The analgesic efficacy of intravenous lidocaine infusion after laparoscopic fundoplication: a prospective, randomized, double-blind, placebo-controlled trial

Abstract

This study aimed to determine if intravenous lidocaine infusion reduces postoperative pain intensity following laparoscopic fundoplication surgery and to also validate the safety of intravenous lidocaine at the dose tested. This was an equally randomized, double-blind, placebo-controlled, parallel-group, single center trial. Adult patients undergoing laparoscopic fundoplication were recruited. The intervention group received 1 mg/kg intravenous lidocaine bolus prior to induction of anesthesia, then an intravenous infusion at 2 mg/kg/h for 24 hours. The primary outcome was pain, measured using a numeric rating scale for 30 hours postoperatively. Secondary outcomes were nausea and vomiting, opioid requirements, adverse events, serum lidocaine concentration, and length of hospital stay. The study was terminated after an interim analysis of 24 patients showed evidence of futility. There was no difference in postoperative pain scores (lidocaine versus control, mean ± standard deviation) at rest (2.0 ± 2.7 vs 2.1 ± 2.4, P=0.286) or with movement (2.0 ± 2.6 vs 2.6 ± 2.7, P=0.487). Three adverse events occurred in the lidocaine group (25% of patients). Intravenous lidocaine did not provide clinically significant analgesia to patients undergoing laparoscopic fundoplication. The serum lidocaine concentration of patients who experienced adverse events were within the therapeutic range. This trial cannot confirm the safety of intravenous lidocaine at the dose tested.

The use of intravenous lidocaine for postoperative pain and recovery: international consensus statement on efficacy and safety

“…Low body weight can result in a reduction in skeletal muscle mass (which normally acts as a storage reservoir for local anaesthetic) and may be associated with an increased frequency of adverse reactions [90]. However, patients with high body mass index (BMI) may also have inadvertently higher plasma concentrations [16, 91]; this may be because actual, rather than ideal, body weight is used for dose calculation. This notion is supported by Dale et al., who showed that patients’ actual plasma concentrations were 20% higher than predicted when actual body weight was used [91].…”

“…However, patients with high body mass index (BMI) may also have inadvertently higher plasma concentrations [16, 91]; this may be because actual, rather than ideal, body weight is used for dose calculation. This notion is supported by Dale et al., who showed that patients’ actual plasma concentrations were 20% higher than predicted when actual body weight was used [91]. Some studies have weight exclusions, for example, < 45 kg and > 100 kg [44], which may have reduced the risk of adverse events.…”

Old drugs are new again (drugs)

“…Kako lidokain ima manji modulatorni i analgetski potencijal od ketamina i klonidina, zbog različitog mehanizma dejstva, bilo je pokušaja u pronalaženju pozitivnog efekta primenom većih doza od preporučene. Međutim, Dale i saradnici 36 su pokušali da merenjem plazmatske koncentracije lidokaina odrede najoptimalniji odnos doze i efekta. Pozivajući se na ranije publikacije, ovi autori su zaključili da benefit od intraoperativne primene lidokaina imaju samo pacijenti podvrgnuti operacijama na crevima i žučnoj kesi, dok su bez benefita urološke operacije (osim operacija prostate), ginekološke, ortopedske, operacije na srcu i operacije u regiji glave i vrata [37][38][39][40] .…”

Single Injection Nerve Blocks Plus IV Lidocaine Infusions as an Alternative to Continuous Nerve Blocks for Perioperative Pain Management: A retrospective review

“…A number of authors have confirmed the safety of the postoperative infusion of lidocaine in doses ranging from 3,200mg to 6,000mg over a 48 hour period. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] In the past few years, the use of interfacial plane blocks has been more and more advocated, 20 including erector spinae plane blocks (ESPB) for thoracic surgery, [21][22][23][24][25] pectoralis and serratus blocks for breast surgery [26][27][28][29] and quadratus lumborum (QL) blocks for abdominal surgery, 30 Intravenous lidocaine (IV lido) infusions have been demonstrated to be an effective technique for postoperative analgesia in several different types of surgery, including abdominal, [31][32][33][34] thoracic, 35,36 and spine. 37,38 We hypothesized that SNBs followed by IV lido would be as effective as CNBs.…”