Intravenous Lidocaine Infusion Research Articles

The role of intravenous lidocaine infusion in enhanced recovery after laparoscopic renal surgeries: A randomized control trial

The role of intravenous lidocaine infusion in enhanced recovery after laparoscopic renal surgeries: A randomized control trial

Perioperative intravenous lidocaine infusion improves postoperative analgesia after hysterectomy: A systematic review and meta-analysis of randomized controlled trials.

The effectiveness of intravenous lidocaine in reducing acute pain after hysterectomy remains uncertain. We conducted a meta-analysis of randomized controlled trials (RCTs) to investigate the impact of intravenous lidocaine on post-hysterectomy recovery. This study was completed based on the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. A systematic search was conducted in PubMed/MEDLINE, the Cochrane Controlled Trials Register (CENTRAL), and Embase up to July 27, 2023. We identified randomized controlled trials (RCTs) involving hysterectomy patients comparing lidocaine to a placebo. Outcome measures included postoperative pain scores at rest and during movement, opioid consumption, postoperative nausea and vomiting (PONV), improvements in functional gastrointestinal recovery, and Quality of Recovery (QoR) scores. Nine RCTs were included in the meta-analysis, comprising 352 patients who received intravenous lidocaine and 354 controls. The analysis revealed that intravenous lidocaine significantly reduced postoperative pain scores at rest at 2, 6, 8, and 24 hours following hysterectomy, as well as postoperative opioid consumption within 24 hours and PONV rates. Furthermore, no observed benefit was noted in shortening the time to first flatus with intravenous lidocaine administration post-hysterectomy. Intravenous lidocaine administration effectively reduces acute postoperative pain, opioid consumption, and PONV rates following hysterectomy. Lidocaine serves as an opioid-sparing agent, reducing the morphine equivalent dose while maintaining a similar degree of postoperative pain.

Perioperative intravenous lidocaine infusion improves postoperative analgesia after hysterectomy: A systematic review and meta-analysis of randomized controlled trials.

The effectiveness of intravenous lidocaine in reducing acute pain after hysterectomy remains uncertain. We conducted a meta-analysis of randomized controlled trials (RCTs) to investigate the impact of intravenous lidocaine on post-hysterectomy recovery. This study was completed based on the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. A systematic search was conducted in PubMed/MEDLINE, the Cochrane Controlled Trials Register (CENTRAL), and Embase up to July 27, 2023. We identified randomized controlled trials (RCTs) involving hysterectomy patients comparing lidocaine to a placebo. Outcome measures included postoperative pain scores at rest and during movement, opioid consumption, postoperative nausea and vomiting (PONV), improvements in functional gastrointestinal recovery, and Quality of Recovery (QoR) scores. Nine RCTs were included in the meta-analysis, comprising 352 patients who received intravenous lidocaine and 354 controls. The analysis revealed that intravenous lidocaine significantly reduced postoperative pain scores at rest at 2, 6, 8, and 24 hours following hysterectomy, as well as postoperative opioid consumption within 24 hours and PONV rates. Furthermore, no observed benefit was noted in shortening the time to first flatus with intravenous lidocaine administration post-hysterectomy. Intravenous lidocaine administration effectively reduces acute postoperative pain, opioid consumption, and PONV rates following hysterectomy. Lidocaine serves as an opioid-sparing agent, reducing the morphine equivalent dose while maintaining a similar degree of postoperative pain.

Effects of intravenous lidocaine on postoperative pain and gastrointestinal function recovery following gastrointestinal surgery: a meta-analysis.

The full extent of intravenous lidocaine's effectiveness in alleviating postoperative pain and enhancing gastrointestinal function recovery remains uncertain. We conducted an exhaustive search of databases to identify randomized controlled trials that compared intravenous lidocaine infusion's efficacy to that of a placebo or routine care in patients undergoing gastrointestinal surgery. The primary outcome measure was resting pain scores 24 h postoperatively. We utilized a random-effects model based on the intention-to-treat principle for the overall results. This study included twenty-four trials with 1533 patients. Intravenous lidocaine significantly reduced resting pain scores 24 h after gastrointestinal surgery (twenty trials, SMD -0.67, 95% CI -1.09 to -0.24, P=0.002, I2 = 90%). This finding was consistent in subgroup analyses and sensitivity analyses. The benefit was also observed at other resting and moving time points (1, 2, 4, and 12 h) postoperatively. Intravenous lidocaine significantly decreased opioid consumption within 24 h after surgery (eleven trials, SMD: -1.19; 95% CI: -1.99 to -0.39; P=0.003). Intravenous lidocaine also shortened the time to bowel sound (MD: -8.51; 95% CI: -14.59 to -2.44; P=0.006), time to first flatus (MD: -6.00; 95% CI: -9.87 to -2.13; P=0.002), and time to first defecation (MD: -9.77; 95% CI: -17.19 to -2.36; P=0.01). Perioperative intravenous lidocaine can alleviate acute pain and expedite gastrointestinal function recovery in patients undergoing gastrointestinal surgery. However, the results should be interpreted with caution due to substantial heterogeneity. Further large-scale studies are necessary to validate these findings.

Prevention of persistent pain with lidocaine infusions in breast cancer surgery (PLAN): study protocol for a multicenter randomized controlled trial

BackgroundPersistent pain is a common yet debilitating complication after breast cancer surgery. Given the pervasive effects of this pain disorder on the patient and healthcare system, post-mastectomy pain syndrome (PMPS) is becoming a larger population health problem, especially as the prognosis and survivorship of breast cancer increases. Interventions that prevent persistent pain after breast surgery are needed to improve the quality of life of breast cancer survivors. An intraoperative intravenous lidocaine infusion has emerged as a potential intervention to decrease the incidence of PMPS. We aim to determine the definitive effects of this intervention in patients undergoing breast cancer surgery.MethodsPLAN will be a multicenter, parallel-group, blinded, 1:1 randomized, placebo-controlled trial of 1,602 patients undergoing breast cancer surgery. Adult patients scheduled for a lumpectomy or mastectomy will be randomized to receive an intravenous 2% lidocaine bolus of 1.5 mg/kg with induction of anesthesia, followed by a 2.0 mg/kg/h infusion until the end of surgery, or placebo solution (normal saline) at the same volume. The primary outcome will be the incidence of persistent pain at 3 months. Secondary outcomes include the incidence of pain and opioid consumption at 1 h, 1–3 days, and 12 months after surgery, as well as emotional, physical, and functional parameters, and cost-effectiveness.DiscussionThis trial aims to provide definitive evidence on an intervention that could potentially prevent persistent pain after breast cancer surgery. If this trial is successful, lidocaine infusion would be integrated as standard of care in breast cancer management. This inexpensive, widely available, and easily administered intervention has the potential to reduce pain and suffering in an already afflicted patient population, decrease the substantial costs of chronic pain management, potentially decrease opioid use, and improve the quality of life in patients.Trial registrationThis trial has been registered on clinicaltrials.gov (NCT04874038, Dr. James Khan. Date of registration: May 5, 2021).

Effects of intravenous single-bolus lidocaine infusion versus intravenous single-bolus magnesium sulfate infusion on postoperative pain, emotional status, and quality of life in patients undergoing spine fusion surgery: a randomized study.

We assessed the efficiency of intravenous adjuvants in decreasing opioid intake and pain scores after spine fusion surgery. This study included 120 patients aged 18-60 listed for spine fusion surgery under general anesthesia. Patients were randomly assigned to four groups: Group (Lidocaine): received IV lidocaine 4 mg/kg in 50 mL volume over 30 min. Group (Magnesium): received IV magnesium sulfate 30mg/kg in 50 mL volume over 30 min. Group (combined Lidocaine and Magnesium): received IV lidocaine 4 mg/kg in 50 mL volume over 30 min.+IV magnesium sulfate 30mg/kg in 50 mL volume over 30 min. Group (Control): received IV saline 50 mL. The time to the first request analgesia, the postoperative pain score, total analgesic use, patient satisfaction, anxiety, depression, mental state, quality of life, and side effects were measured. The combined group had more extended time for the first analgesic request and fewer rescue analgesia doses than the other groups. NRS scores at rest or movement were statistically significantly lower in the lidocaine group and the combined group compared to the control group (P1, P3<0.05) at almost all times. This combination reduces anxiety and depression and improves overall health up to three months after a single infusion. The combined group had higher patient satisfaction. A synergistic effect of a combination of lidocaine and magnesium sulfate on perioperative pain was found. It reduces analgesic consumption, depression, and anxiety and improves overall health up to three months after a single infusion dose.

Вплив періопераційної внутрішньовенної інфузії лідокаїну на якість післяопераційного відновлення після різних видів оперативних втручань у дітей

Introduction. Early postoperative recovery in pediatric practice is an important problem for patients and the health care system as a whole. Aim: to investigate the quality of postoperative recovery of children after various types of surgical interventions. Materials and methods. The study involved 150 children who underwent trauma (group I), abdominal (group II) and urological (group III) surgical interventions. Each of these groups was divided into two subgroups: Іb (n=17), ІІb (n=19) and ІІІb (n=24) subgroups - included children who received intravenous lidocaine in the perioperative period, control Ia (n=23), IIa (n=29) and IIIa (n=38) subgroups - included children to whom lidocaine was not prescribed. The PaedQoR-15 questionnaire was used to assess the quality of postoperative recovery. Results. The use of perioperative intravenous lidocaine infusion is associated with an increase, compared to the control group, in the PaedQoR-15 score by 10.6% at 24 hours after trauma surgical interventions, by 21.3% and by 17% after abdominal and urological surgical interventions due to a decrease in the frequency of postoperative nausea after abdominal surgery, skin itching after all analyzed types of surgical treatment, a reduction 26.7% reduction in the time until the first gas release and by 19.3% reduction in the time until the appearance of bowel movements/defecation after abdominal surgery. It was observed that the stay of patients in the intensive care unit (ICU) was reduced by 120 minutes after trauma surgery and by 1.8 times after abdominal surgery. Conclusions. Perioperative lidocaine infusion may be useful in rapid postoperative rehabilitation programs. The research was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of parents and children was obtained for conducting the studies. No conflict of interests was declared by the authors.

Effect of ultrasound-guided bilateral superficial cervical plexus block versus perioperative intravenous lidocaine infusion on postoperative quality of recovery in patients undergoing thyroidectomy: A randomised double-blind comparative trial.

Recent studies have found that ultrasound-guided (USG) bilateral superficial cervical plexus block (BSCPB) and intravenous infusion of lidocaine (IVL) have the potential to improve the quality of postoperative recovery. This study aimed to investigate and compare their effects on postoperative quality of recovery in patients undergoing thyroidectomy. A total of 135 patients were randomised to Group N: BSCPB with 10 mL 0.75% ropivacaine on each side, Group L: intravenous lidocaine (1.5 mg/kg for 10 min, followed by 1.5 mg/kg/h) and Group C: intravenous saline combined with BSCPB saline. The primary objective was quality of recovery-40 (QoR-40). Other parameters compared were numeric rating pain scale (NRS) score, haemodynamic data, opioid dosage and incidence of adverse effects. Statistical analysis was performed using the one-way analysis of variance (ANOVA), the Kruskal-Wallis test and the Chi-square test. Compared to Group C, both groups N and L had higher QoR-40 total scores as well as scores indicating physical comfort, emotional state and pain dimensions on postoperative day (POD) 1 and POD2 (P < 0.001). The QoR-40 total and pain dimension scores in Group N were higher on POD1 and POD2 (P < 0.05). The NRS scores and the change in haemodynamics were lower in Group N compared to groups L and C (P < 0.05). The results of other parameters were lower in groups N and L than in Group C (P < 0.05). USG BSCPB and IVL are comparable in improving the quality of postoperative recovery in patients undergoing thyroidectomy.

Effects of Intravenous Lidocaine as an Analgesic Adjuvant in Oncological Pain

Objectives: To verify that intravenous lidocaine is effective as an adjuvant analgesic in pain for hospitalized cancer patients at the National Institute of Cancerology, Mexico. Methods: Clinical records of patients hospitalized at the National Institute of Cancerology who received intravenous lidocaine infusion as an adjuvant to pain during the 4-year period from November 1, 2019, to October 31, 2023, were reviewed. Patients who met inclusion and exclusion criteria were included. A statistically significant measure was defined as a decrease equal to or greater than 4 points in the NRS value after lidocaine administration.&#x0D; Results: A total of 179 patients were included; 46.4% were men, and 53.6% were women. The most common painful syndrome was somatic (54%). Patients with neuropathic pain received a higher lidocaine dose (mg/kg/hr) of 1.9 ± 0.79. Regarding adverse effects, 1.7% of patients experienced them. It was established that a reduction of 4 points with respect to the previous value on the numeric rating scale (NRS) would be considered statistically significant. A statistically significant association was found between patients under 38 years old and a higher risk of not achieving the objective (p 0.05, CI 0.95–1 OR 0.9). Patients who received lidocaine infusions for less than 4.63 days also had a risk of not reaching the goal (p 0.02, CI 0.7–0.9, OR 0.8).&#x0D; Conclusions: This study demonstrated that the analgesic adjuvant use of intravenous lidocaine infusion is an effective and well-tolerated analgesic intervention for oncology patients.&#x0D; Keywords: lidocaine, Neuropathic Pain, Somatic Pain, Visceral Pain, numeric rating scale.

Intravenous infusion of lidocaine as a component of opioid-free anesthesia in thoracic surgery: prospective randomized single-center observational study

BACKGROUND: The possibility of reducing doses of narcotic analgesics during the perioperative period is widely discussed in modern scientific literature. This direction is called opioid-free anesthesia and is used in abdominal surgery, oncology, gynecology, and other areas. Publications on the use of opioid-free anesthesia in thoracic surgery are scarce.&#x0D; OBJECTIVE: To evaluate the analgesic effectiveness of intravenous lidocaine infusion as a component of anesthesia in thoracic surgery.&#x0D; MATERIALS AND METHODS: Ninety patients who underwent open lobectomy or pneumonectomy were examined. Depending on the analgesic component, patients were divided into three groups: group 1 (n=30) received intravenous infusion of lidocaine, group 2 (n=30) received epidural block, and group 3 (n=30) had fentanyl infusion. Blood pressure, heart rate, cortisol, and blood serum glycemia levels were measured. The intensity of postoperative pain syndrome and the need for promedol, tramadol, and sanitation fibrobronchoscopy were assessed. Arterial hypotension and frequency of postoperative nausea and vomiting were recorded. The length of stay of the patients in the intensive care unit and hospital was recorded.&#x0D; RESULTS: Cortisol levels did not differ between groups (p=0.26). The glucose level in the epidural block group was significantly lower than that in other groups (p=0.011). A significant increase in mean blood pressure and heart rate was observed in the opioid analgesia group (p 0.001). The lowest severity of pain 6 h after surgery was observed in the epidural blockade and lidocaine groups (p 0.001). Perioperative hypotension was more common in the epidural analgesia group (p=0.045). The incidence of postoperative nausea and vomiting was higher in the opioid anesthesia group (p=0.004). In the fentanyl infusion group, sanitary fibrobronchoscopy was more often required to eliminate atelectasis (p=0.039). The number of bed days spent in the ICU was significantly higher in the opioid analgesic group (p=0.002); however, no significant differences were noted between the groups regarding the number of days spent in the hospital (p=0.228).&#x0D; CONCLUSION: Opioid-free anesthesia based on intravenous lidocaine infusion, as a component of anesthetic management in thoracic surgery, provides sufficient perioperative stability of hemodynamic and neuroendocrine status, has a pronounced analgesic effect, with less opioid consumption on the first day after surgery, and helps reduce the length of stay in the intensive care unit and hospital.

Comparative study between the effect of dexmedetomidine and lidocaine infusion on intraoperative analgesic requirement and hemodynamics during craniotomy

Background: Nowadays, anesthesiologists are evaluating several analgesic adjuncts to minimize opioid use during craniotomy. Some studies have evaluated the analgesic-sparing effect of intravenous infusion of dexmedetomidine and lidocaine on intraoperative hemodynamics and post-operative analgesia. There is a paucity of studies focussing on the intraoperative analgesic requirement. Aims and Objectives: The present study compared dexmedetomidine and lidocaine infusion primarily for their effects on intraoperative fentanyl requirements during craniotomy. Materials and Methods: This study was done on 70 patients aged 18–80 years, the American Society of Anesthesiologists physical status I–II, having Glasgow Coma Scale 15, undergoing craniotomies. Patients were randomly allocated to receive either dexmedetomidine (group A, n=35) at a dose of 0.6 mcg/kg bolus over 10 min followed by 0.6 mcg/kg/h infusion or lidocaine (group B, n=35) at a dose of 1.5 mg/kg bolus over 10 min, followed by 1.5 mg/kg/h infusion till the end of skin suture, respectively. Study drugs were started 10 min before the start of surgery. Intraoperative total fentanyl and propofol consumption, intraoperative hemodynamics, recovery from hypnosis, and time to extubation were recorded. Results: The use of dexmedetomidine resulted in considerably less total fentanyl requirement (245.1 vs. 300.7 mcg, P&lt;0.0001) and total propofol requirement (172.7 vs. 236.7 mg, P&lt;0.0001) compared with lidocaine. Comparatively better hemodynamics were observed with the use of dexmedetomidine at all the points of observation. Conclusion: Dexmedetomidine as an analgesic adjunct can be a better alternative to lidocaine in terms of reduced fentanyl consumption, reduced propofol use and favorable hemodynamics, and early recovery from anesthesia.

Analgesic and hemodynamic effects of intravenous magnesium sulfate infusion versus lidocaine infusion in patients undergoing thyroid surgery for toxic goiter resection: a randomized controlled study

Background Anesthesia for toxic goiter resection is challenging as manipulation of the thyroid gland and inadequate postoperative pain control could lead to hemodynamic instability due to stress and a neurohormonal response. Both magnesium sulfate and lidocaine are known for their analgesic effects and decreasing stress response. Herein, we compared the previous two medications regarding intraoperative hemodynamics and postoperative analgesia. Patients and methods 57 patients who underwent toxic goiter resection were enrolled in this prospective randomized trial (group M received magnesium sulfate, group L received lidocaine, and group C received normal saline). Intraoperative hemodynamics and postoperative analgesic profiles were assessed. Results Both injection groups expressed significantly lower pain scores compared with control group at Post anaesthesia care unit (PACU) and one-hour postoperative. Postoperative fentanyl consumption was significantly lower, and the time to first analgesic request was significantly prolonged in Magnesium and Lidocaine groups than in the control group. The previous beneficial effects were more prominent in the Magnesium Group compared with the Lidocaine Group. There was no significant difference in mean arterial pressure (MAP) and heart rate (HR) among the three study groups at the baseline, after the end of infusion, and after induction. Nonetheless, there was a significant rise in mean arterial pressure and heart rate values in the control group compared with the Magnesium and Lidocaine Groups with intubation and during the first hour of surgery. Conclusion Both magnesium sulfate and lidocaine have beneficial hemodynamic stabilizing and analgesic effects in patients undergoing thyroid surgery for toxic goiter, with a slight superiority for magnesium.

Management of Rib Fractures in the Combat Environment.

Rib fractures in combat casualties are an under-appreciated injury, and their treatment may become more common as more patients survive because of modern body armor and point-ofinjury care. The combat environment has challenges such as equipment availability and sterility. A simple and thoughtful rib fracture treatment algorithm may be useful to reduce the morbidity and mortality of rib fractures in the combat environment. Intravenous lidocaine infusions for patients with traumatic rib fractures may have important combat applications. We propose an algorithm for the management of combat casualties with traumatic rib fractures.

Comparative evaluation of the perioperative anesthesia methods for cancer patients undergoing pancreaticoduodenectomy

BACKGROUND: Pancreatoduodenal resections are one of the most traumatic and technically complex interventions in abdominal surgery. The correct anesthetic management and pain relief allow to substantially reduce the risk of perioperative complications, which remains high even in high-volume oncology centers with extensive experience. Finding new components and methods of anesthesia combined with evaluation of their effectiveness and safety remains a pressing issue.&#x0D; AIM: To evaluate the efficacy and safety of using intravenous lidocaine infusion as a component of anesthesia and postoperative analgesia in cancer patients during pancreatoduodenal resection.&#x0D; MATERIALS AND METHODS: We analyzed the course of anesthesia, operation and postoperative period of 43 patients (mean age 63.2±7.1 years) undergoing pancreaticoduodenectomy. For the purposes of the study, patients were randomly divided into 2 groups, based on anesthesia method: for the first group (n=19) we used epidural analgesia as a component of perioperative anesthesia, for the second group (n=24) we used prolonged intravenous infusion of lidocaine at an average dose of 1 mg/(kg×h). We analyzed the severity of pain syndrome according to Numeric rating scale for pain in postoperative period, as well as opioid requirement, the time of gastrointestinal function recovery, and post-operative complications frequency. In order to prevent systemic toxicity, drug monitoring was carried out — the determination of the plasma concentration of lidocaine.&#x0D; RESULTS: Perioperative opioid requirement was comparable between groups, with no statistically significant differences observed. The degree of pain syndrome according to the Numeric rating scale for pain did not differ statistically, except for the number of points during activation on day 3: 4.00 (95% confidence interval 3.49–4.51) for epidural analgesia group, compared to 3.12 (95% confidence interval 2.64–3.61) for lidocaine infusion group, p=0.014. There was also a statistically significant increase in infusion volume for epidural analgesia group compared to lidocaine infusion group [8.83 ml/(kg×h) (Q1=7.90; Q3=10.06) and 7.33 ml/(kg×h) (Q1=6.28–Q3=8.49) respectively, p=0.034], as well as a greater need for intraoperative vasopressor support among the patients [15 (78.9%) and 10 (43.5%) respectively, p=0.029]. In the lidocaine group, the time to onset of peristalsis was significantly shorter than in the epidural analgesia group [median 48.0 h (Q1=48.00; Q3=72.00) compared to median 60.0 h (Q1=36.00; Q3=64.50) respectively, p=0.042]. The frequency of postoperative complications did not differ between the groups.&#x0D; CONCLUSION: Based on a comparative analysis of the study results, it can be concluded that prolonged intravenous infusion of lidocaine, as a component of perioperative anesthetic protection during pancreatoduodenal resections, is safe and comparable in terms of analgesic efficacy to epidural blockade.

Patient Expectations and Therapeutic Alliance Affect Pain Reduction Following Lidocaine Infusion in an Interdisciplinary Chronic Pain Clinic

Pain experience is affected by both ascending nociceptive signals and descending modulation. Expectations can affect pain experience and augment treatment-induced analgesia through descending inhibitory modulation of pain. This open-label, prospective cohort study examined the association between participant expectation ratings and pain reduction in adult participants with chronic pain receiving an intravenous lidocaine infusion. We aimed to explore whether: 1) participants’ expectations of treatment efficacy were associated with pain reduction over 8 weeks after infusion; and 2) participants’ therapeutic alliance was associated with expectations and/or pain reduction. We recruited 70 participants with chronic pain scheduled for lidocaine infusion. Study measures included pain intensity (pre-treatment, post-treatment, and daily for 8 weeks), treatment expectations (EXPECT), and therapeutic alliance (Trust in Physician and Working Alliance Inventory-Short Revised). Baseline treatment expectations were significantly correlated with pain reduction (r = .42, P < .01). Therapeutic alliance was significantly correlated with expectations (r = .27, P < .05) and pain reduction (r = .38, P < .01). This study quantifies the contribution of: 1) treatment expectations; and 2) therapeutic alliance to the magnitude of lidocaine-induced pain reduction. Results generate the hypothesis that focused efforts to augment treatment expectations and therapeutic alliance could serve to improve pain treatment outcomes. PerspectiveThis study evaluates the relationship between pain reduction and ratings of: 1) treatment expectations; and 2) therapeutic alliance following an intravenous lidocaine infusion. Results generate the hypothesis that focused efforts to augment treatment expectations and therapeutic alliance could serve to improve pain treatment outcomes.

Intraoperative intravenous infusion of lidocaine increases total and small vessel densities of sublingual microcirculation: a randomized prospective pilot study

Objective Multiple organ failure can occur as a result of postoperative complications. Research has indicated that the underlying mechanism of organ dysfunction is a microcirculation disorder. Because of its antioxidant and anti-inflammatory properties, lidocaine has the potential to improve microvascular blood flow. This study was performed to assess the effect of intraoperative intravenous lidocaine infusion on the microcirculation and determine the incidence of postoperative complications. Methods In this prospective randomized double-blind pilot study, 12 patients scheduled for abdominal surgery were randomly allocated to receive an intraoperative infusion of either 1% lidocaine or the same volume of 0.9% sodium chloride solution. The microcirculation was monitored using sidestream dark-field imaging and the vascular occlusion test combined with near-infrared spectroscopy. Results Lidocaine significantly increased the total vascular density and small vessel density after 2 hours of infusion, with preservation of 99% to 100% of the capillary perfusion in both groups. No patients developed organ failure. Conclusions An increase in vessel density may be beneficial in major abdominal surgeries because it is associated with better tissue perfusion and oxygen delivery. However, this finding requires further investigation in patients with increased surgical risk. Overall, this study indicates that lidocaine has potential to improve microvascular perfusion. Research Registry number: 9549 ( https://www.researchregistry.com/browse-the-registry#home/registrationdetails/650ffd27b3f547002bd7635f/ )

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.

Therapeutic efficacy of intravenous lidocaine infusion compared with thoracic epidural analgesia in major abdominal surgery: a noninferiority randomised clinical trial

BackgroundOpen major abdominal surgery is one of the most risky surgical procedures for acute postoperative pain. Thoracic epidural analgesia (TEA) has been considered the standard analgesic approach. In different reports, lidocaine i.v. has been shown to have an analgesic efficacy comparable with TEA. We compared the analgesic efficacy of i.v. lidocaine with thoracic epidural analgesia using bupivacaine in patients undergoing major abdominal surgery. MethodsIn this noninferiority clinical trial, 210 patients were randomised to thoracic epidural bupivacaine with morphine or i.v. lidocaine. Dynamic pain at 24 h after surgery was measured using a numerical pain rating scale (NPR), and morphine consumption was also measured. A difference in i.v. the lidocaine-epidural bupivacaine NPR of ≤1 for dynamic pain was considered a noninferiority margin. ResultsThe NPR for dynamic pain in the lidocaine group at 24 h was between 5.7 (1.8) and 5.2 (1.9) in the epidural group, with a difference of 0.53 (95% confidence interval 0.0–1.0). In the first 24 h, the average difference in morphine consumption was 1.8 mg between the i.v. lidocaine and epidural groups (95% confidence interval 1–3 mg). No differences were found in adverse events or complications associated with the procedures. ConclusionsIntravenous lidocaine is noninferior to thoracic epidural analgesia for acute postoperative pain control in major abdomial surgery at 24 h postoperatively. Clinical trials registrationNCT04017013.

MULTIMODAL LOW-OPIOID GENERAL ANESTHESIA FOR ELECTIVE CAESAREAN SECTION

Introduction: The frequency of general anaesthesia during caesarean section is up to 15 %. The main disadvantages of general anaesthesia during caesarean section are: a high percentage of consciousness during surgery and a pronounced hemodynamic reaction to surgical trauma. The most dangerous part of this surgical intervention is the period before the birth of a child.&#x0D; Purpose: To compare the "routine" technique of total intravenous anaesthesia with artificial lung ventilation for elective caesarean section and multimodal low-opioid general anaesthesia.&#x0D; Materials and methods: Our study is based on an examination of 60 patients. All patients were divided into 2 groups. The first group is a "routine" method of general anaesthesia, the second group is multimodal low-opioid general anaesthesia. Intravenous forms of medical drugs were used as adjuvants: paracetamol (1000 mg), clonidine (100 μg), 30 minutes before surgery and intravenous infusion of lidocaine (after the childbirth). Perioperative monitoring and treatment were based on the recommendations of the Enhanced Recovery After Caesarean Section and the American Association of Anaesthesiologists, the bispectral index and determination of the stress-induced substances (glucose, cortisol) blood levels were added. The newborns were evaluated with the Apgar scale and umbilical venous blood gas analysis was carried out. In the postoperative period, the intensity of pain, the time of patient activation and transfer from the intensive care unit were evaluated. The two-sided Student's t-test was used for statistical data processing (p value = 0.001; t &gt; ± 3,466).&#x0D; Results: The obtained data showed the presence of statistically significant differences between the two groups: mean blood pressure (t = 18.25); heart rate (t = 9.2); bispectral index (t = 5.9); assessment of newborns with the Apgar scale at 1 minute (t = - 4.2); parameters of umbilical venous blood gas analysis (t = - 6,5); glucose (t = 14.5); cortisol (t = 26,2); patient activation time (t = 8.12); the time of transferring from the intensive care unit (t = 8.67); pain assessment on a numerical rating scale (t = 13.4); using of opioids intraoperatively (t = 9.9); using of intravenous anaesthetics (t = 5.25); using of opioids after surgery (t = 8.78). Better indicators were determined in the multimodal low-opioid general anaesthesia group.&#x0D; Conclusions: Based on the obtained results, the multimodal low-opioid general anaesthesia has reasonable (statistically significant) advantages over the "routine" technique of total intravenous anaesthesia with artificial lung ventilation for elective caesarean section.

Effect of Intra Operative Intravenous Lidocaine Infusion on Control of Pain and Recovery of Intestinal Function Following Surgical Appendectomy

Abstract Background Intravenous lidocaine infusion has been shown to facilitate postoperative recovery after major abdominal surgery. This current randomized controlled study will assess the effect of intraoperative intravenous lidocaine infusion on pain intensity, bowel function and cytokine response after surgical appendectomy. Aim of the Work To determine the role of intraoperative lidocaine infusion in reducing perioperative pain and analgesia requirement and enhancing the recovery of intestinal function in patients undergoing surgical Appendectomy. Patients and Methods The current prospective randomized double-blinded study was conducted at the surgery department, Faculty of Medicine, Ain Shams University and it included 40 patients who were undergone urgent open appendectomy and met the selection criteria. They were classified into 2 groups: Group L: patient who received IV bolus injection of lidocaine (1.5 mg/kg slowly over 10 min) 30 minutes before the skin incisions followed by a continuous IV infusion at the rate of 2 mg/kg/h via infusion pump(B-BRAUN), Group S (control): patient who received 0.9% normal saline in equal volume and in the same manner. Results There was statistically significant difference between the studied groups regarding time to pass flatus. Patients within lidocaine group pass flatus significantly earlier than those with control group. There is statistically non-significant difference between the studied groups regarding postoperative complications. Conclusion From the current study, it was concluded that perioperative IV lidocaine injection had significant effect in reduction of postoperative pain and increased the main pain free period also noticed IV lidocaine decreased opioid requirement and time to pass flatus so shorten hospital stay. Perioperative IV lidocaine had no effect on postoperative complications and IV lidocaine during incision and extubation attenuated hemodynamic response.