Evaluation of lignocaine infusion on recovery profile, quality of recovery, and postoperative analgesia in patients undergoing total abdominal hysterectomy

Harish S Koshyari, Veena Asthana, Sanjay Agrawal, Harish S Koshyari, Veena Asthana, Sanjay Agrawal

Abstract

Background and aims: Multimodal analgesia entrains the use of drugs in perioperative period producing adequate pain relief without affecting the quality of recovery by decreasing drug-related adverse effects. Systemic lignocaine has effective analgesic, anti-inflammatory, and anti-hyperalgesic properties and improves the quality of recovery after surgery.

Material and methods: Ninety women scheduled for elective transabdominal hysterectomy under general anesthesia were randomized to receive infusion of lignocaine (1.5 mg/kg over 15 min followed by a 2 mg/kg/h infusion until the end of surgery) (Group 1) or normal saline (10 mL over 15 min followed by infusion 1 mL/kg/h till end of surgery) (Group 2). Standard anesthesia techniques were used in both the groups. The patients received inj. tramadol for postoperative analgesia. Perioperative hemodynamics, extubation variables, postoperative analgesic requirement, and quality of recovery score were evaluated.

Results: Hemodynamics were maintained in both the groups. Time for extubation was also similar. Demand for first postoperative analgesic was after 70.8 ± 70.4 min (Group 1) and 40.7 ± 30.0 min (Group 2) (P = 0.006). Total tramadol usage was 477.0 ± 133.2 mg (Group 1) and 560.0 ± 115.0 mg (Group 2) (P < 0.001). Return of bowel function was faster in Group 2 compared with Group 1 (37.1 ± 5 vs 41.8 ± 7.4 h, P < 0.001). The median (interquartile range) recovery score (QoR-40) was 184 (178-191) in Group 1 and 178 (171-180) in Group 2 (P < 0.001).

Conclusion: Perioperative use of intravenous infusion of lignocaine is associated with decreased analgesic requirement postoperatively, and improved quality of recovery score signifying greater patient satisfaction.

Keywords: Lignocaine infusion; postoperative analgesia; quality of recovery score.

Conflict of interest statement

There are no conflicts of interest.

Copyright: © 2019 Journal of Anaesthesiology Clinical Pharmacology.

Figures

Figure 1
Figure 1
Heart rate variability in study groups
Figure 2
Figure 2
Mean blood pressure changes in study groups

References

    1. Kehlet H, Jensen TS, Woolf C. Persistent postsurgical factors and prevention. Lancet. 2006;367:1618–25.
    1. Carr D, Goudas LC. Acute pain. Lancet. 1999;353:2051–8.
    1. Macintyre PE, Schug SA, Scott DA, Visser EJ, Walker SM. Acute pain and injury response. In: Macintyre PE, Schug SA, Scott DA, Visser EJ, Walker SM, editors. Acute Pain Management: Scientific Evidence. 3rd ed. Melbourne: ANZCA and FPM; 2010. p. 15.
    1. McCarthy GC, Megalla SA, Habib AS. Impact of intravenous lidocaine infusion on postoperative analgesia and recovery from surgery a systematic review of randomized controlled trials. Drugs. 2010;70:1149–63.
    1. Vigneault L, Turgeon AF, Cote D, Lauzier F, Nichole PC, Zarychanski R, et al. Perioperative intravenous lidocaine infusion for postoperative pain control: A meta-analysis of randomized controlled trials. Can J Anaesth. 2011;58:22–37.
    1. Oliveria GSD, Jr, Ahmad S, Fitzgerald PC, Marcus RJ, Altman CS, Panjwani AS, et al. Dose ranging study on the effect of preoperative dexamethasone on postoperative quality of recovery and opioid consumption after ambulatory gynaecological surgery. Br J Anaesth. 2011;107:362–71.
    1. Abelson KS, Hoglund AU. Intravenously administered lidocaine in therapeutic doses increases the intraspinal release of acetylcholine in rats. Neurosci Lett. 2002;317:93–6.
    1. Hollmann MW, Ritter CH, Henle P, De Klaver M, Kamatchi GL, Durieux ME. Inhibition of m3 muscarinic acetylcholine receptors by local anaesthetics. Br J Pharmacol. 2001;133:207–16.
    1. Biella G, Sotgiu ML. Central effects of systemic lidocaine mediated by glycine spinal receptors: An iontophoretic study in the rat spinal cord. Brain Res. 1993;603:201–6.
    1. Coda B, Bausch S, Haas M, Chavkin C. The hypothesis that antagonism of fentanyl analgesia by 2-chloroprocaine is mediated by direct action on opioid receptors. Reg Anesth. 1997;22:43–52.
    1. Cohen SP, Mao J. Is the analgesic effect of systemic lidocaine mediated through opioid receptors? Acta Anaesthesiol Scand. 2003;47:910–1.
    1. De Klaver MJ, Buckingham MG, Rich GF. Lidocaine attenuates cytokine-induced cell injury in endothelial and vascular smooth muscle cells. Anesth Analg. 2003;97:465–70.
    1. Nagy I, Woolf CJ. Lignocaine selectivity reduces C fibre evoked neuronal activity in rat spinal cord in vitro by decreasing N-methyl-D-aspartate and neurokinin receptor-mediated postsynaptic depolarizations; implications for the development of novel centrally acting analgesics. Pain. 1996;64:59–70.
    1. Collinsworth KA, Kalman SM, Harrison DC. The clinical pharmacology of lidocaine as an antiarrhythymic drug. Circulation. 1974;50:1217–30.
    1. Weinberg L, Peake B, Tan C, Nikfarjam M. Pharmacokinetics and pharmacodynamics of lignocaine: A review. World J Anesthesiol. 2015;4:17–29.
    1. Abou-Madi MN, Keszler H, Yacoub JM. Cardiovascular reactions to laryngoscopy and tracheal intubation following small and large intravenous doses of lidocaine. Can Anaesth Soc J. 1977;2:12–9.
    1. Ali QE, Siddiqui OA, Khan YA. Effects of Xylocard pretreatment on hemodynamics in patients undergoing laparoscopic cholecystectomy. RMJ. 2010;35:188–91.
    1. Baral BK, Bhattarai BK, Rahman TR, Singh SN, Regmi R. Perioperative intravenous lidocaine infusion on postoperative pain relief in patients undergoing upper abdominal surgery. Nepal Med Coll J. 2010;12:215–20.
    1. Omar AM. Effect of systemic lidocaine infusion on train-of-four ratios during recovery from general anesthesia. Egyptian J Anaesth. 2012;28:281–6.
    1. Tauzin-Fin P, Bernard O. Benefits of intravenous lidocaine on post-operative pain and acute rehabilitation after laparoscopic nephrectomy. J Anaesthesiol Clin Pharmacol. 2014;30:366–72.
    1. Kim KT, Cho DC, Sung JK, Kim YB, Kang H, Song KS, et al. Intraoperative systemic infusion of lidocaine reduces postoperative pain after lumbar surgery: A double-blinded, randomized, placebo-controlled clinical trial. Spine J. 2014;14:1559–66.
    1. Yon JH, Choi GJ, Kang H, Park JM, Yang HS. Intraoperative systemic lidocaine for pre-emptive analgesics in subtotal gastrectomy: A prospective, randomized, double-blind, placebo-controlled study. Can J Surg. 2014;57:175–82.
    1. Bryson GL, Charapov I, Krolczyk G, Taljaard M, Reid D. Intravenous lidocaine does not reduce length of hospital stay following abdominal hysterectomy. Can J Anaesth. 2010;57:759–66.
    1. Choi SJ, Kim MH, Jeong HY, Lee JJ. Effect of intraoperative lidocaine on anesthetic consumption, and bowel function, pain intensity, analgesic consumption and hospital stay after breast surgery. Korean J Anesthesiol. 2012;62:429–34.
    1. Herroeder S, Pecher S, Schonherr ME, Kaulitz G, Hahnenkamp K, Friess H, et al. Systemic lidocaine shortens length of hospital stay after colorectal surgery: A double-blinded, randomized, placebo-controlled trial. Ann Surg. 2007;246:192–200.
    1. Choi SJ, Kim MH, Jeong HY, Lee JJ. Effect of intraoperative lidocaine on anesthetic consumption, and bowel function, pain intensity, analgesic consumption and hospital stay after breast surgery. Korean J Anesthesiol. 2012;62:429–34.
    1. Wuethrich PY, Romero J, Burkhard FC, Curatolo M. No benefit from perioperative intravenous lidocainein laparoscopic renal surgery: A randomised, placebo-controlled study. Eur J Anaesthesiol. 2012;29:537–43.
    1. Myles PS, Weitkamp B, Jones K, Melick J, Hensen S. Validity and reliability of a postoperative quality of recovery score: The QoR-40. Br J Anaesth. 2000;84:11–5.
    1. De Oliveira GS, Jr, Duncan K, Fitzgerald P, Nader A, Gould RW, McCarthy RJ. Systemic lidocaine to improve quality of recovery after laparoscopic bariatric surgery: A randomized double-blinded placebo-controlled trial. Obes Surg. 2014;24:212–8.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する