Effect of intra‐operative intravenous lidocaine on opioid consumption after bariatric surgery: a prospective, randomised, blinded, placebo‐controlled study

Abstract

Summary Peri‐operative lidocaine infusion warrants investigation in bariatric surgery because obese patients present different physiological and pharmacological risks. This single‐centre, prospective, randomised double‐blind placebo‐controlled study enrolled obese patients scheduled for laparoscopic bariatric surgery using an enhanced recovery protocol. Patients received either lidocaine (bolus of 1.5 mg.kg−1, then a continuous infusion of 2 mg.kg−1.h−1 until the end of the surgery, then 1 mg.kg−1.h−1 for 1 h in the recovery area) or identical volumes and rates of 0.9% saline. The primary outcome was the consumption of the equivalent of oxycodone consumption over the first 3 postoperative days. Secondary outcomes were: postoperative pain; incidence of nausea and vomiting; bowel function recovery; and lengths of stay in the recovery area and in hospital. Plasma concentrations of lidocaine were measured. On the 178 patients recruited, data were analysed from 176. The median (IQR [range]) equivalent intravenous oxycodone consumption was 3.3 mg (0.0–6.0 [0.0–14.5]) and 5.0 mg (3.3–7.0 [3.3–20.0]) in the lidocaine and saline groups, respectively (difference between medians (95%CI): 1.7 (0.6–3.4) mg; p = 0.004). Length of stay in the recovery area, postoperative pain, nausea and vomiting, day of recovery of bowel function, and length of stay in hospital were not different between groups. Mean (SD) lidocaine plasma concentrations were 2.44 (0.70) µg.ml−1 and 1.77 (0.51) µg.ml−1 at the end of surgery and 1 hour after the end of infusion, respectively. Lidocaine infusion during bariatric surgery resulted in a clinically non‐relevant difference in postoperative oxycodone consumption.

<p>Application of Intravenous Lidocaine in Obese Patients Undergoing Painless Colonoscopy: A Prospective, Randomized, Double-Blind, Controlled Study</p>

“…In addition, all patients in group L were observed closely during the perioperative period, and none of them showed cardiovascular toxicity (eg, increasing intervals, widening QRS complex) or any symptoms of toxicity (eg, dizziness, drowsiness, oral metal odor, mouth paresthesia, blurred vision). Based on previous studies 48,49 and the clinical signs of patients in our trial, the plasma concentration of lidocaine achieved at this infusion rate was less than the toxic concentration, which is within the safe range of medication.…”

“…15,50 There are no lidocaine-related adverse reactions in patients undergoing bariatric surgery. 49 However, we will further explore the efficacy of intravenous lidocaine in non-obese patients. Third, we did not compare lidocaine with opioids in combination with propofol for procedural sedation and analgesia.…”

The Use of Intravenous Lidocaine in Perioperative Medicine: Anaesthetic, Analgesic and Immune-Modulatory Aspects

“…Evidence for obstetric and gynaecologic surgery is limited and outcomes are mixed [ 59 ]. Further, a randomised double-blind placebo-controlled study of perioperative lidocaine infusion for patients undergoing bariatric surgery found no difference clinically in terms of postoperative outcomes including pain, nausea and vomiting, length of stay and oxycodone consumption [ 60 ]. On a different note, for breast surgery, lidocaine’s short-term benefit is limited; however, it may prove to be more useful long term as it has been reported to reduce the incidence of chronic postsurgical pain at three and six months after mastectomy [ 61 ].…”

Bariatric surgery in patients with obstructive sleep apnea

“…Lidocaine infusions are controversial in that some studies have shown decreased postoperative pain scores and opioid consumption 64 and others have shown no difference. 65 While there may be evidence for the beneficial effects of individual agents, the ideal combination therapy has not yet been determined.…”