ORIGINAL ARTICLES   

The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2004 September;48(3):207-10

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Should lidocaine be avoided for local anesthesia in radiation synovectomy?

Schweeger I., Pirich C., Ofluoglu S., Sinzinger H.

Department of Nuclear Medicine University of Vienna, Vienna, Austria

Aim. Leakage is of ­major con­cern ­when per­form­ing radi­a­tion syn­ovec­to­my. Although ­post-treat­ment immo­bil­iza­tion was pro­vid­ed, ­extra-artic­u­lar leak­age of radio­ac­tiv­ity has occa­sion­al­ly ­been ­observed in ­patients receiv­ing ­local anes­the­sia in the ­course of radi­a­tion syn­ovec­to­my. This ­study was per­formed to uncov­er any unfa­vour­able ­effect of lid­o­caine on stabil­ity of 166Ho-­FHMA (fer­rum hydrox­ide mac­ro­ag­gre­gate).
Methods. The radio­phar­ma­ceu­ti­cal was inves­ti­gat­ed in ­bovine ser­um albu­min (BSA) solu­tions (5, 10 mg/ml) at pH 6, 7 and 8. Furthermore, the trac­er was incu­bat­ed for 0, 2, 24, 48 and 120 ­hours in syn­ovi­al ­fluid. In ­both ­series the influ­ence of lid­o­caine-HCl 2% (500, 1000 µl) has ­been eval­u­at­ed.
Results. In BSA test­ so­lu­tions, ­amount of lid­o­caine add­ed [df(2), F=7.82, p-lev­el: 0.00] and pH [df(2), F=7.82, p-lev­el: 0.00] sig­nif­i­cant­ly influ­enced in ­vitro stabil­ity of 166Ho ­labeled ­FHMA (n=72). This find­ing was con­firmed in syn­ovi­al ­fluid [df(2), F=3.82, p-lev­el: 0.03] (n=60).
Conclusion. In an experi­men­tal ­design mim­ick­ing nor­mal and inflam­ma­to­ry con­di­tions in the ­joint, addi­tion of a few mil­li­li­ters of lid­o­caine-HCl fol­lowed by a ­shift ­towards low­er pH-val­ues in syn­ovi­al ­fluid may endan­ger stabil­ity of the car­ri­er-trac­er com­plex 166Ho-­FHMA and there­by ­enhance ­extra-artic­u­lar leak­age.