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Soriano PBO, Haselhuhn JJ, Resch JC, Fischer GA, Swanson DB, Holton KJ, Polly DW. Postoperative use and early discontinuation of intravenous lidocaine in spine patients. Spine Deform 2024; 12:141-148. [PMID: 37610553 DOI: 10.1007/s43390-023-00753-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/05/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE Our institution employs a multimodal approach to manage postoperative pain after spine surgery. It involves continuous intravenous (IV) lidocaine until the morning of postoperative day two. This study aimed to determine the rate and reasons for early discontinuation of IV lidocaine in our spine patients. METHODS We conducted a retrospective chart review and included pediatric patients who underwent ≥ 3-level spine surgery and received postoperative IV lidocaine from November 2019 to September 2022. For each case, we recorded the side effects of IV lidocaine, adverse events, time to discontinuation, and discontinuation rate. Subsequently, we used the same methodology to generate an adult cohort for comparison. RESULTS We included 52 pediatric (18M:34F) and 50 (21M:29F) adult patients. The pediatric cohort's mean age was 14 years (8-18), and BMI 23.9 kg/m2 (13.0-42.8). The adult cohort's mean age was 61 years (29-82), and BMI 28.8 kg/m2 (17.2-44.1). IV lidocaine was discontinued prematurely in 21/52 (40.4%) of the pediatric cases and 26/50 (52.0%) of the adult cases (RR = 0.78, p = 0.2428). The side effects noted in the pediatric cases vary, including numbness, visual disturbance, and obtundation, but no seizures. The most common adverse events were fever and motor dysfunction. CONCLUSION The early discontinuation rate of IV lidocaine use after spine surgery for children in our institution does not differ significantly from that of adults. The nature of the side effects and the reasons for discontinuation between the groups were similar. Thus, the safety profile of IV lidocaine for pediatric spine patients is comparable to adults.
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Affiliation(s)
- Paul Brian O Soriano
- Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA
| | - Jason J Haselhuhn
- Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA.
| | - Joseph C Resch
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Gwenyth A Fischer
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Dana B Swanson
- Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA
| | - Kenneth J Holton
- Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA
| | - David W Polly
- Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA.
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA.
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Cukierman DS, Cata JP, Gan TJ. Enhanced recovery protocols for ambulatory surgery. Best Pract Res Clin Anaesthesiol 2023; 37:285-303. [PMID: 37938077 DOI: 10.1016/j.bpa.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION In the United States, ambulatory surgeries account for up to 87% of all surgical procedures. (1) It was estimated that 19.2 million ambulatory surgeries were performed in 2018 (https://www.hcup-us.ahrq.gov/reports/statbriefs/sb287-Ambulatory-Surgery-Overview-2019.pdf). Cataract procedures and musculoskeletal surgeries are the most common surgical interventions performed in ambulatory centers. However, more complex surgical interventions, such as sleeve gastrectomies, oncological, and spine surgeries, and even arthroplasties are routinely performed as day cases or in a model of an ambulatory extended recovery. (2-5) The ambulatory surgery centers industry has grown since 2017 by 1.1% per year and reached a market size of $31.2 billion. According to the Ambulatory Surgery Center Association, there is a potential to save $57.6 billion in Medicare costs over the next decade (https://www.ibisworld.com/industry-statistics/market-size/ambulatory-surgery-centers-united-states/). These data suggest an expected rise in the volume of ambulatory (same day) or extended ambulatory (23 h) surgeries in coming years. Similar increases are also observed in other countries. For example, 75% of elective surgeries are performed as same-day surgery in the United Kingdom. (6) To reduce costs and improve the quality of care after those more complex procedures, ambulatory surgery centers have started implementing patient-centered, high-quality, value-based practices. To achieve those goals, Enhanced Recovery After Surgery (ERAS) protocols have been implemented to reduce the length of stay, decrease costs, increase patients' satisfaction, and transform clinical practices. The ERAS fundamentals for ambulatory surgery are based on five pillars, including (1) preoperative patient counseling, education, and optimization; (2) multimodal and opioid-sparing analgesia; (3) nausea and vomiting, wound infection, and venous thromboembolism prophylaxis; (4) maintenance of euvolemia; and (5) encouragement of early mobility. Those pillars rely on interdisciplinary teamwork led by anesthesiologists, surgery-specific workgroups, and safety culture. (2) Research shows that a team of ambulatory anesthesiologists is crucial in improving postoperative nausea and vomiting (PONV) and pain control. (7) This review will summarize the current evidence on the elements and clinical importance of implementing ERAS protocol for ambulatory surgery.
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Affiliation(s)
- Daniel S Cukierman
- Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA; Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA
| | - Juan P Cata
- Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA; Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA
| | - Tong Joo Gan
- Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA.
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Pillai AK, Guzzi J, Treggiari MM, Yanez ND, Hyman JB. Comparison of electronic versus phone-based administration of the Quality of Recovery-40 survey after ambulatory surgery. J Clin Anesth 2023; 86:111054. [PMID: 36641953 DOI: 10.1016/j.jclinane.2023.111054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 12/22/2022] [Accepted: 01/08/2023] [Indexed: 01/15/2023]
Abstract
STUDY OBJECTIVE Studies that track patient-centered outcomes are better suited to evaluate the relative benefits and harms of an intervention in ambulatory surgery as severe morbidity and mortality have become increasingly rare. This pilot study aimed to assess for differences in response rate and survey scores for phone-based and electronic administration of the Quality of Recovery-40 (QoR-40) survey in patients undergoing general anesthesia for ambulatory surgery. DESIGN A single-center prospective observational study. SETTING Yale New Haven Hospital (September 22-November 2, 2021). PATIENTS 100 consecutive patients undergoing ambulatory surgery under general anesthesia. INTERVENTIONS Patients were randomized to receive QoR-40 surveys via email or phone. MEASUREMENTS The QoR-40 survey is a 40-item questionnaire that provides a global score across five dimensions: patient support, comfort, emotions, physical independence, and pain. The primary outcome was the response rate following the administration of the QoR-40 survey on postoperative days 1, 2, and 7. The secondary outcome was the mean QoR-40 score during the study period. MAIN RESULTS A total of 109 patients consented to participate and 100 patients were randomized in this study. A total of 76%, 72%, and 68% of patients completed the survey on POD 1, 2, and 7, respectively. There were no differences in the response rate of patients who completed the survey between phone (78%) versus electronic (74%) administration (difference 4%, 95% confidence interval (CI): -13%, 21%, respectively) on POD 1, 2 (74% vs 70%, difference 4%, 95% CI -14%, 22%, respectively) or 7 (68% vs 68%, difference 0%, 95% CI -18%, 18%, respectively). The mean (standard deviation) QoR-40 score was 176.2 (18.1), 179.8 (19.4), 187.7 (13.1) on POD 1, 2, and 7, respectively. There were no significant differences in the mean QoR-40 scores between groups at any of the time points. CONCLUSION The response rate following the electronic administration of the QoR-40 survey did not differ from the phone-based administration during the postoperative period following ambulatory surgery. The use of an electronic version of the survey may allow for larger sample sizes with fewer resources utilized in future interventional studies.
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Affiliation(s)
| | - John Guzzi
- Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, TMP 3, New Haven, CT 06510, USA
| | - Miriam M Treggiari
- Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, TMP 3, New Haven, CT 06510, USA
| | - N David Yanez
- Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, TMP 3, New Haven, CT 06510, USA
| | - Jaime B Hyman
- Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, TMP 3, New Haven, CT 06510, USA.
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Omidvar S, Ebrahimi F, Amini N, Modir H, Kia MK, Rahmaty B, Zarei A. Comparing the Effect of Ketamine and Lidocaine on Agitation and Pain in Rhinoplasty: A Randomized Clinical Trial. J Cutan Aesthet Surg 2023; 16:107-113. [PMID: 37554677 PMCID: PMC10405540 DOI: 10.4103/jcas.jcas_205_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
Background Emergence agitation (EA) is an important clinical problem that occurs during the initial period of recovery from anesthesia. This study aimed to determine the effects of ketamine and lidocaine administered on agitation level, postoperative pain, and hemodynamic changes in adults after rhinoplasty. Materials and Methods Totally 72 patients scheduled to undergo elective rhinoplasty were enrolled in this prospective study. Patients were randomly divided into three groups including control group (n = 24), ketamine group (n = 24), and lidocaine group (n = 24). Twenty minutes before surgery completion, 1 ml saline was administered intravenously to the saline group, while 0.5 mg/kg ketamine or 1.5 mg/kg lidocaine was administered to two other groups. The emergence agitation level of the patients was evaluated using the Richmond Agitation-Sedation Scale just after extubation and in the post-anesthesia care unit (PACU). Postoperative pain was evaluated by Numerical Rating Scale that scored (from 0 to 10) every 10 min until the patients were discharged from PACU. Results There was a significant difference between EA level between ketamine (P = 0.049) and lidocaine (P = 0.019) groups compared to the control group, and there was a significant difference between pain level between the ketamine (P = 0.008) and lidocaine (P = 0.035) groups compared the to control group, while there was no significant difference between the level of agitation (P = 0.922) and level of pain (P = 0.845) after extubation between the ketamine and lidocaine groups. Conclusion Ketamine and lidocaine are highly effective in preventing EA and pain control. Further studies with a greater sample size and longer follow-up period are needed to confirm the current findings.
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Affiliation(s)
- Safoora Omidvar
- Department of Paramedicine, Arak University of Medical Sciences, Arak, Iran
| | - Fatemeh Ebrahimi
- Department of Paramedicine, Arak University of Medical Sciences, Arak, Iran
| | - Nazanin Amini
- Department of Paramedicine, Arak University of Medical Sciences, Arak, Iran
| | - Hesameddin Modir
- Department of Anesthesiology, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran
| | | | - Benyamin Rahmaty
- Department of ENT, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Aref Zarei
- Student Research Committee, Arak University of Medical Sciences, Arak, Iran
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Xu S, Liu N, Yu X, Wang S. Effect of co-administration of intravenous lidocaine and dexmedetomidine on the recovery from laparoscopic hysterectomy: a randomized controlled trial. Minerva Anestesiol 2023; 89:10-21. [PMID: 35766956 DOI: 10.23736/s0375-9393.22.16522-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Some evidences have reported that intravenous lidocaine and dexmedetomidine alone can improve the quality of recovery after surgery. The main purpose of our study to explore whether co-administration of lidocaine and dexmedetomidine infusion could further improve the quality of recovery after laparoscopic hysterectomy compared to either lidocaine or dexmedetomidine administration. METHODS A total of 160 subjects were randomly allocated to four groups: the control group (group C) received an equal volume of normal saline, the lidocaine group (group L) received lidocaine (1.5 mg/kg for bolus over 10 min before induction of anesthesia, 1.5 mg/kg/h for continuous infusion), the dexmedetomidine group (group D) received dexmedetomidine (0.5 µg/kg for bolus over 10 min before induction of anesthesia, 0.4 µg/kg/h for continuous infusion), the lidocaine plus dexmedetomidine group (group LD) received lidocaine (1.5 mg/kg for bolus over 10 min before induction of anesthesia, 1.5 mg/kg/h for continuous infusion) and dexmedetomidine combined infusion (0.5 µg/kg for bolus over 10 minutes before induction of anesthesia, 0.4 µg/kg/h for continuous infusion). The primary endpoint was the quality of recovery-40 (QoR-40) scores on postoperative day 1 (POD1). The quality of sleep on POD1, remifentanil total dose, visual analog scale (VAS) pain scores, the number of patients with self-press the pump, time to open eye and extubation, length of postanesthesia care unit (PACU) stay, the incidence of intraoperative bradycardia, hypotension, arrhythmias, hypoxemia in the PACU, and nausea or vomiting within 24 h after surgery were regarded as the secondary outcomes. RESULTS The total QoR-40 scores were significantly increased in groups L, D, and LD on POD1 compared with group C (all P<0.05). The total QoR-40 scores were the highest in group LD on POD1 compared to other three groups (all P<0.001). Sleep quality was significantly improved in group LD compared to other three groups on POD1 (all P<0.05). The VAS pain scores were obviously reduced at 8 h in group L and at 4, 8 h in group D after surgery compared to group C and were the lowest in group LD (all P<0.05). The number of patients with self-press the pump was significantly reduced in groups D and LD compared to group C (8(20.0%) and 27(67.5%), P<0.001; 2(5.0%) and 27(67.5%), P<0.001, respectively). Length of PACU stay significantly prolonged in groups D (21.7±3.0) and LD (25.5±4.0) compared to group C (19.6±3.3) (P=0.028, P<0.001). The incidence of intraoperative bradycardia was significantly higher in groups D and LD than in groups C and L (all P<0.001). The rate of hypoxemia was higher in groups D (55.0%) and LD (70.0%) than in groups C (15.0%) and L (20.0%) (all P<0.05). The incidence of nausea was lower in group LD (10.0%) than in group C (37.5%) (P<0.05). CONCLUSIONS Co-administration of lidocaine plus dexmedetomidine infusion improved to some extent the quality of recovery on POD1 compared to lidocaine and dexmedetomidine alone, but it significantly increased the incidence of intraoperative bradycardia and hypoxemia in the PACU, and prolonged the length of PACU stay.
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Affiliation(s)
- Siqi Xu
- Department of Anesthesiology, The Affiliated Anqing Hospital of Anhui Medical University, Anqing, China
| | - Ning Liu
- Department of Anesthesiology, The Affiliated Anqing Hospital of Anhui Medical University, Anqing, China
| | - Xitong Yu
- Department of Anesthesiology, The Affiliated Anqing Hospital of Anhui Medical University, Anqing, China
| | - Shengbin Wang
- Department of Anesthesiology, The Affiliated Anqing Hospital of Anhui Medical University, Anqing, China -
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Nongnuang K, Limprasert N, Munjupong S. Can intravenous lidocaine definitely attenuate propofol requirement and improve outcomes among colonoscopic patients under intravenous sedation?: A double-blinded, randomized controlled trial. Medicine (Baltimore) 2022; 101:e30670. [PMID: 36181015 PMCID: PMC9524969 DOI: 10.1097/md.0000000000030670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Propofol-sparing effect of lidocaine has not been fully elucidated because propofol is usually mixed with many medications in anesthetic practice. Therefore, the study aimed to verify the additive effect of intravenous lidocaine to propofol without other sedative medications and control the depth of anesthesia using the bispectral index (BIS) during colonoscopy in a prospective, randomized, double-blinded controlled trial. METHODS Sixty-eight patients scheduled and undergoing colonoscopy were randomly allocated to receive intravenous lidocaine (1.5 mg/kg then 4 mg/kg/h) (Group L) or a similar volume of normal saline (Group C) with propofol administration guided by BIS monitoring. The primary outcome was total propofol requirements between group comparisons. The secondary outcomes included the number of hypoxemic periods, hemodynamic changes, duration in returning of BIS > 85, sedation scores, pain scores, postoperative opioid requirement, and patient satisfaction between group comparisons. RESULTS Intravenous lidocaine showed significantly reduced total propofol use (151.76 ± 50.78 mg vs 242.06 ± 50.86 mg, Group L vs Group C, respectively, P < .001). Duration in returning to BIS > 85, sedation scores, and patient satisfaction scores were significantly superior in Group L (P < .05). The number of hypoxemic episodes, changes of hemodynamic response, pain scores, and postoperative opioid requirement were similar in both groups. No adverse effects were detected in both groups. CONCLUSION Intravenous lidocaine produced a definitely effective reduced propofol requirement without other sedative agents and improved outcomes including patient satisfaction, duration in returning to BIS > 85, and sedation score during colonoscopy without adverse effects.
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Affiliation(s)
- Krisana Nongnuang
- Department of Anesthesiology, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Natirat Limprasert
- Department of Anesthesiology, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Sithapan Munjupong
- Department of Anesthesiology, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
- *Correspondence: Sithapan Munjupong, Department of Anesthesiology, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok 10400, Thailand (e-mail: )
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Zhang J, Kong L, Ni J. ED50 and ED95 of Propofol Combined with Different Doses of Intravenous Lidocaine for First-Trimester Uterine Aspiration: A Prospective Dose-Finding Study Using Up-and-Down Sequential Allocation Method. Drug Des Devel Ther 2022; 16:3343-3352. [PMID: 36199630 PMCID: PMC9527702 DOI: 10.2147/dddt.s382412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/15/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose This study aimed to test the effect of different doses of intravenous lidocaine on the median effective dose (ED50) and 95% effective dose (ED95) of propofol-induction dose and identify the optimal dose. Patients and Methods Patients undergoing first-trimester uterine aspiration were screened and randomly enrolled into the following groups: saline (L0), 0.5 mg/kg lidocaine (L0.5), 1.0 mg/kg lidocaine (L1.0), and 1.5 mg/kg lidocaine (L1.5). Anesthesia was induced with 1.0 µg/kg fentanyl. Prepared lidocaine or saline solution was injected later according to allocation, followed by propofol. The dose of propofol for each patient was determined using the up-and-down sequential study design. The primary end point was the ED50 and ED95 of the propofol-induction dose. The total propofol doses, awakening time, and adverse events were recorded. Results The ED50 (95% confidence interval) of propofol was significantly lower in groups L1.0 and L1.5 than group L0 (1.6 [1.5–1.7] mg/kg and 1.8 [1.6–1.9] mg/kg, versus 2.4 [2.3–2.5] mg/kg, respectively; p<0.001). There was no significant difference in ED50 between groups L1.0 and L1.5 (p>0.05). However, surprisingly, the ED50 was significantly higher in group L0.5 than L0 (2.8 [2.6–3.0] mg/kg vs 2.4 [2.3–2.5] mg/kg; p<0.05). The total doses of propofol in groups L1.0 and L1.5 were lower than those in groups L0 and L0.5 (p<0.05). The systolic blood pressure (SBP) decline after anesthesia induction in group L0.5 was greater than that in group L0 (p<0.01). The incidence of respiratory depression in group L0.5 was greater than that in groups L0 and L1.0 (p<0.05). Conclusion In patients who underwent first-trimester uterine aspiration, intravenous lidocaine 1.0 mg/kg prior to propofol injection significantly reduced the ED50 of propofol induction dose without severe side effects, equivalent to the effect of 1.5 mg/kg dose. We recommend 1.0 mg/kg as the optimal dose.
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Affiliation(s)
- Jingwen Zhang
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People’s Republic of China
| | - Linglingli Kong
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People’s Republic of China
| | - Juan Ni
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People’s Republic of China
- Correspondence: Juan Ni, Department of Anesthesiology, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, No. 20, Section 3, South of Renmin Road, Chengdu, Sichuan, 610041, People’s Republic of China, Tel +86 18180609890, Fax +86 2885503752, Email
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Jaensson M, Nilsson U, Dahlberg K. Postoperative recovery: how and when is it assessed: a scoping review. Br J Anaesth 2022; 129:92-103. [PMID: 35623904 DOI: 10.1016/j.bja.2022.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/28/2022] [Accepted: 04/19/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND There is no consensus about the type of instrument with which to assess postoperative recovery or the time points when assessments are most appropriate. It is also unclear whether instruments measure the four dimensions of postoperative recovery, that is physical, psychological, social, and habitual recovery. This scoping review had three objectives: (1) to identify and describe instruments used in clinical trials to assess postoperative recovery; (2) to determine how, when, and the number of times postoperative recovery was measured; and (3) to explore whether the four dimensions of postoperative recovery are represented in the identified instruments. METHODS A literature search was conducted in CINAHL, MEDLINE, and Web of Science. The search terms were related to three search strands: postoperative recovery, instrument, and clinical trials. The limits were English language and publication January 2010 to November 2021. In total, 5015 studies were identified. RESULTS A total of 198 studies were included in the results. We identified 20 instruments measuring postoperative recovery. Different versions of Quality of Recovery represented 81.8% of the included instruments. Postoperative recovery was often assessed at one time point (47.2%) and most often on postoperative day 1 (81.5%). Thirteen instruments had items covering all four dimensions of postoperative recovery. CONCLUSIONS Assessing recovery is important to evaluate and improve perioperative care. We emphasise the importance of choosing the right instrument for the concept studied and, if postoperative recovery is of interest, of assessing more than once. Ideally, instruments should include all four dimensions to cover the whole recovery process.
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Affiliation(s)
- Maria Jaensson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Ulrica Nilsson
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden; Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden
| | - Karuna Dahlberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
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Prabhakar NK, Chadwick AL, Nwaneshiudu C, Aggarwal A, Salmasi V, Lii TR, Hah JM. Management of Postoperative Pain in Patients Following Spine Surgery: A Narrative Review. Int J Gen Med 2022; 15:4535-4549. [PMID: 35528286 PMCID: PMC9075013 DOI: 10.2147/ijgm.s292698] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 04/20/2022] [Indexed: 11/23/2022] Open
Abstract
Perioperative pain management is a unique challenge in patients undergoing spine surgery due to the increased incidence of both pre-existing chronic pain conditions and chronic postsurgical pain. Peri-operative planning and counseling in spine surgery should involve an interdisciplinary approach that includes consideration of patient-level risk factors, as well as pharmacologic and non-pharmacologic pain management techniques. Consideration of psychological factors and patient focused education as an adjunct to these measures is paramount in developing a personalized perioperative pain management plan. Understanding the currently available body of knowledge surrounding perioperative opioid management, management of opioid use disorder, regional/neuraxial anesthetic techniques, ketamine/lidocaine infusions, non-opioid oral analgesics, and behavioral interventions can be useful in developing a comprehensive, multi-modal treatment plan among patients undergoing spine surgery. Although many of these techniques have proved efficacious in the immediate postoperative period, long-term follow-up is needed to define the impact of such approaches on persistent pain and opioid use. Future techniques involving the use of precision medicine may help identify phenotypic and physiologic characteristics that can identify patients that are most at risk of developing persistent postoperative pain after spine surgery.
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Affiliation(s)
- Nitin K Prabhakar
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
| | - Andrea L Chadwick
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Chinwe Nwaneshiudu
- Department of Anesthesiology, Perioperative and Pain Management, Mount Sinai Hospital, Icahn School of Medicine, New York, NY, USA
| | - Anuj Aggarwal
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, CA, USA
| | - Vafi Salmasi
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, CA, USA
| | - Theresa R Lii
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, CA, USA
| | - Jennifer M Hah
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, CA, USA
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Zhao K, Dong Y, Su G, Wang Y, Ji T, Wu N, Cui X, Li W, Yang Y, Chen X. Effect of Systemic Lidocaine on Postoperative Early Recovery Quality in Patients Undergoing Supratentorial Tumor Resection. Drug Des Devel Ther 2022; 16:1171-1181. [PMID: 35496368 PMCID: PMC9041358 DOI: 10.2147/dddt.s359755] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/06/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Lidocaine has been gradually used in general anesthesia. This study was designed to investigate the effect of systemic lidocaine on postoperative quality of recovery (QoR) in patients undergoing supratentorial tumor resection, and to explore its brain-injury alleviation effect in neurosurgical anesthesia. Patients and Methods Sixty adult patients undergoing elective supratentorial tumor resection. Patients were randomly assigned either to receive lidocaine (Group L: 1.5 mg/kg bolus completed 10 min before anesthesia induction followed by an infusion at 2.0 mg/kg/h) or to receive normal saline (Group C: received volume-matched normal saline at the same infusion rate). Primary outcome measures were Quality of Recovery-40 (QoR-40) scores on postoperative day (POD) 1 and 2. Plasma concentrations of S100B protein (S100B), neuron specific enolase (NSE), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) before anesthesia induction and at the end of surgery were assessed. Visual Analogue Scale (VAS) scores were assessed at 1, 2, 6, 12, 24 and 48 h after surgery. Perioperative parameters and adverse events were also recorded. Results Patients between two groups had comparable baseline characteristics. Global QoR-40 scores on POD 1 and POD 2 were significantly higher (P <0.001) in group L (165.5±3.8 vs 173.7±4.7) than those in group C (155.6±4.0 vs 163.2±4.5); and scores of physical comfort, emotional state, and pain in group L were superior to those in group C (P <0.05). In group L, patients possessed lower plasma concentration of pro-inflammatory factors (IL-6, TNF-α) and brain injury-related factors (S100B, NSE) (P <0.05), consumed less remifentanil and propofol, and experienced lower pain intensity. Multiple linear regression analysis demonstrated age and pain were correlated with postperative recovery quality. Conclusion Systemic lidocaine improved early recovery quality after supratentorial tumor resection with general anesthesia, and had certain brain-injury alleviation effects. These benefits may be attributed to the inflammation-alleviating and analgesic properties of lidocaine.
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Affiliation(s)
- Kai Zhao
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Yushan Dong
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Gaowei Su
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Yaolin Wang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Tao Ji
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Nanling Wu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Xiaojie Cui
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Wenzhan Li
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Yanming Yang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Xiuxia Chen
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Correspondence: Xiuxia Chen, Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China, Tel +86 18052268332, Fax +0516-8346-9496, Email
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Opioid-Sparing Analgesia Impacts the Perioperative Anesthetic Management in Major Abdominal Surgery. Medicina (B Aires) 2022; 58:medicina58040487. [PMID: 35454326 PMCID: PMC9029402 DOI: 10.3390/medicina58040487] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 12/13/2022] Open
Abstract
Background and Objectives: The management of acute postoperative pain (APP) following major abdominal surgery implies various analgetic strategies. Opioids lie at the core of every analgesia protocol, despite their side effect profile. To limit patients’ exposure to opioids, considerable effort has been made to define new opioid-sparing anesthesia techniques relying on multimodal analgesia. Our study aims to investigate the role of adjuvant multimodal analgesic agents, such as ketamine, lidocaine, and epidural analgesia in perioperative pain control, the incidence of postoperative cognitive dysfunction (POCD), and the incidence of postoperative nausea and vomiting (PONV) after major abdominal surgery. Materials and Methods: This is a clinical, observational, randomized, monocentric study, in which 80 patients were enrolled and divided into three groups: Standard group, C (n = 32), where patients received perioperative opioids combined with a fixed regimen of metamizole/acetaminophen for pain control; co-analgetic group, Co-A (n = 26), where, in addition to standard therapy, patients received perioperative systemic ketamine and lidocaine; and the epidural group, EA (n = 22), which included patients that received standard perioperative analgetic therapy combined with epidural analgesia. We considered the primary outcome, the postoperative pain intensity, assessed by the visual analogue scale (VAS) at 1 h, 6 h, and 12 h postoperatively. The secondary outcomes were the total intraoperative fentanyl dose, total postoperative morphine dose, maximal intraoperative sevoflurane concentration, confusion assessment method for intensive care units score (CAM-ICU) at 1 h, 6 h, and 12 h postoperatively, and the postoperative dose of ondansetron as a marker for postoperative nausea and vomiting (PONV) severity. Results: We observed a significant decrease in VAS score, as the primary outcome, for both multimodal analgesic regimens, as compared to the control. Moreover, the intraoperative fentanyl and postoperative morphine doses were, consequently, reduced. The maximal sevoflurane concentration and POCD were reduced by EA. No differences were observed between groups concerning PONV severity. Conclusions: Multimodal analgesia concepts should be individualized based on the patient’s needs and consent. Efforts should be made to develop strategies that can aid in the reduction of opioid use in a perioperative setting and improve the standard of care.
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Liu T, Jiang F, Yu LY, Wu YY. Lidocaine represses proliferation and cisplatin resistance in cutaneous squamous cell carcinoma via miR-30c/SIRT1 regulation. Bioengineered 2022; 13:6359-6370. [PMID: 35212616 PMCID: PMC8974189 DOI: 10.1080/21655979.2022.2031419] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This study aimed to determine the effects of lidocaine on cell proliferation and cisplatin resistance in A431 human cutaneous squamous cell carcinoma (cSCC) cells and elucidate the underlying mechanism. Cell proliferation, colony numbers, and cisplatin resistance were determined in A431 or cisplatin-resistant A431 (A431-R) cells that were first transfected with miR-30c-inhibitor or miR-30c-mimic, respectively, and then treated with different concentrations of lidocaine, cisplatin, or both. The expression levels of miR-30c and Sirtuin 1 (SIRT1) in A431 and A431-R cells were determined by quantitative real-time polymerase chain reaction and Western blotting. Lidocaine suppressed A431 cell proliferation and cisplatin resistance in a dose- and time-dependent manner via the miR-30c/SIRT1 pathway. MiR-30c overexpression also suppressed cell proliferation and cisplatin resistance in A431 cells by directly targeting and downregulating SIRT1, thus enhancing the protective effects of lidocaine. Conversely, SIRT1 upregulation or miR-30c inhibition antagonized the inhibitory effects of lidocaine. Our results suggest that lidocaine may suppress the progression of cSCC by activating the miR-30c/SIRT1 pathway, indicating its promising potential as a treatment strategy for cSCC.
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Affiliation(s)
- Tao Liu
- Department of Anesthesiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Fei Jiang
- Department of Anesthesiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Li-Yuan Yu
- Department of Anesthesiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - You-Yang Wu
- Department of Anesthesiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
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Maniker RB, Damiano J, Ivie RMJ, Pavelic M, Woodworth GE. Perioperative Breast Analgesia: a Systematic Review of the Evidence for Perioperative Analgesic Medications. Curr Pain Headache Rep 2022; 26:299-321. [PMID: 35195851 DOI: 10.1007/s11916-022-01031-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Breast surgery is common and may result in significant acute as well as chronic pain. A wide range of pharmacologic interventions is available including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), N-methyl-D-aspartate (NMDA) receptor antagonists, anticonvulsants, and other non-opioids with analgesic properties. We present a review of the evidence for these pharmacologic interventions. A literature search of the MEDLINE database was performed via PubMed with combined terms related to breast surgery, anesthesia, and analgesia. Articles were limited to randomized controlled trial (RCT) design, adult patients undergoing elective surgery on the breast (not including biopsy), and pharmacologic interventions only. Article titles and abstracts were screened, and risk of bias assessments were performed. RECENT FINDINGS The search strategy initially captured 7254 articles of which 60 articles met the full inclusion criteria. Articles were organized according to intervention: 6 opioid agonists, 14 NSAIDs and acetaminophen, 4 alpha-2 agonists, 7 NMDA receptor antagonists, 6 local anesthetics, 7 steroids, 15 anticonvulsants (one of which also discussed an NMDA antagonist), 1 antiarrhythmic, and 2 serotonin reuptake inhibitors (one of which also studied an anticonvulsant). A wide variety of medications is effective for perioperative breast analgesia, but results vary by agent and dose. The most efficacious are likely NSAIDs and anticonvulsants. Some agents may also decrease the incidence of chronic postoperative pain, including flurbiprofen, gabapentin, venlafaxine, and memantine. While many individual agents are well studied, optimal combinations of analgesic medications remain unclear.
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Affiliation(s)
- Robert B Maniker
- Department of Anesthesiology, Columbia University, 622 West 168th Street, PH505, NY, 10032, New York, USA.
| | | | - Ryan M J Ivie
- Oregon Health and Science University, Portland, OR, USA
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14
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Zhou L, Wu R, Cai C, Qi Y, Bi X, Hang Q. The effects of target-controlled infusion of lidocaine undergoing vocal cord polypectomy: A randomized controlled trial (CONSORT compliant). Medicine (Baltimore) 2022; 101:e27642. [PMID: 35147085 PMCID: PMC8830819 DOI: 10.1097/md.0000000000027642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 10/06/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The present study aimed to assess the efficacy and safety of general anesthesia-assisted target-controlled plasma infusion of lidocaine in patients with vocal cord polypectomy using a supporting laryngoscope. METHODS In total, 80 patients undergoing vocal cord polypectomy using a supporting laryngoscope were randomly divided into an intervention group and a control group; each group contained 40 subjects: both groups received general anesthesia; subjects in the intervention also received an additional 3 mg/L of lidocaine by target-controlled plasma infusion during induction and maintenance of anesthesia; heart rate (HR) mean arterial pressure (MAP), propofol and urapidil consumption (Uradil, which is a blood pressure drug that blocks alpha-1, is called Urapidi Hydrochloride Injection. It is produced by Germany, the enterprise name is Nycomed Deutschland GmbH, the import drug registration number is H20090715, and it is widely used in China), recovery time, and cough score (measured by Minogue et al's 5-grade scoring method) during extubation, and throat pain score (measured by visual analogue scale,[VAS]) after extubation and adverse events were recorded. RESULTS Significant differences were observed in HR (P < .05) and MAP (P < .05) immediately after intubation (T2), immediately after the operation starting to support laryngoscope exposure (T3), immediately after operation field adrenergic tampon hemostasis (T4), and 5 minutes after hemostasis (T5) between the 2 groups, and significant differences were also observed in HR (P < .05) before intubation (T1). Moreover, significant differences were observed in propofol consumption (P < .05), urapidil consumption (P < .05), cough score during extubation (P < .05), and throat pain score after extubation (P < .05). However, no significant difference was observed in the recovery time (P > .05). Furthermore, no adverse events were detected in either group. CONCLUSION The results of this study showed that target-controlled plasma infusion of lidocaine can reduce propofol consumption in patients undergoing vocal cord polypectomy by supporting laryngoscopy, and the hemodynamics are more stable and reduce the coughing reaction in the wake period and throat pain after extubation without adverse events.
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Affiliation(s)
| | | | | | | | | | - Qi Hang
- Department of otolaryngology, Ningbo Medical Center Lihuili Hospital
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Voltage-Gated Sodium Channels as Potential Biomarkers and Therapeutic Targets for Epithelial Ovarian Cancer. Cancers (Basel) 2021; 13:cancers13215437. [PMID: 34771603 PMCID: PMC8582439 DOI: 10.3390/cancers13215437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/24/2021] [Accepted: 10/26/2021] [Indexed: 12/17/2022] Open
Abstract
Simple Summary Voltage-gated sodium channels are membrane proteins that change conformation in response to depolarization of the membrane potential, allowing sodium ions to flow into cells. While voltage-gated sodium channels are normally studied in terms of neuron impulses and skeletal or cardiac muscle contraction, abnormal ion channel expression is a feature of many cancer cells. The aim of our study was to assess the expression of voltage-gated sodium channels in ovarian cancer cells. We found that ovarian cancer cells generally express lower levels of voltage-gated sodium channels than normal cells and that two voltage-gated sodium channels, SCN8A and SCN1B, were prognostic biomarkers for ovarian cancer overall survival. In vitro studies suggested that drugs that block voltage-gated sodium channels, such as certain anti-epileptic drugs and local anesthetics, might sensitize ovarian cancer cells to chemotherapy. These findings suggest that voltage-gated sodium channels may be interesting targets for ovarian cancer therapy. Abstract Abnormal ion channel expression distinguishes several types of carcinoma. Here, we explore the relationship between voltage-gated sodium channels (VGSC) and epithelial ovarian cancer (EOC). We find that EOC cell lines express most VGSC, but at lower levels than fallopian tube secretory epithelial cells (the cells of origin for most EOC) or control fibroblasts. Among patient tumor samples, lower SCN8A expression was associated with improved overall survival (OS) (median 111 vs. 52 months; HR 2.04 95% CI: 1.21–3.44; p = 0.007), while lower SCN1B expression was associated with poorer OS (median 45 vs. 56 months; HR 0.69 95% CI 0.54–0.87; p = 0.002). VGSC blockade using either anti-epileptic drugs or local anesthetics (LA) decreased the proliferation of cancer cells. LA increased cell line sensitivity to platinum and taxane chemotherapies. While lidocaine had similar additive effects with chemotherapy among EOC cells and fibroblasts, bupivacaine showed a more pronounced impact on EOC than fibroblasts when combined with either carboplatin (ΔAUC −37% vs. −16%, p = 0.003) or paclitaxel (ΔAUC −37% vs. −22%, p = 0.02). Together, these data suggest VGSC are prognostic biomarkers in EOC and may inform new targets for therapy.
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Hung KC, Chu CC, Hsing CH, Chang YP, Li YY, Liu WC, Chen IW, Chen JY, Sun CK. Association between perioperative intravenous lidocaine and subjective quality of recovery: A meta-analysis of randomized controlled trials. J Clin Anesth 2021; 75:110521. [PMID: 34547603 DOI: 10.1016/j.jclinane.2021.110521] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/21/2021] [Accepted: 09/13/2021] [Indexed: 12/16/2022]
Abstract
STUDY OBJECTIVE To evaluate the impact of perioperative intravenous lidocaine on the quality of recovery (QoR) following surgery. DESIGN Meta-analysis of randomized controlled trials (RCTs). SETTING Postoperative care. INTERVENTION Intravenous lidocaine during perioperative period. PATIENTS Adults undergoing surgery under general anesthesia. MEASUREMENTS The primary outcome was postoperative QoR measured with QoR-40 questionnaire, while the secondary outcomes included five individual dimensions (i.e., emotional, state, physical comfort, psychological support, physical independence, and pain) of QoR-40, intraoperative opioid consumption, and risk of chronic postsurgical pain (CPSP). MAIN RESULTS Medline, Cochrane Library, Google scholar, and EMBASE databases were searched from inception to June 2021. Fourteen RCTs involving 1148 patients in total undergoing elective surgery published from 2012 to 2021 were included. QoR-40 scores were evaluated at postoperative 24 h (12 trials), 72 h (one trial), and Day 5 (one trial), respectively. Pooled results revealed significantly higher global [mean difference (MD) = 9.65, 95% confidence interval (CI): 6.33 to 12.97; I2 = 97%; 13 RCTs; n = 1085] and individual dimension QoR-40 scores in the lidocaine group than those in placebo group. Subgroup analysis demonstrated no significant impact of the type of surgery, age, gender, surgical time, anesthetic technique, lidocaine dosage, and time of assessment on global QoR-40 scores. The use of intravenous lidocaine was associated with a significant reduction in intraoperative remifentanil consumption compared with that in the placebo group (standardized MD = -0.91, 95%CI: -1.32 to -0.51; I2 = 86%; 10 RCTs; n = 799). There was no difference in risk of CPSP between the two groups [relative risk (RR) = 0.65, 95%CI: 0.33 to 1.25; I2 = 58%; 4 RCTs; n = 309]. CONCLUSION Our results verified the efficacy of intravenous lidocaine for enhancing postoperative quality of recovery by using a validated subjective tool and reducing intraoperative remifentanil consumption in patients receiving elective surgery under general anesthesia. Further studies are warranted to verify its efficacy in the acute care setting.
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Affiliation(s)
- Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan
| | - Chin-Chen Chu
- Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan
| | - Chung-Hsi Hsing
- Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan; Department of Medical Research, Chi-Mei Medical Center, Tainan city, Taiwan
| | - Yang-Pei Chang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Yu Li
- Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan
| | - Wei-Cheng Liu
- Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan
| | - I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan
| | - Jen-Yin Chen
- Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, Kaohsiung city, Taiwan; College of Medicine, I-Shou University, Kaohsiun cityg, Taiwan.
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Lv X, Li X, Guo K, Li T, Yang Y, Lu W, Wang S, Liu S. Effects of Systemic Lidocaine on Postoperative Recovery Quality and Immune Function in Patients Undergoing Laparoscopic Radical Gastrectomy. DRUG DESIGN DEVELOPMENT AND THERAPY 2021; 15:1861-1872. [PMID: 33976537 PMCID: PMC8106403 DOI: 10.2147/dddt.s299486] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/26/2021] [Indexed: 12/09/2022]
Abstract
Objective This study aimed to explore the effects of lidocaine on postoperative quality of recovery (QoR) and immune function in patients undergoing laparoscopic radical gastrectomy. Methods In total, 135 patients were enrolled and were equally randomized to receive low-dose lidocaine (Group LL: 1.5 mg/kg bolus followed by an infusion at 1.0 mg/kg/hour) or high-dose lidocaine (Group HL: 1.5 mg/kg bolus followed by an infusion at 2.0 mg/kg/hour) or Controls (Group C: received a volume-matched normal saline at the same rate). The primary outcome was a QoR-40 score on postoperative day (POD) 1. Secondary outcomes were a QoR-40 score on POD 3, levels of inflammatory factors (IL-6, IL-10, TNF-α) and CD4+T cells, CD8+T cells proportions, and CD4+/CD8+ cell ratios and postoperative recovery of bowel function. Results There were no statistically significant differences in patient characteristics at baseline. The total QoR-40 scores on POD 1 in Group HL (171.4±3.89) were higher than those in Group LL (166.20±4.05) and in Group C (163.40±4.38) (adjusted P<0.001). Differences in the dimension scores of QoR-40 for pain, physical comfort, and emotional state were significant across the three groups. Lidocaine administration significantly reduced the release of IL-6, IL-10, TNF-α, and attenuated immune changes induced by trauma. Kaplan–Meier curves showed that the median time to the first exhaust and defecation were shorter in the Group HL than in Groups LL and C (1.55 days vs 2.4 days vs 2.6 days, log rank P<0.0001; and 2.86 days vs 3.22 days vs 3.46 days, log rank P=0.002, respectively). Additionally, patients in lidocaine groups required less remifentanil consumption and experienced lower pain intensity, compared with the control group. Conclusion Systemic lidocaine improved postoperative recovery, alleviated inflammation and immunosuppression, and accelerated the return of bowel function, and is thus, worthy of clinical application. Clinical Trials Registration ChiCTR2000028934.
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Affiliation(s)
- Xueli Lv
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China
| | - Xiaoxiao Li
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China
| | - Kedi Guo
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China
| | - Tong Li
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China
| | - Yuping Yang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China
| | - Wensi Lu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China
| | - Shuting Wang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China
| | - Su Liu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China.,Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China
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Ates I, Aydin ME, Albayrak B, Disci E, Ahiskalioglu EO, Celik EC, Baran O, Ahiskalioglu A. Pre-procedure intravenous lidocaine administration on propofol consumption for endoscopic retrograde cholangiopancreatography: A prospective, randomized, double-blind study. J Gastroenterol Hepatol 2021; 36:1286-1290. [PMID: 33217031 DOI: 10.1111/jgh.15356] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/08/2020] [Accepted: 11/12/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIM The endoscopic retrograde cholangiopancreatography (ERCP) procedure is generally performed in patients with high comorbidity. We aimed to reduce the consumption of propofol by adding lidocaine before ERCP. METHODS Eighty ERCP patients with ASA I-III, aged between 45-75 years, were randomly divided into two groups. Lidocaine group (group L, n = 40), received 1-mg midazolam, 1.5 mg/kg lidocaine, and 1 mg/kg propofol intravenously. The control group (group C, n = 40) received 1-mg midazolam, saline in the same volume as the lidocaine group, and 1 mg/kg propofol intravenously. Propofol was administered with intermittent bolus doses. Propofol consumption, oropharyngeal reflex, recovery time, endoscopist satisfaction, ketamine need, and side-effects were recorded. RESULTS Propofol consumption during the procedure was statistically lower in group L than in the control group (157.25 ± 39.16 mg vs 228.75 ± 64.62 mg respectively, P < 0.001). Additionally, recovery time was statistically faster in group L compared with the control group (7.78 ± 3.95 min vs 11.92 ± 3.24 min respectively, P < 0.001). The oropharyngeal reflex was less in group L than control group (6/40 vs 15/40 respectively, P = 0.042). There was no significant difference between the two groups regarding visual analogue scale scores and endoscopist satisfaction (P > 0.05). CONCLUSIONS We recommend the use of intravenous lidocaine before the ERCP procedure as it reduces propofol consumption, recovery times, and oropharyngeal reflex.
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Affiliation(s)
- Irem Ates
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - Muhammed Enes Aydin
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey.,Clinical Research, Development and Design Application and Research Center, School of Medicine, Ataturk University, Erzurum, Turkey
| | - Bulent Albayrak
- Department of Gastroenterology, School of Medicine, Ataturk University, Erzurum, Turkey
| | - Esra Disci
- Department of General Surgery, School of Medicine, Ataturk University, Erzurum, Turkey
| | - Elif Oral Ahiskalioglu
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - Erkan Cem Celik
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey.,Clinical Research, Development and Design Application and Research Center, School of Medicine, Ataturk University, Erzurum, Turkey
| | - Onur Baran
- Department of Anesthesiology and Reanimation, Palandoken State Hospital, Erzurum, Turkey
| | - Ali Ahiskalioglu
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey.,Clinical Research, Development and Design Application and Research Center, School of Medicine, Ataturk University, Erzurum, Turkey
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Meillat H, Magallon C, Brun C, de Chaisemartin C, Moureau-Zabotto L, Bonnet J, Faucher M, Lelong B. Systematic Early Urinary Catheter Removal Integrated in the Full Enhanced Recovery After Surgery (ERAS) Protocol After Laparoscopic Mid to Lower Rectal Cancer Excision: A Feasibility Study. Ann Coloproctol 2021; 37:204-211. [PMID: 33887815 PMCID: PMC8391039 DOI: 10.3393/ac.2020.05.22] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/22/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose Enhanced Recovery After Surgery (ERAS) programs advocate early urinary catheter removal after rectal cancer surgery; however, the optimal duration remains unclear. This study assessed the feasibility of the early urinary catheter removal protocol after rectal cancer surgery within an ERAS pathway and identified predictive factors for failure of this strategy. Methods Between March 2017 and October 2018, all unselected and consecutive patients who underwent rectal cancer resection and benefited from our ERAS program were included. Urinary complications (infection and retention) were prospectively recorded. Success was defined as catheter removal on postoperative day (POD) 3 without urinary complications. Results Of 135 patients (male, 63.7%; neoadjuvant chemoradiation, 57.0%; urology history, 17.8%), 120 had early urinary catheter removal with no complications (success rate, 88.9%), 8 did not have urinary catheter removal on POD 3 due to clinical judgment or prescription error, 5 experienced a urinary tract infection, and 2 had acute urinary retention. Obesity (odds ratio [OR], 0.16; P = 0.003), American Society of Anesthesiologists physical status classification > II (OR, 0.28; P = 0.048), antiaggregant platelet medication (OR, 0.12; P < 0.001), absence of anastomosis (OR, 0.1; P = 0.003), and prolonged operative time (OR, 0.21; P = 0.020) were predictive factors for failure. Conversely, optimal compliance with the ERAS program (OR, 7.68; P < 0.001), postoperative nonsteroidal anti-inflammatory drug use (OR, 21.71; P < 0.001), and balanced intravenous fluid therapy (OR, 7.87; P = 0.001) were associated with increased strategy success. Conclusion Withdrawal of the urinary catheter on POD 3 was successfully achieved after laparoscopic rectal resection and can be safely implemented in the ERAS program.
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Affiliation(s)
- Hélène Meillat
- Department of Digestive Surgical Oncology, Institut Paoli Calmettes, Marseille, France
| | - Cloé Magallon
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, Marseille, France
| | - Clément Brun
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, Marseille, France
| | | | | | - Julien Bonnet
- Department of Digestive Surgical Oncology, Institut Paoli Calmettes, Marseille, France
| | - Marion Faucher
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, Marseille, France
| | - Bernard Lelong
- Department of Digestive Surgical Oncology, Institut Paoli Calmettes, Marseille, France
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Lovett-Carter D, Kendall MC, Park J, Ibrahim-Hamdan A, Crepet S, De Oliveira G. The effect of systemic lidocaine on post-operative opioid consumption in ambulatory surgical patients: a meta-analysis of randomized controlled trials. Perioper Med (Lond) 2021; 10:11. [PMID: 33845914 PMCID: PMC8042682 DOI: 10.1186/s13741-021-00181-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 03/10/2021] [Indexed: 11/22/2022] Open
Abstract
Background Ambulatory surgical procedures continue to grow in relevance to perioperative medicine. Clinical studies have examined the use of systemic lidocaine as a component of multimodal analgesia in various surgeries with mixed results. A quantitative review of the opioid-sparing effects of systemic lidocaine in ambulatory surgery has not been investigated. The primary objective of this study was to systematically review the effectiveness of systemic lidocaine on postoperative analgesic outcomes in patients undergoing ambulatory surgery. Methods We performed a quantitative systematic review of randomized controlled trials in electronic databases (Cochrane Library, Embase, PubMed, and Google Scholar) from their inception through February 2019. Included trials investigated the effects of intraoperative systemic lidocaine on postoperative analgesic outcomes, time to hospital discharge, and adverse events. Methodological quality was evaluated using Cochrane Collaboration’s tool and the level of evidence was assessed using GRADE criteria. Data was combined in a meta-analysis using random-effects models. Results Five trials evaluating 297 patients were included in the analysis. The pooled effect of systemic lidocaine on postoperative opioid consumption at post-anesthesia care unit revealed a significant effect, weighted mean difference (95% CI) of − 4.23 (− 7.3 to 1.2, P = 0.007), and, at 24 h, weighted mean difference (95% CI) of − 1.91 (− 3.80 to − 0.03, P = 0.04) mg intravenous morphine equivalents. Postoperative pain control during both time intervals, postoperative nausea and vomiting reported at post anesthesia care unit, and time to hospital discharge were not different between groups. The incidence rate of self-limiting adverse events of the included studies is 0.007 (2/297). Conclusion Our results suggest that intraoperative systemic lidocaine as treatment for postoperative pain has a moderate opioid-sparing effect in post anesthesia care unit with limited effect at 24 h after ambulatory surgery. Moreover, the opioid-sparing effect did not impact the analgesia or the presence of nausea and vomiting immediately or 24 h after surgery. Clinical trials with larger sample sizes are necessary to further confirm the short-term analgesic benefit of systemic lidocaine following ambulatory surgery. Trial registration PROSPERO (CRD42019142229) Supplementary Information The online version contains supplementary material available at 10.1186/s13741-021-00181-9.
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Affiliation(s)
- Danielle Lovett-Carter
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI, 02903, USA
| | - Mark C Kendall
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI, 02903, USA.
| | - James Park
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI, 02903, USA
| | - Anas Ibrahim-Hamdan
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI, 02903, USA
| | - Susannah Crepet
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI, 02903, USA
| | - Gildasio De Oliveira
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI, 02903, USA
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21
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Wang L, Sun J, Zhang X, Wang G. The Effect of Lidocaine on Postoperative Quality of Recovery and Lung Protection of Patients Undergoing Thoracoscopic Radical Resection of Lung Cancer. Drug Des Devel Ther 2021; 15:1485-1493. [PMID: 33854301 PMCID: PMC8039043 DOI: 10.2147/dddt.s297642] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/05/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the effectiveness and safety of lidocaine on postoperative quality of recovery and lung protection of patients undergoing thoracoscopic radical resection of lung cancer. Patients and Methods Seventy ASA II–III patients undergoing thoracoscopic radical resection of lung cancer were randomly assigned into either the lidocaine group (Group L) or control group (Group C). Patients in Group L received lidocaine with a 1.5 mg/kg bolus before induction of anesthesia, followed by 2.0 mg/kg/h until the end of the operation while the patients in Group C received volume-matched normal saline at the same rate. The main outcome was the quality of recovery-40 score (QoR-40 score) at 24 h postoperatively. The peak airway pressure (Ppeak) and plateau airway pressure (Pplat), the partial pressure of oxygen in arterial blood (PaO2), partial pressure of carbon dioxide in arterial blood (PaCO2), alveolar-arterial oxygen gradient (A-aDO2), oxygenation index (OI), time to first flatus and defecation, intraoperative hemodynamics and opioid consumption were also recorded. Results There were no statistically difference at patients’ baseline characteristics. The QoR-40 score of Group L was significantly higher than that of Group C at 24 h after surgery (P=0.014). Ppeak, Pplat, and A-aDO2 of Group L were significantly lower than those of Group C (P<0.001, P<0.001, P=0.025, respectively) after the ventilation recovery of both lungs, and the PaO2 and OI of the Group L were significantly higher than those of Group C (P=0.027, P=0.027, respectively). Time to first flatus and defecation in Group L was significantly lower compared with Group C (P=0.037, P=0.025, respectively). Conclusion Intravenous lidocaine can improve the quality of recovery of patients undergoing thoracoscopic radical resection of lung cancer, while also providing lung protection, favorable postoperative analgesia, a reduction in the time to first flatus and defecation after surgery.
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Affiliation(s)
- Lei Wang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, People's Republic of China.,Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, People's Republic of China
| | - Jing Sun
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, People's Republic of China.,Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, People's Republic of China
| | - Xueguang Zhang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, People's Republic of China.,Department of Pain, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, People's Republic of China
| | - Guanglei Wang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, People's Republic of China.,Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, People's Republic of China
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22
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Yao Y, Jiang J, Lin W, Yu Y, Guo Y, Zheng X. Efficacy of systemic lidocaine on postoperative quality of recovery and analgesia after video-assisted thoracic surgery: A randomized controlled trial. J Clin Anesth 2021; 71:110223. [PMID: 33676296 DOI: 10.1016/j.jclinane.2021.110223] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/17/2021] [Accepted: 02/23/2021] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE Intraoperative systemic lidocaine has become widely accepted as an adjunct to general anesthesia, associated with opioid-sparing and enhanced recovery. We hypothesized that perioperative systemic lidocaine improves postoperative pain and enhances the quality of recovery (QoR) in patients following video-assisted thoracic surgery (VATS). DESIGN Prospective, single-center, double-blind, randomized placebo-controlled clinical trial. SETTING Single institution, tertiary university hospital. PATIENTS Adult patients aged 18 to 65 undergoing VATS were eligible for participation. INTERVENTIONS Patients enrolled in this study were randomized to receive either system lidocaine (a bolus of 1.5 mg kg-1, followed by an infusion of 2 mg kg-1 h-1 until the end of the surgical procedure) or identical volumes and rates of 0.9% saline. MEASUREMENTS The primary outcome was a global QoR-15 score 24 h after surgery. Secondary outcomes included postoperative pain score, cumulative opioid consumption, emergence time, length of PACU stay, adverse events, and patient satisfaction. MAIN RESULTS There was no difference in the global QoR-15 scores at 24 h postoperatively between the lidocaine and saline groups (median 117, IQR 113.5-124, vs. median 116, IQR 111-120, P = 0.067), with a median difference of 3 (95% CI 0 to 6, P = 0.507). Similarly, postoperative pain scores, postoperative cumulative opioid consumption, PACU length of stay, the occurrence of PONV, and patient satisfaction were comparable between the two groups (all P > 0.05). CONCLUSIONS Our current findings do not support using perioperative systemic lidocaine as a potential strategy to improve postoperative pain and enhance QoR in patients undergoing VATS. TRIAL REGISTRATION Chinese Clinical Trial Registry (identifier: ChiCTR1900027515).
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Affiliation(s)
- Yusheng Yao
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Jundan Jiang
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Wenjun Lin
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Yazhen Yu
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Yanhua Guo
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Xiaochun Zheng
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China.
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23
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Xie C, Wang Q, Huai D. Intravenous Infusion of Lidocaine Can Accelerate Postoperative Early Recovery in Patients Undergoing Surgery for Obstructive Sleep Apnea. Med Sci Monit 2021; 27:e926990. [PMID: 33529177 PMCID: PMC7870156 DOI: 10.12659/msm.926990] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 11/15/2020] [Indexed: 12/16/2022] Open
Abstract
Obstructive sleep apnea (OSA) is defined by intermittent and recurrent episodes of partial or complete obstruction of the upper airway during sleep. Intermittent and recurrent hypoxia/reoxygenation is the main pathophysiological mechanism of OSA. Its consequences include systemic inflammation, activation of the sympathetic nervous system, and release of oxygen free radicals. Infusion of intravenous (IV) lidocaine has anti-inflammatory, antihyperalgesic, and analgesic properties, supporting its use as an anesthetic adjuvant. Lidocaine can reduce nociception and/or cardiovascular responses to surgical stress, as well as postoperative pain and/or analgesic requirements. Because of the high prevalence of OSA in obese patients, the use of opioids to manage postoperative pain in that population is often accompanied by the development of adverse respiratory events, such as hypoventilation and hypoxemia. IV infusion of lidocaine has been shown to enhance the quality of early recovery after laparoscopic bariatric and upper airway surgery. However, limited evidence exists regarding its use in patients undergoing surgery for OSA. In addition, whether IV infusion of lidocaine can improve postoperative early recovery in patients undergoing surgery for OSA remains unknown. Therefore, we hypothesized that IV infusion of lidocaine can improve postoperative early recovery in patients undergoing surgery for OSA. Perioperative infusion also may be a promising analgesic adjunct to enhanced recovery after surgery (ERAS) protocols.
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Affiliation(s)
- Chenglan Xie
- Department of Anesthesiology, The Affiliated Huaian Hospital of Xuzhou Medical University and Huaian Second People’s Hospital, Huaian, Jiangsu, P.R. China
| | - Qiao Wang
- Department of Anesthesiology, The Affiliated Huaian Hospital of Xuzhou Medical University and Huaian Second People’s Hospital, Huaian, Jiangsu, P.R. China
| | - De Huai
- Department of Ear, Nose and Throat, The Affiliated Huaian Hospital of Xuzhou Medical University and Huaian Second People’s Hospital, Huaian, Jiangsu, P.R. China
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24
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Stessel B, Hendrickx M, Pelckmans C, De Wachter G, Appeltans B, Braeken G, Herbots J, Joosten E, Van de Velde M, Buhre WFFA. One-month recovery profile and prevalence and predictors of quality of recovery after painful day case surgery: Secondary analysis of a randomized controlled trial. PLoS One 2021; 16:e0245774. [PMID: 33497408 PMCID: PMC7837485 DOI: 10.1371/journal.pone.0245774] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/04/2021] [Indexed: 11/19/2022] Open
Abstract
Background/Objectives This study aimed to study one-month recovery profile and to identify predictors of Quality of Recovery (QOR) after painful day surgery and investigate the influence of pain therapy on QOR. Methods/Design This is a secondary analysis of a single-centre, randomised controlled trial of 200 patients undergoing ambulatory haemorrhoid surgery, arthroscopic shoulder or knee surgery, or inguinal hernia repair between January 2016 and March 2017. Primary endpoints were one-month recovery profile and prevalence of poor/good QOR measured by the Functional Recovery Index (FRI), the Global Surgical Recovery index and the EuroQol questionnaire at postoperative day (POD) 1 to 4, 7, 14 and 28. Multiple logistic regression analysis was performed to determine predictors of QOR at POD 7, 14, and 28. Differences in QOR between pain treatment groups were analysed using the Mann-Whitney U test. Results Four weeks after haemorrhoid surgery, inguinal hernia repair, arthroscopic knee and arthroscopic shoulder surgery, good QOR was present in 71%, 76%, 57% and 24% respectively. Poor QOR was present in 5%, 0%, 7% and 29%, respectively. At POD 7 and POD 28, predictors for poor/intermediate QOR were type of surgery and a high postoperative pain level at POD 4. Male gender was another predictor at POD 7. Female gender and having a paid job were also predictors at POD 28. Type of surgery and long term fear of surgery were predictors at POD 14. No significant differences in total FRI scores were found between the two different pain treatment groups. Conclusions The present study shows a procedure-specific variation in recovery profile in the 4-week period after painful day surgery. The best predictors for short-term (POD 7) and long-term (POD 28) poor/intermediate QOR were a high postoperative pain level at POD 4 and type of surgery. Different pain treatment regimens did not result in differences in recovery profile. Trial registration European Union Clinical Trials Register 2015-003987-35.
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Affiliation(s)
- Björn Stessel
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, The Netherlands
- UHasselt, Faculty of Medicine and Life Sciences, LCRC, Agoralaan, Diepenbeek, Belgium
- * E-mail:
| | - Maarten Hendrickx
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
- Department of Anaesthesiology and Pain Medicine, University Hospital, Leuven, Belgium
| | - Caroline Pelckmans
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
| | | | - Bart Appeltans
- Department of Abdominal Surgery, Jessa Hospital, Hasselt, Belgium
| | - Geert Braeken
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
| | - Jeroen Herbots
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
| | - Elbert Joosten
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Marc Van de Velde
- Department of Anaesthesiology and Pain Medicine, University Hospital, Leuven, Belgium
| | - Wolfgang F. F. A. Buhre
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNS), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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25
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Grandhi RK, Perona B. Mechanisms of Action by Which Local Anesthetics Reduce Cancer Recurrence: A Systematic Review. PAIN MEDICINE 2021; 21:401-414. [PMID: 31282958 DOI: 10.1093/pm/pnz139] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Surgery in concert with anesthesia is a key part of the management of advanced-stage cancers. Anesthetic agents such as opioids and volatile anesthetics have been shown to promote recurrence in preclinical models, whereas some animal models have shown that the use of lidocaine may be beneficial in reducing cancer recurrence. The purpose of this article is to review the current literature to highlight the mechanisms of action by which local anesthetics are thought to reduce cancer recurrence. METHODS A systematic review was conducted using the PubMed (1966 to 2018) electronic database. Search terms included "lidocaine," "ropivicaine," "procaine," "bupivicaine," "mepivicaine," "metastasis," "cancer recurrence," "angiogenesis," and "local anesthetics" in various combinations. The search yielded 146 total abstracts for initial review, 20 of which met criteria for inclusion. Theories for lidocaine's effect on cancer recurrence were recorded. All studies were reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. RESULTS Numerous mechanisms were proposed based on the local anesthetic used and the type of cancer. Mechanisms include those that are centered on endothelial growth factor receptor, voltage-gated sodium and calcium channels, transient receptor melanoplastin 7, hyperthermia, cell cycle, and demyelination. CONCLUSIONS In vivo models suggest that local anesthetic administration leads to reduced cancer recurrence. The etiology of this effect is likely multifactorial through both inhibition of certain pathways and direct induction of apoptosis, a decrease in tumor migration, and an association with cell cycle-mediated and DNA-mediated effects. Additional research is required to further define the clinical implications.
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Affiliation(s)
- Ravi K Grandhi
- Department of Anesthesiology, Maimonides Medical Center, Brooklyn, New York
| | - Barbara Perona
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
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26
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Bi Y, Ye Y, Ma J, Tian Z, Zhang X, Liu B. Effect of perioperative intravenous lidocaine for patients undergoing spine surgery: A meta-analysis and systematic review. Medicine (Baltimore) 2020; 99:e23332. [PMID: 33235097 PMCID: PMC7710210 DOI: 10.1097/md.0000000000023332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Perioperative intravenous lidocaine has been reported to have analgesic and opioid-sparing effects in many kinds of surgery. Several studies have evaluated its use in the settings of spine surgery. The aim of the study is to examine the effect of intravenous lidocaine in patients undergoing spine surgery. METHODS We performed a quantitative systematic review. Databases of PubMed, Medline, Embase database and Cochrane library were investigated for eligible literatures from their establishments to June, 2019. Articles of randomized controlled trials that compared intravenous lidocaine to a control group in patients undergoing spine surgery were included. The primary outcome was postoperative pain intensity. Secondary outcomes included postoperative opioid consumption and the length of hospital stay. RESULT Four randomized controlled trials with 275 patients were included in the study. postoperative pain compared with control was reduced at 6 hours after surgery (WMD -0.50, 95%CI, -0.76 to -0.25, P < .001), at 24 hours after surgery (WMD -0.50, 95%CI, -0.70 to -0.29, P < .001) and at 48 hours after surgery (WMD -0.57, 95%CI, -0.96 to -0.17, P = .005). The effect of intravenous lidocaine on postoperative opioid consumption compared with control revealed a significant effect (WMD -15.36, 95%CI, -21.40 to -9.33 mg intravenous morphine equivalents, P < .001). CONCLUSION This quantitative analysis of randomized controlled trials demonstrated that the perioperative intravenous lidocaine was effective for reducing postoperative opioid consumption and pain in patients undergoing spine surgery. The intravenous lidocaine should be considered as an effective adjunct to improve analgesic outcomes in patients undergoing spine surgery. However, the quantity of the studies was very low, more research is needed.
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Affiliation(s)
| | - Yu Ye
- Department of Anesthesiology
| | - Jun Ma
- Department of Anesthesiology
| | | | | | - Bin Liu
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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27
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Lee J, Lee S, Lee H, Kim HC, Park C, Kim JY. The effect of preoperative intravenous lidocaine on postoperative pain following hysteroscopy: A randomized controlled trial. Medicine (Baltimore) 2020; 99:e22751. [PMID: 33080740 PMCID: PMC7571958 DOI: 10.1097/md.0000000000022751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The use of hysteroscopy for the diagnosis and treatment of uterine and endometrial abnormalities is often associated with postoperative pain. This randomized controlled trial aimed to assess the efficacy of preoperative intravenous (IV) lidocaine in reducing pain after hysteroscopy. METHODS In total, 138 patients undergoing elective hysteroscopy at the CHA Bundang Medical Center, Seongnam, Korea were randomly assigned to a control group (n = 69) or a lidocaine group (n = 69), which received normal saline or IV lidocaine at 1.5 mg/kg, respectively. The primary outcome was the incidence of postoperative pain. RESULTS The incidence of pain was significantly lower in the IV lidocaine group than in the control group at the post-anesthesia care unit (27.3% vs 68.2%, P < .001). The visual analog scale (0-10) score (median [interquartile range]) was lower in the IV lidocaine group than in the control group (0 [0-2]) vs 2 [0-4]), P < .001). The use of rescue analgesics and postoperative nausea and vomiting were similar between the 2 groups. This study demonstrated that administering 1.5 mg/kg of preoperative IV lidocaine can be a simple method to reduce incidence of pain after hysteroscopy. CONCLUSION Preoperative bolus administration of 1.5 mg/kg of IV lidocaine may be used to decrease incidence of pain after hysteroscopy under general anesthesia.
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Affiliation(s)
- Jiyoung Lee
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam
- Department of Medical Sciences, Graduate School of Ajou University, Suwon
| | - Seunghoon Lee
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam
| | - Heungwoo Lee
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam
| | - Hyeon Chul Kim
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam
| | - Chunghyun Park
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam
| | - Jong Yeop Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea
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Liu J, Liu X, Peng LP, Ji R, Liu C, Li YQ. Efficacy and safety of intravenous lidocaine in propofol-based sedation for ERCP procedures: a prospective, randomized, double-blinded, controlled trial. Gastrointest Endosc 2020; 92:293-300. [PMID: 32156544 DOI: 10.1016/j.gie.2020.02.050] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 02/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Propofol-based sedation is widely used in ERCP procedures, but adverse respiratory or cardiovascular events commonly occur. Intravenous injection of lidocaine has an analgesic effect and can reduce the requirements of fentanyl and propofol during abdominal surgery. The objective of this study was to assess the efficacy and safety of intravenous lidocaine on propofol requirements during ERCP procedures. METHODS Forty-eight patients scheduled for ERCP were randomly divided into 2 groups, the lidocaine group and the control group. All patients received .02 mg/kg midazolam and .1 μg/kg sufentanil intravenously as premedication. A bolus of propofol was applied for induction of sedation, and perfusion of propofol was applied for maintenance. Patients in the lidocaine group received a bolus of 1.5 mg/kg lidocaine intravenously followed by continuous infusion of 2 mg/kg/h, whereas the control group received the same volumes of saline solution. The primary outcome was the propofol requirement during ERCP. RESULTS Compared with the control group, propofol requirements were reduced by 33.8% in the lidocaine group (212.0 ± 118.2 mg vs 320.0 ± 189.6 mg, P = .023). Involuntary movement was less common in the lidocaine group than in the control group (12.5% vs 41.7%, P = .049). In the lidocaine group, postprocedure pain and fatigue, as measured by the visual analog scale, were significantly reduced (0 [range, 0-4] vs 3 [range, 0-5], P = .005; 2 [range, 0-4] vs 5 [range, 2-8], P < .001).The incidence of oxygen desaturation, hypotension, and bradycardia tended to be lower in the lidocaine group. CONCLUSIONS Intravenous lidocaine can significantly decrease propofol requirements during ERCP, with higher sedation quality and endoscopist satisfaction. (Clinical trial registration number: NCT03996577.).
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Affiliation(s)
- Jing Liu
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China; Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xiaoping Liu
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Li-Ping Peng
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Rui Ji
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Chao Liu
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yan-Qing Li
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China; Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China; Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital of Shandong University, Jinan, Shandong, China
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Yue H, Zhou M, Lu Y, Chen L, Cui W. Effect of Intravenous Lidocaine on Postoperative Pain in Patients Undergoing Intraspinal Tumor Resection: Study Protocol for a Prospective Randomized Controlled Trial. J Pain Res 2020; 13:1401-1410. [PMID: 32606906 PMCID: PMC7297458 DOI: 10.2147/jpr.s249359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/26/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose Patients undergoing intraspinal tumor resection usually experience severe acute pain, delaying postoperative rehabilitation, and increasing incidence of chronic pain. Recently, an increasing number of studies have found that low-dose intravenous lidocaine infusion during and/or after surgery can reduce opioid usage and the incidence of related side effects, inhibit hyperalgesia and promote recovery. Thus far, no studies have evaluated the analgesic effect and safety of perioperative intravenous lidocaine infusion for intraspinal tumor resection, especially the long-term analgesic effects of patient-controlled analgesia (PCA) with lidocaine during the first postoperative 48 hours. This study tests the hypothesis that intra- and postoperative systemic lidocaine infusion for patients undergoing intraspinal tumor resection can relieve postoperative acute or chronic pain and reduce the opioid dosage and incidence of related side effects without other problems. Study Design and Methods This is a prospective, randomized, placebo-controlled, and double-blinded study. In total, 180 participants scheduled for intraspinal tumor resection will be randomly divided into lidocaine and placebo groups. The lidocaine group will be administered lidocaine intravenously during anesthesia and postoperative pain management during the first 48 postoperative hours; the placebo group will be administered normal saline at the same volume, infusion rate, and timing. The primary outcome will be the postoperative visual analog scale (VAS) score. Secondary outcomes will be postoperative cumulative sufentanil consumption, indicators of postoperative recovery, and the incidence of perioperative adverse events. Discussion This study investigates the effect of continuous intravenous lidocaine infusion on postoperative sufentanil consumption and VAS scores. The findings will provide a new strategy of anesthesia and analgesia management for intraspinal tumor resection.
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Affiliation(s)
- Hongli Yue
- Department of Anesthesiology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Man Zhou
- Department of Anesthesiology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yu Lu
- Department of Anesthesiology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Liang Chen
- Department of Anesthesiology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Weihua Cui
- Department of Anesthesiology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, People's Republic of China
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Comparison of Perioperative Systemic Lidocaine or Systemic Ketamine in Acute Pain Management of Patients With Opioid Use Disorder After Orthopedic Surgery. J Addict Med 2020; 13:220-226. [PMID: 30499871 DOI: 10.1097/adm.0000000000000483] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION AND AIMS Patients with opioid use disorder experience great challenges during acute pain management due to opioid tolerance or withdrawal symptoms. Previous studies have recommended the use of adjuvant drugs in these patients. In this study, we compared the effect of intraoperative lidocaine with ketamine in postoperative pain management of these patients. DESIGN AND METHODS In this randomized clinical trial, 180 patients with opioid use disorder who underwent orthopedic surgery under general anesthesia were randomly allocated into 3 groups. Patients in groups A, B, and C received intravenous lidocaine, ketamine, or normal saline, respectively, during the operation. Then, postoperative pain scores, analgesic requirements, patient satisfaction, and patient sleepiness were recorded and compared among the 3 groups. RESULTS Numerical rating scales during the first hour postoperation were significantly lower in the lidocaine group than in the ketamine or control group (P < 0.001). The mean total amount of morphine consumption during the first 24-hour postoperation was 14.49 ± 26.89, 16.59 ± 30.65, and 21.72 ± 43.29 mg in the lidocaine, ketamine, and control group, respectively, being significantly lower in the lidocaine group in comparison with the other groups (P < 0.001). Patients in the lidocaine group were less restless, calmer, and less drowsy than patients in the ketamine and control group (P < 0.001). DISCUSSION AND CONCLUSION According to these findings, systemic lidocaine is more effective than systemic ketamine to improve the quality of acute pain management without causing any significant complications in patients with opioid use disorder.
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Tovikkai P, Rogers SJ, Cello JP, Mckay RE. Intraoperative lidocaine infusion and 24-hour postoperative opioid consumption in obese patients undergoing laparoscopic bariatric surgery. Surg Obes Relat Dis 2020; 16:1124-1132. [PMID: 32553616 DOI: 10.1016/j.soard.2020.04.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/05/2020] [Accepted: 04/13/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Bariatric surgery is the most effective long-term treatment for obesity. Opioid-sparing anesthesia and multimodal analgesia such as lidocaine infusion have been recommended in these patients to reduce opioid-related complications. However, evidence supporting its use for bariatric surgery population is limited. OBJECTIVE To investigate whether intraoperative lidocaine infusion is associated with decreasing opioid consumption in laparoscopic bariatric surgery. SETTING A university hospital, California, USA. METHODS In this retrospective cohort study, outcomes among consecutive obese patients undergoing laparoscopic bariatric surgery between January 2016 to December 2018 were evaluated to determine the impact of adjunctive intraoperative lidocaine infusion on 24-hour postoperative opioid consumption. Secondary outcomes, including opioid consumption during hospitalization, length of stay, and postoperative complications were determined. Post hoc analyses were performed exploring possible dose effects and drug-drug interactions. Univariable and multivariable analyses were performed to identify factors associated with opioid consumption. RESULTS Among 345 patients, 54 (15.7%) received intraoperative lidocaine infusion (L+) whereas 291 (84.3%) did not receive intraoperative lidocaine infusion (L-). Both L+ and L- groups shared similar demographic characteristics. The 24-hour postoperative opioid consumption was 17.6% lower in L+ (95% confidence interval -28.4 to -5.2, P = .007), but nonsignificantly lower in the multivariate model (12.8%, 95% confidence interval -24.4 to .5, P = .06). Opioid consumption during hospitalization, length of stay, and other clinically significant outcomes did not differ. However, subgroup analysis restricted to opioid-naïve patients indicated significantly reduced opioid consumption in the L+ group. Post hoc analysis suggested interaction between lidocaine and ketamine in decreasing 24-hour postoperative opioid consumption. CONCLUSIONS Intraoperative lidocaine infusion was not significantly associated with decreasing 24-hour postoperative opioid consumption in obese patients undergoing laparoscopic bariatric surgery.
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Affiliation(s)
- Parichat Tovikkai
- Department of Surgery, University of California San Francisco, San Francisco, California; Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Stanley J Rogers
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - John P Cello
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Rachel Eshima Mckay
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California
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Assessment of the Effect of Perioperative Venous Lidocaine on the Intensity of Pain and IL-6 Concentration After Laparoscopic Gastroplasty. Obes Surg 2020; 30:3912-3918. [PMID: 32533519 DOI: 10.1007/s11695-020-04748-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/22/2020] [Accepted: 05/28/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Opioids are associated with sedation and respiratory depression. The primary objective of this study was to assess pain intensity after gastric bypass with lidocaine. The secondary objective was to assess the IL-6 concentration, consumption of morphine, time to morphine request, time to extubation, and side effects. METHODS Sixty patients aged 18 to 60 years, with ASA (American Society of Anesthesiologists) scores of 2 or 3, who underwent bariatric surgery were allocated to two groups. Patients in group 1 were administered lidocaine (1.5 mg/kg) 5 min before the induction of anesthesia, and group 2 was administered 0.9% saline solution in an equal volume. Subsequently, lidocaine (2 mg/kg/h) or 0.9% saline was infused during the entire surgical procedure. Anesthesia was performed with fentanyl (5 μg/kg), propofol, rocuronium, and sevoflurane. Postoperative patient-controlled analgesia was provided with morphine. The following were evaluated: pain intensity, IL-6, 24-h consumption of morphine, time to the morphine request, time to extubation, and adverse effects. RESULTS The lidocaine group had a lower pain intensity than the saline group for up to 1 h, with no differences between groups in IL-6 and time to extubation. The lidocaine group consumed less morphine within 24 h, had a longer time until the first supplemental morphine request, and had a lower incidence of nausea. CONCLUSIONS Lidocaine reduced the intensity of early postoperative pain, incidence of nausea, and consumption of morphine within 24 h and increased time to the first morphine request, without reducing the plasma concentrations of IL-6.
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Ghimire A, Subedi A, Bhattarai B, Sah BP. The effect of intraoperative lidocaine infusion on opioid consumption and pain after totally extraperitoneal laparoscopic inguinal hernioplasty: a randomized controlled trial. BMC Anesthesiol 2020; 20:137. [PMID: 32493276 PMCID: PMC7268281 DOI: 10.1186/s12871-020-01054-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/25/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND As a component of multimodal analgesia, the administration of systemic lidocaine is a well-known technique. We aimed to evaluate the efficacy of lidocaine infusion on postoperative pain-related outcomes in patients undergoing totally extraperitoneal (TEP) laparoscopies inguinal hernioplasty. METHODS In this randomized controlled double-blind study, we recruited 64 patients to receive either lidocaine 2% (intravenous bolus 1.5 mg. kg - 1 followed by an infusion of 2 mg. kg- 1. h- 1), or an equal volume of normal saline. The infusion was initiated just before the induction of anesthesia and discontinued after tracheal extubation. The primary outcome of the study was postoperative morphine equivalent consumption up to 24 h after surgery. Secondary outcomes included postoperative pain scores, nausea/vomiting (PONV), sedation, quality of recovery (scores based on QoR-40 questionnaire), patient satisfaction, and the incidence of chronic pain. RESULTS The median (IQR) cumulative postoperative morphine equivalent consumption in the first 24 h was 0 (0-1) mg in the lidocaine group and 4 [1-8] mg in the saline group (p < 0.001). Postoperative pain intensity at rest and during movement at various time points in the first 24 h were significantly lower in the lidocaine group compared with the saline group (p < 0.05). Fewer patients reported PONV in the lidocaine group than in the saline group (p < 0.05). Median QoR scores at 24 h after surgery were significantly better in the lidocaine group (194 (194-196) than saline group 184 (183-186) (p < 0.001). Patients receiving lidocaine were more satisfied with postoperative analgesia than those receiving saline (p = 0.02). No difference was detected in terms of postoperative sedation and chronic pain after surgery. CONCLUSIONS Intraoperative lidocaine infusion for laparoscopic TEP inguinal hernioplasty reduces opioid consumption, pain intensity, PONV and improves the quality of recovery and patient satisfaction. TRIAL REGISTRATION ClinicalTrials.gov- NCT02601651. Date of registration: November 10, 2015.
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Affiliation(s)
- Anup Ghimire
- Department of Anesthesiology, Nepal Mediciti Hospital, Lalitpur, Nepal
| | - Asish Subedi
- Department of Anesthesiology & Critical Care Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal.
| | - Balkrishna Bhattarai
- Department of Anesthesiology & Critical Care Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Birendra Prasad Sah
- Department of Anesthesiology & Critical Care Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
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Batko I, Kościelniak-Merak B, Tomasik PJ, Kobylarz K, Wordliczek J. Lidocaine as an element of multimodal analgesic therapy in major spine surgical procedures in children: a prospective, randomized, double-blind study. Pharmacol Rep 2020; 72:744-755. [PMID: 32297162 PMCID: PMC7329801 DOI: 10.1007/s43440-020-00100-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 02/27/2020] [Accepted: 03/19/2020] [Indexed: 12/15/2022]
Abstract
Background Introducing the principles of multimodal analgesic therapy is necessary to provide appropriate comfort for the patient after surgery. The main objective of the study was evaluating the influence of perioperative intravenous (i.v.) lidocaine infusion on postoperative morphine requirements during the first 48 h postoperatively in children undergoing major spine surgery. Materials and methods Prospective, randomized, double-blind study: 41 children, qualified to multilevel spine surgery, were randomly divided into two treatment groups: lidocaine and placebo (control). The lidocaine group received lidocaine as a bolus of 1.5 mg/kg over 30 minutes, followed by a continuous infusion at 1 mg/kg/h to 6 hours after surgery. The protocol of perioperative management was identical for all patients. Measurements: morphine demand, intensity of postoperative pain (the Numerical Rating Scale), oral feeding initiation time, first attempts at assuming erect position, postoperative quality of life (the Acute Short-form /SF-12/ health survey). Results Patient data did not differ demographically. Compared to the control group, lidocaine treatment reduced the demand for morphine during the first 24h [95% CI 0.13 (0.11-0.28) mg/kg, p = 0.0122], 48h [95% CI 0.46 (0.22-0.52) mg/kg, p = 0.0299] after surgery and entire hospitalization [95% CI 0.58 (0.19-0.78) mg/kg, p = 0.04]; postoperative pain intensity; nutritional withdrawal period [introduction of liquid diet (p = 0.024) and solid diet (p = 0.012)], and accelerated the adoption of an upright position [sitting (p = 0.048); walking (p = 0.049)]. The SF-12 generic health survey did not differ between groups before operation, 2 months and 4 years after surgery. Conclusions Perioperative lidocaine administration, as a part of the applied analgesic therapy regimen, may decrease postoperative opioid demand and accelerates convalescence of children undergoing major surgery.
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Affiliation(s)
- Ilona Batko
- Department of Anesthesiology and Intensive Care, University Children's Hospital, 265 Wielicka St, 30-663, Cracow, Poland.
| | - Barbara Kościelniak-Merak
- Department of Clinical Biochemistry, University Children's Hospital, Jagiellonian University Medical College, Cracow, Poland
| | - Przemysław J Tomasik
- Department of Clinical Biochemistry, University Children's Hospital, Jagiellonian University Medical College, Cracow, Poland
| | - Krzysztof Kobylarz
- Department of Anesthesiology and Intensive Care, University Children's Hospital, 265 Wielicka St, 30-663, Cracow, Poland.,Department of Anesthesiology and Intensive Care, Jagiellonian University Medical College, Cracow, Poland
| | - Jerzy Wordliczek
- Department of Anesthesiology and Intensive Care, Jagiellonian University Medical College, Cracow, Poland.,Department of Interdisciplinary Intensive Care, Jagiellonian University Medical College, Cracow, Poland
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Wang Q, Ding X, Huai D, Zhao W, Wang J, Xie C. Effect of Intravenous Lidocaine Infusion on Postoperative Early Recovery Quality in Upper Airway Surgery. Laryngoscope 2020; 131:E63-E69. [PMID: 32119135 DOI: 10.1002/lary.28594] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/22/2020] [Accepted: 02/08/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Systemic infusions of lidocaine have been widely used as perioperative analgesic adjuvants. The aim of this randomized, double-blinded, controlled trial was to investigate the effect of perioperative lidocaine infusion on postoperative early recovery quality in upper airway surgery. STUDY DESIGN Prospective, randomized, double-blinded, placebo-controlled trial. METHODS A total of 99 patients were randomly assigned to the lidocaine group (group L) or the control group (group C). The patients received 2 mg/kg lidocaine completed within 10 minutes before the induction of anesthesia followed by continuous infusions of 2 mg/kg/hr lidocaine (group L) or the same volume of 0.9% normal saline (group C) intravenously during anesthesia. The Quality of Recovery-40 (QoR-40) survey was administered on the preoperative day (Pre) and postoperative days 1 (POD1) and 2 (POD2). The primary endpoint was QoR-40 score on POD1 and POD2. RESULTS Compared with Pre, global QoR-40 scores on POD1 and POD2 were significantly lower (P < .05). Compared with group C, global QoR-40 scores were significantly higher in group L on POD1 and POD2 (P < .05). Among the five dimensions of QoR-40, the scores for physical comfort, emotional state, and pain were superior in group L compared to group C (P < .05). Compared with group C, the consumption of remifentanil and diclofenac as well as the incidence of postoperative nausea and vomiting (PONV) and postoperative 48-hour numeric rating scale (NRS) scores in group L were significantly lower (P < .05). CONCLUSIONS Systemic lidocaine infusion can improve QoR-40 scores in patients with upper airway surgery, reduce the dosage of intraoperative opioids, decrease the incidence of PONV and NRS scores 2 days after surgery, thus improving postoperative early recovery quality. LEVEL OF EVIDENCE 1b Laryngoscope, 131:E63-E69, 2021.
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Affiliation(s)
- Qiao Wang
- School of Anesthesiology, Xuzhou Medical University, Xuzhou, China.,Department of Anesthesiology, The Affiliated Huaian Hospital of Xuzhou Medical University and Huaian Second People's Hospital, Huaian, China
| | - Xiaojun Ding
- School of Anesthesiology, Xuzhou Medical University, Xuzhou, China.,Department of Anesthesiology, The Affiliated Huaian Hospital of Xuzhou Medical University and Huaian Second People's Hospital, Huaian, China
| | - De Huai
- Ear, Nose, and Throat Department, The Affiliated Huaian Hospital of Xuzhou Medical University and Huaian Second People's Hospital, Huaian, China
| | - Weibing Zhao
- Department of Anesthesiology, Huaian Huaiyin Hospital, Huaian, China
| | - Jun Wang
- Department of Anesthesiology, The Affiliated Huaian Hospital of Xuzhou Medical University and Huaian Second People's Hospital, Huaian, China
| | - Chenglan Xie
- Department of Anesthesiology, The Affiliated Huaian Hospital of Xuzhou Medical University and Huaian Second People's Hospital, Huaian, China
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Veiga de Sá A, Cavaleiro C, Campos M. Haemodynamic and analgesic control in a perioperative opioid-free approach to bariatric surgery - A case report. Indian J Anaesth 2020; 64:141-144. [PMID: 32139933 PMCID: PMC7017667 DOI: 10.4103/ija.ija_620_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 09/26/2019] [Accepted: 11/12/2019] [Indexed: 11/25/2022] Open
Abstract
New approaches to bariatric surgery aim to achieve stress-free anaesthesia with sympathetic stability to protect organs and provide sufficient tissue perfusion, analgesia and rapid emergence. Opioid-free and multimodal approaches to anaesthesia provide intra- and post-operative sedation and analgesia, particularly advantageous in morbidly obese patients, but their feasibility and efficacy are still disputed. We describe the case of a female patient proposed for laparoscopic bariatric surgery, conducted under an opioid-free anaesthesia protocol, the haemodynamic, ventilatory and analgesic control, and intra- and post-operative monitoring and complications.
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Affiliation(s)
- Ana Veiga de Sá
- Department of Anaesthesiology, Critical Care and Emergency, Service of Anaesthesiology, Centro Hospitalar do Porto, Porto, Portugal
| | - Carla Cavaleiro
- Department of Anaesthesiology, Critical Care and Emergency, Service of Anaesthesiology, Centro Hospitalar do Porto, Porto, Portugal
| | - Manuel Campos
- Department of Anaesthesiology, Critical Care and Emergency, Service of Anaesthesiology, Centro Hospitalar do Porto, Porto, Portugal
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Elaziz RAEA, Shaban S, Elaziz SA. Effects of Lidocaine Infusion on Quality of Recovery and Agitation after Functional Endoscopic Sinus Surgery: Randomized Controlled Study. OPEN JOURNAL OF ANESTHESIOLOGY 2020; 10:435-448. [DOI: 10.4236/ojanes.2020.1012038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Jesus M, Padilha V, Tocheto R, Comasetto F, Ronchi S, Oleskovicz N. Infusão de morfina e cetamina, associada ou não à lidocaína, em gatas submetidas à ovariossalpingo-histerectomia. ARQ BRAS MED VET ZOO 2020. [DOI: 10.1590/1678-4162-10880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O objetivo deste estudo foi avaliar os efeitos analgésicos transoperatórios da infusão contínua de morfina e cetamina, associada ou não à lidocaína, em gatas submetidas à OSH eletiva. Foram utilizadas 16 fêmeas adultas, hígidas, pré-medicadas com acepromazina (0,1mg/kg) e morfina (0,5mg/kg), ambas pela via intramuscular, induzidas com cetamina (1mg/kg) e propofol (4mg/kg), pela via intravenosa, e mantidas sob anestesia geral inalatória com isoflurano a 1,4 V%. Os animais foram alocados aleatoriamente em dois grupos: grupo morfina, lidocaína e cetamina (MLK, n=8), que recebeu bolus de lidocaína (1mg/kg), pela via IV, seguido de infusão de morfina, lidocaína e cetamina (0,26mg/kg/h, 3mg/kg/h e 0,6mg/kg/h, respectivamente); e grupo morfina e cetamina (MK, n=8), que recebeu bolus de solução salina, seguido de infusão de morfina e cetamina, nas mesmas doses do MLK. Os momentos avaliados foram: M0, basal, cinco minutos após a indução; M1, imediatamente após a aplicação do bolus de lidocaína ou solução salina; M2, M3, M4 e M5, a cada cinco minutos, até completar 20 minutos do início da infusão; M6, após a incisão da musculatura; M7, após pinçamento do primeiro pedículo ovariano; M8, após pinçamento do segundo pedículo ovariano; M9, após pinçamento da cérvix; M10, após sutura da musculatura; M11, ao final da cirurgia; e M12, M13 e M14, intervalos de cinco minutos, até completar uma hora de infusão. A FP no M0 foi maior no MLK quando comparado ao MK. Em ambos os grupos, a PAS foi maior no M7 e no M8 em relação ao M0, porém no MK, além da PAS, a FP foi maior do M7 ao M13, assim como a f. Os animais do MK necessitaram de um número maior de resgates transoperatorios, total de 23, do que o MLK, total de sete. Conclui-se que a adição de lidocaína incrementou a analgesia oferecida, reduzindo o número de resgates analgésicos transoperatórios, a dose total de fentanil, bem como a probabilidade de os animais necessitarem dese tipo de resgate.
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Affiliation(s)
- M. Jesus
- Univesidade Federal do Rio Grande do Sul, Brazil
| | | | - R. Tocheto
- Universidade do Estado de Santa Catarina, Brazil
| | - F. Comasetto
- Universidade do Estado de Santa Catarina, Brazil
| | - S.J. Ronchi
- Universidade do Estado de Santa Catarina, Brazil
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Pharmacological strategies in multimodal analgesia for adults scheduled for ambulatory surgery. Curr Opin Anaesthesiol 2019; 32:720-726. [DOI: 10.1097/aco.0000000000000796] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Lee HM, Choi KW, Byon HJ, Lee JM, Lee JR. Systemic Lidocaine Infusion for Post-Operative Analgesia in Children Undergoing Laparoscopic Inguinal Hernia Repair: A Randomized Double-Blind Controlled Trial. J Clin Med 2019; 8:jcm8112014. [PMID: 31752236 PMCID: PMC6912688 DOI: 10.3390/jcm8112014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/15/2019] [Accepted: 11/15/2019] [Indexed: 12/14/2022] Open
Abstract
Systemic lidocaine can provide satisfactory post-operative analgesia in adults. In this study, we assessed whether intravenous lidocaine is effective for post-operative analgesia and recovery in children undergoing laparoscopic inguinal hernia repair. A total of 66 children aged from six months to less than six years were classified in either the lidocaine (L) or control (C) groups. Children in Group L received a lidocaine infusion (a bolus dose of 1 mL kg−1, followed by a 1.5 mg kg−1 h−1 infusion), whereas Group C received the same volume of 0.9% saline. The primary outcome was the number of patients who presented face, legs, activity, crying and consolability (FLACC) scores of four or more, and therefore received rescue analgesia in the post-anesthesia recovery care unit (PACU). Secondary outcomes included the highest FLACC score in the PACU, FLACC, and the parents’ postoperative pain measure (PPPM) score at 48 h post-operation, as well as side effects. The number of children who received rescue analgesia in the PACU was 15 (50%) in Group L and 22 (73%) in Group C (p = 0.063). However, the highest FLACC score in PACU was lower in Group L (3.8 ± 2.4) than in Group C (5.3 ± 2.7) (p = 0.029). In conclusion, systemic lidocaine did not reduce the number of children who received rescue analgesia in PACU.
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Affiliation(s)
- Hye-Mi Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (H.-M.L.); (H.-J.B.); (J.-M.L.)
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
| | - Kwan-Woong Choi
- Department of Anesthesiology and Pain Medicine, National Health Insurance Service Il San Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 10444, Korea;
| | - Hyo-Jin Byon
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (H.-M.L.); (H.-J.B.); (J.-M.L.)
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
| | - Ji-Min Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (H.-M.L.); (H.-J.B.); (J.-M.L.)
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
| | - Jeong-Rim Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (H.-M.L.); (H.-J.B.); (J.-M.L.)
- Correspondence:
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Hakim KYK, Wahba WZB. Opioid-Free Total Intravenous Anesthesia Improves Postoperative Quality of Recovery after Ambulatory Gynecologic Laparoscopy. Anesth Essays Res 2019; 13:199-203. [PMID: 31198230 PMCID: PMC6545966 DOI: 10.4103/aer.aer_74_19] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Gynecological laparoscopic surgery is commonly performed on an ambulatory basis under general anesthesia. The postoperative quality of recovery (QOR) should be considered one of the principal endpoints after ambulatory surgery. Total intravenous anesthesia (TIVA) with opioids is known to improve postoperative QOR after ambulatory surgery. However, opioids can be associated with an increased incidence of postoperative complications, which can affect postoperative QOR. The primary aim of this study was to compare the patient recovery using the QOR-40 at 24 h postoperative in ambulatory gynecological laparoscopy between opioid-free (OF) TIVA and opioid-based TIVA. Settings and Design: A prospective, randomized, controlled, comparative study was conducted at the day surgery center. Patients and Methods: Eighty females were included in the study. They were randomized into two equal groups: OF TIVA group with dexmedetomidine and propofol or opioid-based TIVA (O) group with fentanyl and propofol. The primary outcome was QOR-40 at 24 h postoperative, and the secondary outcomes were postoperative numerical rating scale (NRS), time to first rescue analgesia, number of rescue tramadol analgesia, and the incidence of postoperative nausea and vomiting. Results: A statistically significant difference in total QOR-40 score at 24 h postoperative was observed between the groups (median [range] QOR-40 of 182.0 [164.0–192.0] in the OF TIVA group and 170.0 [156.0–185.0] in the O group; P = 0.03). OF group had significantly lower time to first rescue analgesia, maximum NRS pain scores, number of rescue tramadol analgesia, and ondansetron use. Conclusions: OF TIVA significantly improves postoperative QOR in patients undergoing ambulatory gynecological laparoscopic surgery.
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Intravenous infusion of lidocaine significantly reduces propofol dose for colonoscopy: a randomised placebo-controlled study. Br J Anaesth 2018; 121:1059-1064. [DOI: 10.1016/j.bja.2018.06.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/08/2018] [Accepted: 07/01/2018] [Indexed: 12/18/2022] Open
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Beaussier M, Delbos A, Maurice-Szamburski A, Ecoffey C, Mercadal L. Perioperative Use of Intravenous Lidocaine. Drugs 2018; 78:1229-1246. [DOI: 10.1007/s40265-018-0955-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Venkatraghavan L, Li L, Bailey T, Manninen PH, Tymianski M. Sumatriptan improves postoperative quality of recovery and reduces postcraniotomy headache after cranial nerve decompression. Br J Anaesth 2018; 117:73-9. [PMID: 27317706 DOI: 10.1093/bja/aew152] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Microvascular decompression (MVD) is a surgical treatment for cranial nerve disorders via a small craniotomy. The postoperative pain of this procedure can be classified as surgical site somatic pain and postcraniotomy headache similar in nature to a migraine, including its association with photophobia, nausea, and vomiting. This headache can be difficult to treat and can impact on postoperative recovery. Sumatriptan is used to treat migraine-like headaches in various settings. This single-centre randomized controlled trial investigated whether postoperative administration of sumatriptan after MVD surgery impacts the quality of postoperative recovery. METHODS Fifty patients who complained of postoperative headache after MVD were randomized to receive an s.c. injection of sumatriptan (6 mg) or saline. The primary outcome was quality of recovery as measured by the Quality of Recovery-40 (QoR-40) score at 24 h. RESULTS The QoR-40 scores were significantly higher in the sumatriptan group (median 184; interquartile range 169-196) than in the placebo group (133; 119-155; P<0.01), suggesting higher quality of recovery. The sumatriptan group also had significantly lower headache scores at 4, 12, and 24 h. There were no significant differences in other secondary outcomes. CONCLUSIONS Use of sumatriptan improved the quality of recovery as measured by the QoR-40 and reduction of headache at 24 h after surgery. Sumatriptan is a useful alternative treatment for postcraniotomy headache. The mechanism remains unknown but could be related to reduction in headache, mood modulation, or both, mediated by a serotonin effect. CLINICAL TRIAL REGISTRATION NCT01632657.
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Affiliation(s)
| | - L Li
- Department of Anesthesia Present address: Department of Anaesthesia, Ninewells Hospital and Medical School, Dundee, UK
| | - T Bailey
- Department of Anesthesia Present address: Department of Anaesthesia, Waikato Hospital, Hamilton 3204, New Zealand
| | | | - M Tymianski
- Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Does fentanyl or remifentanil provide better postoperative recovery after laparoscopic surgery? a randomized controlled trial. BMC Anesthesiol 2018; 18:81. [PMID: 29996760 PMCID: PMC6042429 DOI: 10.1186/s12871-018-0547-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 06/20/2018] [Indexed: 11/12/2022] Open
Abstract
Background Fentanyl and remifentanil are widely used opioids in surgery, but it has not been evaluated whether the choice of opioids during surgery affects the patients’ postoperative quality of recovery. Accordingly, we aim to compare postoperative recovery of fentanyl-based anesthesia with remifentanil-based anesthesia after laparoscopic surgery using the QoR 40 questionnaire (QoR-40). Methods The study was prospective, randomized, patient and investigator-blinded, controlled, clinical trial. Seventy patients undergoing laparoscopic or retroperitoneoscopic renal or ureteral surgery were recruited and randomized to either fentanyl or remifentanil based anesthesia groups. The primary outcome was the global QoR-40 at 24 h after surgery. Results The global median (interquartile range) QoR-40 score was 160 (138–177) in the fentanyl group (n = 32) and 140 (127–166) in the remifentanil group (n = 31). Physical comfort and physical independence, the two out of the five dimensions of the QoR-40, demonstrated significantly high scores in the fentanyl group (P = 0.047 and P = 0.032, respectively). Conclusion Although the global QoR is higher in the fentanyl group by 20 points compared with remifentanil group, no significant differences revealed between the groups. Further studies with large numbers of subjects of the same gender are needed. Trial registration University Hospital Medical Information Network (UMIN), UMIN000010464. Registered 10 April 2013.
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Koepke EJ, Manning EL, Miller TE, Ganesh A, Williams DGA, Manning MW. The rising tide of opioid use and abuse: the role of the anesthesiologist. Perioper Med (Lond) 2018; 7:16. [PMID: 29988696 PMCID: PMC6029394 DOI: 10.1186/s13741-018-0097-4] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/18/2018] [Indexed: 12/13/2022] Open
Abstract
Opioid use has risen dramatically in the past three decades. In the USA, opioid overdose has become a leading cause of unintentional death, surpassing motor vehicle accidents. A patient's first exposure to opioids may be during the perioperative period, a time where anesthesiologists have a significant role in pain management. Almost all patients in the USA receive opioids during a surgical encounter. Opioids have many undesirable side effects, including potential for misuse, or opioid use disorder. Anesthesiologists and surgeons employ several methods to decrease unnecessary opioid use, opioid-related adverse events, and side effects in the perioperative period. Multimodal analgesia, enhanced recovery pathways, and regional anesthesia are key tools as we work towards optimal opioid stewardship and the ideal of effective analgesia without undesirable sequelae.
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Affiliation(s)
- Elena J. Koepke
- Division of General, Vascular and Transplant Anesthesiology, Department of Anesthesiology, Duke University, Box 3094, 2301 Erwin Road, Durham, NC 27710 USA
| | - Erin L. Manning
- Division of Regional Anesthesiology, Department of Anesthesiology, Duke University, Durham, USA
| | - Timothy E. Miller
- Division of General, Vascular and Transplant Anesthesiology, Department of Anesthesiology, Duke University, Box 3094, 2301 Erwin Road, Durham, NC 27710 USA
| | - Arun Ganesh
- Division of Pain, Department of Anesthesiology, Duke University, Durham, USA
| | - David G. A. Williams
- Division of General, Vascular and Transplant Anesthesiology, Department of Anesthesiology, Duke University, Box 3094, 2301 Erwin Road, Durham, NC 27710 USA
| | - Michael W. Manning
- Division of General, Vascular and Transplant Anesthesiology, Department of Anesthesiology, Duke University, Box 3094, 2301 Erwin Road, Durham, NC 27710 USA
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Weibel S, Jelting Y, Pace NL, Helf A, Eberhart LHJ, Hahnenkamp K, Hollmann MW, Poepping DM, Schnabel A, Kranke P. Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery in adults. Cochrane Database Syst Rev 2018; 6:CD009642. [PMID: 29864216 PMCID: PMC6513586 DOI: 10.1002/14651858.cd009642.pub3] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The management of postoperative pain and recovery is still unsatisfactory in a number of cases in clinical practice. Opioids used for postoperative analgesia are frequently associated with adverse effects, including nausea and constipation, preventing smooth postoperative recovery. Not all patients are suitable for, and benefit from, epidural analgesia that is used to improve postoperative recovery. The non-opioid, lidocaine, was investigated in several studies for its use in multimodal management strategies to reduce postoperative pain and enhance recovery. This review was published in 2015 and updated in January 2017. OBJECTIVES To assess the effects (benefits and risks) of perioperative intravenous (IV) lidocaine infusion compared to placebo/no treatment or compared to epidural analgesia on postoperative pain and recovery in adults undergoing various surgical procedures. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, and reference lists of articles in January 2017. We searched one trial registry contacted researchers in the field, and handsearched journals and congress proceedings. We updated this search in February 2018, but have not yet incorporated these results into the review. SELECTION CRITERIA We included randomized controlled trials comparing the effect of continuous perioperative IV lidocaine infusion either with placebo, or no treatment, or with thoracic epidural analgesia (TEA) in adults undergoing elective or urgent surgery under general anaesthesia. The IV lidocaine infusion must have been started intraoperatively, prior to incision, and continued at least until the end of surgery. DATA COLLECTION AND ANALYSIS We used Cochrane's standard methodological procedures. Our primary outcomes were: pain score at rest; gastrointestinal recovery and adverse events. Secondary outcomes included: postoperative nausea and postoperative opioid consumption. We used GRADE to assess the quality of evidence for each outcome. MAIN RESULTS We included 23 new trials in the update. In total, the review included 68 trials (4525 randomized participants). Two trials compared IV lidocaine with TEA. In all remaining trials, placebo or no treatment was used as a comparator. Trials involved participants undergoing open abdominal (22), laparoscopic abdominal (20), or various other surgical procedures (26). The application scheme of systemic lidocaine strongly varies between the studies related to both dose (1 mg/kg/h to 5 mg/kg/h) and termination of the infusion (from the end of surgery until several days after).The risk of bias was low with respect to selection bias (random sequence generation), performance bias, attrition bias, and detection bias in more than 50% of the included studies. For allocation concealment and selective reporting, the quality assessment yielded low risk of bias for only approximately 20% of the included studies.IV Lidocaine compared to placebo or no treatment We are uncertain whether IV lidocaine improves postoperative pain compared to placebo or no treatment at early time points (1 to 4 hours) (standardized mean difference (SMD) -0.50, 95% confidence interval (CI) -0.72 to -0.28; 29 studies, 1656 participants; very low-quality evidence) after surgery. Due to variation in the standard deviation (SD) in the studies, this would equate to an average pain reduction of between 0.37 cm and 2.48 cm on a 0 to 10 cm visual analogue scale . Assuming approximately 1 cm on a 0 to 10 cm pain scale is clinically meaningful, we ruled out a clinically relevant reduction in pain with lidocaine at intermediate (24 hours) (SMD -0.14, 95% CI -0.25 to -0.04; 33 studies, 1847 participants; moderate-quality evidence), and at late time points (48 hours) (SMD -0.11, 95% CI -0.25 to 0.04; 24 studies, 1404 participants; moderate-quality evidence). Due to variation in the SD in the studies, this would equate to an average pain reduction of between 0.10 cm to 0.48 cm at 24 hours and 0.08 cm to 0.42 cm at 48 hours. In contrast to the original review in 2015, we did not find any significant subgroup differences for different surgical procedures.We are uncertain whether lidocaine reduces the risk of ileus (risk ratio (RR) 0.37, 95% CI 0.15 to 0.87; 4 studies, 273 participants), time to first defaecation/bowel movement (mean difference (MD) -7.92 hours, 95% CI -12.71 to -3.13; 12 studies, 684 participants), risk of postoperative nausea (overall, i.e. 0 up to 72 hours) (RR 0.78, 95% CI 0.67 to 0.91; 35 studies, 1903 participants), and opioid consumption (overall) (MD -4.52 mg morphine equivalents , 95% CI -6.25 to -2.79; 40 studies, 2201 participants); quality of evidence was very low for all these outcomes.The effect of IV lidocaine on adverse effects compared to placebo treatment is uncertain, as only a small number of studies systematically analysed the occurrence of adverse effects (very low-quality evidence).IV Lidocaine compared to TEAThe effects of IV lidocaine compared with TEA are unclear (pain at 24 hours (MD 1.51, 95% CI -0.29 to 3.32; 2 studies, 102 participants), pain at 48 hours (MD 0.98, 95% CI -1.19 to 3.16; 2 studies, 102 participants), time to first bowel movement (MD -1.66, 95% CI -10.88 to 7.56; 2 studies, 102 participants); all very low-quality evidence). The risk for ileus and for postoperative nausea (overall) is also unclear, as only one small trial assessed these outcomes (very low-quality evidence). No trial assessed the outcomes, 'pain at early time points' and 'opioid consumption (overall)'. The effect of IV lidocaine on adverse effects compared to TEA is uncertain (very low-quality evidence). AUTHORS' CONCLUSIONS We are uncertain whether IV perioperative lidocaine, when compared to placebo or no treatment, has a beneficial impact on pain scores in the early postoperative phase, and on gastrointestinal recovery, postoperative nausea, and opioid consumption. The quality of evidence was limited due to inconsistency, imprecision, and study quality. Lidocaine probably has no clinically relevant effect on pain scores later than 24 hours. Few studies have systematically assessed the incidence of adverse effects. There is a lack of evidence about the effects of IV lidocaine compared with epidural anaesthesia in terms of the optimal dose and timing (including the duration) of the administration. We identified three ongoing studies, and 18 studies are awaiting classification; the results of the review may change when these studies are published and included in the review.
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Affiliation(s)
- Stephanie Weibel
- University of WürzburgDepartment of Anaesthesia and Critical CareOberduerrbacher Str. 6WürzburgGermany
| | - Yvonne Jelting
- University of WürzburgDepartment of Anaesthesia and Critical CareOberduerrbacher Str. 6WürzburgGermany
| | - Nathan L Pace
- University of UtahDepartment of Anesthesiology3C444 SOM30 North 1900 EastSalt Lake CityUTUSA84132‐2304
| | - Antonia Helf
- University of WürzburgDepartment of Anaesthesia and Critical CareOberduerrbacher Str. 6WürzburgGermany
| | - Leopold HJ Eberhart
- Philipps‐University MarburgDepartment of Anaesthesiology & Intensive Care MedicineBaldingerstrasse 1MarburgGermany35043
| | - Klaus Hahnenkamp
- University HospitalDepartment of AnesthesiologyGreifswaldGermany17475
| | - Markus W Hollmann
- Academic Medical Center (AMC) University of AmsterdamDepartment of AnaesthesiologyMeibergdreef 9AmsterdamNetherlands1105 DD
| | - Daniel M Poepping
- University Hospital MünsterDepartment of Anesthesiology and Intensive CareAlbert Schweitzer Str. 33MünsterGermany48149
| | - Alexander Schnabel
- University of WürzburgDepartment of Anaesthesia and Critical CareOberduerrbacher Str. 6WürzburgGermany
| | - Peter Kranke
- University of WürzburgDepartment of Anaesthesia and Critical CareOberduerrbacher Str. 6WürzburgGermany
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Piegeler T, Werdehausen R. [Systemic effects of amide-linked local anesthetics : Old drugs, new magic bullets?]. Anaesthesist 2018; 67:525-528. [PMID: 29802438 DOI: 10.1007/s00101-018-0453-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Besides the well-known analgesic effects of amide-linked local anesthetics exerted via the inhibition of the voltage-gated sodium channel, these substances also possess a certain number of properties, which bear the potential to positively influence the outcome after surgery. The results of several experimental as well as clinical studies suggest the possibility of an enhanced recovery after surgery, reduction in the incidence of chronic pain, preservation of endothelial barrier function during acute lung injury and the prevention of metastasis of solid tumors by systemic effects of local anesthetic administration. Mechanistic studies were able to identify several "new targets", such as the inhibition of spinal glycine transporters or of inflammatory signaling as induced by tumor necrosis factor alpha. Further elucidation of these mechanistic pathways as well as the translation of these promising experimental results into clinical practice is a crucial component of research activities in the field of anesthesia.
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Affiliation(s)
- T Piegeler
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Leipzig (AöR), Liebigstraße 20, 04103, Leipzig, Deutschland.
| | - R Werdehausen
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Leipzig (AöR), Liebigstraße 20, 04103, Leipzig, Deutschland
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Ibrahim A, Aly M, Farrag W. Effect of intravenous lidocaine infusion on long-term postoperative pain after spinal fusion surgery. Medicine (Baltimore) 2018; 97:e0229. [PMID: 29595671 PMCID: PMC5895437 DOI: 10.1097/md.0000000000010229] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 01/05/2018] [Accepted: 03/01/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Intravenous lidocaine infusion is known to reduce postoperative pain for days or weeks beyond the infusion time, and plasma half-life in several types of surgical procedures. OBJECTIVES To evaluate the effect of intravenous (IV) lidocaine infusion on long term postoperative pain intensity for 3 months in patients undergoing spinal fusion surgery. STUDY DESIGN Prospective randomized, double-blinded study. SETTING Assiut University Hospital, Assiut, Egypt. METHODS Forty patients undergoing spinal fusion surgery were randomized into 2 equal groups (n = 20 in each). Patients in the lidocaine group received IV lidocaine at a dosage of 2.0 mg/kg slowly before induction of anesthesia, followed by lidocaine IV infusion at a rate of 3.0 mg/kg/h until the end of surgery. Patients in the control group received an equal volume of normal saline. The following data were assessed: pain by Visual Analog Score (VAS) at 1 hour, 6 hours, 12 hours, 24 hours, 48 hours, at discharge time, and at 1 month, 2 months, and 3 months post-operation, time to first request for additional analgesia, and total morphine consumption in 24 hours. RESULTS Lidocaine significantly reduced the postoperative pain score (VAS) for up to 3 months (P < .05), and significantly reduced morphine consumption (4.5 mg vs. 19.85 mg) in the 1st 24 hours postoperative. Lidocaine also significantly, prolonged (P < .05) the time to first request for additional analgesia (9.56 ± 2.06 hours vs 1.82 ± 0.91 hours). CONCLUSION Intra-operative lidocaine, when given intravenously as a bolus followed by an infusion, significantly decreased long term postoperative back pain intensity in patients undergoing spinal fusion surgery.
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