A comparison between intravenous lidocaine and ketamine on acute and chronic pain after open nephrectomy: A prospective, double-blind, randomized, placebo-controlled study

Abstract

Background:Recently, there has been increasing interest in the use of analgesic adjuncts such as intravenous (IV) ketamine and lidocaine.Objectives:To compare the effects of perioperative IV lidocaine and ketamine on morphine requirements, pain scores, quality of recovery, and chronic pain after open nephrectomy.Study Design:A prospective, randomized, placebo-controlled, double-blind trial.Settings:The study was conducted in Charles Nicolle University Hospital of Tunis.Methods:Sixty patients were randomly allocated to receive IV lidocaine: bolus of 1.5 mg/kg at the induction of anesthesia followed by infusion of 1 mg/kg/h intraoperatively and for 24 h postoperatively or ketamine: bolus of 0.15 mg/kg followed by infusion of 0.1 mg/kg/h intraoperatively and for 24 h postoperatively or an equal volume of saline (control group [CG]).Measurements:Morphine consumption, visual analog scale pain scores, time to the first passage of flatus and feces, postoperative nausea and vomiting (PONV), 6-min walk distance (6MWD) at discharge, and the incidence of chronic neuropathic pain using the “Neuropathic Pain Questionnaire” at 3 months.Results:Ketamine and lidocaine reduced significantly morphine consumption (by about 33% and 42%, respectively) and pain scores compared with the CG (P < 0.001). Lidocaine and ketamine also significantly improved bowel function in comparison to the CG (P < 0.001). Ketamine failed to reduce the incidence of PONV. The 6 MWD increased significantly from a mean ± standard deviation of 27 ± 16.2 m in the CG to 82.3 ± 28 m in the lidocaine group (P < 0.001). Lidocaine, but not ketamine, reduced significantly the development of neuropathic pain at 3 months (P < 0.05).Conclusion:Ketamine and lidocaine are safe and effective adjuvants to decrease opioid consumption and control early pain. We also suggest that lidocaine infusion serves as an interesting alternative to improve the functional walking capacity and prevent chronic neuropathic pain at 3 months after open nephrectomy.

Adult Cancer Pain, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology

“…Although data supporting the use of intravenous lidocaine for treatment of cancer pain are limited, case reports and smaller studies have been published that support its use for opioid-refractory cancer pain or postsurgical pain. [131][132][133][134] One phase 2, randomized, double-blind crossover study of 50 patients with opioid-refractory cancer pain found that pain relief was better with intravenous lidocaine compared with placebo (P,.001). Additionally, more patients were able to decrease their analgesic requirements after administration of intravenous lidocaine than placebo (P5.0012).…”

“…133 Some reports suggest that intravenous lidocaine may be especially useful for cancer-related neuropathic pain. [132][133][134] Selecting a Route of Administration for Opioid Analgesics and Mixed Mechanism Drugs The least invasive, easiest, and safest route of opioid administration should be provided to ensure adequate analgesia.…”

Lidocaine as an element of multimodal analgesic therapy in major spine surgical procedures in children: a prospective, randomized, double-blind study

“…Recent studies report that perioperative infusion of lidocaine may also have an analgesic effect by affecting postoperative serum concentrations of endocannabinoids, N-acylethanolamines (NAE) and endogenous opioids: β-endorphin, enkephalin and dynorphin [28,29]. Numerous studies and meta-analyzes have shown a positive effect of the perioperative systemic lidocaine administration in adults on the postoperative analgesia, gastrointestinal recovery and duration of hospitalization in major surgery [9,10,13,17,21,30]. However recent meta-analyzes suggest that lidocaine exerts a positive analgesic effect only in abdominal surgery [11,12].…”

“…Recently, it has been reported that lidocaine also beneficially supplements therapy aiming at improving patient comfort in the postoperative period [9][10][11][12][13][14][15][16][17]. However, there are no studies evaluating the intravenous (i.v) lidocaine as an element of analgesic multimodal therapy in spine surgery in children.…”

The Effect of Intravenous Infusion of Lidocaine to Control Postoperative Pain After Gynecologic Laparoscopic Surgery: A Randomized Double-Blind Placebo-Controlled Clinical Trial

“…However, a recent study showed that although lidocaine may give rise to a mean reduction of 0.8 to 0.3 in VAS at 1 to 4 hours and 24 hours, no difference could be expected after 24 hours of surgery (7). Lidocaine is shown to also be effective after open surgery as well as tonsillectomy, arthroplasty, coronary artery bypass surgery, supratentorial tumor surgery, and nephrectomy; nevertheless, well-documented detailed evidence has not been reported on its effect after laparoscopic surgery (17)(18)(19)(20)(21). Furthermore, there have been studies, such as that by Gregory L Bryson showing no effect for lidocaine infusion on postoperative pain (5).…”