Effect of intravenous lidocaine infusion on long-term postoperative pain after spinal fusion surgery

Abstract

Background:Intravenous lidocaine infusion is known to reduce postoperative pain for days or weeks beyond the infusion time, and plasma half-life in several types of surgical procedures.Objectives:To evaluate the effect of intravenous (IV) lidocaine infusion on long term postoperative pain intensity for 3 months in patients undergoing spinal fusion surgery.Study Design:Prospective randomized, double-blinded study.Setting:Assiut University Hospital, Assiut, Egypt.Methods:Forty patients undergoing spinal fusion surgery were randomized into 2 equal groups (n = 20 in each). Patients in the lidocaine group received IV lidocaine at a dosage of 2.0 mg/kg slowly before induction of anesthesia, followed by lidocaine IV infusion at a rate of 3.0 mg/kg/h until the end of surgery. Patients in the control group received an equal volume of normal saline. The following data were assessed: pain by Visual Analog Score (VAS) at 1 hour, 6 hours, 12 hours, 24 hours, 48 hours, at discharge time, and at 1 month, 2 months, and 3 months post-operation, time to first request for additional analgesia, and total morphine consumption in 24 hours.Results:Lidocaine significantly reduced the postoperative pain score (VAS) for up to 3 months (P < .05), and significantly reduced morphine consumption (4.5 mg vs. 19.85 mg) in the 1st 24 hours postoperative. Lidocaine also significantly, prolonged (P < .05) the time to first request for additional analgesia (9.56 ± 2.06 hours vs 1.82 ± 0.91 hours).Conclusion:Intra-operative lidocaine, when given intravenously as a bolus followed by an infusion, significantly decreased long term postoperative back pain intensity in patients undergoing spinal fusion surgery.

Application of intravenous lidocaine in patients undergoing operative hysteroscopy: a randomized, double-blind, controlled study

“…To observe postoperative earlier analgesic effect of intravenous lidocaine, another advantage of remifentanil is its ability to avoid interference of using other opioid drugs. Administration of intravenous lidocaine was shown to have an opioid sparing effect during GA, including fentanyl [16], sufentanil [17] and morphine [18]. In a recent study, the remifentanil sparing effect of intravenous lidocaine in the intraoperative period was found [19], which was consistent with our findings.…”

Intravenous lidocaine as a non-opioid adjunct analgesic for traumatic rib fractures

“…In both adjusted and unadjusted analyses, IVL was not significantly associated with opioid use during hospitalization or pain scores during admission hours 24-48. Our findings show conflicting evidence and only partially corroborate previous studies that showed an association between IVL use and decreased opioid utilization after various operations [18][19][20][21][22][23][24]. Notably these studies assessed opioid utilization at different time points after surgery, ranging from 6 hours to up to 72 hours [23,24].…”

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

“…However recent meta-analyzes suggest that lidocaine exerts a positive analgesic effect only in abdominal surgery [11,12]. Benefits of lidocaine usage in spine surgery in adults have not been thoroughly investigated yet [3,16,31,32]. The results of the few studies conducted in the adults population are ambiguous: Farag et al reported that i.v.…”

“…lidocaine significantly improved the postoperative analgesia, and patients undergoing complex spine surgery receiving lidocaine had significantly higher physical SF-12 scores, evaluated one month and three months after surgery than from the placebo group; there were no differences between the groups in PONV intensity and time of hospitalization [3]; Kim et al found that i.v. lidocaine decreased the severity of the postoperative pain, the consumption of opioids and reduced the length of hospital stay after microdiscectomy surgery [32]; Ibrahim et al reported that lidocaine significantly reduced hospitalization time and the postoperative pain for up to three months after spine fusion surgery [16]. Dewiter et al observed no effect of lidocaine on the postoperative pain severity, morphine requirements, PONV, the intensity of the postoperative inflammatory reaction, the hospitalization time and quality of life evaluated one month postoperatively.…”

“…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.…”