Is there Any Difference in the Efficacy of Lidocaine or Bilane for Local Anesthesia?
Lidocaine, also known as xerocaine, is one of the most widely used local anesthetics since its clinical application in 1948. With the gradual deepening of the clinical application of lidocaine and its pharmacological research, it has been found that its clinical effects are very Extensive, now summarized as follows.
Anesthetic effect Lidocaine is a local anesthetic of the amide type, which is fast absorbed and has a half-life of 90 minutes. Compared with the same concentration of procaine, lidocaine produces a fast and strong local anesthetic effect. Because of its large safety range, it can be worn Transmucosal, so it can be used for local anesthesia in various departments, and is known as a global anesthetic.
Anti-arrhythmic effect Lidocaine was originally a local anesthetic. It has been used in the treatment of ventricular arrhythmia since 1950. It is an anti-ventricular arrhythmia drug with the best curative effect and the highest safety. Its effect is rapid and disappears quickly after stopping the drug. Standard drugs are usually evaluated for the efficacy of various new antiarrhythmic drugs. The mechanism of action is to promote K + outflow of ventricular muscle and rarely promote Na + influx, reduce the fourth-phase diastolic depolarization rate of action potentials and reduce autonomy. The dose of an intravenous bolus is 1～2mg/kg, followed by 1～4mg/min intravenous infusion.
The effect of lidocaine on the early treatment of endotoxin lung injury We have seen in foreign journals that pre-administration of lidocaine has a protective effect on endotoxin lung injury. Recently, many scholars in China have used lidocaine for endotoxin Early treatment after endocrine lung injury has been beneficially explored. The results suggest that lidocaine has a therapeutic effect on the early stage after endotoxin lung injury. Its mechanism of action is: early treatment of endotoxin lung injury with lidocaine can inhibit the lung complement system. It activates, inhibits the accumulation of neutrophils in the lung, reduces finger peroxidation and the release of inflammatory mediators, reduces pulmonary vascular permeability, reduces pulmonary edema, and has a therapeutic effect on early lung injury.
Antitussive effect of lidocaine. During general anesthesia, intravenous administration of lidocaine can strengthen the depth of anesthesia, reduce the vitality of the throat reflex, inhibit the cough reflex after tracheal intubation, and can effectively inhibit coughs of different causes during anesthesia. Commonly used doses It is an intravenous bolus of 1.5 to 2 mg/kg, and its effect is mainly achieved through the inhibition of brainstem nerve activity.
Antibacterial activity Many scholars at home and abroad have demonstrated through clinical bacterial specimen studies that lidocaine has varying degrees of inhibition on pathogenic bacteria and isolated fungi, and the inhibition rate increases with the increase of the local anesthetic concentration. Recently, we have used lidocaine and When other drugs are combined for long-term epidural analgesia, the fluid from the epidural catheter is drawn for bacterial culture, and there is no bacterial growth, which can prove that lidocaine is safe and feasible for epidural anesthesia or long-term postoperative pain relief. The mechanism may be related to the interaction between the local anesthetic and most of the bacterial cell surface or cell membrane, resulting in the death or growth of the bacteria.
5.1. Bilan is the trade name, and its drug name is Articaine Epinephrine Injection. The main ingredients are: articaine hydrochloride 4%, epinephrine 1:100,000. Articaine and lidocaine are both amide local injection anesthetics.
5.2. Bilan has: fast onset of anesthesia (about 2-3 minutes), strong tissue infiltration (routine use of submucosal local infiltration method can be used to complete the extraction of the upper and lower posterior teeth, tooth preparation and pulp Treatment and other surgical procedures), high anesthesia efficiency (a small dose of injection can achieve the ideal anesthesia effect), and the characteristics of small side effects.
5.3. Bilan and lidocaine are both amide local anesthetics. If the user has no history of allergy to lidocaine, then he should not be allergic to articaine. According to the latest approved instructions for use, it is best to inject 5%-10% of the test for allergic reactions before using Bilan.
5.4. Bilan contains epinephrine 1:100,000, so it should be used with caution for hypertensive patients and the elderly, but not forbidden. The doctor also decides based on the actual clinical situation of the user. In addition, because the conventional dosage of Bilan is small, and the local mucosal infiltration injection method is generally used, the actual amount of adrenaline injected into the body is very small. However, the injection speed should be slow and the injection speed should not exceed 1ml/min.
5.5. When using Bilan, usually only local mucosal infiltration injection method can achieve anesthesia effect, but Bilan can be used for conduction block anesthesia. On the contrary, when treating multiple teeth, it should be simpler to use one-needle conduction block anesthesia. But at this time, attention should be paid to sucking back blood to avoid injection of Bilan into the blood vessel. Injection speed, 1 ml/min.
5.6. When the mandibular posterior teeth are extracted, only the local mucosal infiltration injection method can achieve the ideal anesthesia effect. It should be noted that in clinical practice, individual patients may experience incomplete extraction socket hyperemia after tooth extraction. This is due to the effect of adrenaline. At this time, in order to avoid the occurrence of dry socket, after tooth extraction, the gums should be scraped to make the extraction socket completely congested, and then pressure to stop bleeding.
5.7. The specification of Bilan is 1.7ml/piece, 50 pieces/box. Routinely, local injection of 0.8ml for a single tooth and 1.5-1.7ml for multiple teeth is sufficient.
Lidocaine’s anti-epileptic effect Haudin and other experiments have proved that lidocaine has obvious anti-epileptic effects. It has a certain effect on major seizures, minor seizures, and persistent states. The dose is 1 to 3 mg/kg. After dilution, it is slowly injected and is effective. After 2 to 6 mg/(kg·h) intravenous infusion, but high-dose administration may induce convulsions. Therefore, it is recommended to use diazepam and barbiturates for better effect.
The sensitizing effect of lidocaine on anticancer drugs. Foreign scholars have found that lidocaine can enhance the cytotoxicity of anticancer drugs such as doxorubicin and bleomycin in vitro, and it has a synergistic effect as the dose of local anesthetics increases. Strengthening, compared with the pure doxorubicin group, the average cell death rate increased by 34% and 30%, respectively. Therefore, lidocaine can be used as a biological response modifier in combination with anticancer drugs in the treatment of tumors, and the effect will be further improved.
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