Caution in the Use of Lidocaine Infusion in the Surgical Patient

Abstract

In Response: We thank Dr. Drage for his comments about our study. The immuno-modulation possible with the administration of lidocaine was a consideration when planning our research. We chose elective retropubic prostatectomy in part because it is a clean operation. Antibiotics are administered prophylatically to treat any occult prostate infections, and any urinary tract infections are treated preoperatively. Lidocaine has a long history of intraoperative use: as a local or neuraxial anesthetic, for attenuation of the hemodynamic responses to tracheal intubation and extubation, and as a perioperative antiarrhythmic. Dr. Drage refers to a study demonstrating no increased frequency of infection in patients receiving short-term lidocaine therapy for their arrhythmias. Intraoperative epidural use combined with general anesthesia is frequently used in colon surgery [1]. We are not aware of any reports of higher perioperative infections involving patients treated in this manner, although blood levels of epidural lidocaine can reach levels similar to those of IV infusion [2]. The effect of lidocaine in the presence of infection is further complicated by the in vivo antimicrobial activity demonstrated by this agent [3]. The perioperative effects of the inflammatory response are not always desirable. In sterile wounds, the release of leukotrienes, interleukins, and thromboxanes can cause additional tissue damage, produce platelet aggregation and vascular damage, and increase microvascular permeability [4]. Diminished inflammation of the peritoneum is one of the mechanisms we suggested for the more rapid return of bowel function in our prostate patients after lidocaine administration. Alterations of immune function are associated with many agents currently used in anesthesia and are usually well tolerated by patients. We agree with Dr. Drage that further study is necessary before a treatment found effective in one type of surgery (radical retropubic prostatectomy) can be applied to all general surgical procedures. However, the potential benefits from this simple and inexpensive intervention warrants further clinical trials demonstrating safety and effect in a wider range of patients. Scott Groudine, MD Philip D. Lumb, MD Department of Anesthesiology; Albany Medical College; Albany, NY 12208