Continuous intravenous lidocaine in the treatment of paralytic ileus due to severe spinal cord injury

Abstract

Paralytic ileus is a major concern in the acute phase of spinal cord injury. Classical treatment with neostigmine is often ineffective. Continuous intravenous (i.v.) lidocaine infusion has been previously proposed intra and post-operatively in order to decrease the duration of post-operative ileus after abdominal surgery. We report the cases of seven patients suffering from complete paralytic spinal cord injury-related ileus with colectasy resistant to neostigmine, who were treated by i.v. lidocaine infusion.

Transversus abdominis plane block or intravenous lignocaine in open prostate surgery: a randomized controlled trial

“…Patients and procedures characteristics did not differ between groups ( Table 1). Cumulative piritramide consumption after 48 h was 28 [23] mg in the control group, 21 [29] mg in the TAP block group and 21 [31] mg in the lignocaine group (P = 0.15, Fig. 2).…”

“…The systematic administration of paracetamol is likely to have reduced opioid requirements in all study groups and thereby may have attenuated the benefit of the TAP block and of the intravenous infusion of lignocaine. 21 It can be hypothesized that ketorolac and lignocaine have synergistically reduced bowel inflammation and favoured the recovery of the bowel function. The authors of this meta-analysis also established that the cumulative opioid-sparing effect of the TAP block was 11 mg after 24 h, which they qualified marginal and of questionable clinical relevance.…”

“…Rather, the effect of lignocaine on the recovery of bowel function is thought to be related to its anti-inflammatory effects 20 or to a direct effect on enteric sympathetic plexus. 21 It can be hypothesized that ketorolac and lignocaine have synergistically reduced bowel inflammation and favoured the recovery of the bowel function. The fact that we did not give non-steroidal anti-inflammatory drugs and that we observed no opioid-sparing effect with intravenous lignocaine could account for the lack of effect on the recovery of bowel function.…”

“…Secondary endpoints included pain scores at rest and upon coughing, need for rescue tramadol, incidence of post-operative nausea and vomiting (PONV), recovery of bowel function and incidence of bladder catheter-related discomfort. Results: Cumulative piritramide consumption after 48 h was 28 [23] mg in the control group, 21 [29] mg in the TAP group and 21 [31] mg in the lignocaine group (P = 0.065). There was no significant difference in post-operative pain scores between groups.…”

Intravenous lignocaine for treatment of refractory ileus following spinal cord injury

“…Lidocaine may improve smooth muscle contractility and basic cell function by cellular repair mechanisms which are still unknown. [2] Neostigmine has been suggested as one of the therapeutic modality for refractory ileus in spinal cord injured patient. [3] However, we did not use neostigmine for the treatment of ileus in our patient as there was chance of deleterious effects of neostigmine in spinal cord injured patients who may be prone to autonomic disturbance and bradycardia.…”