Intraoperative Lidocaine Infusion Research Articles

Pregabalin and intravenous lidocaine for management of postoperative pain and surgical stress response in elective laparotomies: A double blind randomised controlled trial

Introduction: Postoperative pain remains a significant problem in patients undergoing abdominal surgeries, and has a profound effect on patient recovery. High-dose opioids hamper bowel motility and increase nausea and vomiting. Intravenous lidocaine has been used as part of a multimodal analgesia protocol for providing effective pain relief and attenuating surgery-associated inflammatory response. Preoperative pregabalin also has a beneficial effect in reducing pain. This study was carried out to assess the efficacy of combining these drugs in reducing pain, paralytic ileus, and stress response. Method: Patients undergoing elective laparotomy were randomized into two groups. Group A patients received preoperative placebo and intraoperative lidocaine infusion. Group B patients received preoperative pregabalin and lidocaine. The pain was assessed using a visual analog scale at 2, 6, 18, and 24 hours postoperatively. Morphine consumption on a patient-controlled analgesia pump was also noted. Surgical stress response was assessed by measuring perioperative total leucocyte count, interleukin-6, and C-reactive protein. Result: Postoperative pain scores at 6, 18, and 24 hours were significantly lower in Group B patients who had received pregabalin. These patients also had lower morphine consumption and earlier bowel recovery as measured by the first passage of stools. Perioperative inflammatory markers were similar in both groups. Conclusion: Preoperative pregabalin when used with intravenous lidocaine has a synergistic effect on reducing postoperative pain and opioid consumption. This also has a beneficial effect on the return of bowel function.

Retrospective assessment of the relationship between intraoperative nociception and postoperative analgesia requirements in dogs undergoing thoracic surgery.

The analgesia management of thoracic surgery can be challenging and debate exists regarding the efficacy of pre-emptive analgesia and its relationship with postoperative pain. The aim of this study was to assess the relationship between intraoperative nociception and postoperative pain in dogs undergoing thoracic surgery. If proven, effective prevention of intraoperative nociception could imply prospective lower postoperative analgesia requirements. The study was retrospective and observational. Clinical records from dogs undergoing thoracic surgery (2015-2019) were reviewed and cases were allocated to one of two groups: NOCI-FREE - dogs with no evidence of intraoperative nociception; NOCI - dogs that required intraoperative rescue analgesia to address a nociceptive response. Pre-anaesthetic medication, locoregional analgesia, intraoperative infusions and rescue analgesia were used. Additionally, postoperative pain scores and analgesia plans were registered and compared between groups. Our study failed to identify a difference in the postoperative pain scores and analgesia requirements between dogs having signs of intraoperative nociception and those without. Additionally, the use of postoperative analgesic preventive infusions and rescue analgesia was similar for both NOCI and NOCI-FREE. Being on an intraoperative infusion of opioids, dexmedetomidine or lidocaine was identified as a protective factor for nociception [OR=11; (4.15-29.7)]. In the population studied, it appears that dogs showing signs of nociception intraoperatively do not necessarily show higher pain scores nor do they need additionally pain relief in the postoperative period.

The effect of intraoperative lidocaine infusion on postoperative opioid consumption in adolescents undergoing posterior spinal instrumentation and fusion for idiopathic scoliosis

The effect of intraoperative lidocaine infusion on postoperative opioid consumption in adolescents undergoing posterior spinal instrumentation and fusion for idiopathic scoliosis

Efficacy of intravenous lidocaine infusions for pain relief in children undergoing laparoscopic appendectomy: a randomized controlled trial

Intravenous lidocaine, a potent local anesthetic with analgesic and anti-inflammatory properties, has been shown to be an effective adjunct that reduces intra- and postoperative opioid consumption and facilitates pain management in adults. While it shows promise for use in the pediatric population, limited evidence is available.ObjectivesTo determine if general anesthesia with intraoperative intravenous lidocaine infusion versus general anesthesia without intravenous lidocaine infusion in children undergoing laparoscopic appendectomy decreased opioid requirements intra- and postoperatively.DesignA single-center parallel single-masked randomized controlled study. A computer-generated blocked randomization list was used to allocate participants. The study was conducted between March 2019 and January 2020. Setting: Pediatric teaching hospital in Poland.ParticipantsSeventy-four patients aged between 18 months and 18 years undergoing laparoscopic appendectomy. Seventy-one patients fulfilled the study requirements.InterventionIntravenous lidocaine bolus of 1.5 mg/kg over 5 min before induction of anesthesia followed by lidocaine infusion at 1.5 mg/kg/h intraoperatively. The infusion was discontinued before the patients’ transfer to the postanesthesia care unit (PACU).Primary outcome measureThe primary outcome measure was total nalbuphine requirement in milligrams during the first 24 h after surgery.Secondary outcome measuresThe secondary outcome measures were intraoperative fentanyl consumption, intraoperative sevoflurane consumption, time to the first rescue analgesic request, incidence of postoperative nausea and vomiting during the first 24 h after surgery, frequency of side effects of lidocaine.ResultsChildren (n = 74) aged 5–17 randomly allocated to receive intraoperative lidocaine infusion (n = 37) or no intervention (n = 37). Seventy-one were included in the analysis (35 in the study group and 36 in the control group). There was no difference in the cumulative dose of nalbuphine in the first 24 h after removal of the endotracheal tube between groups [median of 0.1061 (IQR: 0.0962–0.2222) mg/kg in the lidocaine group, compared to the control group median of 0.1325 (IQR: 0.0899–0.22020) mg/kg, p = 0.63].Intraoperative fentanyl consumption was lower in the lidocaine group [median of 5.091 (IQR: 4.848–5.714) μg/kg] than in the control group [median of 5.969 (IQR: 5.000–6.748), p = 0.03].Taking into account the additional doses administered based on clinical indications, the reduction in the requirement for fentanyl in the lidocaine group was even greater [median of 0.0 (IQR: 0.0–0.952) vs 0.99 (IQR: 0.0–1.809) μg/kg, p = 0.01].No difference was observed in the sevoflurane consumption between the two groups [median of 32.5 ml (IQR 25.0–43.0) in the lidocaine group vs median of 35.0 ml (IQR: 23.5–46.0) in the control group, p = 0.56].The time to first analgesic request in the lidocaine group was prolonged [median of 55 (IQR: 40–110) min in the lidocaine group vs median of 40.5 (IQR: 28–65) min in the control group, p = 0.05].There was no difference in the frequency of PONV between the two groups (48.57% in the lidocaine group vs 61.11% in the control group, p = 0.29).No lidocaine related incidence of anaphylaxis, systemic toxicity, circulatory disturbances or neurological impairment was reported, during anesthesia or postoperative period.ConclusionsIntraoperative systemic lidocaine administration reduced the intraoperative requirement for opioids in children undergoing laparoscopic appendectomy. This effect was time limited, and hence did not affect opioid consumption in the first 24 h following discontinuation of lidocaine infusion.Trial registrationNCT03886896.

The effect of erector spinae plane block on perioperative analgesic consumption and complications in dogs undergoing hemilaminectomy surgery: a retrospective cohort study

ObjectiveTo compare the perioperative use of analgesics and complication rates in dogs administered an erector spinae plane (ESP) block or a traditional opioid-based (OP) treatment as part of analgesic management during hemilaminectomy. Study designRetrospective cohort study. AnimalsMedical records of 114 client-owned dogs. MethodsGeneral data included demographics, duration of procedure, number of laminae fenestrated, perioperative use of steroid and non-steroidal anti-inflammatory drugs. Intra- and postoperative analgesics used in 48 hours and complications rates were compared between groups. Opioid use was expressed in morphine equivalents [ME (mg kg−1)]. Continuous data were compared using the Mann–Whitney U test and incidence of events with a Fisher's exact tests. Multiple linear regression was used to evaluate association between perioperative ME consumption (dependent variable) with other independent variables. Data are presented as median (range). Differences were considered significant when p < 0.05. ResultsGroup ESP comprised 42 dogs and group OP 72 dogs. No differences were observed in the general data. Intraoperative ME was 0.65 (0.20–3.74) and 0.79 (0.19–5.60) mg kg−1 in groups ESP and OP, respectively (p = 0.03). Intraoperative infusion of lidocaine was administered intravenously (IV) to 23.8% and 68% of groups ESP and OP, respectively (p < 0.0001). Intraoperative infusion of ketamine was administered IV to 21% and 40% of groups ESP and OP, respectively (p = 0.04). Regression analysis revealed the ESP block as the only independent variable affecting the perioperative ME consumption. Pharmacological intervention to treat cardiovascular complications was administered to 21.4% and 47.2% of dogs in groups ESP and OP, respectively (p = 0.008). There were no differences in postoperative complication rates. Conclusions and clinical relevanceESP block was associated with reduced perioperative opioid consumption, intraoperative adjuvant analgesic use and incidence of pharmacological interventions to treat cardiovascular complications in dogs undergoing hemilaminectomy.

Intraoperative infusion of lidocaine 2% reduces postoperative fentanyl requirements for pain control in renal transplantation surgery

BackgroundIntravenous lidocaine has been shown to be an analgesic and anti-inflammatory medication with modulation of excessive inflammatory response.We investigated the efficacy of intraoperative lidocaine 2% infusion in reducing the postoperative Fentanyl requirements for analgesia in renal transplant recipients. Patients were assigned equally into two groups by computer-generated list compiled before the start of the study. Control group: fentanyl (F) group and study group: lidocaine 2% (L) group. Medication used is either lidocaine in the dose of 2 mg/kg/h and the other syringe contained saline both have been infused by rate of 10 ml/h. Fentanyl induction dose given for the two groups was 1.5 mcg/kg. Both groups have received extra fentanyl according to their intraoperative analgesic requirements, patients in the lidocaine group received the fentanyl induction dose accompanied by lidocaine 2% 1.5 mg/kg as loading dose, followed by maintenance dose of lidocaine 2% infusion 2 mg/kg/h. After transfer to the PACU nursing staff administered fentanyl 0.5 mcg/kg boluses for postoperative pain relief every 10 min up to 2 mcg/kg, the recovery nurse used the pain numerical score to assess pain. The recovery nurse referred the patient to the responsible anesthesiologist covering the recovery unit if he required more than 2 mcg/kg of fentanyl to control postoperative pain. Patient was then transferred to the RTU (renal transplant unit), postoperative pain and fentanyl PCA consumption were followed up during the first 24 h.ResultsOur study detected increased fentanyl consumption in the recovery for the fentanyl group more than the lidocaine group. The request of the first dose of analgesic was significantly longer in lidocaine group than in fentanyl group.ConclusionThe usage of intraoperative lidocaine infusion decreased postoperative fentanyl requirements as analgesic in patients undergoing renal transplantation.Trial registrationRegistration on ANZCTR number ACTRN12618001335280, REGISTERED 08 August 2018.

The effect of intraoperative lidocaine infusion on opioid consumption and pain after totally extraperitoneal laparoscopic inguinal hernioplasty: a randomized controlled trial

BackgroundAs a component of multimodal analgesia, the administration of systemic lidocaine is a well-known technique. We aimed to evaluate the efficacy of lidocaine infusion on postoperative pain-related outcomes in patients undergoing totally extraperitoneal (TEP) laparoscopies inguinal hernioplasty.MethodsIn this randomized controlled double-blind study, we recruited 64 patients to receive either lidocaine 2% (intravenous bolus 1.5 mg. kg − 1 followed by an infusion of 2 mg. kg− 1. h− 1), or an equal volume of normal saline. The infusion was initiated just before the induction of anesthesia and discontinued after tracheal extubation. The primary outcome of the study was postoperative morphine equivalent consumption up to 24 h after surgery. Secondary outcomes included postoperative pain scores, nausea/vomiting (PONV), sedation, quality of recovery (scores based on QoR-40 questionnaire), patient satisfaction, and the incidence of chronic pain.ResultsThe median (IQR) cumulative postoperative morphine equivalent consumption in the first 24 h was 0 (0–1) mg in the lidocaine group and 4 [1–8] mg in the saline group (p < 0.001). Postoperative pain intensity at rest and during movement at various time points in the first 24 h were significantly lower in the lidocaine group compared with the saline group (p < 0.05). Fewer patients reported PONV in the lidocaine group than in the saline group (p < 0.05). Median QoR scores at 24 h after surgery were significantly better in the lidocaine group (194 (194–196) than saline group 184 (183–186) (p < 0.001). Patients receiving lidocaine were more satisfied with postoperative analgesia than those receiving saline (p = 0.02). No difference was detected in terms of postoperative sedation and chronic pain after surgery.ConclusionsIntraoperative lidocaine infusion for laparoscopic TEP inguinal hernioplasty reduces opioid consumption, pain intensity, PONV and improves the quality of recovery and patient satisfaction.Trial registrationClinicalTrials.gov- NCT02601651. Date of registration: November 10, 2015.

Association between intraoperative intravenous lidocaine infusion and survival in patients undergoing pancreatectomy for pancreatic cancer: a retrospective study

BackgroundIntravenous lidocaine has been shown to reduce opioid consumption and is associated with favourable outcomes after surgery. In this study, we explored whether intraoperative lidocaine reduces intraoperative opioid use and length of stay (LOS) and improves long-term survival after pancreatic cancer surgery. MethodsThis retrospective study included 2239 patients who underwent pancreatectomy from January 2014 to December 2017. The patients were divided into non-lidocaine and lidocaine (bolus injection of 1.5 mg kg−1 at the induction of anaesthesia followed by a continuous infusion of 2 mg kg−1 h−1 intraoperatively) groups. The overall use of postoperative rescue analgesia and LOS were recorded. Propensity score matching was used to minimise bias, and disease-free survival and overall survival were compared between the two groups. ResultsAfter propensity score matching, patient characteristics were not significantly different between groups. Intraoperative sufentanil consumption and use of postoperative rescue analgesia in the lidocaine group were significantly lower than those in the non-lidocaine group. The LOS was similar between groups. There was no significant difference in disease-free survival between groups (hazard ratio [HR]=0.913; 95% confidence interval [CI], 0.821–1.612; P=0.316). The overall survival rates at 1 and 3 yr were significantly higher in the lidocaine group than in the non-lidocaine group (68.0% vs 62.6%, P<0.001; 34.1% vs 27.2%, P=0.011). The multivariable analysis indicated that intraoperative lidocaine infusion was associated with a prolonged overall survival (HR=0.616; 95% CI, 0.290–0.783; P=0.013). ConclusionIntraoperative intravenous lidocaine infusion was associated with improved overall survival in patients undergoing pancreatectomy.

Intraoperative lidocaine infusion and 24-hour postoperative opioid consumption in obese patients undergoing laparoscopic bariatric surgery.

Bariatric surgery is the most effective long-term treatment for obesity. Opioid-sparing anesthesia and multimodal analgesia such as lidocaine infusion have been recommended in these patients to reduce opioid-related complications. However, evidence supporting its use for bariatric surgery population is limited. To investigate whether intraoperative lidocaine infusion is associated with decreasing opioid consumption in laparoscopic bariatric surgery. A university hospital, California, USA. In this retrospective cohort study, outcomes among consecutive obese patients undergoing laparoscopic bariatric surgery between January 2016 to December 2018 were evaluated to determine the impact of adjunctive intraoperative lidocaine infusion on 24-hour postoperative opioid consumption. Secondary outcomes, including opioid consumption during hospitalization, length of stay, and postoperative complications were determined. Post hoc analyses were performed exploring possible dose effects and drug-drug interactions. Univariable and multivariable analyses were performed to identify factors associated with opioid consumption. Among 345 patients, 54 (15.7%) received intraoperative lidocaine infusion (L+) whereas 291 (84.3%) did not receive intraoperative lidocaine infusion (L-). Both L+ and L- groups shared similar demographic characteristics. The 24-hour postoperative opioid consumption was 17.6% lower in L+ (95% confidence interval -28.4 to -5.2, P = .007), but nonsignificantly lower in themultivariate model (12.8%, 95% confidence interval -24.4 to .5, P = .06). Opioid consumption during hospitalization, length of stay, and other clinically significant outcomes did not differ. However,subgroup analysis restricted to opioid-naïve patients indicated significantly reduced opioid consumption in the L+ group. Post hoc analysis suggested interaction between lidocaine and ketaminein decreasing 24-hour postoperative opioid consumption. Intraoperative lidocaine infusion was not significantly associated with decreasing 24-hour postoperative opioid consumption in obese patients undergoing laparoscopic bariatric surgery.

Intraoperative lidocaine infusion reduces analgesic and anesthetic requirements in patients with high body mass index undergoing laparoscopic cholecystectomy

Background: Intravenous (IV) lidocaine has analgesic, antihyperalgesic, and anti-inflammatory properties. Intraoperative use of lidocaine infusion reduces the analgesic and anesthetic requirement during laparoscopic cholecystectomy surgeries.Aims: Our study was designed to analyze the effect of intraoperative infusion of lidocaine, on perioperative opioid, anesthetic and neuromuscular agent requirements, and the incidence of side effects in patients with high body mass index undergoing laparoscopy cholecystectomy.Methods: This is a randomized double-blinded prospective study conducted at a tertiary hospital. Of the 38 patients enrolled in the study, due to cancellation and conversion to open surgery, only 33 patients completed the study (16 in the control group [C] and 17 in the lidocaine group [L]). Patients from both the groups received the test drug (lidocaine or normal saline) as 2 mg/kg bolus during induction and continued as an infusion at a rate of 2 mg/kg/h throughout the surgery which was terminated 30 min after extubation. The patients were analyzed for perioperative analgesic, anesthetic, muscle relaxant requirement, and adverse effects.Results: The mean visual analog scale (VAS) score in 1st and 2nd hour after surgery was less in the group receiving IV lidocaine infusion (7.5 ± 7.8* vs. 10.5 ± 11.8; 12.5 ± 8.1* vs. 23 ± 24.6 [* denotes lidocaine group]); compared to the control group the intraoperative opioid requirement decreased by 43% in the lidocaine group. There was a reduction of 13%–21% in the minimum alveolar concentration of isoflurane in the lidocaine group. The cumulative dose of rocuronium was found to be 53% lesser in the lidocaine group. There was no difference in the sedation scores and there were no adverse effects in either of the groups.Conclusions: The study demonstrates the usefulness of IV lidocaine infusion as an adjunct to provide anesthesia with decreased requirements of opioid, inhalation, and neuromuscular-blocking agents.

The effect of intraoperative lidocaine versus esmolol infusion on postoperative analgesia in laparoscopic cholecystectomy: a randomized clinical trial

BackgroundAs a part of multimodal analgesia for laparoscopic cholecystectomy, both intraoperative lidocaine and esmolol facilitate postoperative analgesia. Our objective was to compare these two emerging strategies that challenge the use of intraoperative opioids. We aimed to assess if intraoperative esmolol infusion is not inferior to lidocaine infusion for opioid consumption after laparoscopic cholecystectomy.MethodsIn this prospective, randomized, double-blind, non-inferiority clinical trial, 90 female patients scheduled for elective laparoscopic cholecystectomy received either intravenous (IV) lidocaine bolus 1.5 mg/kg at induction followed by an infusion (1.5 mg/ kg/h) or IV bolus of esmolol 0.5 mg/kg at induction followed by an infusion (5–15 μg/kg/min) till the end of surgery. Remaining aspect of anesthesia followed a standard protocol apart from no intraoperative opioid supplementation. Postoperatively, patients received either morphine or tramadol IV to maintain visual analogue scale (VAS) scores ≤3. The primary outcome was opioid consumption (in morphine equivalents) during the first 24 postoperative hours. Pain and sedation scores, time to first perception of pain and void, and occurrence of nausea/vomiting were secondary outcomes measured up to 24 h postoperatively.ResultsTwo patients in each group were excluded from the analysis. The postoperative median (IQR) morphine equivalent consumption in patients receiving esmolol was 1 (0–1.5) mg compared to 1.5 (1–2) mg in lidocaine group (p = 0.27). The median pain scores at various time points were similar between the two groups (p > 0.05). More patients receiving lidocaine were sedated in the post-anesthesia care unit (PACU) than those receiving esmolol (p < 0.05); however, no difference was detected later.ConclusionInfusion of esmolol is not inferior to lidocaine in terms of opioid requirement and pain severity in the first 24 h after surgery. Patients receiving lidocaine were more sedated during their stay in PACU than those receiving esmolol.Trial registrationClinicalTrials.gov- NCT02327923. Date of registration: December 31, 2014.

Attenuation of Pneumoperitoneum-Induced Hypertension by Intraoperative Lidocaine Infusion in Laparoscopic Cholecystectomy

Background: Laparoscopy has now become the standard technique and is considered gold standard for cholecystectomy but the intraoperative requirements of laparoscopic surgery produce significant physiological changes, which pose many challenges for the anesthesiologist. Objective: The aim of this work was to evaluate the effect of intraoperative IV lidocaine infusion for attenuation of pneumoperitoneum-induced hypertension. Patients and Methods: After approval of the Medical Ethical Committee at Al-Azhar University Hospitals, Department of Anesthesia, and after patient written consent, 90 patients of American Society of Anesthesiologists (ASA) physical status I or II, scheduled for laparoscopic cholecystectomy were enrolled in this randomized, controlled, prospective, double-blind, clinical trial study. Results: Regarding the intraoperative and postoperative hemodynamics, in the present study it was observed that patients who received intravenous lidocaine (1.5 mg/kg bolus before skin incision and abdominal inflation followed by 1 mg/kg/h or 2 mg/kg/h and stopped immediately after abdominal deflation) were associated with a reduction in intraoperative BP and HR without any associated hemodynamic instability in comparison to patients who did not received lidocaine with no statistically significant difference between the two doses of lidocaine. Conclusion: This study showed that the intraoperative infusion of lidocaine of two different doses in patients undergoing laparoscopic cholecystectomy was associated with attenuation of blood pressure, heart rate, decreases the intensity of postoperative pain, and early recovery of bowel function without causing significant adverse effects, with more satisfaction for both patients and surgeons.

Attenuation of Pneumoperitoneum-Induced Hypertension by Intraoperative Lidocaine Infusion in Laparoscopic Cholecystectomy

Background: Laparoscopy has now become the standard technique and is considered gold standard for cholecystectomy but the intraoperative requirements of laparoscopic surgery produce significant physiological changes, which pose many challenges for the anesthesiologist. Objective: The aim of this work was to evaluate the effect of intraoperative IV lidocaine infusion for attenuation of pneumoperitoneum-induced hypertension. Patients and Methods: After approval of the Medical Ethical Committee at Al-Azhar University Hospitals, Department of Anesthesia, and after patient written consent, 90 patients of American Society of Anesthesiologists (ASA) physical status I or II, scheduled for laparoscopic cholecystectomy were enrolled in this randomized, controlled, prospective, double-blind, clinical trial study. Results: Regarding the intraoperative and postoperative hemodynamics, in the present study it was observed that patients who received intravenous lidocaine (1.5 mg/kg bolus before skin incision and abdominal inflation followed by 1 mg/kg/h or 2 mg/kg/h and stopped immediately after abdominal deflation) were associated with a reduction in intraoperative BP and HR without any associated hemodynamic instability in comparison to patients who did not received lidocaine with no statistically significant difference between the two doses of lidocaine. Conclusion: This study showed that the intraoperative infusion of lidocaine of two different doses in patients undergoing laparoscopic cholecystectomy was associated with attenuation of blood pressure, heart rate, decreases the intensity of postoperative pain, and early recovery of bowel function without causing significant adverse effects, with more satisfaction for both patients and surgeons.

Perioperative Pregabalin and Intraoperative Lidocaine Infusion to Reduce Persistent Neuropathic Pain After Breast Cancer Surgery: A Multicenter, Factorial, Randomized, Controlled Pilot Trial

Persistent postsurgical pain is defined as pain localized to the area of surgery of a duration of ≥2 months and is, unfortunately, a common complication after breast cancer surgery. Although there is insufficient evidence to support any preventative strategy, prior literature suggests the possible efficacy of intravenous lidocaine and perioperative pregabalin in preventing persistent pain after surgery. To determine feasibility of conducting a larger definitive trial, we conducted a multicenter 2 × 2 factorial, randomized, placebo-controlled pilot trial of 100 female patients undergoing breast cancer surgery. Patients were randomized to receive an intraoperative lidocaine infusion (1.5 mg/kg bolus followed by 2 mg/kg/h) or placebo and perioperative pregabalin (300 mg preoperatively, 75 mg twice daily for 9 days) or placebo. All feasibility criteria were surpassed; recruitment of 100 patients was accomplished within 42 weeks, with a follow-up rate of 100% and study drug compliance of ≥80%. At 3 months, 53% of patients reported persistent neuropathic pain. Although there was no interaction between lidocaine and pregabalin, lidocaine decreased the development of persistent neuropathic pain (43.1% vs 63.3%; relative risk = .68; 95% confidence interval = .47–1.0). Pregabalin did not reduce persistent pain (60% vs 46%; relative risk = 1.3; 95% confidence interval = .90–1.90) and neither pregabalin nor lidocaine impacted acute postoperative pain, opioid consumption, pain interference, or quality of life. Our pilot trial successfully demonstrated feasibility and provided promising data for conducting further trials of intraoperative lidocaine infusions during breast cancer surgeries.Clinical trial number: NCT02240199 PerspectiveThis article reports the findings of a pilot randomized, controlled trial evaluating the effects of perioperative pregabalin and intraoperative lidocaine infusions in patients undergoing breast cancer surgery. This trial demonstrated the feasibility of conducting a larger trial and provided promising data that these interventions may decrease the development of persistent pain.

A Comparative Study to Evaluate the Efficacy of three Different Doses of Intraoperative Infusion of Intravenous Preservative Free Lidocaine in Patients Undergoing Laparoscopic Cholecystectomy

A Comparative Study to Evaluate the Efficacy of three Different Doses of Intraoperative Infusion of Intravenous Preservative Free Lidocaine in Patients Undergoing Laparoscopic Cholecystectomy

Effects of Continuous Intravenous Intraoperative Lidocaine Infusion on Opioids Consumption and Postoperative Recovery in Patients Undergoing Video-assisted Thoracoscopic Lobectomy

Objective To investigate whether continuous intravenous intraoperative lidocaine infusion can reduce the opioids dosage and improve postoperative recovery in patients undergoing video-assisted thoracoscopic(VATS) lobectomy. Methods Totally 60 patients undergoing VATS lobectomy were enrolled in this single-center randomized controlled study.The patients were equally randomized into lidocaine continuous pumping group(lidocaine group) and control group by computer-based random numbers.The patients had double-lumen catheter intubation,and total intravenous anesthesia was administrated intraoperatively.In the lidocaine group,patients continuously received intravenous pumping of lidocaine [2 mg/(kgdh) ] after a loading doses(1 mg/kg) until the end of the operation.We recorded the basic characteristics,preoperative examination,intraoperative medications,and postoperative recovery of both groups.Results The basic characteristics and preoperative examination findings were comparable between these two groups(all P>0.05).Compared with the control group,the intraoperative sufentanil consumption significantly decreased in the lidocaine group [(32.3±7.5) μg vs.(40.9±10.2) μg,P<0.001].Significantly more patients were given esmolol intraoperatively in the control group to lower heart rate(P=0.010).The incidence of postoperative nausea within 24 hours was significantly lower in the lidocaine group(P=0.045).There was no significant difference between the two groups in postoperative recovery(all P>0.05).Conclusion Intravenous continuous pumping of lidocaine during operation can reduce opioids consumption and lower the incidence of postoperative nausea without extra adverse or toxic reaction in patients undergoing VATS lobectomy.

The effect of intraoperative lidocaine infusion on perioperative opioid consumption for laparoscopic cholecystectomy

Objective The aim of this study was to determine the role of intraoperative lidocaine infusion in reducing perioperative pain and analgesia requirement in patients undergoing laparoscopic cholecystectomy. Background An alternative approach to pain relief in laparoscopic cholecystectomy is the use of intravenous (i.v.) lidocaine intraoperatively, which decreases perioperative analgesic requirement. Patients and methods This double-blinded randomized study was conducted on 60 patients of both sexes. Patients between 40 and 50 years of age, of American Society of Anesthesiologists I and II physical status, and scheduled for laparoscopic cholecystectomy were included in the study. Patients were randomly assigned using computerized software to one of the two groups, each containing 30 patients. Group L (the study group) was infused with lidocaine at a rate of 2 mg/kg/h, and group S (the control group) was infused with normal saline at a rate of 2 mg/kg/h. Anesthesia was induced with i.v. fentanyl 2 mg/kg and propofol 2–3 mg/kg. Patients received supplemental i.v. dose of morphine 0.1 mg/kg intraoperatively if needed. (Additional morphine intraoperatively was indicated when heart rate and mean arterial blood pressure increased more than 20% of preoperative heart rate and mean arterial blood pressure values.) The total amount of opioid used for patients intraoperatively and postoperatively was recorded. All patients were asked to quantify their pain on a visual analog scale immediately postoperatively and every 4 h until hospital discharge. Results In the current study, there was a significant difference as regards postoperative pain; it was significantly lower in the lidocaine group. Total analgesic dose required was significantly lower in the lidocaine group. Conclusion Perioperative i.v. lidocaine provides analgesia and low pain scores after laparoscopic cholecystectomy. The use of lidocaine intraoperatively decreases perioperative opioid consumption.

Intravenous lidocaine infusion during laparoscopic cholecystectomy: efficacyand safety in pain management

Systemic administration of lidocaine can improve perioperative analgesia for patients during laparoscopic cholecystectomy and reduce opiate-associated side effects. Aim of the study was to determine the efficacy and safety of intravenous infusion of lidocaine for pain relief during laparoscopic cholecystectomy. A prospective controlled study was conducted at the Department of Surgery, Anesthesiology and Intensive Care in Postgraduate Institute of Bogomolets National Medical University. The study enrolled 60 adult patients with acute and chronic cholecystitis, who was elected for laparoscopic cholecystectomy. Patients were randomised to 2 groups – Group L (lidocaine) and Group C (control). Intraoperative intravenous infusion of lidocaine during laparoscopic cholecystectomy, reduced average pain intensity at rest and during movement, the number of patients with moderate and severe pain, amount of analgesia “on demand”. The use of intraoperative lidocaine infusion allowed to significantly reduce the consumption of anesthetics and analgesics intraoperative and in early postoperative period, and accordingly reduce the incidence of opiate-associated adverse events, accelerate the recovery of bowel function after laparoscopic cholecystectomy and reduce the incidence of intraoperative hypertension.

The effect of intravenous lidocaine infusion on bispectral index during major abdominal surgery.

Intraoperative lidocaine infusion has become widely accepted as an adjunct to general anesthesia where its use has been associated with opioid-sparing and enhanced recovery. The aims of this study were to determine whether or not intravenous (IV) lidocaine infusion (a) has an anesthetic sparing effect during major colorectal procedures and (b) if it also affects level of hypnosis as measured by bispectral index (BIS). Twenty-five patients undergoing laparotomy for resection of colorectal tumours were randomized to receive either IV lidocaine (1.5mg kg-1 bolus then 1mg kg-1 per hour) or an equivalent volume of normal saline commenced after intravenous induction of general anesthesia. Anesthesia was maintained with volatile anesthetic agent combined with intermittent IV fentanyl titrated to hemodynamic stability. Minimum alveolar concentration (MAC) of volatile was calculated using an age-adjusted algorithm (corrected MAC). BIS values were recorded throughout; however, treating anesthesiologists were blinded to BIS values and hence they were not used to guide depth of anesthesia. No other regional anesthesia techniques were used. During the maintenance phase of anesthesia, corrected MAC of volatile agent was lower (1.0 versus 1.1, p = 0.003); whereas BIS values were higher (45 versus 39, p < 0.001) in patients who received lidocaine versus placebo. No differences in mean arterial pressure (80 versus 80mmHg, p = 0.796) or total fentanyl dose (538 versus 444 mcg, p = 0.24) were observed between the two groups. Heart rate was slightly higher in patients who received lidocaine versus placebo (67 versus 64bpm, p = 0.001). Lidocaine infusion resulted in mean plasma levels of 1.7 mcg ml-1 (1.3-2.0 mcg ml-1, 95% CI). Our results support an anesthetic sparing effect of lidocaine infusion indicated by lower MAC requirements. Higher BIS values in the lidocaine versus placebo group may indicate that levels of hypnosis were not equivalent. Alternatively, BIS may not be a sensitive indicator of synergistic interactions between local anesthetic and volatile agent. Our results advocate a cautious approach to titration of general anesthesia when combined with lidocaine infusion.

INTRAVENOUS LIDOCAINE INFUSION AS A PERSPECTIVE COMPONENT OF MULTIMODAL ANALGESIA, WHICH AFFECTS ON EARLY POSTOPERATIVE OUTCOME

The review represents the analysis of literature data on the effectiveness of intravenous lidocaine infusion as a component of multimodal analgesia. The data suggests that intraoperative lidocaine infusion at the rate of 1-1.5 mg /kg /h (if it’s possible - with the prolongation to the early postoperative period) is an advisable component of the multimodal analgesia. This technique can reduce the intraoperative doses of propofol, MAC of inhalation anesthetics, also reduces the postoperative need for analgesics and the frequency of postoperative nausea and vomiting. Furthermore, lidocaine infusion permits to shorten the time of resolution of postoperative ileus (approaching in this the effect of epidural analgesia) and, perhaps, to reduce the frequency and severity of postoperative cognitive dysfunction. The most effective use of this technique is in laparoscopic surgery on the abdominal and pelvic organs.