Discover Tranquil Comfort: Lidocaine, The Ultimate Topical Relief

This week on Drug of the Week, let’s talk about Lidocaine. If you have ever been to a dentist’s office for a root canal or any other procedure that requires anesthesia, you will most probably have received Lidocaine. 

Date of approval by FDA: 17 September 1997 

Mode of Administration: a clear and colorless Lidocaine Hydrochloride Injection BP 2% w/v. One should take it as a subcutaneous, intramuscular, or intravenous injection. 

Indications

1. Is given after an acute myocardial infarction
2. Dental anesthetic, sometimes used along with adrenaline

Contraindications

1. One should not use it for ocular purpose (usage in the eye) as it can disturb the pH of the ocular solutions
2. Pregnant ladies especially in their early pregnancy
3. Lactating ladies as it can secrete into breast milk and might cause an allergic reaction to the infant

Mechanism of action

The drug has a range of actions. 

It blocks the nerves at various sites in the body and also helps in the ionic control of dysrhythmias. It also inhibits the ionic reflexes needed for the initiation and conduction of impulses and thereby helps stabilize the neuronal membrane. 

It acts on both the peripheral and central nervous systems in addition to the cardiovascular system. Concerning the cardiovascular system, it mainly acts on the myocardium where it reduces the electrical excitability, and rate of conduction and thereby reduces the force of contraction. 

The above information was taken from the spmc of the drug

Current research

Lidocaine as an anticancer drug

A team of scientists recently identify the anticancer effect of lidocaine on oral squamous cell carcinoma. The researchers performed a series of tests and assays to study cell viability, proliferation, cell migration, and cell invasion following which a range of immuno-fluorescence and immuno-histochemistry experiments. 

Conclusion

They conclude the drug had suppressive affection through reduced viability, migration, and invasion of the cancer cells. It reduced IGF2BP2 resulting in poor survival of cancer cells. An over-expression of cave-in reversed the suppressive effect of lidocaine. Hence, lidocaine as an anticancer agent acts through the regulation of cave-in mediated by IGFBP2

Lidocaine injection in the form of Microneedles (MNs)

For those who are scared of injections and find topical aesthetic creams uncomfortable, a discovery by a team from China comes as a boon. It is a microneedle that can quickly dissolve the drug and release the drug within five minutes. Its excellent biocompatibility indicates its potential in the dental industry as an anesthetic. 

Lidocaine and Patient expectations

An interesting correlation was found between the expectations of a patient and their relationship with the healthcare provider. This might influence pain management. Their effect was demonstrated through an intravenous lidocaine injection. They concluded that building a strong trust with the healthcare provider might greatly help improve pain management.

Lidocaine and Tendinopathy

The overuse of joints results in pain and swelling of joints leading to reduced function. These symptoms characterize tendinopathy. Lidocaine is generally administered for the treatment of tendinopathy. However, recent studies have shown that lidocaine has a negative effect on tendon healing. To look up this, they studied the molecular mechanisms of lidocaine on the migration of tenocytes. Migration ability was studied using electric cell-substrate impedance sensing. After several tests, it was observed that lidocaine inhibited cell spreading by changing the cell morphology and F-actin distribution.

Lidocaine as an epidural

Being an analgesic, it is also used for giving epidural injection during delivery. This case reports the importance of the right placement of epidural catheters. If incorrectly placed, the patient may experience serious consequences like spinal block. 

Lidocaine on Adipose Stem Cells

It is generally not used while handling adipose stem cells (ASC). To find out if used alone or combined with epinephrine affected ASCs, they did a series of experiments to finally conclude that neither lidocaine nor its combination with epinephrine had a cytotoxic impact on ASCs at a concentration equivalent to top tumescent anesthesia. 

Lidocaine as an anti-arrhythmic

Despite the several roles, the most intriguing one is its role as an anti-arrhythmic. It acts by blocking voltage and pH-dependent sodium channels which reduces this condition.