Lidocaine infusion adjunct to total intravenous anesthesia reduces the total dose of propofol during intraoperative neurophysiological monitoring

Abstract

Total intravenous anesthesia (TIVA) with propofol and opioids is frequently utilized for spinal surgery where somatosensory evoked potentials (SSEP) and motor evoked potentials (tcMEP) are monitored. Lidocaine infusions can contribute to antinociception and unconsciousness, thus allowing for a reduction in the total dose of propofol. We examined our recent experience with lidocaine infusions to quantify this effect. After institutional review board approval, we conducted a retrospective review of propofol usage in propofol-opioid TIVA (with and without lidocaine) for spine cases monitored with SSEP and tcMEP over a 7 months period. The propofol infusion rate, cortical amplitudes of the SSEP (median nerve, posterior tibial nerve), amplitudes and stimulation voltage of the tcMEP (adductor pollicis brevis, tibialis anterior) were evaluated. The savings of propofol and sufentanil were estimated based on utilization in 50 milliliter (ml) bottles and 5 ml ampules, respectively. 129 cases were evaluated. Propofol infusion rates were reduced with lidocaine infusion from an average of 115-99 μg/kg/min (p = 0.00038) and sufentanil infusions from an average of 0.36-0.29 μg/kg/h (p = 0.0059). This reduction in propofol infusion was also seen when the cases were divided into anterior cervical, posterior cervical, or posterior thoraco-lumbar procedures. No significant differences in the cortical SSEP or tcMEP amplitudes or the tcMEP stimulation voltages used were observed. No complications were associated with the use of the lidocaine infusion. The total estimated drug savings included 104 50 ml bottles of propofol and 5 5 ml ampules of sufentanil. These cases indicate that a lidocaine infusion can be effectively utilized in spine surgery with SSEP and tcMEP monitoring as a means to reduce propofol and sufentanil usage without a negative effect on the monitoring.

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.…”

The effects of general anaesthesia on nerve‐motor response characteristics (rheobase and chronaxie) to peripheral nerve stimulation

“…A subset of the patients received a relatively low dose of intravenous lidocaine; however, the results show that lidocaine had no significant effect on chronaxie or rheobase in anaesthetised patients (Table ). Indeed, previous studies have shown that lidocaine infusion can reduce propofol usage without affecting intra‐operative neurophysiological monitoring . Finally, I attempted to reduce inter‐operator variability using a standardised motor response grading scale.…”

A comparison of the effects of desflurane and total intravenous anaesthesia on the motor evoked responses in scoliosis surgery

“…In a study performed on anaesthesia in scoliosis surgery, lidocaine was added to the propofol infusion in order to decrease the concentration levels of propofol, and cortical SSEPs and tcMEPs were found not to differ significantly. 20 In another two studies, similarly conducted, propofol and dexmedetomidine infusions were administered together, and dexmedetomidine was recommended to be used as a TIVA component associated with propofol, in spinal cases who undergo neurological monitorization. 21 Suvadeep et al have reported that dexmedetomidine-added TIVA leads to a radical lowering of propofol concentrations, with the subsequent occurrence of the required depth of anaesthesia without any complication, and with the correct tcMEP and SSEP data.…”