Comparison Between Intraperitoneal and Intravenous Lidocaine for Postoperative Analgesia After Elective Abdominal Hysterectomy, a Double-Blind Placebo Controlled Study

Saghar Samimi, Arman Taheri, Fatemeh Davari Tanha, Saghar Samimi, Arman Taheri, Fatemeh Davari Tanha

Abstract

Objective: To compare the efficacy of intravenous and intraperitoneal injection of lidocaine and normal saline in relieving postoperative pain after elective abdominal hysterectomy.

Materials and methods: For this double-blind randomized controlled study 109 patients undergoing elective abdominal hysterectomy were randomly allocated to three groups :1) IV group (intravenous injection group) received intravenous lidocaine %2 bolus 1.5mg/kg 30 min before incision and then a continuous lidocaine infusion of 2mg/kg and before the wound closure an intraperitoneal injection of N/S , 2) IP group (intraperitoneal group) received intravenous N/S and intraperitoneal lidocaine 3mg/kg , 3) P group (placebo, N/S) received both intravenous and intraperitoneal N/S. The pain scores (VAS) at rest, total morphine consumption , the time to first need for rescue analgesic ,incidence of lidocaine related adverse effects and nausea and vomiting were recorded at 0,2,4,8,12 and 24 hrs postoperatively.

Results: The VAS scores were significantly lower in IP and IV groups compared with placebo (p = 0.001). Total consumption of morphine (p = 0.001) and time to firs request of recue analgesic (p = 0.001) were lower too in IP and IV groups.Incidence of vomiting was comparable between groups (p < 0.05) but nausea was higher in control group (p > 0.05).There were not notable lidocaine-related adverse effects. IP and IV groups were not statistically different for all investigated variables.

Conclusion: This study showed lidocaine administration both intravenously and intraperitoneally are effective in reducing the postoperative pain and also have opioid sparing effect and can be safely used in elective abdominal hysterectomy without any major adverse effects.

Keywords: Abdominal Hysterectomy; Intraperitoneal; Intravenous; Pain; Post Operative; lidocaine; lidocaine Adverse Effects.

References

    1. Pogatzki-Zahn E, Chandrasena C, Schug SA. Nonopioid analgesics for postoperative pain management. Curr Opin Anaesthesiol. 2014;27:513–9.
    1. Gottschalk A, Smith DS. New Concepts in Acute Pain Therapy: Preemptive Analgesia. AMERICAN FAMILY PHYSICIAN. 2001;63:1979–84.
    1. Miller, Eriksson, Fleisher, Wiener-Kronish, Cohen & Young. Miller's Anesthesia, 2-Volume Set, 8th Edition. Chapter 98. Acute Postoperative Pain. 8th Edition. Elsevier Health Sciences; 2010.
    1. White PF. The Role of Non-Opioid Analgesic Techniques in the Management of Postoperative Pain. Anesth Analg. 2002;94:577–85.
    1. Stanley G, Appadu B, Mead M, Rowbotham DJ. Dose requirements, efficacy and side effects of morphine and pethidine delivered by patient-controlled analgesia after gynaecological surgery. Br J Anaesth. 1996;76:484–6.
    1. Woodhouse A, Mather LE. The effect of duration of dose delivery with patient-controlled analgesia on the incidence of nausea and vomiting after hysterectomy. Br J Clin Pharmacol. 1998;45:57–62.
    1. LAURETTI GR. Mecanismos Envolvidos na Analgesia da Lidocaína por Via Venosa. Mechanisms of Analgesia of Intravenous Lidocaine Rev Bras Anestesiol. 2008;58:280–6.
    1. Koppert W1, Ostermeier N, Sittl R, Weidner C, Schmelz M. Low-dose lidocaine reduces secondary hyperalgesia by a central mode of action. Pain. 2000;85:217–24.
    1. Cassuto J, Sinclair R, Bonderovic M. Anti-inflammatory properties of local anaesthetic and their present and potential clinical implications. Acta Anaesthesiol Scand. 2006;50:256–282.
    1. Hollmann MW, Durieux ME. Local anesthetics and the inflammatory response: a new therapeutic indication? Anesthesiology. 2000;93:858–75.
    1. Kang JG, Kim MH, Kim EH, Lee SH. Intraoperative intravenous lidocaine reduces hospital length of stay following open gastrectomy for stomach cancer in men. J Clin Anesth. 2012;24:465–70.
    1. Kaba A, Detroz BJ, Laurent SR, Lamy ML, Joris JL. Acute rehabilitation programme after laparoscopic colectomy using intravenous lidocaine. Acta Chir Belgium. 2005;105:53–8.
    1. Akahokehr A. Intraperitoneal local anesthetic for postoperative pain. Saudi J Anaesth. 2013;7:5.
    1. Gvozdenović L, Pajtić V, Ivanov D, Cvijanović R, Gavrilović S, Gojković Z, et al. Acute postoperative pain relief, by intraperitoneal application of local anesthetics, during laparoscopic cholecystectomy. Health Scien. 2011;1:90–5.
    1. Ng A, Smith G. Intraperitoneal administration of analgesia: is this practice of any utility. Br. J. Anaesth. 2002;89:535–7.
    1. Bucciero M, Ingelmo PM, Fumagalli R, Noll E, Garbagnati A, Somaini M, et al. Intraperitoneal ropivacaine nebulization for pain management after laparoscopic cholecystectomy: a comparison with intraperitoneal instillation. Anesth Analg. 2011;113:1266–71.
    1. Grigoras A, Lee P, Sattar F, Shorten G. Perioperative intravenous lidocaine decreases the incidence of persistent pain after breast surgery. Clin J Pain. 2012;28:567–72.
    1. Khan MR, Raza R, Zafar SN, Shamim F, Raza SA, Pal KM, et al. Intraperitoneal lignocaine (lidocaine) versus bupivacaine after laparoscopic cholecystectomy: Results of a randomized controlled trial. Journal of Surgical Research. 2012;178:662–9.
    1. Williamson KM, Cotton BR, Smith G. Intraperitoneal lignocaine for pain relief after total abdominal hysterectomy. Br J Anaesth. 1997;78:675–7.
    1. Zmora O, Stolik-Dollberg O, Bar-Zakai B, Rosin D, Kuriansky J, Shabtai M, et al. Intraperitoneal bupivacaine does not attenuate pain following laparoscopic cholecystectomy. J Soc Lapar Surg. 2000;4:301–4.
    1. Donatsky AM , Bjerrum F, Gögenur I. Intraperitoneal instillation of saline and local anesthesia for prevention of shoulder pain after laparoscopic cholecystectomy: a systematic review. Surgi Endos. 2013;27:2283–92.
    1. Ali PB, Cotton BR, Williamson KM, Smith G. Intraperitoneal bupivacaine or lidocaine does not provide analgesia after total abdominal hysterectomy. British journal of anesthesia. 1998;80:245–7.
    1. Elfberg BA, Sjövall-Mjöberg S. Intraperitoneal bupivacaine does not effectively reduce pain after laparoscopic cholecystectomy: a randomized, placebo-controlled and double-blind study. Surg Laparosc Endosc Percutan Tech. 2000;10:357–9.
    1. Kaba A, Laurent SR, Detroz BJ, Sessler DI, Durieux ME, Lamy ML, et al. Intravenous lidocaine infusion facilitates acute rehabilitation after laparoscopic colectomy. Anesthesiol. 2007;106:11–8.
    1. Koppert W, Weigand M, Neumann F, Sittl R, Schuettler J, Schmelz M, et al. Perioperative intravenous lidocaine has preventive effects on postoperativepain and morphine consumption after major abdominal surgery. Anesth Analg. 2004;98:1050–5.
    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. Groudine SB, Fisher HA, Kaufman RP, Patel MK, Wilkins LJ, Mehta SA, et al. Intravenous lidocaine speeds the return of bowel function, decreases postoperative pain, and shortens hospital stay in patients undergoing radical retropubic prostatectomy. Anesth Analg. 1998;86:235–9.
    1. Gupta A, Perniola A, Axelsson K, Thorn SE, Crafoord K, Rawal N. Postoperative pain after abdominal hysterectomy: A double-blind comparison between placebo and local anesthetic infused intraperitoneally. Anesth Analg. 2004;99:1173–9.
    1. El-Sherbiny W, Saber W, Askalany AN, El-Daly A, Abdel-aziz seleem A. The Effect of Intraabdominal Instillation of Lidocaine during Gynecological Laparoscopic Procedures. Med J Cairo Univ. 2009;77:97–101.
    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.

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