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If you wish to respond to a paper or other item already published in the BJA, please go to the abstract/full text version of that item and click on the link "E-Letters: Submit a response to the article".

Electronic Letters to:

Clinical Investigation:
Y. -C. P. Arai, M. Ikeuchi, K. Fukunaga, W. Ueda, T. Kimura, and T. Komatsu
Intra-articular injection of warmed lidocaine improves intraoperative anaesthetic and postoperative analgesic conditions
Br. J. Anaesth. 2005; 0: aei292v1 [Abstract] [PDF]
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Electronic letters published:

[Read E-letter] Re: How to warm lignocaine?
Young-Chang P. Arai Arai   (16 February 2006)
[Read E-letter] How to warm lignocaine?
Amar Karmarkar, Swati Karmarkar   (15 February 2006)

Re: How to warm lignocaine? 16 February 2006
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Young-Chang P. Arai Arai,
Multidisciplinary pain center, Aichi Medical University
Multidisciplinary pain center, Aichi Medical University

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Re: Re: How to warm lignocaine?

We thank for the letter from Dr.Amar Karmarkar. I usually put a lidocaine/bupivacaine ampoule and a syringe into a plastic bag, then store the bag in a water bath warmed to 40 degree celusius for 1 hour or a stove warmed to 40 degree celusius for 24 hours just before an intra-articular injection (1).

Reference (1) Young-Chang P. Arai et al. The influence of hyperbaric bupivacaine temperature on the spread of spinal anesthesia. Anesthesia & Analgesia 2006; 102: 272-5

Conflict of Interest:

None declared
How to warm lignocaine? 15 February 2006
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Amar Karmarkar,
SpR Anaesthetics
North Manchester General hospital,
Swati Karmarkar

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Re: How to warm lignocaine?

We read with intrest your article 'Intra-articular injection of warmed lidocaine improves intraoperative anaesthetic and postoperative analgesic conditions'. We are a major orthopaedics and trauma centre and perform many knee arthroscopies under general anaesthetic using propofol and fentanyl/ morphine. Our current practice is to use 20 mls of unwarmed intra-articular 0.5% levobupivacaine at the end of the arthroscopy for post opeartive analgesia. Although we haven't formally studied the effect on perioperative analgesic requirements it would be beneficial to apply your study findings to our routine practice because it will avoid any opioid usage which might speed up the recovery and discharge with better turn over of patients. The major hurdle we are experiencing is how to warm up the lidocaine, how to maintain and measure its temperature at 40 degrees and still keep it sterile. Does it also apply for 0.5% bupivacaine? Kindly advice so that we can apply your findings to our practice and help patients to get better perioperative pain relief.

Conflict of Interest:

None declared