Effect of intravenous lignocaine infusion on bispectral index during spinal anaesthesia for caesarean section: A prospective randomised double-blind study

Marzieh Beigom Khezri, Maryam Rajabi, Siamak Yaghoobi, Ameneh Barikani, Marzieh Beigom Khezri, Maryam Rajabi, Siamak Yaghoobi, Ameneh Barikani

Abstract

Background and aims: Systemic lignocaine has been shown to have sedative effects. We designed this randomised-double-blind, placebo-controlled study to evaluate the effect of intravenous lignocaine on the bispectral index (BIS) during caesarean section under spinal anaesthesia.

Methods: 80 patients scheduled for elective caesarean section under spinal anaesthesia were randomly allocated to 2 study groups. Group L received intravenous 1.5 mg/kg of lignocaine bolus, 15 minutes before spinal anaesthesia followed by an intravenous infusion 1.5 mg/kg/h for 60 minutes intravenously. The patients in the control group (C group) were given 0.9% sodium chloride in a double-blind fashion. Spinal anaesthesia was performed with 10 mg of 0.5% bupivacaine. The changes of Sao2, BIS and hemodynamic variables during caesarean section, Apgar score of neonate and the incidence of adverse effects were recorded.

Results: BIS values were lower in the L group compared to C group (P ≤ 0.001). Comparison of mean arterial pressure (MAP) changes during spinal anaesthesia and surgery reveal statistically significant difference between two groups through repeated measure analysis (P ≤ 0.001), but comparision of heart rate (HR) changes during spinal anaesthesia and surgery failed to reveal any statistically significant difference between two groups. (P = 0.261). The Apgar scores did not reveal a significant difference between the two groups at first and five minutes after delivery (P = 0.99).

Conclusion: Intravenous lignocaine infusion given with spinal anaesthesia in women undergoing elective caesarean delivery providing lower BIS values without respiratory depression, in the absence of foetal compromise.

Keywords: Bispectral index monitor; caesarean section; intravenous lignocaine; spinal anaesthesia.

Conflict of interest statement

There are no conflicts of interest.

Copyright: © 2020 Indian Journal of Anaesthesia.

Figures

Figure 1
Figure 1
Consort flow diagram
Figure 2
Figure 2
Bispectral Index (BIS) in the two groups. BIS values were expressed as mean and error bars representing standard deviation (SD) value
Figure 3
Figure 3
Hemodynamic variables in the two groups. Data are presented as mean ± SD, MAP: Mean arterial blood pressure (mmHg), HR: Heart rate (bpm), SA: Spinal anaesthesia. P values are from Repeated measures analysis

References

    1. Hans GA, Lauwick SM, Kaba A, Bonhomme V, Struys MM, Hans PC, et al. Intravenous lidocaine infusion reduces bispectral index-guided requirements of propofol only during surgical stimulation. Br J Anaesth. 2010;105:471–9.
    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. Cavalli Rde C, Lanchote VL, Duarte G, Dantas EC, de Prado MF, de Duarte LB, et al. Pharmacokinetics and transplacental transfer of lidocaine and its metabolite for perineal analgesic assistance to pregnant women. Eur J Clin Pharmacol. 2004;60:569–74.
    1. El-Tahan MR, Warda OM, Diab DG, Ramzy EA, Matter MK. A randomized study of the effects of perioperative i.v. lidocaine on hemodynamic and hormonal responses for cesarean section. J Anesth. 2009;23:215–21.
    1. Bagchi D, Mandal MC, Das S, Basu SR, Sarkar S, Das J. Bispectral index score and observer's assessment of awareness/sedation score may manifest divergence during onset of sedation: Study with midazolam and propofol. Indian J Anaesth. 2013;577:351–7.
    1. Iida R, Iwasaki K, Kato J, Ogawa S. Bispectral index is related to the spread of spinal sensory block in patients with combined spinal and general anaesthesia. Br J Anaesth. 2011;106:202–7.
    1. Ozkan-Seyhan T, Sungur MO, Senturk E, Karadeniz M, Basel A, Senturk M, et al. BIS guided sedation with propofol during spinal anaesthesia: Influence of anaesthetic level on sedation requirement. Br J Anaesth. 2006;96:645–9.
    1. Pollock JE, Neal JM, Liu SS, Burkhead D, Polissar N. Sedation during spinal anesthesia. Anesthesiology. 2000;93:728–34.
    1. Yang MK, Kim JA, Ahn HJ, Choi DH. Influence of the baricity of a local anaesthetic agent on sedation with propofol during spinal anaesthesia. Br J Anaesth. 2007;98:515–8.
    1. Senturk M, Pembeci K, Menda F, Ozkan T, Gucyetmez B, Tugrul M, et al. Effects of intramuscular administration of lidocaine or bupivacaine on induction and maintenance doses of propofol evaluated by bispectral index. Br J Anaesth. 2002;89:849–52.
    1. Szmuk P, Farrow-Gillespie A, Sheeran P, Ezri T. The sedative effect of high dose lidocaine. Anesth Analg. 2007;104:1613–4.
    1. MacDougall LM, Hethey JA, Livingston A, Clark C, Shmon CL, Duke-Novakovski T. Antinociceptive, cardiopulmonary, and sedative effects of five intravenous infusion rates of lidocaine in conscious dogs. Vet Anaesth Analg. 2009;36:512–22.
    1. Kaka U, Hui Cheng C, Meng GY, Fakurazi S, Kaka A, Behan AA. Electroencephalographic changes associated with antinociceptive actions of lidocaine, ketamine, meloxicam, and morphine administration in minimally anaesthetized dogs. Biomed Res Int. 2015;2015:305367.
    1. Luo Z, Yu M, Smith SD, Kritzer M, Du C, Ma Y, et al. The effect of intravenous lidocaine on brain activation during non-noxious and acute noxious stimulation of the forepaw: A functional magnetic resonance imaging study in the rat. Anesth Analg. 2009;108:334–44.
    1. Uzun S, Yuce Y, Erden A, Aypar U. Impact of perioperative lidocaine infusion and BIS monitorization on remifentanil dosage in hypotensive anesthesia. Eur Rev Med Pharmacol Sci. 2014;18:559–65.
    1. Taniguchi T, Shibata K, Yamamoto K, Mizukoshi Y, Kobayashi T. Effects of lidocaine administration on hemodynamics and cytokine responses to endotoxemia in rabbits. Crit Care Med. 2000;28:755–9.
    1. Sugimoto M, Uchida I, Mashimo T. Local anaesthetics have different mechanisms and sites of action at the recombinant N-methyl-D-aspartate (NMDA) receptors. Br J Pharmacol. 2003;138:876–82.
    1. Wagner AE, Mama KR, Steffey EP, Ferreira TH, Rezende ML. Comparison of the cardiovascular effects of equipotent anesthetic doses of sevoflurane alone and sevoflurane plus an intravenous infusion of lidocaine in horses. Am J Vet Res. 2011;72:452–60.
    1. Newton DJ, McLeod GA, Khan F, Belch JJ. Mechanisms influencing the vasoactive effects of lidocaine in human skin. Anaesthesia. 2007;62:146–50.
    1. Abboud TK, Sarkis F, Blikian A, Varakian L, Earl S, Henriksen E. Lack of adverse neonatal neurobehavioral effects of lidocaine. Anesth Analg. 1983;62:473–5.
    1. Khezri MB, Rajabi M, Yaghobi S, Pakniat H. Analgesic efficacy of intravenous lidocaine infusion in cesarean section under spinal anesthesia: A prospective randomized double-blind study. J Adv Med Biomed Res. 2019;27:31–7.

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