Biography
Biography: David Ling
Abstract
The first local anesthetic to be discovered was cocaine an alkaloid in large amount (0.6 to 1.8%) on the leaves of Erythroxylon coca a shrub growing in the Andes Mountains. Vast quantities were consumed orally and annually. The plant ash when chewed releases the plant alkaloid and absorbed across the mouth mucous membrane. In 1880 Niemann noted that the tongue was numb with no sensation upon chewing this substance. It is well known that Lidocaine was absorbed across the mucous membrane. Anesthesia for gynecological surgery procedure is not very satisfactory in certain aspects. General anesthesia is excellent but it involves the services of a anesthesiologist in the hospital. Paracervical block uses from 10 to 18 cc of 1% Lidocaine a relatively large amount. The VAS score from the block itself is between 19 to 69 mm. A quoted study showed that paracervical block does not significantly decrease pain with IUD insertion.
Study Design: This is a retroactive study comparing patients with gynecological procedure without any anesthesia and with ° intrauterine 1% Lidocaine injected into the uterine cavity. Pain was evaluated with the VAS score at 1. Instrument insertion, 2. Actual procedure and 3. 5 minutes post operation. The procedures include 1. IUD insertion, 2. SIS, 3. Endometrial biopsy, 4. D&C. Others such as IUI , sterilization etc may also be included. ,
Results: After 3-5 cc of 1% Lidocaine injection into the uterine cavity, the median VAS score is only about 5 mm. On testing serum Lidocaine at 5 minutes after injection the serum level is below 1.5 mg/L. Our normal Lidocaine therapeutic level is 1.5 to 5 mg/L. Without anesthesia the VAS score is about 75 mm. Conclusion: Injecting 3-5 cc of 1% Lidocaine into the uterus results in very good anesthesia. Knowing the serum level is below 1.5 mg/L this procedure can be used with impunity.