IV LIGNOCAINE AS A PERIOPERATIVE ANALGESIA MODALITY : CURRENT EVIDENCE

PRESENTER : DR PRAHBO
SUPERVISOR : PROF SHAHNAZ

Objective:

The causes of perioperative pain are complex, and the management of perioperative pain has primarily been based on opioids. However, concern about opioid risks in the perioperative period has spurred an increased interest in the use non-opioid analgesic adjuncts. Multimodal analgesia techniques have been popularised to improve perioperative pain management and significantly reduce opioid usage and its associated side effects.

Lidocaine is a commonly used local anaesthetic that demonstrates analgesic, anti-inflammatory and anti-hyperalgesic properties. IV Lidocaine can be administered peri and / or post-operatively to decrease pain and improve other outcomes. Lidocaine has also shown its potential to improve ERAS (Enhanced Recovery After Surgery) outcomes.

Learning Points:

  • The use of perioperative IV Lidocaine infusion as a mode of multimodal analgesia shows that it is an effective modality and has a significant role as part of perioperative and post-operative analgesia.
    • However, the clinical effectiveness may vary from surgical procedure.
  • Periop Lidocaine infusion may be a useful analgesic adjunct in enhanced recovery protocols
  • Open and laparoscopic procedures have shown benefits in pain scores, opioid use, length of hospital stay and other outcomes
  • Plasma concentrations remain well below toxic levels (5mcg/ml) even after 24 hours at doses cited above (1-2mg/kg/hr).

Discussion:

  • Perioperatively, when IV Lidocaine is administered as a continuous infusion at clinically relevant doses (1-2mg/kg/hr), it usually results in plasma concentrations that remain below 5 μg/ml
  • Lidocaine at this plasma level is adequate:
    • To attenuate sympathetic responses
    • To decrease pain
    • To demonstrate a volatile anaesthetic and opioid-sparing effect
  • Use of Lidocaine for up to 24 hours
    • Shown to significantly reduce pain
    • Reduce analgesic requirements
    • Faster return of intestinal function
    • Overall reduction in side effects
  • Clinical benefits of perioperative Lidocaine infusion have been reviewed in several meta-analyses and systematic reviews
    • Majority are in patients undergoing open and laparoscopic abdominal procedures
    • Data also available for other types of surgery
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