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Created May 21, 2015, last updated almost 4 years ago.
Collection: 15, Score: 3325, Trend score: 0, Read count: 3560, Articles count: 12, Created: 2015-05-21 02:21:11 UTC. Updated: 2021-02-07 07:14:53 UTC.Notes
There is some evidence supporting the benefit of perioperative intravenous lignocaine/lidocaine infusion in both laparoscopic and open abdominal surgery.
The strongest evidence supports both improved analgesia and reduction in nausea, with weaker evidence suggesting faster improvement in GIT function and earlier discharge from hospital.
Safety data is reassuring but far from conclusive due to the small size of most studies.
Daniel Jolley
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Collected Articles
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Anesthesia and analgesia · Aug 2012
Randomized Controlled TrialSystemic lidocaine to improve postoperative quality of recovery after ambulatory laparoscopic surgery.
Intraoperative intravenous lidocaine improves the quality of recovery following ambulatory laparoscopic surgery.
pearl -
Randomized Controlled Trial
Perioperative intravenous lidocaine decreases the incidence of persistent pain after breast surgery.
Perioperative lidocaine (1.5 mg/kg bolus then 1.5 mg/kg/h until 1 h after skin closure) reduces the incidence of persistent post-surgical pain after breast cancer surgery at 3 months.
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Review Meta Analysis
Impact of intravenous lidocaine infusion on postoperative analgesia and recovery from surgery: a systematic review of randomized controlled trials.
Postoperative pain continues to be inadequately managed. While opioids remain the mainstay for postoperative analgesia, their use can be associated with adverse effects, including ileus, which can prolong hospital stay. A number of studies have investigated the use of perioperative intravenous lidocaine infusion for improving postoperative analgesia and enhancing recovery of bowel function. ⋯ In conclusion, intravenous lidocaine infusion in the perioperative period is safe and has clear advantages in patients undergoing abdominal surgery. Patients receiving lidocaine infusion had lower pain scores, reduced postoperative analgesic requirements and decreased intraoperative anaesthetic requirements, as well as faster return of bowel function and decreased length of hospital stay. Further studies are needed to assess whether lidocaine has a beneficial effect in patients undergoing other types of surgery and to determine the optimum dose, timing and duration of infusion of lidocaine in this setting.
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Cochrane Db Syst Rev · Jan 2015
Review Meta AnalysisContinuous intravenous perioperative lidocaine infusion for postoperative pain and recovery.
Perioperative lignocaine infusion reduces postoperative pain and nausea, and may improve GIT function and speed hospital discharge.
pearl -
Curr Opin Anaesthesiol · Aug 2014
ReviewSystemic lidocaine in surgical procedures: effects beyond sodium channel blockade.
This review presents current data on the systemic administration of lidocaine. The focus is on studies in the perioperative setting. In addition, there is a brief look at experimental data on the effect of lidocaine at the molecular level. ⋯ Positive effects on postoperative pain, as well as on bowel motility and hospital discharge time, have regularly been observed. However, contradictory findings have also been published. As almost all of the studies only include very small patient numbers, large multicenter investigations are needed.
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Anesthesia and analgesia · Nov 2012
Randomized Controlled TrialThe effect of perioperative intravenous lidocaine and ketamine on recovery after abdominal hysterectomy.
Perioperative ketamine infusion reduces postoperative pain; perioperative lidocaine infusion reduces postoperative narcotic consumption, speeds recovery of intestinal function, improves postoperative fatigue, and shortens hospital stay. However, it is unknown whether perioperative IV lidocaine and/or ketamine enhances acute functional recovery. We therefore tested the primary hypothesis that perioperative IV lidocaine and/or ketamine in patients undergoing open abdominal hysterectomy improves rehabilitation as measured by a 6-minute walk distance (6-MWD) on the second postoperative morning. ⋯ Our results do not support use of lidocaine or ketamine for improving 6-MWD on the second postoperative day after open hysterectomy.
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Bartlett and Hutaserani published the first description of the intravenous use of lignocaine for postoperative pain management in 1961.
"THE SEARCH for a nondepressant, long-acting drug to control postoperative pain has gone on for many years. Like many other institutions, ours has run the gamut of drugs as they have been released: nupercaine-in-oil, intravenous procaine, efocaine, intravenous alcohol, d-tubocurarine-in-oil, etc. All have had their drawbacks."The researchers investigated a progressive range of administration routes and dosages, ultimately reaching 1000 mg lignocaine in 1L IVF given over the duration of surgery. 302 patients receiving intravenous lignocaine were compared to matched controls, finding:
"...during the first 3 postoperative days 83 per cent of the patients who received Xylocaine experienced either no pain or 1+ pain (soreness only) as contrasted with 25 per cent of the controls."Intravenous lignocaine also dramatically reduced post-operative opioid consumption.
Another group (N=60) received 500 mg lignocaine into the rectus muscles after laparotomy, improving no-pain or 1+ pain incidence to 95%.
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Anesthesia and analgesia · Dec 2009
Randomized Controlled TrialSystemic lidocaine decreased the perioperative opioid analgesic requirements but failed to reduce discharge time after ambulatory surgery.
In this randomized, blinded, placebo-controlled trial, we evaluated whether systemic lidocaine would reduce pain and time to discharge in ambulatory surgery patients. ⋯ Perioperative systemic lidocaine significantly reduces opioid requirements in the ambulatory setting without affecting time to discharge.
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Reg Anesth Pain Med · May 2016
Randomized Controlled TrialSystemic Lidocaine Fails to Improve Postoperative Pain, But Reduces Time to Discharge Readiness in Patients Undergoing Laparoscopic Sterilization in Day-Case Surgery: A Double-Blind, Randomized, Placebo-Controlled Trial.
Perioperative systemic lidocaine provides postoperative analgesia, decreases opioid consumption, and facilitates rehabilitation in abdominal surgery. We hypothesized that systemic lidocaine has analgesic effects in women undergoing day-case laparoscopic sterilization. ⋯ In laparoscopic sterilization, systemic lidocaine reduces time to readiness for hospital discharge.
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Cochrane Db Syst Rev · Jun 2018
Review Meta AnalysisContinuous intravenous perioperative lidocaine infusion for postoperative pain and recovery in adults.
Even if beneficial, perioperative lignocaine infusions probably have no analgesic benefit beyond 24 hours post-operatively.
pearl -
Review Meta Analysis
Efficacy and safety of intravenous lidocaine for postoperative analgesia and recovery after surgery: a systematic review with trial sequential analysis.
Intravenous lidocaine improves postoperative analgesia at 4h and 24h after laparoscopic or open abdominal surgery, but not at 48h or for other surgery types.
pearl -
Review Meta Analysis Comparative Study
An estimation for an appropriate end time for an intraoperative intravenous lidocaine infusion in bowel surgery: a comparative meta-analysis.
There exists no commonly accepted regimen for an intravenous lidocaine infusion (IVLI). This study aims to determine an appropriate end time for an IVLI during bowel surgery. ⋯ Continuing an IVLI beyond 60 minutes after surgery has no added analgesic or gastrointestinal benefit. Further research is needed to clarify an optimal IVLI regimen and end time.
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