Equivalent Outcomes During Postoperative Patient-Controlled Intravenous Analgesia with Lidocaine Plus Morphine Versus Morphine Alone

Abstract

To evaluate a possible opioid-sparing effect of intravenous lidocaine we conducted a randomized, double-blind clinical trial. Patients undergoing intraabdominal surgery under general anesthesia were treated with patient-controlled analgesia (PCA) in three groups: Group 1 (n = 100; morphine 1 mg/mL), Group 2 (n = 44; morphine 1 mg/mL plus lidocaine 10 mg/mL), and Group 3 (n = 51; morphine 1 mg/mL plus lidocaine 20 mg/mL). Pain was evaluated using a 0-10 visual analog scale in the postanesthesia care unit (PACU) during deep inhalation at 15 and 30 min, and at 1, 2, and 4 h after arrival in the PACU, and continued after PACU discharge every 4 h for 36 h. Patients whose pain was more than 4/10 in the PACU received 2.5 mliters of the respective solutions every 7 min until pain was less than 4/10; then PCA was started. The number of bolus and cumulative drug doses during the study were recorded. Along with pain intensity, we assessed vital signs and side effects. Time to acceptance of oral liquids was also determined. Adding lidocaine 10 or 20 mg/mL to PCA morphine 1 mg/mL for acute pain treatment after abdominal surgery yielded no differences in opioid use, pain levels, or side effects.

Lidocaine vs. magnesium: effect on analgesia after a laparoscopic cholecystectomy

“…Contrary to our finding, however, other studies failed to demonstrate a significant analgesic effect of lidocaine in the post‐operative period 23,24 . The discrepancy might be related to the types of surgery or the timing of lidocaine administration.…”

The Effect of Adding Lidocaine to Patient Controlled Analgesia with Morphine on Pain Intensity after Caesarean Section with Spinal Anesthesia: A Double-Blind, Randomized, Clinical Trial

“…The results of Moslemi et al on patients undergoing gynecologic laparoscopic surgery indicate that infusion of lidocaine (1.5 mg/kg) could significantly affect postoperative pain reduction [18]. Also, it has been shown that adding lidocaine to morphine PCA, compared to morphine PCA alone, has no significant efficacy in postoperative pain reduction after abdominal surgery [19]. The results of these studies are consistent with our study.…”

Lack of Impact of Intravenous Lidocaine on Analgesia, Functional Recovery, and Nociceptive Pain Threshold after Total Hip Arthroplasty

“…16 Various lidocaine infusion protocols have been used only during surgery, 4,12,17,18 intraoperatively and for 24 h postoperatively, 11,13,19 -21 or exclusively after surgery with patient-controlled analgesia. 22 Only two trials using patient-controlled analgesia associating morphine plus lidocaine 21 and perioperative 22 lidocaine administration failed to demonstrate opioid-sparing effect. The other studies reported various impacts on analgesia associated with a reduction of postoperative morphine requirement but opioid consumption was generally only secondary endpoints (except in three studies).…”