Perioperative Use of Intravenous Lidocaine

Abstract

Lidocaine is an amide local anaesthetic initially used intravenously as an antiarrhythmic agent. At some point it was proposed that intravenous lidocaine (IVL) had an analgesic effect that could be potentially beneficial in perioperative settings. Since these preliminary reports, a large body of evidence confirmed that IVL had anti-inflammatory and opiate-sparing effects, a combination of characteristics leading to an array of effects such as a decrease in postoperative pain and opiate consumption, and a reduction in the duration of digestive ileus. Additional studies demonstrated IVL to possess antithrombotic, antimicrobial and antitumoral effects. Beneficial effects of IVL have been characterized in abdominal surgery but remain controversial in other types of surgeries. Because the quality of evidence was limited, due to inconsistency, imprecision and study quality, recent conclusions from meta-analysis pooling together all types of surgery stated the uncertainty about IVL benefits. Additional indications such as the prevention of propofol-induced injection pain, prevention of hyperalgesia, protection against bronchial reactivity by bronchotracheal relaxation during surgery, and the increase in depth of general anaesthesia have since emerged. IVL is rapidly distributed in the body and metabolized by the liver. With the commonly recommended doses, lidocaine's therapeutic index remains very high and the plasma concentrations stay largely below the cardiotoxic and neurotoxic threshold levels, a notion that may be used by clinicians to draw conclusions on the benefit-risk profile of IVL in comparison to other analgesic strategies. The purpose of this review is to address the pharmacokinetic and pharmacodynamic properties of lidocaine in healthy and pathological conditions.

<p>Application of Intravenous Lidocaine in Obese Patients Undergoing Painless Colonoscopy: A Prospective, Randomized, Double-Blind, Controlled Study</p>

“…Compared with non-obese patients, the elimination half-life of lidocaine in obese patients was markedly prolonged, 46 primarily due to the increase in the absolute volume of distribution induced by higher body weight. 47 However, there are rare clinical reports of adverse effects of prolonged elimination half-life in obese patients. In addition, all patients in group L were observed closely during the perioperative period, and none of them showed cardiovascular toxicity (eg, increasing intervals, widening QRS complex) or any symptoms of toxicity (eg, dizziness, drowsiness, oral metal odor, mouth paresthesia, blurred vision).…”

Effect of ketamine combined with lidocaine in pediatric anesthesia

“…Besides, intravenous lidocaine before operation exhibited its preventive effect on propofol-induced injection pain and hyperalgesia, and subsequently protected against bronchial reactivity due to bronchotracheal relaxation during the operation, consequently resulting in the increase in depth of general anesthesia. 12 A double-blind and randomized study performed by Jendoubi et al 13 flagged the use of intravenous lidocaine and ketamine as safe and effective adjuvants to decrease opioid consumption and for early pain management after open nephrectomy procedure. Moreover, pretreatment with lidocaine (20 mg) and ketamine (5 mg) with venous occlusion for 1 minute is the most effective in attenuating the pain on propofol injection vs pretreatment with the lidocaine combined with metoclopramide or plain lidocaine.…”

“Minimally invasive” regional anesthesia and the expanding use of interfascial plane blocks: the need for more systematic evaluation

“…This is particularly important as certain local anesthetics such as lidocaine have clearly exhibited powerful analgesic effects when given intravenously. 29 Hence, anatomical and radiological studies are designed to explain the plausibility of a technique and do not account for live tissue characteristics, anatomical variability, performer learning curve, or observer bias. Despite the weaknesses of these anatomical studies, one key lesson from them is that there appears to be considerable variability in injectate spread.…”

“…Ceci est particulièrement important étant donné que certains anesthésiques locaux, tels que la lidocaïne, ont clairement démontré des effets analgésiques puissants lors de leur administration intraveineuse. 29 Par conséquent, les études anatomiques et radiologiques ont pour objet d'expliquer la plausibilité d'une technique et ne tiennent pas compte des caractéristiques des tissus vivants, de la variabilité anatomique, de la courbe d'apprentissage de l'opérateur, ou du biais de l'observateur. Malgré les écueils de ces études anatomiques, l'important est qu'il semble y avoir une variabilité considérable dans la dispersion du produit injecté.…”