Ic antiarrhythmics on tetrodotoxin-resistant Na+ currents in rat sensory neurons. Anesth Analg. 2004;99:464-471.

Koppert W, Weigand M, Neumann F. Perioperative intravenous lidocaine has preventive effects on postoperative pain and morphine consumption after major abdominal surgery. Anesth Analg. 2004;98:1050-1055.

Fernandes Fraceto L, Spisni A, Schreier S. Differential effects of uncharged aminoamide local anesthetics on phospholipid bilayers, as monitored by 1H-NMR measurements. Biophys Chem. 2005;115:11-18.

Sheets MF, Hanck DA. Molecular action of lidocaine on the voltage sensors of sodium channels. J Gen Physiol. 2003;121:163-175.

Kitagawa N, Oda M, Totoki T. Possible mechanism of irreversible nerve injury caused by local anesthetics: detergent properties of local anesthetics and membrane disruption. Anesthesiology. 2004;100:962-967.

Aydin ON, Eyigor M, Aydin N. Antimicrobial activity of ropivacaine and other local anaesthetics. Eur J Anaesthesiol. 2001;18:687-694.

Chandan SS, Faoagali J, Wainwright CE. Sensitivity of respiratory bacteria to lignocaine. Pathology. 2005;37:305-307.

Kawasaki T, Kawasaki C, Ogata M. The effect of local anesthetics on monocyte mCD14 and human leukocyte antigen-DR expression. Anesth Analg. 2004;98:1024-1029.

Kawamata M, Sugino S, Narimatsu E. Effects of systemic administration of lidocaine and QX-314 on hyperexcitability of spinal dorsal horn neurons after incision in the rat. Pain. 2006;122:68-80.

Finnerup NB, Biering-Sorensen F, Johannesen IL. Intravenous lidocaine relieves spinal cord injury pain: a randomized controlled trial. Anesthesiology. 2005;102:1023-1030.

Haller I, Hausott B, Tomaselli B. Neurotoxicity of lidocaine involves specific activation of the p38 mitogen-activated protein kinase, but not extracellular signal-regulated or c-jun N-terminal kinases, and is mediated by arachidonic acid metabolites. Anesthesiology. 2006;105:1024-1033.

Abelson KS, Hoglund AU. Intravenously administered lidocaine in therapeutic doses increases the intraspinal release of acetylcholine in rats. Neurosci Lett. 2002;317:93-96.

Hollmann MW, Ritter CH, Henle P. Inhibition of m3 muscarinic acetylcholine receptors by local anaesthetics. Br J Pharmacol. 2001;133:207-216.

Biella G, Sotgiu ML. Central effects of systemic lidocaine mediated by glycine spinal receptors: an iontophoretic study in the rat spinal cord. Brain Res. 1993;603:201-206.

Coda B, Bausch S, Haas M. The hypothesis that antagonism of fentanyl analgesia by 2-chloroprocaine is mediated by direct action on opioid receptors. Reg Anesth. 1997;22:43-52.

Cohen SP, Mao J. Is the analgesic effect of systemic lidocaine mediated through opioid receptors?. Acta Anaesthesiol Scand. 2003;47:910-911.

Nagy I, Woolf CJ. Lignocaine selectivity reduces C fibre-evoked neuronal activity in rat spinal cord in vitro by decreasing N-methyl-D-aspartate and neurokinin receptor-mediated post-synaptic depolarizations: implications for the development of novel centrally acting analgesics. Pain. 1996;64:59-70.

Rooney BA, Crown ED, Hulsebosch CE. Preemptive analgesia with lidocaine prevents Failed Back Surgery Syndrome. Exp Neurol. 2007.

Locher-Claus MT, Erickson TE, Law AS. Effects of pre-emptive morphine, ibuprofen or local anesthetic on fos expression in the spinal trigeminal nucleus following tooth pulp exposure in the rat. J Endod. 2005;31:578-583.

Fassoulaki A, Melemeni A, Zotou M. Systemic ondansetron antagonizes the sensory block produced by intrathecal lidocaine. Anesth Analg. 2005;100:1817-1821.

de Klaver MJ, Buckingham MG, Rich GF. Lidocaine attenuates cytokine-induced cell injury in endothelial and vascular smooth muscle cells. Anesth Analg. 2003;97:465-470.

Cao H, Kass IS, Cottrell JE. Pre- or postinsult administration of lidocaine or thiopental attenuates cell death in rat hippocampal slice cultures caused by oxygen-glucose deprivation. Anesth Analg. 2005;101:1163-1169.

Guler G, Erdogan F, Golgeli A. Ketamine reduces lidocaine-induced seizures in mice. Int J Neurosci. 2005;115:1239-1244.

Honemann CW, Hahnenkamp K, Podranski T. Local anesthetics inhibit thromboxane A2 signaling in Xenopus oocytes and human k562 cells. Anesth Analg. 2004;99:930-937.

Nordstrom H, Stange K. Plasma lidocaine levels and risks after liposuction with tumescent anaesthesia. Acta Anaesthesiol Scand. 2005;49:1487-1490.

Thomasy SM, Pypendop BH, Ilkiw JE. Pharmacokinetics of lidocaine and its active metabolite, monoethylglycinexylidide, after intravenous administration of lidocaine to awake and isoflurane-anesthetized cats. Am J Vet Res. 2005;66:1162-1166.

Gaughen CM, Durieux M. The effect of too much intravenous lidocaine on bispectral index. Anesth Analg. 2006;103:1464-1465.

Marttin S, Orlando R, Bertoli M. Differential effect of chronic renal failure on the pharmacokinetics of lidocaine in patients receiving and not receiving hemodialysis. Clin Pharmacol Ther. 2006;80:597-606.

Shimizu W, Antzelevitch C, Suyama K. Effect of sodium channel blockers on ST segment, QRS duration, and corrected QT interval in patients with Brugada syndrome. J Cardiovasc Electrophysiol. 2000;11:1320-1329.

Sucena M, Cachapuz I, Lombardia E. Plasma concentration of lidocaine during bronchoscopy. Rev Port Pneumol. 2004;10:287-296.

Tei Y, Morita T, Shishido H. Lidocaine intoxication at very small doses in terminally ill cancer patients. J Pain Symptom Manage. 2005;30:6-7.

Matharu MS, Cohen AS, Boes CJ. Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing syndrome: a review. Curr Pain Headache Rep. 2003;7:308-318.

Gupta A, Perniola A, Axelsson K. Postoperative pain after abdominal hysterectomy: a double-blind comparison between placebo and local anesthetic infused intraperitoneally. Anesth Analg. 2004;99:1173-1179.

Estebe JP, Gentili ME, Langlois G. Lidocaine priming reduces tourniquet pain during intravenous regional anesthesia: A preliminary study. Reg Anesth Pain Med. 2003;28:120-123.

Kaba A, Laurent SR, Detroz BJ. Intravenous lidocaine infusion facilitates acute rehabilitation after laparoscopic colectomy. Anesthesiology. 2007;106:11-18.

Adamzik M, Groeben H, Farahani R. Intravenous lidocaine after tracheal intubation mitigates bronchoconstriction in patients with asthma. Anesth Analg. 2007;104:168-172.

Attal N, Gaude V, Brasseur L. Intravenous lidocaine in central pain: a double- blind, placebo-controlled, psychophysical study. Neurology. 2000;54:564-574.

Challapalli V, Tremont-Lukats IW, McNicol ED. Systemic administration of local anesthetic agents to relieve neuropathic pain. Cochrane Database Syst Rev. 2005.

Carroll I. Intravenous lidocaine for neuropathic pain: diagnostic utility and therapeutic efficacy. Curr Pain Headache Rep. 2007;11:20-24.

Attal N, Rouaud J, Brasseur L. Systemic lidocaine in pain due to peripheral nerve injury and predictors of response. Neurology. 2004;62:218-225.

Ferrante FM, Paggioli J, Cherukuri S. The analgesic response to intravenous lidocaine in the treatment of neuropathic pain. Anesth Analg. 1996;82:91-97.

5dd6b27d0e88250f6613f286 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections