Analgesic Efficacy of Intravenous Lidocaine Infusion in Cesarean Section under Spinal Anesthesia: A Prospective Randomized Double-Blind Study

Abstract

10.30699/jambs.27.123.23 Background & Objective: Nowadays, conventional analgesic agents that are usually used for pain killing after cesarean sections do not provide enough analgesia with infrequent serious side effects. Lidocaine has been suggested as an adjuvant analgesic agent for postoperative pain relief. We designed this randomized doubleblind, placebo-controlled study to evaluate the analgesic efficacy of intravenous lidocaine in patients undergoing a cesarean section under spinal anesthesia. Materials & Methods: Eighty patients undergoing elective cesarean section under spinal anesthesia were randomly divided into two groups to receive intravenous 1.5 mg/kg of lidocaine 2% bolus 15 minutes prior to spinal anesthesia followed by an intravenous infusion of 1.5 mg/kg/h for 60 minutes (L group) or 0.9% sodium chloride (C group) in a double-blind fashion. The time until the first request for an analgesic, the duration of sensory and motor blockade, hemodynamic variables and adverse events were recorded. Results: The difference in sensory (95% CI 10.18 to 18.01; P≤0.001) and motor (95% CI 35.50 to 50.19; P≤0.001) blockade durations between groups L and C were significant. Similarly, the mean time until the first analgesic request was longer in group L (175.37±21.43) than in group C (157.12±15.25); the difference between the two groups was significant (95% CI9.95 to 26.54; P<0.001). Conclusion: Intravenous lidocaine given as a supplementary agent in patients undergoing cesarean section under spinal anesthesia prolonged the duration of the sensory and motor blockade of spinal anesthesia and delayed the first analgesic request by patients without hemodynamic disturbance, respiratory depression and compromising the fetus.

Effects of preoperative melatonin on postoperative pain following cesarean section: A randomized clinical trial

“…In the present study, patients in the placebo group and the melatonin group received more opioid analgesia at a dose of 5 mg. Similarly, in the study of Khezri et al [ 34 ], patients receiving melatonin at a dose of 6 mg received more analgesia than patients receiving melatonin at a dose of 3 mg. On the other hand, studies have shown that the incidence of side effects of prescribed exogenous melatonin, even at high intravenous doses, is very rare [ 39 , 40 ]. A review reported long-term side effects of melatonin like dizziness, drowsiness and somnolence in patients undergoing general anesthesia surgery [ 41 ] and cognitive decline in elderly patients under general anesthesia in hip surgery [ 42 , 43 ].…”

“…In the study of Khezri et al [ 34 ], the incidence of complications was almost the same in the three groups, and only in the group receiving 6 mg melatonin, the incidence of headache was significantly higher than the other two groups. However, in the present study, no side effects were observed in patients receiving 10 mg melatonin at a dose of 10 mg, while in patients receiving placebo and 5 mg melatonin were presented with headache and nausea/vomiting.…”

“…The sedation was higher in melatonin group at 1 and 2 postoperative hours, respectively [ 33 ]. In a prospective randomized double-blind study by Khezri et al [ 34 ], 120 patients undergoing cesarean section received 3 mg, 6 mg or placebo, 20 min prior to spinal anesthesia. The study reported that the time at first dose of analgesia was required was not significantly different in the three groups following 24 h after the surgery, however, patients who revived 3 mg of melatonin required less analgesia compared to the other two groups.…”

<p>Safety and Efficacy of Oral Melatonin When Combined with Thoracic Epidural Analgesia in Patients with Bilateral Multiple Fracture Ribs</p>

“…There were no significant differences between the three groups in terms of side effects, either intraoperatively or postoperatively, including pruritus, nausea/vomiting, vertigo, dizziness, and respiratory depression. 24 Some researchers have reported that premedication by oral melatonin 3 or 5 mg can reduce the need for propofol for induction and not increase the post-anesthesia recovery stay period. 25 Limitations to our study include the small sample size involved.…”

Effect of intravenous lignocaine infusion on bispectral index during spinal anaesthesia for caesarean section: A prospective randomised double-blind study

“…Since literature on the effects of intraoperative infusion of lignocaine during spinal anaesthesia on the BIS was limited, we chose a dose of lignocaine with the acceptable efficacy and the least toxicity for mother and the fetus. [ 7 12 20 21 ]…”