Efficacy of Lidocaine Infusion in High-Risk Vascular Surgery—A Randomized, Double-Blind, Placebo-Controlled Single-Center Clinical Trial

Abstract

Background: In perioperative pain control, adjuvants such as lidocaine can reduce opioid consumption in a specific type of surgery. The aim of this single-center prospective double-blinded randomized controlled trial was to determine opioid consumption in the perioperative period in patients receiving continuous lidocaine infusion. Methods: Patients undergoing elective abdominal aorta and/or iliac arteries open surgery were randomized into two groups to receive 1% lidocaine or placebo at the same infusion rate based on ideal body weight (bolus of 0.15 mL/kg during the induction of anesthesia followed by continuous infusion of 0.2 mL/kg/h during surgery; postoperatively 0.1 mL/kg/h for 24 h) additionally to standard opioid analgesia. Results: Total opioid consumption within 24 h after surgery was 89.2 mg (95%CI 80.9–97.4) in the lidocaine and 113.1 mg (95%CI 102.5–123.6) in the placebo group (p = 0.0007). Similar findings were observed in opioid consumption intraoperatively (26.7 mg (95%CI 22.2–31.3) vs. 35.1 mg (95%CI 29.1–41.2), respectively, p = 0.029) and six hours postoperatively (47.5 mg (IQR 37.5–59.5) vs. 60 mg (IQR 44–83), respectively, p = 0.01). Conclusions: In high-risk vascular surgery, lidocaine infusion as an adjunct to standard perioperative analgesia is effective. It may decrease opioid consumption by more than 20% during the first 24 h after surgery, with no serious adverse effects noted during the study period.

Effect of lidocaine on intraoperative blood pressure variability in patients undergoing major vascular surgery

“…The data collected from the study by Gajniak et al involved patients undergoing subrenal major aortic surgery [ 11 ]. In the original study no differences were observed between the groups considering comorbidities, surgical techniques and depth of anesthesia.…”

“…We performed a post-hoc analysis of the data collected during the previous randomized clinical trial by Gajniak et al carried out at the university hospital in Poland between February 2019 and July 2022 [ 11 ]. The original study was approved by the Medical University of Silesia’s Ethics Committee in Katowice, Poland (KNW/0022/KB1/1/19) and registered at ClinicalTrials.gov (registration number NCT04691726).…”

“…One of the drugs used in multimodal analgesia is lidocaine, administered as a continuous intravenous infusion. Its effectiveness was demonstrated mainly in abdominal surgery including major vascular surgery [ 10 , 11 ]. Therefore, we sought to verify whether the use of intravenous lidocaine may affect intraoperative BPV in patients undergoing major vascular procedures performed using the classical (open) technique.…”

“…This is a secondary analysis of our primary study on efficacy and safety of lidocaine in this clinical scenario [ 11 ].…”