title: Lignocaine plasma levels following topical gel application in laparoscopic and hysteroscopic procedures.
abstract: The study aim was to determine plasma lignocaine concentrations resulting from topical application of a newly formulated, sterile two-pack lignocaine gel in laparoscopic and hysteroscopic procedures. This was an open label single-centre study in which six female patients underwent laparoscopy and six underwent hysteroscopy. One venous blood sample was extracted pre-gel application, followed by 10 samples over a 24 hour period following application. Samples were centrifuged, stored at -20°C and subsequently analysed for lignocaine and its metabolite, monoethyl-glycinexylidide. Application of gel in doses between 2.7 and 5.8 mg/kg of lignocaine resulted in a maximum plasma concentration in any patient of 1520 ng/ml lignocaine and 240 ng/ml monoethyl-glycinexylidide. These maximum concentrations were recorded in a patient undergoing a laparoscopic procedure and patients undergoing hysteroscopic procedures all recorded lower maximum concentrations compared with patients undergoing laparoscopy; the maximum observed concentrations in a patient having a hysteroscopy were 420 ng/ml lignocaine and 56 ng/ml of monoethyl-glycinexylidide.A new sterile two-pack topical lignocaine gel, applied at the end of laparoscopic and hysteroscopic procedures in doses up to 5.84 mg/kg, resulted in plasma lignocaine levels below those known to have the potential to cause central nervous system toxicity.
authors.affiliation: Women's Health and Research Institute of Australia, University of New South Wales, Sydney, Australia.
authors.forename: E A
authors.initials: EA
authors.lastname: Hewitt
authors.forename: G
authors.initials: G
authors.lastname: Armstrong
authors.forename: N
authors.initials: N
authors.lastname: Beg
authors.forename: S
authors.initials: S
authors.lastname: Katz
authors.forename: T G
authors.initials: TG
authors.lastname: Vancaillie
mesh_terms: D000287:Administration, Topical; D000465:Algorithms; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000097:blood*; D019540:Area Under Curve; D002138:Calibration; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D005782:Gels; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008012:Lidocaine / Q000008:administration & dosage* / Q000031:analogs & derivatives / Q000097:blood*; D011446:Prospective Studies
chemical_list: D000779:Anesthetics, Local; D005782:Gels; D008012:Lidocaine; C001173:monoethylglycinexylidide