Intravenous lidocaine administration is gaining interest as adjuvant in post-operative pain control. Its use has been proven to be safe and effective in abdominal, breast, spinal surgery, and, more recently, also in thoracic surgery. Lidocaine aids reducing opioid consumption, that could contribute to post-operative pulmonary complications and may be implicated in cancer recurrence.
We conducted a pilot case-control study to investigate if such findings would be confirmed in our clinical practice.
Key words: intravenous lidocaine, post-operative pain, opioid consumption
We selected 20 patient undergoing lobectomy or segmentectomy via minithoracotomy or biportal VATS.
In 10 patients (Lidocaine group), before induction of general anesthesia, we administered an intravenous bolus of Lidocaine (1,5 mg/kg), followed by a continuous intraoperative infusion (2 mg/kg/h) maintained up to 2 h after surgery. The patients previously described received also usual post-operative Morphine therapy. Other 10 patients (Control group), received only usual post-operative Morphine therapy. In nearly all patients of both groups, locoregional anesthesia by extemporaneous paravertebral or intercostal nerve block with levobupivacaine was performed by the surgeon before the end of surgery.
Intraoperative analgesia management was standardized using Remifentanil.
We assessed the post-operative pain by using the Numeric Rating Scale (NRS) at rest (static) and during movement (dynamic), and opioid consumption normalized to body weight, at the arrival in the Recovery Room (RR, time 0) and 2, 6, 12, 24 and 48 hours post-operatively.
Lidocaine related side effects were recorded as well.
There was no statistical difference between the two group in regard to demographic data and comorbities, surgical procedure and the locoregional techniques employed were comparable to.
No Lidocaine side effects were detected.
Lidocaine group showed a slighty lower static NRS compared to the Control group at RR arrival (p=0,0503). The maximum registered static and dynamic NRS during observation period did not differ between the two groups (p=0,0782 and p=0,2022, respectively), with evidence of an adequate pain control in both groups.
This satisfactory pain control was achieved by using significant less Morphine at 2, 6 and 12 h postoperatively in Lidocaine group (p=0,0376 p=0,0376 p=0,0494, respectively). Morphine consumption was lower in Lidocaine group also at 24 h (median [Interquartile range]: 0,4715 [0,3750-0,5700] vs 0,6250 [0,4000-0,6300] mg/kg; p=0,0538) and at 48 h (0,4915 [0,4210-0,7810] vs 0,7680 [0,5600-0,8890] mg/kg; p=0,0588), although it did not reach statistical significance.
The Morphine starter bolus, given 30 minutes before the end of surgery, was comparable in the two groups (p=0,1207). Excluding it from post-operative Morphine consumption count, a significantly lower Morphine consumption in Lidocaine group at 24h was found (0,2705 [0,1630-0,3750] vs 0,4120 [0,1880-0,4210], p=0,0494).
Intravenous Lidocaine administration seems to be safe and effective in achieving a good post-operative pain control in thoracic surgery, associated to a lower opioid consumption. Further studies are needed to confirm these findings on a larger scale.
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