Local anaesthetics in the management of duodenal ulceration: A clinical trial of oxethazaine hydrochloride (Mucaine)

The use of local anaesthetics in the management of dyspepsia has been widely reported, and the results appear to have been very encouraging. During this trial a similar degree of improvement was generally observed. The same degree of improvement, however, was observed when a control antacid preparation was administered. Local anaesthetics are thought to act partly by a reduction in gastric acidity (Woodward and Schapiro, 1958) and partly by a possible direct action on nerve endings in the gastric and duodenal mucosa. Bayer in 1934 used doses of 100 ml. of an 0-25 % solution of an aminobenzoate in the treatment of peptic ulcers, and since then several similar local anaesthetics have been used (Bayer, 1934; Hamori, 1943; Szenes, 1943; Gambigliani-Zoccoli and Zambelli, 1946; Boncour, 1946; Thomas and Kamath, 1950; Balfour and Wharton, 1952). The efficacy of a local anaesthetic depends partly upon its degree of ionization, for it acts on the nerve endings in its un-ionized form. The effect of gastric acidity, however, is to produce a marked degree of ionization of most local anaesthetics, including those used in previous rdgimes (Glassman, Hudyma, and Seifter, 1957). Recently, however, a new local anaesthetic agent, oxethazaine, has been developed, which is chemically a glycine amide rather than the usual benzoate or aminobenzoate. It is markedly resistant to ionization in an acid medium (Schwartz and Spertus, 1962). Clinical trials of oxethazaine in the management of oesophagitis (Jankelson and Jankelson, 1959; Ryall, 1962; Sklaroff and Karayannis, 1962), peptic ulceration (Moffitt, 1961; Hollander, 1960), and gastritis (Moffitt, 1961; Deutsch and Christian, 1959) seem to have been generally encouraging. A combination of the oxethazaine hydrochloride in aluminium and magnesium hydroxide gel is used, and this preparation (marketed as Mucaine) forms the basis of the present trial,