Anesthesia & Clinical Research
Open Access

Abstract

Safety and Efficacy of Perioperative Lidocaine Infusion- A Prospective, Controlled Study

Vakhtang Shoshiashvili, Ashraf EL-Molla, Fawzia Aboul Fetouh, Rashed Alotaibi, Abir Kandil, Osama Shaalan, Yasser Ali

Background: After introduction of synthetic opioids, in 1960s, safe and stress-free opioid balanced anesthesia has
been developed. Opioids have well known side effects such as respiratory depression, immunosuppression, muscle
rigidity, negative inotropism, nausea, vomiting, hyperalgesia, urinary retention, postoperative ileus and drowsiness
which are clinically important. Perioperative opioids are important factor of opioid epidemic in USA and other
countries. Therefore, there is increased interest in perioperative use of non-opioid analgesics especially lidocaine.
Patients and Methods: 185 adult patients, undergoing various elective surgical procedures, were divided into; control
group I (105 patients) [Fentanyl Group], and group II (80 patients) [Opioid Free Anesthesia Group]. Patients of both
groups received at anesthetic induction; lidocaine 1.5 mg/kg bolus followed by 1.5 mg/kg/h infusion
intraoperatively, and 2 mg/Kg/h infusion for 2-8 hours postoperatively. Both groups received other analgesic
adjuvants such as diclofenac 75 mg, paracetamol 1 gm, and MgSO4 30-50 mg/kg intraoperatively. A supplemental
fentanyl 1 mcg/kg was used if there is increase of mean arterial pressure (MAP) and/ or heart rate (HR) more than
20% above base line. Intraoperative fentanyl consumption and visual analog scale (VAS) pain score assessment at
immediate recovery time as well as after 24 hours postoperatively were assessed and analgesic requirements were
recorded. Postoperative bowel function was also monitored by auscultation until recovery.
Results: Supplemental intraoperative fentanyl was needed in 8.6% of cases in group I, and in 30% of cases in group
II. Group II also needed a higher minimum alveolar concentration (MAC) of sevoflurane during first 30 minutes.
Both groups needed analgesia immediately post extubation if surgeries were less than 3 hours. After 8 hours of
lidocaine infusion, there was no need for additional opioids for 24 hours and only paracetamol 1 gm and/or
diclofenac 75 mg were enough in both groups. No significant differences in bowel function were observed between
the 2 groups. There are no clinically detected or observed toxicity or side effects due to lidocaine infusion.
Conclusion: Safety and efficacy of perioperative lidocaine infusion have been demonstrated. Opioid free anesthesia
(OFA) is possible in 70% of cases. Antinociceptive action of lidocaine is time dependent and no immediate analgesia
was needed after extubation if the duration of intraoperative lidocaine infusion was more than 3 hours as the VASpain score after recovery was 0-3, versus 3-7 if the duration of lidocaine infusion was 40-150 minutes. Post-operative
lidocaine infusion for 5-8 hours was sufficient for pain relieve with minimal non opioid analgesia for 24 hours.

Published Date: 2020-05-25; Received Date: 2020-05-07