Lidocaine
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Lidocaine Unilateral oedema in the arytenoid membrane and salivary gland or duct obstruction: case report
A 42-year-old woman developed unilateral oedema in the arytenoid membrane and salivary gland or duct obstruction after receiving lidocaine for local anaesthesia. The woman presented to the emergency department because of severe pain with redness in her left hand, front of the neck and legs (current presentation). Four hours before the current presentation, she was stung by a Trachinus Draco fish. Subsequently, at the outside hospital, she received local anaesthesia with 2% lidocaine injection to her wounds, which included 3mL (60mg) to the neck, 5mL (100mg) to the lower extremity and 4mL (80mg) to the left hand [route not stated]. The total dose of lidocaine was 240mg. After administration of lidocaine, her pain reduced, and she was discharged. However, she experienced hoarseness and shortness of breath. At the time of current presentation, her vital signs were as follows: BP: 130/70mm Hg, pulse: 98 beats/min, RR: 22 breaths/min, oxygen saturation: 99% and GCS score: 15 (G4M6S5). ECG showed sinus tachycardia. Neurological and cardiopulmonary examinations were normal. She also had hyperemic lesions and painful ecchymosis on her front neck near the midline, middle third of the medial side of her right thigh, the upper third of the medial side of her left leg and proximal phalanx of the flexor face of her left second finger. Her peripheral pulses were symmetrical and palpable. No movement limitation in her extremities or uvula edema on her oropharynx was observed. On her right arytenoid membrane, oedema was present. However, no swelling or oedema around the vocal cords was seen. The neck CT scan showed oedema in the right arytenoid membrane at the side of the neck where she was injected with lidocaine. The woman received immediate wound care, and spines were removed with sterile technique. Her extremities were dipped in hot water. Also, a hot compress was applied at the neck. She received treatment with diphenhydramine, ranitidine and methylprednisolone. She also received tenoxicam [tenoksikam] and paracetamol for analgesia, along with tetanus toxoid prophylaxis. Laboratory test showed a low haematocrit level, while increased levels of creatine kinase and amylase. Her haemoglobin level was decreased on the second day of hospitalisation, while amylase level increased on day 1 of hospitalisation. No increase in serum lipase level was noted. No abdominal pain was noted. Abdominal ultrasonography showed no acute pathology. Her hyperamylasemia was attributed to a toxin. Salivary gland or duct obstruction associated with the lidocaine injection was considered as possible aetiology. Her creatine kinase value increased on day 1 of hospitalisation. Her fluid deficits were corrected, and urine output was monitored. She was treated with fluid replacement therapy. On the seventh day of hospitalisation, she was discharged without any complications. Gulen M, et al. Envenomation by Trachinus draco and Pain Management. Wild
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