Drucker M, Cardenas E, Arizti P, Valenzuela A, Gamboa A
Department of Surgery, Hospital General Dr. Manuel Gea Gonzalez, Mexico City, D.F., Mexico.
World J Surg. 1998 Apr;22(4):394-7; discussion 397-8. doi: 10.1007/s002689900403.
Local anesthetics have several effects on wound healing. In experimental studies, procaine at high concentrations has been proved to retard healing in surgical wounds by diminishing the synthesis of mucopolysaccharides and hence probably collagen. Other studies have shown that lidocaine and bupivacaine inhibit collagen synthesis in fibroblast tissue cultures in rats. This study was designed to evaluate the effect of lidocaine on wound healing. An experimental, prospective, comparative, crossover and double-blind study was designed. Forty male guinea pigs, weighing 300 to 600 g, were randomly assigned to two groups. In control group A (20 animals), skin and subcutaneous tissue in a clean wound were incised and infiltrated with regular saline solution; in group B 20 animals were infiltrated with 1% lidocaine. All animals were sacrificed on day 8 and evaluated for breaking strength, number of collagen fibers by morphometry, and histologic examination of collagenization, edema, vascularity, and presence of acute and chronic inflammatory cells. The histopathologic appearance of tissues infiltrated with lidocaine did not vary consistently in relation to collagenization, edema, or acute and chronic inflammatory processes. The mean breaking strength between both groups was not statistically significant (p = 0.120). Important statistical differences were observed in vascularity (p < 0.003) and morphometric results (p < 0.001), where collagen was found in small amounts in the lidocaine group. The results of this study suggest that local infiltration of lidocaine produces significant histopathologic changes, but it does not substantially alter wound healing as there were no differences in the breaking strength of the wounds.
局部麻醉药对伤口愈合有多种影响。在实验研究中,已证明高浓度的普鲁卡因会通过减少粘多糖的合成进而可能减少胶原蛋白的合成,从而延缓手术伤口的愈合。其他研究表明,利多卡因和布比卡因会抑制大鼠成纤维细胞组织培养中的胶原蛋白合成。本研究旨在评估利多卡因对伤口愈合的影响。设计了一项实验性、前瞻性、对比性、交叉性和双盲研究。40只体重在300至600克之间的雄性豚鼠被随机分为两组。在对照组A(20只动物)中,切开清洁伤口的皮肤和皮下组织,并用生理盐水浸润;在B组中,20只动物用1%的利多卡因浸润。所有动物在第8天被处死,并评估其抗张强度、通过形态计量学测定的胶原纤维数量,以及对胶原化、水肿、血管分布以及急性和慢性炎症细胞的存在情况进行组织学检查。用利多卡因浸润的组织的组织病理学表现与胶原化、水肿或急性和慢性炎症过程之间并无一致的差异。两组之间的平均抗张强度无统计学意义(p = 0.120)。在血管分布(p < 0.003)和形态计量学结果(p < 0.001)方面观察到了重要的统计学差异,利多卡因组中发现的胶原蛋白量较少。本研究结果表明,利多卡因局部浸润会产生显著的组织病理学变化,但由于伤口的抗张强度没有差异,因此它并没有实质性地改变伤口愈合情况。