A randomised controlled trial of peri‐operative lidocaine infusions for open radical prostatectomy

Abstract

SummaryWe allocated 76 men scheduled for radical retropubic prostatectomy to peri‐operative lidocaine 2% or saline 0.9%: a pre‐operative 0.075 ml.kg−1 intravenous bolus; an intra‐operative intravenous infusion at 0.075 ml.kg−1.h−1; and 24 hours' postoperative subcutaneous infusion at 0.075 ml.kg−1.h−1. Lidocaine reduced the postoperative hospital stay by a mean (95% CI) of 1.3 (0.3–2.4) days, p = 0.017, from a mean (SD) of 4.6 (3.2) days with saline. Lidocaine reduced pain at rest during the first 24 postoperative hours by a mean (95% CI) of 1.8 (0.7–2.9) mm.h−1, p = 0.001. Lidocaine reduced 24‐h morphine consumption by a mean (95% CI) of 13.9 (2.2–25.7) mg, p = 0.021, from a mean (SD) of 52.3 (26.9) mg with saline. There were no differences in other outcomes.

The use of intravenous lidocaine for postoperative pain and recovery: international consensus statement on efficacy and safety

“…Studies using 1.5mg.kg -1 . h -1 : •Koppert et al [5]; ▲ Dewinter et al [65]; ⃝ Weinberg et al [69]; ■ Martin et al [79]; ▼ El-Tahan et al [83]; and ♦ Grigoras et al [84]. Studies using 2mg.kg -1 .h -1 : □ Kaba et al [31]; M Striebel et al [81]; ◇ Birch et al [82]; and ▽ Lee et al [85].…”

Efficacy of Perioperative Intravenous Lidocaine for Multimodal Analgesia

“…53.4 mg (p = 0.021). Finally, patients reported less pain during the first 24 hours after receiving a lidocaine infusion (p-0.001) [38]. In a previous study, patients who received intravenous lidocaine at 1 mg/kg/hr during surgery and 2 mg/kg/hr 24 hours post-operatively had improvement in walking capacity post-operatively compared to saline (p < 0.01) [39].…”

Peri‐operative lidocaine infusion for open radical prostatectomy – a reply

“…The original article [1] has been corrected as per Dr. Weinberg's letter in this edition of the journal. …”

“…Similarly, reference 14 is cited as having shown "intravenous lidocaine infusions can reduce pain and postoperative stay" but that study actually concluded "lidocaine infusion offered no beneficial effects" [2]. We thank Loadsman et al for their important questions about our paper [1]. Regarding the primary outcome, using non-parametric testing the median (IQR) length of stay was 3.1 (2.9-3.8) days after lidocaine vs. 3.9 (3.0-4.9) days after saline (p = 0.003).…”