• Grégoire Wallon, Julien Erbacher, Edris Omar, Christian Bauer, Grégory Axiotis, Sylvie Thevenon, Jean-Luc Soubirou, and Frédéric Aubrun.
• From the Département d'anesthésie-réanimation, Centre Léon Bérard (GW, JE, GA, JLS), Département d'anesthésie-réanimation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon (EO, CB, FA), Centre de recherche clinique, Hôpital de la Croix-Rousse, Hospices Civils de Lyon (ST), and Research on Healthcare Performance (RESHAPE), U1290, INSERM et Université Claude Bernard Lyon 1, Lyon, France (FA).
• Eur J Anaesthesiol. 2022 Sep 1; 39 (9): 735742735-742.

BackgroundTreatment of postoperative pain after ear, nose and throat (ENT) cancer surgery is mainly morphine administration. Additional systemic lidocaine has shown promising results in some surgical procedures.ObjectiveThe main objective was to evaluate morphine consumption in the first 48 postoperative hours after intra-operative lidocaine infusion during major ENT cancer surgery.DesignA randomised, double-blind, placebo-controlled trial.SettingBicentric study including a university hospital and a major cancer centre, conducted from December 2016 to December 2019.PatientsA total of 144 patients undergoing major ENT cancer surgery were included.InterventionThe patients were randomly assigned to receive intravenous lidocaine or placebo during surgery and in the recovery room.Main Outcome MeasuresEndpoints were postoperative morphine consumption in the first 24 and 48 h postoperatively, intra-operative remifentanil consumption, adverse events occurrence and assessment 3 to 6 months after surgery with the McGill pain questionnaire.ResultsA total of 118 patients were included (lidocaine n  = 57; placebo n  = 61, 26 patients were excluded). There was no significant difference in morphine consumption during the first 48 postoperative hours in the lidocaine group compared with the placebo group with a median [IQR] of 0.60 [0.30 to 1.03] mg kg -1 vs. 0.57 [0.37 to 0.96] mg kg -1 , total dose 44 [21 to 73.3] mg vs. 38 [23.3 to 56.5] mg, P  = 0.92.There was no significant difference between the two groups in any of the other endpoints, including at follow up 3 to 6 months after surgery.ConclusionIntravenous lidocaine in ENT cancer surgery did not show any additional analgesic or morphine-sparing effect 48 h after surgery. Three to six months after surgery, there was no significant difference in pain scores or consumption of analgesics. Patients treated pre-operatively with opioids were not evaluated in the study.Trial RegistrationClinicaltrials.gov identifier: NCT02894710 and EUDRACT number 2015-005799-90.Copyright © 2022 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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