Evaluation of continuous intravenous lidocaine on brain relaxation, intraoperative opioid consumption, and surgeon’s satisfaction in adult patients undergoing craniotomy tumor surgery: A randomized controlled trial

Abstract

Background: In craniotomy tumor removal, brain relaxation after dura opening is essential. Lidocaine is known to have analgesic and antiinflammatory effects. It is excellent in decreasing cerebral metabolic rate of oxygen, cerebral blood flow, and cerebral blood volume; and can potentially reduce intracranial pressure, resulting in exceptional brain relaxation after dura opening. However, no study has examined continuous intravenous lidocaine infusion on brain relaxation, intraoperative opioid consumption and surgeon's satisfaction in adult patients undergoing craniotomy tumor removal.Methods: A total of 60 subjects scheduled for craniotomy tumor removal were enrolled in a double-blind, randomized controlled trial with consecutive sampling. Patients received either an intravenous bolus of lidocaine (2%) 1.5 mg/kg before induction followed by 2 mg/kg/h continuous infusion up to skin closure (lidocaine group) or placebo with similar volume (NaCl 0.9%). Neurosurgeons evaluated brain relaxation and surgeon's satisfaction with a 4-point scale, total intraoperative opioid consumption was recorded in μg and μg/kg/min.Results: All sixty subjects were included in the study. Lidocaine group showed better brain relaxation after dura opening (96.7% vs 70%; lidocaine vs placebo, P < .006), less intraoperative fentanyl consumption (369.2 μg vs 773.0 μg; P < .001, .0107 vs .0241 μg/kg/min; lidocaine vs placebo, P < .001). Higher surgeon's satisfaction was found in lidocaine group (96.7% vs 70%, P = .006). No side effects were observed during this study.Conclusions: Continuous lidocaine intravenous infusion improves brain relaxation after dura opening, and decreases intraoperative opioid consumption, with good surgeon satisfaction in adult patients undergoing craniotomy tumor removal.Abbreviations: CBF = cerebral blood flow, CMRgluc = cerebral metabolic rate for glucose, CMRO 2 = cerebral metabolic rate of oxygen, ICP = intracranial pressure, PMNs = polymorphonuclear cells.

Multimodal Analgesia and Intraoperative Neuromonitoring

“…Lidocaine infusion has demonstrated efficacy as a co-analgesic in various surgical populations that include both intracranial and spine surgery patients. 25,26 While its exact mechanism of action remains elusive, it has been postulated that lidocaine exerts its antinociceptive, antiinflammatory, and anti-hyperanalgesic properties through both central and peripheral pathways. 27 Earlier studies reported conflicting effects of lidocaine infusions on IONM when used in clinically relevant doses, and a possible depression of signals has been postulated to be the result of partial inactivation of sodium channels.…”

“…Lidocaine infusion has demonstrated efficacy as a co-analgesic in various surgical populations that include both intracranial and spine surgery patients 25,26. While its exact mechanism of action remains elusive, it has been postulated that lidocaine exerts its antinociceptive, anti-inflammatory, and anti-hyperanalgesic properties through both central and peripheral pathways 27.…”