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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


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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.

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