Subscribe to RSS
Wire Myography for Continuous Estimation of the Optimal Concentration of Topical Lidocaine as a Vasodilator in MicrosurgeryFunding This work was supported by JSPS KAKENHI (grant number JP 12850582).
Background Intraoperative vasospasm during reconstructive microvascular surgery is often unpredictable and may lead to devastating flap loss. Therefore, various vasodilators are used in reconstructive microsurgery to prevent and relieve vasospasm. Lidocaine is a vasodilator commonly used in microvascular surgery. Although many reports have described its in vitro and in vivo concentration-dependent vasodilatory effects, limited studies have examined the pharmacological effects of lidocaine on blood vessels in terms of persistence and titer.
Methods In this study, the vasodilatory effect of lidocaine was examined by using the wire myograph system. Abdominal aortas were harvested from female rats, sliced into rings of 1-mm thickness, and mounted in the wire myograph system. Next, 10, 5, 2, and 1% lidocaine solutions were applied to the artery, and the change in vasodilation force, persistence of the force, and time required to reach equilibrium were measured.
Results The vasodilatory effect was confirmed in all groups following lidocaine treatment. Although strong vasodilation was observed in the 10% lidocaine group, it was accompanied by irreversible degeneration of the artery. Vasodilation in the 1% lidocaine group was weaker than that in the other groups 500 seconds after lidocaine addition (p < 0.05). Between the 5 and 2% lidocaine groups, 5% lidocaine showed a stronger vasodilatory effect 400 to 600 seconds after lidocaine addition (p < 0.01); however, there was no significant difference in these groups after 700 seconds. Additionally, there was no difference in the time required for the relaxation force to reach equilibrium among the 5, 2, and 1% lidocaine groups.
Conclusion Although our study confirmed the dose-dependent vasodilatory effect of lidocaine, 5% lidocaine showed the best vasodilatory effect and continuity with minimal irreversible changes in the arterial tissue.
Keywordswire myography - lidocaine - vasodilator - microvascular surgery - reconstructive microsurgery
Received: 12 August 2020
Accepted: 19 November 2020
31 January 2021 (online)
© 2021. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
- 1 Turin SY, Walton RL, Dumanian GA, Hijjawi JB, LoGiudice JA, Alghoul M. Current practices in the management of postoperative arterial vasospasm in microsurgery. J Reconstr Microsurg 2018; 34 (04) 242-249
- 2 Rinkinen J, Halvorson EG. Topical vasodilators in microsurgery: what in the evidence?. J Reconstr Microsurg 2017; 33 (01) 1-7
- 3 Ricci JA, Koolen PG, Shah J, Tobias AM, Lee BT, Lin SJ. Comparing the outcomes of different agents to treat vasospasm at microsurgical anastomosis during the papaverine shortage. Plast Reconstr Surg 2016; 138 (03) 401e-408e
- 4 Hou SM, Seaber AV, Urbaniak JR. Relief of blood-induced arterial vasospasm by pharmacologic solutions. J Reconstr Microsurg 1987; 3 (02) 147-151
- 5 Beekman WH, Sluimers JE, Kort WJ, van der Meulen JC. Resolution of experimental microvascular vasoconstriction in rats by topical application of lidocaine hydrochloride in varying concentrations. Ann Plast Surg 1988; 21 (06) 570-575
- 6 Yu JTS, Patel AJK, Malata CM. The use of topical vasodilators in microvascular surgery. J Plast Reconstr Aesthet Surg 2011; 64 (02) 226-228
- 7 Beekman WH, Dammeijer PF, Sluimers JE, Kort WJ, van der Meulen JHC. Improvement in blood flow and diameter of the postanastomotic rat tail artery by topical application of lidocaine in varying concentrations. Ann Plast Surg 1990; 24 (03) 248-251
- 8 Blair WF, Greene ER, Eldridge M, Cipoletti R. Hemodynamics after microsurgical anastomosis: the effects of topical lidocaine. J Microsurg 1981; 2 (03) 157-164
- 9 Yokoyama T, Kadota S, Takeuchi K. et al. Changes in the blood flow and prevention of vasospasm of the femoral artery by topical application of lidocaine in rats. Ann Plast Surg 2011; 67 (02) 178-183
- 10 Haines PC, Ranzoni J, Longnecker DE, Morgan RF. Effects of lidocaine concentration on distal capillary blood flow in a rabbit ear model. Microsurgery 1987; 8 (02) 54-56
- 11 Wadström J, Gerdin B. Modulatory effects of topically administered lidocaine and pentobarbital on traumatic vasospasm in the rabbit ear artery. Br J Plast Surg 1991; 44 (05) 341-347
- 12 Kerschner JE, Futran ND. The effect of topical vasodilating agents on microvascular vessel diameter in the rat model. Laryngoscope 1996; 106 (11) 1429-1433
- 13 Geter RK, Winters RRW, Puckett CL. Resolution of experimental microvascular spasm and improvement in anastomotic patency by direct topical agent application. Plast Reconstr Surg 1986; 77 (01) 105-115
- 14 Puckett CL, Winters RRW, Geter RK, Goebel D. Studies of pathologic vasoconstriction (vasospasm) in microvascular surgery. J Hand Surg Am 1985; 10 (03) 343-349
- 15 Evans GR, Gherardini G, Gürlek A. et al. Drug-induced vasodilation in an in vitro and in vivo study: the effects of nicardipine, papaverine, and lidocaine on the rabbit carotid artery. Plast Reconstr Surg 1997; 100 (06) 1475-1481
- 16 Vargas CR, Iorio ML, Lee BT. A systematic review if topical vasodilators for the treatment of intraoperative vasospasm in reconstructive microsurgery. Plast Reconstr Surg 2015; 136 (02) 411-422
- 17 Demaria RG, Vernhet H, Aya G, Oliva-Lauraire MC, Juan JM, Dauzat MM. Experimental model for comparative evaluation of pharmacologically induced vasodilation of arterial wall mechanical properties. J Cardiovasc Pharmacol 2003; 42 (03) 389-394
- 18 Zhang J, Lipa JE, Black CE. et al. Pharmacological characterization of vasomotor activity of human musculocutaneous perforator artery and vein. J Appl Physiol (1985) 2000; 89 (06) 2268-2275
- 19 Ueda K, Harii K. Comparative study of topical use of vasodilating solutions. Scand J Plast Reconstr Surg Hand Surg 2003; 37 (04) 201-207
- 20 Chen LE, Seaber AV, Urbaniak JR. Vasodilator action of prostaglandin E1 on microcirculation of rat cremaster muscle. Microsurgery 1990; 11 (03) 204-208
- 21 Gherardini G, Evans GRD, Milner SM. et al. Comparison of vascular effects of calcitonin gene-related peptide and lidocaine on human veins. J Reconstr Microsurg 1996; 12 (04) 241-245
- 22 Qu D, Liu J, Lau CW, Huang Y. Differential mechanisms for insulin-induced relaxations in mouse posterior tibial arteries and main mesenteric arteries. Vascul Pharmacol 2014; 63 (03) 173-177
- 23 Salomone S, Foresti R, Villari A, Giurdanella G, Drago F, Bucolo C. Regulation of vascular tone in rabbit ophthalmic artery: cross talk of endogenous and exogenous gas mediators. Biochem Pharmacol 2014; 92 (04) 661-668
- 24 Sakakibara S, Ishida Y, Hashikawa K, Yamaoka T, Terashi H. Intima/medulla reconstruction and vascular contraction-relaxation recovery for acellular small diameter vessels prepared by hyperosmotic electrolyte solution treatment. J Artif Organs 2014; 17 (02) 169-177
- 25 Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 2013; 48 (03) 452-458
- 26 Zhou X, Li YH, Yu HZ, Wang RX, Fan TJ. Local anesthetic lidocaine induces apoptosis in human corneal stromal cells in vitro. Int J Ophthalmol 2013; 6 (06) 766-771
- 27 Yu HZ, Li YH, Wang RX. et al. Cytotoxicity of lidocaine to human corneal endothelial cells in vitro. Basic Clin Pharmacol Toxicol 2014; 114 (04) 352-359
- 28 Chang YS, Tseng SY, Tseng SH, Wu CL. Cytotoxicity of lidocaine or bupivacaine on corneal endothelial cells in a rabbit model. Cornea 2006; 25 (05) 590-596
- 29 Piper SL, Laron D, Manzano G. et al. A comparison of lidocaine, ropivacaine and dexamethasone toxicity on bovine tenocytes in culture. J Bone Joint Surg Br 2012; 94 (06) 856-862
- 30 Miyazaki T, Kobayashi S, Takeno K, Yayama T, Meir A, Baba H. Lidocaine cytotoxicity to the bovine articular chondrocytes in vitro: changes in cell viability and proteoglycan metabolism. Knee Surg Sports Traumatol Arthrosc 2011; 19 (07) 1198-1205
- 31 Formica F, Ferro O, Brustia M. et al. Effects of papaverine and glycerylnitrate-verapamil solution as topical and intraluminal vasodilators for internal thoracic artery. Ann Thorac Surg 2006; 81 (01) 120-124
- 32 Tayo FM. Comparative effects of noradrenaline and serotonin in a central and a peripheral artery in vitro. Afr J Med Med Sci 1983; 12 (3-4): 139-143