Continuous Lidocaine Infusion Research Articles

Feasibility of opioid-free anesthesia in laparoscopic radical prostatectomy: A retrospective, quasi-experimental study

Abstract Background and Aims: Opioid-free anesthesia (OFA) provides adequate analgesia minimizing opioids. OFA has not been evaluated in laparoscopic radical prostatectomy (LRP). Our aim was to evaluate OFA feasibility and its effectiveness in LRP. Material and Methods: A quasi-experimental retrospective study of 55 adult patients undergoing LRP was performed from September 2020 until December 20223. Predefined protocols for either opioid-based anesthesia (OBA; with continuous remifentanil infusion) or OFA (continuous lidocaine, dexmedetomidine, and ketamine infusion) were followed. In both groups, wound infiltration was performed before skin incision. Primary outcome was postoperative pain management (numerical rating scale [NRS]) in the first 24 postoperative hours. Secondary outcomes were opioid consumption, start to sitting and ambulation, postoperative complications, and length of hospital stay. Results: OFA protocol patients had better median pain scores during movement at 1, 18 and 24 h, that is, 1 (interquartile range [IQR] 0–3) versus 2.5 (IQR 0–4), P = 0.047; 0 (IQR 0–1) versus 1 (IQR 0–2), P = 0.017; and 0 (IQR 0–0.25) versus 1 (IQR 0–2), P = 0.013, respectively. At 6 and 12 h, there were no statistically significant differences, that is, 0.5 (IQR 0–2) versus 1 (IQR 0–2), P = 0.908 and 1 (IQR 0–2) versus 0.5 (IQR 0–2), P = 0.929, respectively. Lower morphine requirements were recorded in the first 18 and 24 postoperative hours, that is, 0 (IQR 0–0) versus 1 (IQR 0–2.75) mg, P = 0.028 and 0 (IQR 0–2) versus 1.5 (IQR 0–3) mg, P = 0.012, respectively. Start to sitting and ambulation occurred earlier in the OFA group (P = 0.030 and P = 0.002, respectively). Linear regression showed that ambulation was independently associated with the analgesic technique (P = 0.034). Only one patient had postoperative nausea and vomiting (PONV) and belonged to the OBA group. There was no difference in total complications or the length of stay. Conclusion: In this study, OFA strategy was found to be safe, feasible, and provided adequate analgesia, minimizing the use of postoperative opioids, and was independently associated with earlier ambulation.

Use of IV Lidocaine Infusion Postoperatively Within the ERAS Surgical Population

PurposeThe aim of this project was to investigate whether opioid pain scores, postoperative opioid requirements, and postanesthesia care unit (PACU) length of stay were impacted when comparing a 24-hour intravenous lidocaine infusion versus postoperative discontinuation of the lidocaine infusion. DesignA retrospective chart review was used both before and after the discontinuation of postoperative lidocaine infusions for a quality improvement project. MethodsThe project was carried out in the adult surgery PACU setting at a level 1 trauma center between April 2021 and September 2021. The sample included 100 adult patients who fell under surgical specialties that used enhanced recovery after surgery protocol. After approval was obtained, data was collected via an electronic chart review using an evaluation tool created by the project team. FindingsBetween the five surgical specialties used for this review, the PACU length of stay variable was reduced only in the gynecology oncology service (P= .041). Additionally, the postoperative opioid requirements were significantly reduced in the surgical oncology service (P = .02). Comparing the groups as a whole, 50 participants who had a 24-hour continuous lidocaine infusion and 50 participants whose lidocaine infusion was discontinued before PACU admission had no statistically significant values with pain scores, postoperative opioid requirements, and PACU length of stay. ConclusionsResults indicate that a 24-hour lidocaine infusion did not impact this patient population’s pain scores, postoperative opioid requirements, or PACU length of stay.

Preliminary Experience With a Continuous Lidocaine Infusion as an Analgesia Adjunct for Acute Pain Management Following Surgery in Pediatric Patients

Preliminary Experience With a Continuous Lidocaine Infusion as an Analgesia Adjunct for Acute Pain Management Following Surgery in Pediatric Patients

Efficacy of Lidocaine Infusion in High-Risk Vascular Surgery—A Randomized, Double-Blind, Placebo-Controlled Single-Center Clinical Trial

In perioperative pain control, adjuvants such as lidocaine can reduce opioid consumption in a specific type of surgery. The aim of this single-center prospective double-blinded randomized controlled trial was to determine opioid consumption in the perioperative period in patients receiving continuous lidocaine infusion. Patients undergoing elective abdominal aorta and/or iliac arteries open surgery were randomized into two groups to receive 1% lidocaine or placebo at the same infusion rate based on ideal body weight (bolus of 0.15 mL/kg during the induction of anesthesia followed by continuous infusion of 0.2 mL/kg/h during surgery; postoperatively 0.1 mL/kg/h for 24 h) additionally to standard opioid analgesia. Total opioid consumption within 24 h after surgery was 89.2 mg (95%CI 80.9-97.4) in the lidocaine and 113.1 mg (95%CI 102.5-123.6) in the placebo group (p = 0.0007). Similar findings were observed in opioid consumption intraoperatively (26.7 mg (95%CI 22.2-31.3) vs. 35.1 mg (95%CI 29.1-41.2), respectively, p = 0.029) and six hours postoperatively (47.5 mg (IQR 37.5-59.5) vs. 60 mg (IQR 44-83), respectively, p = 0.01). In high-risk vascular surgery, lidocaine infusion as an adjunct to standard perioperative analgesia is effective. It may decrease opioid consumption by more than 20% during the first 24 h after surgery, with no serious adverse effects noted during the study period.

Lidocaine for Neuropathic Cancer Pain (LiCPain): study protocol for a mixed-methods pilot study

IntroductionMany patients experience unrelieved neuropathic cancer-related pain. Most current analgesic therapies have psychoactive side effects, lack efficacy data for this indication and have potential medication-related harms. The local anaesthetic lidocaine...

Retracted: Effects of Continuous Infusion of Lidocaine under Ultrasound-Guided Cervical Sympathetic Ganglion Catheterization on Cerebral Hemodynamics and Thermal Imaging Characteristics of Head and Neck in Patients with Angioneurotic Headache.

[This retracts the article DOI: 10.1155/2022/7696251.].

Opioid sparing analgesia: Continuous intraoperative infusion of dexmedetomidine versus lidocaine for intracranial surgeries in children: A double-blind randomized clinical trial

ABSTRACT Background The usage of opioid sparing analgesia in different surgeries leads to varied results. The aim of this study is to compare between the effects of continuous intraoperative infusion of dexmedetomidine versus lidocaine as opioid sparing analgesia in children undergoing intracranial surgeries. Methods It is a double-blind randomized clinical study in which, 64 children were randomly allocated into 2 equal groups; 32 children for each group. The first one was dexmedetomidine group which received continuous intraoperative dexmedetomidine iv infusion [1ug/kg dexmedetomidine over 15 minutes as a loading dose and 0.5ug/kg/h for maintenance]. The second one was lidocaine group which received continuous intraoperative lidocaine iv infusion [1.5mg/kg lidocaine over 15 minutes as a loading dose and 1.5mg/kg/h for maintenance]. The continuous intraoperative iv infusion of each tested drug was stopped 10 minutes before the end the surgical procedure. Results Intraoperative total fentanyl consumption was significantly reduced in dexmdetomidine compared to lidocaine group ([19.33±11.15 vs 43.10±21.15] ug, 95% CI, -45.8 to -1.7). Children in dexmedetomidine group were significantly more sedated compared to lidocaine group. The time to reach Wong–Baker Faces Pain Rating Scale (WBFPS) scores 4 or more was around 4 hours in dexmedetomidine and around 1hour in lidocaine group. The time to first call of naluphine with dexmedetomidine was significantly prolonged compared to lidocaine ([235.03±5.02 vs 55.87±6.28] min, 95% CI, 176.3-182) with significantly reduced total postoperative naluphine consumption in dexmedetomidine compared to lidocaine ([4.22±1.46 vs 7.96±2.8] mg, 95% CI,-4.9 to -2.6) . The duration of PACU stay was significantly prolonged in lidocaine compared to dexmedetomidine ([99.75±14.36 vs 114.28±10.56] min, 95% CI,-20.8 to -8.2). Conclusion Continuous Intraoperative intravenous infusion of dexmedetomidine was superior to lidocaine in opioid sparing analgesia during intracranial surgeries in children.

Effects of Continuous Infusion of Lidocaine under Ultrasound-Guided Cervical Sympathetic Ganglion Catheterization on Cerebral Hemodynamics and Thermal Imaging Characteristics of Head and Neck in Patients with Angioneurotic Headache.

Angioneurotic headache is a common headache type in clinical treatment. At present, patients with nervous headache are mainly treated with oral western medicine in clinic, but it is usually difficult to obtain the ideal effect. In this study, we analyzed the effects of continuous lidocaine infusion through an ultrasound-guided cervical sympathetic ganglia (SG) catheter on cerebral hemodynamics and thermal imaging characteristics of head and neck in patients with angioneurotic headache and explored the clinical feasibility of this scheme. The results show that continuous infusion of lidocaine under ultrasound-guided SG catheterization can alleviate headache in patients with angioneurotic headache, which may be related to improving cerebral hemodynamics.

New strategies for multimodal analgesia in patients with high-risk geriatric cancer in perioperative period.

12046 Background: Perioperative pain (POP) in high-risk geriatric patients with cancer (HRGCP) is an important issue. The purpose of this study was to optimize perioperative analgesia in HRGCP. Methods: This randomized study of the quality and effectiveness of perioperative analgesics included 115 HRGCP aged 64-88 years who underwent surgeries on the organs of the chest, abdomen and pelvis for various cancers. The patients were divided into 2 groups. Group 1 (n = 52): patient-controlled analgesia with morphine and nonsteroidal anti-inflammatory drugs (NSAIDs); group 2 (n = 63): ultrasound-guided bilateral transversus abdominis plane (TAP) block with ropivacaine. Intraoperative and perioperative analgesia was maintained with a continuous infusion of lidocaine, magnesium sulphate, microdoses of fentanyl and NSAIDs. Results and pain syndrome were assessed by monitoring the Efficacy Safety Score (ESS), personal and reactive anxiety, stress response (cortisol, insulin, lactate, glucose), rates of functional activity recovery, the need for opioid analgesics, frequency of postoperative nausea and vomiting (PONV). Results: Patients in group 2 showed a significant decrease in the perioperative need for opioid analgesics and significantly decreased POP. Analysis of variance of mean values revealed statistically lower scores of ESS, visual analogue scale and POP (p < 0.05) during the first 24 hours of perioperative period in group 2 compared with group 1. Patient-controlled analgesia showed analgesic effect in 88.5% (p < 0.05) cases. However, the effect was less pronounced, compared to multimodal analgesia, and did not reduce cognitive disorders. In group 2, opioid-sparing analgesic effect was 95.3% (p < 0.05). Multimodal analgesia reduced the stress response (p < 0.05) in perioperative period and did not cause cognitive dysfunction while reducing PONV episodes, unlike morphine. Despite the minimal doses of narcotic analgesics in group 2, multimodal analgesia provided safe analgesia and functional activity recovery in perioperative period with minimum negative effects of opioids. Conclusions: The strategy of multimodal analgesia based on a combination of intraoperative TAP block and infusions of lidocaine and microdoses of fentanyl can significantly improve the quality of analgesia in perioperative period.

Perioperative opioid-sparing multimodal analgesia (OSMMA) in cancer patients.

e17552 Background: Perioperative (PO) pain management is one of the most important issues in cancer treatment. The purpose of the study was to improve the quality of PO analgesia in cancer patients. Methods: A prospective randomized study of the quality and efficacy of various analgesics included 104 patients aged 34 to 77 years who underwent surgical interventions for ovarian cancer. The patients were divided into 2 groups. Group 1 (n = 49): patient-controlled analgesia with trimeperidine and nonsteroidal anti-inflammatory drugs (NSAIDs); group 2 (n = 55): preemptive analgesia based on a continuous infusion of lidocaine, magnesium sulphate, microdoses of fentanyl (4 µg/h) and NSAIDs. Results and pain syndrome were assessed by the visual analogue scale (VAS), personal and reactive anxiety, levels of glucose, cortisol, insulin, lactate, and the Kerdo index. Results: Analgesic effect of trimeperidine was obtained in 85.7% (p < 0.05). However, the effect was less pronounced, compared to OSMMA, and did not reduce the cognitive component of pain after surgical treatment. In group 2, opioid-sparing analgesic effect was 96.4% (p < 0.05). OSMMA limited the increase of cortisol, glucose, insulin, CRP and lactate (p < 0.05) providing effective PO pain relief. OSMMA did not cause residual sedation, anxiety, depressive effects and cognitive impairments, which showed its advantages over trimeperidine. Therefore, despite the minimal doses of narcotic analgesics in group 2, OSMMA improved the quality of pain relief and the well-being of patients in perioperative period being a significant advantage in minimizing the negative effects of opioids. Conclusions: Lidocaine-based PO analgesia with microdoses of fentanyl can significantly limit endocrine and metabolic changes and improve the quality of pain relief contributing to the early rehabilitation of cancer patients.

Comparison of Mean Consumption of Postoperative Analgesia with Intravenous Lidocaine Versus Normal Saline in patients Undergoing Laparoscopic Surgery

Aim: To compare the mean postoperative opioid consumption in patients with and without perioperative intravenous lidocaine undergoing laparoscopic surgery Methodology: The study, which took place at Idrees Teaching Hospital in Sialkot and was approved by the Ethical Committee, lasted six months. A random sample of 100 laparoscopic procedures was used in this study. That was all we required. The patients were separated into two groups according to their lot number. To begin, patients in group A received a 1.5mg/kg bolus of lidocaine, which was then followed by a continuous infusion of lidocaine at a rate of 2mg/kg/hr until the procedure was completed. All treatments were conducted in 60 minutes by a single surgical team. The intake of opioids persisted for 24 hours. Results: The total number of patients in this trial was 49.3410.30. Male patients constituted 20% of the total population, with females accounting for the remaining 80%.In the lidocaine group, the mean dose was 81.8017.01mg, while the mean dose in the saline group was 89.3517.74mg. There was a significant difference in opioid use between the lidocaine and control groups (p-value=0.032). Conclusion: According to the findings of the study, lidocaine reduces overall opioid use following surgery. Keywords: Postoperative Opioids, Analgesia, and Pain Management

Continuous infusion of lidocaine in pediatric colonoscopy: A randomized double-blind placebo-controlled study.

Background:Propofol is commonly used for providing procedural sedation during pediatric colonoscopy. Intravenous (i.v.) lidocaine can mitigate visceral pain and reduce propofol requirements during surgery. The aim of this study is to investigate the effect of i.v. lidocaine on perioperative propofol and sufentanil dose, pulse oxygen saturation, postoperative pain score, and recovery time during pediatric colonoscopy.Methods:We designed a randomized, double-blind, placebo-controlled study and enrolled 40 children aged from 3 to 10 years who underwent colonoscopy. After titration of propofol to achieve unconsciousness, the patients were given i.v. lidocaine (1.5 mg/kg later 2 mg/kg/ hour) or the same volume of saline. Sedation was standardized and combined propofol with sufentanil. The primary outcome variables were intraoperative propofol and sufentanil requirements, and the number of oxygen desaturation episodes. Secondary outcome variables were recovery time after colonoscopy and post-colonoscopy pain.Results:Lidocaine infusion resulted in a significant reduction in propofol requirements: (median (quartile) 1.8 (1.5-2.0) vs. 3.0 (2.8-3.3) mg/kg respectively; P < 0.001) and sufentanil requirements: (median (quartile) 0.06 (0.05-0.08) vs. 0.1 (0.1-0.1) μg/kg respectively; P < 0.001). The number of subjects who experienced oxygen desaturation below 95% in the lidocaine group was also significantly less than that in the control group: 1 vs. 6 (P = 0.04). The mean (SD) recovery time was significantly shorter in the lidocaine group: (19.2 (2.6) vs. 13.3 (2.6) min respectively; P < 0.001). There was no significant difference in post-colonoscopy pain.Conclusion:Continuous infusion of lidocaine resulted in reduction of propofol and sufentanil requirements, recovery time, and risk of hypoxemia during pediatric colonoscopy.

Comparison of continuous intravenous lidocaine versus transversus abdominis plane block for kidney transplant surgery: a randomized, non-inferiority trial

Background and objectivesTransversus abdominis plane (TAP) blocks are associated with an improvement in postoperative analgesia following kidney transplant surgery. However, these blocks carry inherent risk and require a degree of...

Lidocaine Infusions for Pain Management in Pediatrics.

Lidocaine is an amino amide with a well-established role as a local anesthetic agent. Systemic intravenous administration expands its clinical use to include acute and chronic pain circumstances, such as postoperative pain, neuropathic pain, postherpetic neuralgia, hyperalgesia, visceral pain, and centrally mediated pain. For refractory pain that has not responded to conventional therapy or if further escalation of treatment is prevented by contraindications or side effects to standard therapies, a continuous infusion of lidocaine may be considered as a single intervention or as a sequence of infusions. Here, we review and evaluate published data reflecting the use of lidocaine continuous infusions for pain management in the pediatric population.

Comparison of the Effect of Epidural Bolus and Continuous Infusion of Lidocaine %1 on Pain, the Progress of Vaginal Delivery and Motor Function in Labor Epidural Analgesia

Background: The pain of childbirth is the most severe pain that a woman experiences. This study aimed to compare the effect of epidural bolus and epidural continuous infusion of lidocaine %1 on pain and progress of vaginal delivery and motor function in labor epidural analgesia.&#x0D; Methods: This randomized clinical trial was conducted on 50 pregnant women aged between 18-45 years. They were randomly assigned into two groups of bolus injections of lidocaine1% and continuous infusion using an epidural approach. The evaluated variables included systolic and diastolic blood pressures, mean arterial pressure, pain score, heart rate, satisfaction rate, nausea, vomiting, itching, the progress of delivery, and the level of motor and sensory block. The collected data were analyzed in SPSS software (Version 21). P-value less than 0.05 was considered statistically significant.&#x0D; Results: Two groups were similar in age. There were no significant differences between two groups in terms of mean diastolic blood pressure, incidence of hypotension and C/S rate (P&gt; 0.005). Mean arterial pressure, sedation score and neonatal Apgar scores in the first and fifth minutes in the continuous group were significantly lower than the bolus group. Pain score (VAS) in the bolus group) 2.55±1.04 (was significantly lower than infusion group (5.22±2.50). The length of the first and second stages of labor in the bolus group (42.28 and 34.12) was less than continuous infusion (47.04 and 47.00) (P&lt; 0.005).&#x0D; Conclusion: In women undergoing epidural analgesia, epidural bolus injection of lidocaine 1% is associated with greater analgesia and satisfaction than continuous infusion.

Continuous Infusion of Ketamine and Lidocaine Either with or without Maropitant as an Adjuvant Agent for Analgesia in Female Dogs Undergoing Mastectomy

Maropitant, an antagonist of neurokinin-1 (NK-1) receptors, blocks the pharmacological action of substance P on the central and peripheral nervous systems. The objective of this study was to compare the antinociceptive and cardiorespiratory effects of the continuous intraoperative infusion of maropitant with ketamine and lidocaine in female dogs undergoing unilateral radical mastectomy. Twenty-four female dogs were used and were divided randomly into two groups (n = 12). The GLK group received ketamine bolus (1.0 mg/kg), lidocaine bolus (1.5 mg/kg), and continuous infusion of ketamine and lidocaine (10 mcg/kg/min and 50 mcg/kg/min), respectively; the GLKM group received the same anesthetic protocol combined with maropitant bolus (1.5 mg/kg/IV) and continuous infusion of maropitant (100 mcg/kg/h). Continuous infusion was initiated at the start of surgery and was maintained until 1 hour postoperatively. Pain was evaluated in the postoperative period using four scales and a digital analgesimeter. Data were analysed using analysis of variance, Student's t-test, Mann–Whitney test, and Friedman's test (P < 0.05). Kaplan–Meier curves were compared using the log-rank test. The results indicated lower pain scores, better survival curves with a lower number of patients requiring rescue analgesia, and lower peripheral sensitization, in the GLKM group than in the GLK group. It was concluded that the coadministration of maropitant with ketamine and lidocaine had an adjuvant effect with minimal cardiorespiratory effects and effective analgesia, improving pain management and patient comfort.

Ultrasound guided paravertebral block versus intravenous lidocaine infusion for management of post-thoracotomy pain

ABSTRACT Background To compare the analgesic effects of thoracic paravertebral block versus lidocaine infusion for management of post-thoracotomy pain. Methods 60 patients who were scheduled for thoracotomy were randomly divided into two equal groups: IV group received 1.5 mg/kg of 1% lidocaine over 10 min then infusion of 1.5 mg/kg/h, and thoracic paravertebral group (PVB) received 10 ml lidocaine 1% over 30 s then infusion of 1.5 mg/kg/h through catheter was inserted under ultrasound guidance. Hemodynamic and respiratory variables, frequency and duration of postoperative mechanical ventilation, duration of ICU stay, time till start of respiratory exercise and till chest tube removal, analgesia was assessed using 100-point visual analogue scale and defined as VAS <30 mm at rest, and in case of inadequate analgesia, IV morphine 2 mg bolus was given. Frequencies of complications and postoperative hospital stay were also recorded. Results 17 patients of both groups were maintained on MV for mean duration of 1.5 ± 0.5 days. PVB group was successfully weaned from MV and extubated after significantly shorter duration. Mean duration of ICU stay, time till start of respiratory exercise, and till removal of chest tube were significantly shorter in PVB group. All patients requested analgesia, but the frequency of consumption and mean number of requests were significantly higher in IV group. VAS scores determined at 1, 2, 12, 36 and cumulative 48 hours were significantly lower in PVB group compared to IV group. Conclusion Ultrasound guidance allowed safe paravertebral space catheterization. PVB using continuous lidocaine infusion provided adequate analgesia for post-thoracotomy pain with significant reduction of rescue analgesia, shorter time till respiratory exercises start, minimal complications and shorter hospital stay.

Lidocaine administered at a continuous rate infusion does not impair left ventricular systolic and diastolic function of healthy rabbits sedated with midazolam

Lidocaine is a versatile drug that not only provides local anesthesia, but also reduces anesthetic requirements of other agents and has antiarrhythmic, pro-kinetic, anti-inflammatory, antiendotoxemic and antioxidant effects. As it is a drug commonly used in critically ill patients, its safety from the cardiovascular system should be ensured. The aim of this study was to determine the effects of a continuous rate infusion (CRI) of lidocaine on left ventricular systolic and diastolic function of healthy rabbits sedated with midazolam by use of transthoracic echocardiography.Ten New Zealand healthy rabbits were sedated with intramuscular midazolam (1 mg/kg) and enrolled in two experimental treatments (control or lidocaine). The control treatment (CT) comprised an intravenous bolus of 0.9% sodium chloride (0.05 mL/kg) followed by CRI at 5 mL/h, whereas the lidocaine treatment (LT) comprised a bolus of 2% lidocaine without epinephrine at 1 mg/kg followed by CRI at 50 µg/kg/minute. Echocardiographic and hemodynamic variables were studied. Variables were recorded at baseline (TB) and 20, 40 and 60 minutes following start of CRI (T20, T40 and T60, respectively). No differences were found between treatments. The results of this study demonstrate that a continuous rate infusion of lidocaine at 50 µg/kg/minute does not impair echocardiographic indices of left ventricular systolic and diastolic function of healthy rabbits sedated with midazolam.

Continuous paravertebral block by intraoperative direct access versus systemic analgesia for postthoracotomy pain relief

BackgroundSystemic analgesia with paracetamol and nonsteroidal anti-inflammatory drugs plus opioids as a rescue medication had reported to be better than that depend mainly on opioids for postoperative pain relief. Thoracic paravertebral block reported to provide a comparable postthoracotomy pain relief to epidural analgesia, with fewer side effects due to its unilateral effect. Thoracic paravertebral catheter can be inserted intraoperatively under direct vision during thoracic surgery (Sabanathan’s technique). This prospective randomized study was designed to evaluate the safety and efficacy of this technique with continuous infusion of lidocaine compared to systemic analgesia for postthoracotomy pain relief.ResultsSixty-three patients were randomized to receive a continuous infusion of lidocaine in the paravertebral catheter for 3 postoperative days (thoracic paravertebral group, n = 32) or systemic analgesia (systemic analgesia group, n = 31). All patients underwent standard posterolateral thoracotomy. There were no significant differences between both groups in age, sex, side, type, and duration of operation. Pain scores measured on visual analogue scale and morphine consumption were significantly lower in thoracic paravertebral group in all postoperative days. Spirometric pulmonary functions were not reaching the preoperative values in the third postoperative day in both groups, but restorations of pulmonary functions were superior in paravertebral group. No complications could be attributed to the paravertebral catheter. Side effects, mainly nausea and vomiting followed by urinary retention, were significantly more in systemic analgesia group (P = 0.03). Also, pulmonary complications were more in systemic analgesia group but not reaching statistical significance (P = 0.14).ConclusionContinuous paravertebral block by direct access to the paravertebral space using a catheter inserted by the surgeon is a simple technique, with low risk of complications, provides effective pain relief with fewer side effects, and reduces the early loss of postoperative pulmonary functions when compared to systemic analgesia.

Effect of two-week continuous epidural administration of 2% lidocaine on mechanical allodynia induced by spinal nerve ligation in rats.

BackgroundLidocaine is an effective against certain types of neuropathic pain. This study aimed to investigate whether timing of initiating continuous epidural infusion of lidocaine affected the glial activation and development of neuropathic pain induced by L5/6 spinal nerve ligation (SNL) in rats.MethodsFollowing L5/6 SNL, rats were epidurally infused 2% lidocaine (drug infusion initiated on days 1, and 7 post SNL model establishment) or saline (saline infusion initiated on day 1 post SNL model establishment) continuously for 14 days. Mechanical allodynia of the hind paw to von Frey filament stimuli was determined prior to surgery, postoperative day 3, and once weekly after SNL model establishment. At 7 days after the infusion of saline or lidocaine ended, spinal activation of proinflammatory cytokines and astrocytes was evaluated immunohistochemically, using antibodies to interleukin-6 (IL-6) and glial fibrillary acidic protein (GFAP).ResultsContinuous epidural administration of 2% lidocaine for 14 days increased the mechanical withdrawal threshold regardless of the difference in timing of initiating lidocaine administration. Epidurally infusing 2% lidocaine inhibited nerve ligation-induced IL-6 and GFAP activation. In the 2% lidocaine infusion group, rats maintained the increased mechanical withdrawal threshold even at 7 days after the discontinuation of 2% lidocaine infusion. ConclusionsContinuous epidural administration of 2% lidocaine inhibited the development of SNL-induced mechanical allodynia and suppressed IL-6 and GFAP activation regardless of the difference in timing of initiating lidocaine administration.