RE: Lidocaine take away that pain!

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RE: Lidocaine take away that pain! - September 23, 2008 12:42:47 PM

Shill

Posts: 1092
Joined: February 13, 2003
From: Madison WI USA
Status: offline

Hi Denton,
Thanks for the reply. Regarding the ionic cancellation, Im sure it is far more complex than this, but the way I look at this is similar to the way I look at mixing colors. Once you combine red and blue, you are going to get a purple mess. The red and blue may still be there, but would they be separated out by applying a current? Not if they are no longer charged, I believe.

Would a chemist and/or electrophysicist please answer this? Yeah, like that is going to happen.

It is probably not even a question that is worth answering, but my curiosity gets the best of me. My gut instincts tell me that before the end of my lifetime, we will learn that iontophoresis is generally useless in the PT world, but that the application of the DC current has an effect of some sort. Again, just my gut and opinion, combined with clinical observations.

(in reply to Dnorwood)

Post #: 21

RE: Lidocaine take away that pain! - September 23, 2008 1:33:37 PM

buckeye

Posts: 170
Joined: May 24, 2007
Status: offline

From Clinical Therapeutics. Study funded by a company with an interest - they manufacture/market a drug delivery system. The 'sham' treatment was with iontophoresis with saline and epinephrine.

Background: Commonly used classes of topical anesthetics require 30 to 60 minutes to provide effective anesthesia.

A new low-dose lidocaine iontophoresis system (LDLIS) may provide topical anesthesia in 10 minutes at

a lower dose than previous systems, thereby limiting adverse events.

Methods: This was a prospective, randomized, muhicenter, double-blind, placebo-controlled, clinical trial.

Adults and children aged 5 to 17 years (inclusive) received a 10-minute iontophoretic treatment with either lidocaine

or a saline placebo before venipuncture or venous cannulation. Intensity of pain associated with venipuncture

or venous cannulation was assessed using either a 10-cm Visual Analog Scale (VAS) for adults and children

aged 12 to 17 years or the Facial Affective Scale (FAS) for all children enrolled.

Results: Five hundred forty-eight patients (276 adults, 272 children) participated. Mean (SD) VAS pain scores

were lower in adults who received iontophoresis with lidocaine rather than with placebo (0.77 [1.49] vs 2.52

[2.30], P < 0.001) and in children aged 12 to 17 years (1.50 [1.87] vs 2.58 [2.26], P = 0.011). FAS pain scores

were lower among children who received iontophoresis with lidocaine rather than with placebo (0.36 [0.26] vs

0.51 [0.27], P < 0.001). Similar results were found for children stratified by age group (5-7 years: 0.40 [0.30]

vs 0.60 [0.31], P = 0.011; 8-11 years: 0.35 [0.27] vs 0.48 [0.27], P = 0.021; 12-17 years: 0.33 [0.21] vs 0.48

[0.24], P = 0.001). Mean (SD) parental ratings of pain on the FAS for children aged 5 to 11 years were also lower

for the lidocaine group (0.45 [0.28] vs 0.55 [0.25], P = 0.018). Adverse events were similar between groups and

included skin erythema and edema. One patient in the study experienced a partial-thickness burn.

Conclusion: In this study of adults and children, the LDLIS provided effective topical anesthesia for venipuncture

Medica, Inc.

(in reply to Shill)

Post #: 22

RE: Lidocaine take away that pain! - September 23, 2008 1:47:05 PM

buckeye

Posts: 170
Joined: May 24, 2007
Status: offline

The Clinical Journal of Pain, Volume 13(1), March 1997, pp 22-26

Abstract:
Objective: The primary objective was to evaluate the clinical safety and effectiveness of the iontophoretic administration of lidocaine HCl 2% and epinephrine 1:100,000 to induce local dermal anesthesia before intravenous (IV) cannulation.
Design: Section I: Open, nonblinded.
Section II: Randomized, double-blind, placebo-controlled.
Setting: Section I: Healthy adult volunteers.
Section II: Patients presenting for scheduled outpatient eye surgery.
Patients: Section I: Seven healthy adult volunteers.
Section II: Forty-four patients requiring IV cannulation before scheduled eye surgery.
Interventions: Section I: Volunteers received iontophoresis of lidocaine HCl 2% with epinephrine 1:100,000 for a total delivery current of 40 mA · min.
Section II: Patients received iontophoresis for a total delivery current of 40 mA · min of lidocaine HCl 2% with epinephrine 1:100,000 (active) or saline (control) immediately before intravenous cannulation with a 20-gauge IV catheter.
Major Outcome Measures: Section I: Venous blood plasma lidocaine levels, adverse events associated with iontophoresis.
Section II: Patient and investigator assessment of analgesia, patient acceptance of iontophoresis, adverse events associated with iontophoresis.
Results: Section I: No detectable levels of lidocaine were identified in any blood plasma sample. Adverse effects were minimal and transitory.
Section II: Pain was decreased following lidocaine iontophoresis in comparison with controls, as determined by the patients and investigators. Iontophoresis was well accepted by the patients. Adverse effects were minimal and transitory.
Conclusions: Iontophoresis of lidocaine 2% with 1:100,000 epinephrine for short delivery times does not lead to delivery of clinically important systemic levels of lidocaine in healthy adults. Iontophoresis of lidocaine 2% with 1:100,000 epinephrine provides adequate skin anesthesia for placement of peripheral small-gauge IV catheters.

(in reply to buckeye)

Post #: 23

RE: Lidocaine take away that pain! - September 23, 2008 2:01:10 PM

Dnorwood

Posts: 14
Joined: September 19, 2008
Status: offline

Shill,
I like the color analogy and I agree a chemist probably doesn't read this little blog. But I think it would just come down to whether the electrical current would be enough to overcome any attraction that the molecules may have to each other. My gut instict is the same as yours as I stated earlier.

Buckeye,
The first article is interesting in the fact that I can see why the subjects treated with the ionto with lidocaine had lower pain score as lidocaine is a topical analgesic.

_____________________________

Denton Norwood, MS, ATC

(in reply to buckeye)

Post #: 24

RE: Lidocaine take away that pain! - September 23, 2008 4:33:03 PM

buckeye

Posts: 170
Joined: May 24, 2007
Status: offline

The article abstracts are posted since they have some comparison of lidocaine with sham treatment but still receiving the current.

(in reply to Dnorwood)

Post #: 25

RE: Lidocaine take away that pain! - September 23, 2008 11:45:16 PM

hmgross

Posts: 292
Joined: February 28, 2003
From: Minnesota
Status: offline

Kiwi, I have the new EMPI Hybresis unit (the fancy band-aid) I don't use Ionto often but I have been noticing better results with this vs the "old blue box"
Decreased pain in 2-3 Rx vs the 6 but like I said, I don't use it often enough. It seems to work best on bony shoulders and knees