Abstract
Background
In Japan, endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) is performed by endoscopists on patients under sedation. There is an increased risk of anesthesia-related complications due to the higher sedative doses required during lengthier ESDs, so we sought to determine whether a local pain control method could safely reduce such doses.
Methods
Twenty EGC patients enrolled in this study received local lidocaine injections during ESDs at our hospital (lidocaine group; LG). Electrocardiography, heart rate, oxygen saturation, and blood pressure were monitored during and after the ESDs, along with the doses of midazolam and pentazocine. Pain assessments were recorded for LG patients on the day of their ESDs and the following day.
Results
The mean volume of lidocaine injection solution was 55.4 ml and the mean dose of lidocaine was 236 mg (range, 100–300 mg). The mean size of the resected specimens was 39.3 mm and mean procedure time was 66.0 min. There were no lidocaine-related complications, and electrocardiography, heart rate, oxygen saturation and blood pressure measurements were normal. In comparison to 157 consecutive patients (control group; CG), who had similar characteristics and had undergone ESDs previously with submucosal injections of conventional normal saline solution, the mean ± SD pentazocine dose of 15.8 ± 10.3 mg in the LG was significantly lower (P < 0.01) than the dose of 23.1 ± 9.5 mg in the CG, and none of the LG patients complained of abdominal pain on the day of their ESDs, whereas such pain was reported by 17% (27/157) of the CG.
Conclusion
Local lidocaine injections into the submucosal layer were safe when administered during ESDs performed on EGC patients under sedation.
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References
Oda I, Gotoda T, Hamanaka H, Eguchi T, Saito Y, Matsuda T, et al. Endoscopic submucosal dissection for early gastric cancer: technical feasibility, operation time and complications from a large consecutive series. Dig Endosc 2005;17:54–58.
Patel S, Vargo JJ, Khandwala F, Lopez R, Trolli P, Dumot JA, et al. Deep sedation occurs frequently during elective endoscopy with meperidine and midazolam. Am J Gastroenterol 2005;100:2689–2695.
Karaaslan D, Sivaci RG, Akbulut G, Dilek ON. Preemptive analgesia in laparoscopic cholecystectomy: a randomized controlled study. Pain Pract 2006;6:237–241.
Goldstein A, Grimault P, Henique A, Keller M, Fortin A, Darai E. Preventing postoperative pain by local anesthetic instillation after laparoscopic gynecologic surgery: a placebo-controlled comparison of bupivacaine and ropivacaine. Anesth Analg 2000;91:403–407.
Einarsson JI, Sun J, Orav J, Young AE. Local analgesia in laparoscopy: a randomized trial. Obstet Gynecol 2004;104:1335–1339.
Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma–2nd English edition. Gastric Cancer 1998;1:10–24.
Gotoda T, Yamamoto H, Soetikno RM. Endoscopic submucosal dissection of early gastric cancer. J Gastroenterol 2006;41:929–942.
Gotoda T, Kondo H, Ono H, Saito Y, Yamaguchi H, Saito D, et al. A new endoscopic mucosal resection (EMR) procedure using an insulation-tipped diathermic (IT) knife for rectal flat lesions. Gastrointest Endosc 1999;50:560–563.
Gotoda T. Endoscopic diagnosis and treatment for early gastric cancer. Cancer Review: Asia-Pacific 2004;2:17–37.
Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut 2001;48:225–229.
Polk JW, Bailey AH. Topical anesthesia for endoscopy; evaluation of prilocaine (Citanest), a new local anesthetic. Dis. Chest 1967;51:293–297.
Mather LE, Tucker GT, Murphy TM, Stanton-Hicks MD, Bonica JJ. The effects of adding adrenaline to etidocaine and lignocaine in extradural anaesthesia. II: Pharmacokinetics. Br J Anaesth 1976;48:989–994.
Garwood S, Reeder M, Mackenzie IZ, Guillebaud J. Tubal surface lidocaine mediates pre-emptive analgesia in awake laparoscopic sterilization: a prospective, randomized clinical trial. Am J Obstet Gynecol 2002;186:383–388.
Smith G. Intraperitoneal administration of analgesia: is this practice of any utility? Br J Anaesth 2002;89:535–537.
Elhakim M, Elkott M, Ali NM, Tahoun HM. Intraperitoneal lidocaine for postoperative pain after laparoscopy. Acta Anaesthesiol Scand 2000;44:280–284.
Carbonell AM, Harold KL, Mahmutovic AJ, Hassan R, Matthews BD, Kercher KW, et al. Local injection for the treatment of suture site pain after laparoscopic ventral hernia repair. Am Surg 2003;69:688–691.
Zullo F, Pellicano M, Cappiello F, Zupi E, Marconi D, Nappi C. Pain control after microlaparoscopy. J Am Assoc Gynecol Laparosc 1998;5:161–163.
Sweetman SC, Blake PS, McGlashan JM, Neathercoat GC, Parsons AV. Lidocaine. In: Martindale: the complete drug reference. 35th ed. London/Chicago: Pharmaceutical Press; 2006. p. 1702–1706.
Rembacken BJ, Gotoda T, Fujii T, Axon ATR. Endoscopic mucosal resection. Endoscopy 2001;33:709–718.
Soetikno RM, Gotoda T, Nakanishi Y, Soehendra N. Endoscopic mucosal resection. Gastrointest Endosc 2003;57:567–579.
Eguchi T, Gotoda T, Oda I, Hamanaka H, Hasuike N, Saito D. Is endoscopic one-piece mucosal resection essential for early gastric cancer? Dig Endosc 2003;15:113–116.
Kedek A, Derbent A, Uyar M, Bilgen C, Uyar M, Kirazli, et al. Pre-emptive effect of ibuprofen syrup and lidocaine infiltration on post-operative analgesia in children undergoing adenotonsillectomy. J Int Med Res 2005;33:188–195.
Homer JJ, Swallow J, Semple P. Audit of pain management at home following tonsillectomy in children. J Laryngol Otol 2001;115:205–208.
Wu CT, Yett CC, Yu JC, Lee MMS, Tao PL, Ho ST, et al. Preincisional epidural ketamine, morphine and bupivacaine combined with epidural and general anaesthesia provides pre-emptive analgesia for upper abdominal surgery. Acta Anasthesiol Scand 2000;44:63–68.
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Kiriyama, S., Oda, I., Nishimoto, F. et al. Pilot study to assess the safety of local lidocaine injections during endoscopic submucosal dissection for early gastric cancer. Gastric Cancer 12, 142–147 (2009). https://doi.org/10.1007/s10120-009-0514-y
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DOI: https://doi.org/10.1007/s10120-009-0514-y