Systemic intraoperative lidocaine infusion for postoperative pain management in obese patients: A randomized, placebo controlled pilot study

Abstract

Background: Systemic intraoperative lidocaine has been seen to decrease postoperative pain following abdominal surgery, but few studies have examined its use in morbidly obese patients. Objective: We sought to evaluate the safety and effects of intravenous lidocaine in obese patients undergoing laparoscopic Roux-en-Y gastric bypass (RYGB) surgery. Methods: Setting: University-affiliated, private hospital, United States. In this preliminary prospective, double-blinded, and placebo-controlled safety study, we enrolled 21 patients and 20 completed the study. Ten patients were randomly assigned to the study group and received a continuous infusion of lidocaine intravenously from induction of general anesthesia until the end of the operation. Ten other patients were assigned to the control group and received a dextrose placebo intravenously over the same time period. Subjects were followed for 24 hours postoperatively. The primary endpoint was the presence of symptoms of lidocaine toxicity at 1 hour postoperatively. Exploratory outcomes were adverse events, visual analog scale (VAS) pain scores, opioid consumption, time to first passage of flatus and bowel movement, and length of hospital stay. Results: No significant differences were seen between groups for overt signs of lidocaine toxicity or adverse events, opioid consumption, postoperative pain scores, time to first passage of flatus or first bowel movement, or length of hospital. We identified a trend towards less opioid consumption in patients receiving lidocaine. We were underpowered to detect statistical differences due to our pilot study design; addressing safety as the primary outcome measure as opposed to efficacy. Conclusions: In this study, intravenous lidocaine in RYGB surgery was found to be safe without differences in postoperative pain or adverse effects.

Lidocaína al 1% para analgesia posoperatoria en la reparación de hernia inguinal

“…Finalmente, al analizar cada grupo en estudio se evidenció que los pacientes pertenecientes al grupo 2 presentaron mas efectos adversos en 18,7% en comparación al grupo 1 con 0,32%. Sin embargo, estos efectos adversos se observaron en un pequeño porcentaje de los participantes siendo la agitación el efecto adverso que se evidenció con más frecuencia, en contraposición a los hallazgos de Alvey [14] cuyo efecto adverso más frecuente fue el sabor metálico en 19,04%.Se puso especial atención en los posibles efectos secundarios de la lidocaína durante su período de administración, y aunque este tiempo fue muy corto, no se presentaron alteraciones electrocardiográficas, no le dimos oportunidad a que se almacenara el fármaco en el cuerpo, por el tiempo tan corto en que se administró.…”

Continuous surveillance of oxygen saturation and respirations after bariatric surgery

“…Some of this cohort was used in a previous study to evaluate the efficacy of intraoperative lidocaine infusion or placebo for post-operative pain management. [3] Though 10 patients were given lidocaine while under anesthesia and 10 were in the control group and given saline, we analyzed data collectively since the effects of lidocaine dissipated 3 hrs post-operatively. [3] In order to measure respiratory effects, we continuously monitored and recorded S p O 2 and respirations post-surgery using the Masimo Radical 7 Pulse CO-Oximeter.…”

“…[3] Though 10 patients were given lidocaine while under anesthesia and 10 were in the control group and given saline, we analyzed data collectively since the effects of lidocaine dissipated 3 hrs post-operatively. [3] In order to measure respiratory effects, we continuously monitored and recorded S p O 2 and respirations post-surgery using the Masimo Radical 7 Pulse CO-Oximeter. RR and S p O 2 heart rate were continuously monitored and collected from the time of PACU arrival and for the following 24 hrs.…”