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MORPHOLOGICAL CHANGES IN THE SMALL INTESTINE AFTER
LOCAL ANESTHESIA IN EXPERIMENTAL MECHANICAL TRAUMA
Tillaev Saidbek Sobir ugli
Bukhara State Medical Institute
https://doi.org/10.5281/zenodo.13354695
Abstract
This literature review presents the pharmacokinetic properties
of local anesthetics responsible for the effectiveness of regional anesthesia
methods, and also examines in detail the gastrointestinal effects of local
anesthetics, allowing a broader look at the possibilities of their use in intensive
care.
Keywords
: local anesthetics, gastrointestinal tract, local anesthetics.
Аннотация
В
данном
литературном
обзоре
изложены
фармакокинетические свойства местных анестетиков, ответственных за
эффективность методов регионарной анестезии, а также подробно
рассмотрены желудочно-кишечные эффекты местных анестетиков,
позволяющие более широко посмотреть на возможности их применения в
интенсивной терапии.
Ключевые слова
: местные анестетики, желудочно-кишечный тракт,
местные анестетики
Relevance
. Today, several modern types of analgesics and drugs have
been developed. It is very useful for performing invasive procedures in surgery,
dentistry and traumatology. The methods used in anesthesia and the effects of
drugs on all organs have been studied by scientists for many years, but the
morphological changes of anesthetics in the intestine have not been fully
studied.
The effect of local anesthetics on the rate of gastrointestinal paresis
resolution as a manifestation of systemic anti-inflammatory action. The
pathophysiology of postoperative intestinal paresis is complex. Factors such as
surgical stress response, sympathetic hyperactivity, intestinal manipulations,
visceral pain stimulate nociceptive afferent and sympathetic efferent nerve
fibers. The stress response is accompanied by increased release of endogenous
opioids, which inhibit the propulsive activity of the gastrointestinal tract.
The use of opioid analgesics in the postoperative period also prevents the
restoration of normal gastrointestinal function due to the effect on opiate
receptors of the small intestine. Increased formation of inflammatory mediators
during tissue damage sensitizes peripheral nociceptors. Persistent activation of
C-fibers contributes to central sensitization with expansion of receptor fields.
Morphine and other opioid analgesics suppress the release of acetylcholine from
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the mesenteric plexus, which increases the tone of intestinal smooth muscles
and reduces the propulsive activity of the intestinal tract. Intravenous infusion
of MA, in particular lidocaine, seems very promising in light of the recent trends
of reducing the length of patients' stay in the clinic, as well as increasing their
satisfaction with the quality of treatment in general.
The severity of postoperative paresis depends on: a) the intensity of the
inflammatory process, b) increased sympathetic tone, c) the total dose of
prescribed opioids. It is believed that the positive effect of MA on this process
mainly depends on their systemic anti-inflammatory effect [8], although one
cannot ignore the decrease in the doses of opioid analgesics noted in a number
of studies [9, 10]. Intravenous administration of lidocaine can also have a certain
effect on sympathetic tone, although limited by its low concentration in plasma.
Harvey K. et al. (2019) believe that systemic administration of MA has
both peripheral and central mechanisms of action [11]. At the peripheral level,
MA limit the synthesis of inflammatory mediators, at the central level, they
modulate neuronal responses at the level of the posterior horns of the spinal
cord. MA have a direct stimulating effect on intestinal smooth muscles, which is
possibly the result of blockade of inhibitory reflexes originating from the
mesenteric plexus. In addition, spinal reflexes, as well as peripheral reflexes
conducted through the prevertebral ganglia, have an inhibitory effect on
gastrointestinal motility. Intravenous infusion of lidocaine can limit the duration
of postoperative intestinal paresis by reducing postoperative irritation of the
peritoneum, as well as inhibition of inhibitory gastrointestinal reflexes.
Some authors believe that amide MA, in addition to a powerful anti-
inflammatory effect, are also capable of significantly reducing sympathetic
activity, which, in particular, is manifested by a decrease in the concentration of
catecholamines in the urine for 48 hours after surgery [12, 13]. Some studies
have shown that intravenous prolonged administration of lidocaine allows not
only to shorten the period of inpatient treatment, but also reduces the intensity
of postoperative pain syndrome [9, 14]. The reduction in the length of stay in the
hospital is mainly due to faster recovery of gastrointestinal functions.
Three independent studies [8, 9, 14] showed that patients (open and
endoscopic colorectal surgery, as well as radical prostatectomy) who underwent
intravenous lidocaine infusion were discharged from the clinic 24 hours earlier
than the control group, which is associated with faster recovery of gas passage
and independent stool. The end of the infusion time varied from 1 to 24 hours
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after the end of the surgery. In all cases, the plasma concentration of lidocaine
did not reach toxic levels.
In the already mentioned study by Harvey K. et al. (2019), patients who
underwent elective colon surgery received patient-controlled intravenous
analgesia (PCA) with morphine in the postoperative period [11]. In addition,
patients in the study group received an intravenous infusion of lidocaine 1
mg/min for 24 hours after surgery. Against the background of lidocaine infusion,
a decrease in the average intensity of postoperative pain was noted, in
particular, 24 hours after surgery it was 26.1 ± 8.2 on a 100-point VAS, and in
the comparison group - 45.4 ± 6.4. The appearance of the first peristaltic noises
in the lidocaine group was noted after 88.3±6.8 hours, in patients receiving
placebo – after 116±10.1 hours (28 hours later). It is interesting to note that
against the background of the introduction of lidocaine, no decrease in the
average doses of morphine was noted, compared with the placebo group, i.e., the
earlier restoration of gastrointestinal motility in this study cannot be explained
by the opioid-sparing effect.
Lidocaine infusion allowed patients to be discharged from the hospital on
average one day earlier. Intestinal paresis is a serious enough problem in the
acute phase of spinal cord injury. In the study by Baumann A. et al. (2019), it was
shown that intravenous lidocaine infusion at a rate of 2–3 mg/min allowed to
eliminate intestinal paresis within 10–20 hours in patients resistant to
neostigmine therapy [15]. No signs of systemic toxicity of lidocaine were noted
in any of the studies. It is known to be dose-dependent and usually manifests
itself when the infusion rate is >3 mg/min and the drug concentration in plasma
reaches >5 μg/ml [16].
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