Efficacy of Perioperative Intravenous Lidocaine for Multimodal Analgesia

Abstract

Given the rising incidence of opioid misuse and opioid-related deaths worldwide, it is imperative to find nonopioid analgesic adjuncts for perioperative pain management. Perioperative opioid exposure in opioid-naïve patients for even minor surgical procedures may result in significant opioid dependence. Although the use of intravenous lidocaine in the perioperative period is not novel, recently it has been proposed as an important adjunct to multimodal analgesia. In addition to improving acute pain, lidocaine may reduce the incidence of chronic post-operative pain syndrome (CPPS), improve bowel function, and decrease post-operative nausea and vomiting (PONV) thereby speeding up the post-operative recovery process. Furthermore, lidocaine has efficacy in a variety of procedures including abdominal, gynecological, and urological surgeries. The aim of this narrative review is to evaluate the effects of intravenous lidocaine compared to traditional analgesic methods on post-operative pain control and recovery for various surgical procedures.

Evaluation of the effects of the local anesthetics on immunity during mastectomy

“…17 Lockwood Н. showed that a bolus IV dose of 1 mg/kg lidocaine given prior to induction of anesthesia, followed by infusion of lidocaine during surgery and in PACU resulted in a significant peroperative reduction of opioid use and statistically significant lower postoperative VAS scores. 18 Furthermore, it was found that local anesthetics can annul the immunosuppressive effects of volatile anesthetics. 14 The role of TNFα in dissemination of the tumor cells is still unknown.…”

Intravenous Lidocaine in Non-Opioid Multimodal Perioperative Pain Management: Current Controversy and Future Perspectives

“…injection), but a very short duration (10-20 min after 50 or 100 mg i.v. boluses) [2,65]. When administered intravenously, lidocaine initially follows distribution in the highly vascularized organs of the body, such as the liver, heart, lung, and brain with a large volume of distribution of 0.6-4.5 L/kg.…”

“…Intravenous Lidocaine in Non-Opioid Multimodal Perioperative Pain Management: Current… DOI: http://dx.doi.org/10.5772/intechopen.111864 elimination of lidocaine usually follows a linear pharmacokinetic model with a halflife of approximately 1.5-2 hours after bolus or after infusion within 12-hour time frame. After 12-hour infusion, lidocaine exerts time-dependent rather than linear pharmacokinetic model of elimination and may have a half-life up to 4 hours [65].…”

“…Current evidence suggests that i.v. lidocaine alone may provide sufficient antinociceptive effect in patients undergoing abdominal surgery in addition to being an important component of perioperative multimodal analgesia [65]. In this context, the Enhanced Recovery After Surgery society guidelines for perioperative care in elective colorectal surgery (2019) make strong recommendations for lidocaine infusions during colorectal cancer surgery [78].…”

“…lidocaine has no significant benefits for patients undergoing robot-assisted colorectal surgery, including cumulated morphine consumption at 24 hours or 72 hours after the end of surgery [80]. To date, there appears to be limited evidence supporting Intravenous Lidocaine in Non-Opioid Multimodal Perioperative Pain Management: Current… DOI: http://dx.doi.org/10.5772/intechopen.111864 that lidocaine reduces opioid consumption intraoperatively and in the immediate postoperative period in breast and spine surgeries [65,81]. The same applies to renal and orthopedic surgeries.…”