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Osborne KW, MacFater WS, Anderson BJ, Svirskis D, Hill AG, Hannam JA. Pharmacokinetics of Intraperitoneal Lidocaine for Sustained Postoperative Analgesia in Adults. Eur J Drug Metab Pharmacokinet 2025:10.1007/s13318-025-00948-1. [PMID: 40342039 DOI: 10.1007/s13318-025-00948-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2025] [Indexed: 05/11/2025]
Abstract
BACKGROUND AND OBJECTIVE Intraperitoneal lidocaine is an emerging strategy for analgesia following abdominal surgery but its pharmacokinetics are poorly quantified. We aimed to develop a pharmacokinetic model for unbound and total lidocaine by intraperitoneal and intravenous routes. METHODS Unbound and total lidocaine concentrations, and pain scores (visual analogue score 0-10) were from a published randomized control trial of adults (n = 56) undergoing laparoscopic colon resection. Participants received intravenous or intraperitoneal lidocaine (2 mg/kg bolus then 1.5 mg/kg/h infusion) for 72 h postoperatively. Data were pooled with literature-derived alpha-1-acid glycoprotein concentrations (AAG) to support total lidocaine modelling. Unbound kinetics were described using compartmental models with first order absorption between intraperitoneal and plasma compartments. A turnover model described AAG kinetics with constant binding to lidocaine. An inhibitory pharmacodynamic model was explored to link concentration to pain scores. RESULTS Maximum lidocaine concentrations after intraperitoneal administration were means (range) of 3.0 (0.4-4.5) mg/L total and 0.6 (0.1-0.9) mg/L unbound. Intraperitoneal absorption was incomplete (bioavailability = 0.66, 95% confidence interval (CI) 0.6-0.76) with a half-time of 0.5 (0.4-0.8) h. A two-compartment model with first order elimination fit best, with unbound clearance 121 (108-136) L/h/70 kg. The binding constant to AAG (KD) was 2.98 (2.69-3.35) µmol/L. A pharmacodynamic model with C50 of 0.21 mg/L and maximal reduction (Emax) of 6 units captured pain scores and was used to simulate dosing strategies. CONCLUSIONS A third of the intraperitoneal dose did not reach the central compartment and absorption took ~2 h. Simulations show that 2 mg/kg/h intraperitoneal infusion achieves a 5-point pain score reduction within ~36 min.
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Affiliation(s)
- Kenyon W Osborne
- Department of Pharmacology and Clinical Pharmacology, University of Auckland, Auckland, New Zealand
| | - Wiremu S MacFater
- Department of Surgery, South Auckland Clinical Campus, Middlemore Hospital, University of Auckland, Auckland, New Zealand
| | - Brian J Anderson
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - Darren Svirskis
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Andrew G Hill
- Department of Surgery, South Auckland Clinical Campus, Middlemore Hospital, University of Auckland, Auckland, New Zealand
| | - Jacqueline A Hannam
- Department of Pharmacology and Clinical Pharmacology, University of Auckland, Auckland, New Zealand.
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand.
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Paterson H, Vadiveloo T, MacLennan G. Intravenous Lidocaine for Gut Function Recovery-Reply. JAMA 2025:2833018. [PMID: 40257775 DOI: 10.1001/jama.2025.0995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2025]
Affiliation(s)
- Hugh Paterson
- Colorectal Surgery Unit, Western General Hospital, Edinburgh, United Kingdom
| | - Thenmalar Vadiveloo
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Graeme MacLennan
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, United Kingdom
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Spindler-Vesel A, Jenko M, Repar A, Potocnik I, Markovic-Bozic J. Effectiveness of tramadol or topic lidocaine compared to epidural or opioid analgesia on postoperative analgesia in laparoscopic colorectal tumor resection. Radiol Oncol 2025; 59:132-138. [PMID: 39754642 PMCID: PMC11867567 DOI: 10.2478/raon-2025-0003] [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: 06/18/2024] [Accepted: 10/24/2024] [Indexed: 01/06/2025] Open
Abstract
BACKGROUND Chronic postoperative pain is the most common postoperative complication that impairs quality of life. Postoperative pain gradually develops into neuropathic pain. Multimodal analgesia targets multiple points in the pain pathway and influences the mechanisms of pain chronification. PATIENTS AND METHODS We investigated whether a lidocaine patch at the wound site or an infusion of metamizole and tramadol can reduce opioid consumption during laparoscopic colorectal surgery and whether the results are comparable to those of epidural analgesia. Patients were randomly divided into four groups according to the type of postoperative analgesia. Group 1 consisted of 20 patients who received an infusion of piritramide. Group 2 consisted of 21 patients who received an infusion of metamizole and tramadol. Group 3 consisted of 20 patients who received patient-controlled epidural analgesia. Group 4 consisted of 22 patients who received piritramide together with a 5% lidocaine patch on the wound site. The occurrence of neuropathic pain was also investigated. RESULTS Piritramide consumption was significantly lowest in group 3 on the day of surgery and on the first and second day after surgery. Group 4 required significantly less piritramide than group 1 on the day of surgery and on the first and second day after surgery. The group with metamizole and tramadol required significantly less piritramide than groups 1 and 4 on the first and second day after surgery. On the day of surgery, this group required the highest amount of piritramide. CONCLUSIONS Weak opioids such as tramadol in combination with non-opioids such as metamizole were as effective as epidural analgesia in terms of postoperative analgesia and opioid consumption. A lidocaine patch in combination with an infusion of piritramide have been able to reduce opioid consumption.
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Affiliation(s)
- Alenka Spindler-Vesel
- Clinical Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Matej Jenko
- Clinical Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Ajsa Repar
- Department of Anaesthesiology and Intensive Care, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Iztok Potocnik
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
- Department of Anaesthesiology and Intensive Care, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Jasmina Markovic-Bozic
- Clinical Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
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Atter M, Stoddart A, Cotton S, Vadiveloo T, Innes K, Balfour A, Arnott R, Aucott L, Batham Z, Foo I, MacLennan G, Nimmo S, Speake D, Norrie J, Paterson H. Intravenous lidocaine for gut function recovery in colonic surgery: a health economic evaluation of the ALLEGRO randomised clinical trial. BMJ Open 2025; 15:e088298. [PMID: 40000075 PMCID: PMC12083329 DOI: 10.1136/bmjopen-2024-088298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 01/23/2025] [Indexed: 02/27/2025] Open
Abstract
OBJECTIVES To compare costs, health outcomes and cost-effectiveness of using intravenous lidocaine (bolus given at induction of anaesthesia, followed by infusion for 6-12 hours) during colorectal surgery to improve the return of gastrointestinal function. DESIGN Within-trial planned analysis of data from a randomised controlled trial using an intention-to-treat approach. SETTING 27 hospitals from across the UK. PARTICIPANTS 557 patients aged 25-91 having minimally invasive elective colorectal resection. INTERVENTION A 1:1 randomisation between intravenous lidocaine and placebo, minimised for age (<50 years, 50-74 years, ≥75 years), gender, and trial centre. PRIMARY OUTCOME MEASURES Mean differences between trial arms in 30-day and 90-day quality-adjusted life-years (QALYs) and 30-day total National Health Service costs, as well as the 30-day incremental cost-effectiveness ratio. RESULTS Compliance and data quality were high. Intravenous lidocaine is associated with differences of £38 (95% CI: -£463, £589) in total 30-day costs, -0.0005 (95% CI: -0.0027, 0.0015) in 30-day QALYs and -0.0008 (95% CI: -0.0066, 0.0048) in 90-day QALYs. No large, statistically significant or meaningful differences in primary or secondary outcome measures between trial arms were detected, other than for the intervention costs. CONCLUSION Intravenous lidocaine is not found to impact costs or health outcomes for patients undergoing colorectal surgery. In the absence of a clinical effect, disinvestment from perioperative lidocaine could save costs associated with infusion monitoring. TRIAL REGISTRATION NUMBER International Standard Randomised Controlled Trial Number 52352431.
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Affiliation(s)
- Marek Atter
- The University of Edinburgh, Edinburgh, Edinburgh, UK
| | | | | | | | | | - Angie Balfour
- The University of Edinburgh, Edinburgh, Edinburgh, UK
| | - Robert Arnott
- Association of Coloproctology of Great Britain and Ireland, London, UK
- University of Oxford, Oxford, UK
| | | | - Zoe Batham
- HSRU, University of Aberdeen, Aberdeen, UK
| | - Irwin Foo
- Western General Hospital, Edinburgh, UK
| | | | | | | | - John Norrie
- The University of Edinburgh, Edinburgh, Edinburgh, UK
| | - Hugh Paterson
- The University of Edinburgh, Edinburgh, Edinburgh, UK
- Western General Hospital, Edinburgh, UK
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Paterson H, Vadiveloo T, Innes K, Balfour A, Atter M, Stoddart A, Cotton S, Arnott R, Aucott L, Batham Z, Foo I, MacLennan G, Nimmo S, Speake D, Norrie J. Intravenous Lidocaine for Gut Function Recovery in Colonic Surgery: A Randomized Clinical Trial. JAMA 2025; 333:39-48. [PMID: 39602290 PMCID: PMC11603374 DOI: 10.1001/jama.2024.23898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 10/24/2024] [Indexed: 11/29/2024]
Abstract
Importance Despite the recovery advantages of minimally invasive surgical techniques, delayed return of gut function after colectomy is a common barrier to timely discharge from hospital. Objective To evaluate the effect of 2% perioperative intravenous lidocaine infusion on return of gut function after elective minimally invasive colon resection. Design, Setting, and Participants The ALLEGRO trial was a randomized, placebo-controlled, double-blind trial conducted in 27 UK hospitals. A total of 590 adults scheduled for elective minimally invasive colon resection for benign or malignant disease were randomized 1:1 to 2% intravenous lidocaine or saline placebo. Enrollment occurred from August 13, 2018, to April 11, 2023, with a pause in recruitment from March 20, 2020, through July 6, 2020; final follow-up was on August 10, 2023. Interventions The intervention patients received 2% intravenous lidocaine administered as 1.5-mg/kg bolus at induction of anesthesia followed by 1.5 mg/kg/h for 6 or 12 hours. Control patients received 0.9% saline placebo for 6 or 12 hours. Main Outcomes and Measures The primary outcome was the proportion of patients with return of gut function at 72 hours after surgery, defined by the GI-3 composite end point of tolerating diet (ingestion of food and drink without significant nausea or vomiting for 3 consecutive meals) and passage of flatus or stool. There were 11 secondary outcomes, including time to GI-3 recovery, time to GI-2 recovery (tolerance of oral diet and passage of stool), prolonged postoperative ileus, postoperative nausea and vomiting score, Overall Benefit of Analgesia Score, postoperative opioid consumption, Quality of Recovery-15, quality of life (EuroQol 5-Dimension 5-Level), enhanced recovery protocol adherence, time to meeting medically defined criteria for discharge, and time to patient self-assessed readiness for discharge. Results The trial enrolled 590 patients (295 intervention, 295 control); after 33 postrandomization exclusions, 557 patients were included (279 intervention, 278 control; 249 female patients [44.7%]; mean [SD] age, 66 [10.9] years); 532 (96%) received the randomized treatment. Return of gut function as defined by the GI-3 composite outcome was achieved at 72 hours by 160 patients (57.3%) in the intravenous lidocaine group vs 164 patients (59.0%) in the placebo group (adjusted absolute difference, -1.9% [95% CI, -8.0% to 4.2%]; relative risk, 0.97 [95% CI, 0.88 to 1.07]). There was no significant difference between the intervention and control groups in any of the 11 secondary end points. Conclusions and Relevance Among patients undergoing elective minimally invasive colon resection, perioperative administration of 2% intravenous lidocaine did not improve return of gut function at 72 hours. Trial Registration isrctn.org Identifier: ISRCTN52352431.
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Affiliation(s)
- Hugh Paterson
- University of Edinburgh, Edinburgh, United Kingdom
- Western General Hospital, Edinburgh, United Kingdom
| | - Thenmalar Vadiveloo
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Karen Innes
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, United Kingdom
| | - Angie Balfour
- Western General Hospital, Edinburgh, United Kingdom
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, United Kingdom
| | - Marek Atter
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, United Kingdom
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Andrew Stoddart
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, United Kingdom
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Seonaidh Cotton
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, United Kingdom
| | - Robert Arnott
- Association of Coloproctology of Great Britain and Ireland, London, United Kingdom
| | - Lorna Aucott
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Zoe Batham
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, United Kingdom
| | - Irwin Foo
- Western General Hospital, Edinburgh, United Kingdom
| | - Graeme MacLennan
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, United Kingdom
| | - Susan Nimmo
- Western General Hospital, Edinburgh, United Kingdom
| | - Doug Speake
- Western General Hospital, Edinburgh, United Kingdom
| | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, United Kingdom
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
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Prajapati DJ, Patel M, Patel P, Ganpule A, Mistry D. The role of intravenous lidocaine infusion in enhanced recovery after laparoscopic renal surgeries: A randomized control trial. J Anaesthesiol Clin Pharmacol 2024; 40:612-618. [PMID: 39759055 PMCID: PMC11694884 DOI: 10.4103/joacp.joacp_98_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/07/2025] Open
Abstract
Background and Aims Enhanced recovery after surgery (ERAS) has been applied in various laparoscopic procedures. Intravenous lidocaine (IVL) infusion is used for laparoscopic procedures as a part of ERAS protocols. The study aimed to evaluate the role of IVL infusion in enhanced bowel recovery after laparoscopic renal surgeries. Material and Methods A randomized, double-blind, placebo-control trial was conducted on 80 patients (with American Society of Anesthesiologists physical status I-II) who presented for laparoscopic renal surgeries under general anesthesia. The study period was from Oct 2018 to Sept 2019. By computer-generated codes, patients were randomly divided into two groups: L (lidocaine) and C (control). Group L received an intravenous (IV) bolus (1.5 mg/kg) of 2% lidocaine over 2 min, followed by an IV lidocaine infusion at the rate of 1.5 mg/kg/h until skin closure. Group C received the same volume of bolus followed by normal saline infusion. Patients were monitored for bowel functions, total hospital stay, and total analgesic consumption. Student's t-test and Chi-square test were used for quantitative data and occurrence of events, respectively. P <0.05 was considered to be statistically significant. Results First bowel sound, flatus, and defecation occurred in 16.4 ± 2.50, 26.7 ± 9.02, and 39.1 ± 6.31 h, respectively, in group L and 18.2 ± 2.90, 32.3 ± 3.11, and 43.3 ± 4.22 h, respectively, in group C (P = 0.006, 0.001, and 0.01, respectively). Total hospital stay was 4.0 ± 0.74 and 5.3±0.0.91 days in groups L and C, respectively (P < 0.001). Conclusion The present study concluded that IVL could enhance the bowel recovery and reduce total hospital stay after laparoscopic renal surgeries.
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Affiliation(s)
- Dinesh J. Prajapati
- Department of Anaesthesiology, Muljibhai Patel Urological Hospital, Nr Dr. Virendra Desai Road, Nadiad, Gujarat, India
| | - Manoj Patel
- Department of Anaesthesiology, Muljibhai Patel Urological Hospital, Nr Dr. Virendra Desai Road, Nadiad, Gujarat, India
| | - Pankaj Patel
- Department of Anaesthesiology, Muljibhai Patel Urological Hospital, Nr Dr. Virendra Desai Road, Nadiad, Gujarat, India
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Mahato VK, Dongol A, Acharya P, Yadav AK, Subedi A, Jaisani MR. "Can Perioperative Intravenous Lidocaine Decrease Postoperative Pain After Oral and Maxillofacial Surgeries?": A Randomized Clinical Trial. J Maxillofac Oral Surg 2024; 23:1240-1247. [PMID: 39376771 PMCID: PMC11455827 DOI: 10.1007/s12663-022-01831-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose To determine the efficacy of perioperative intravenous lidocaine in decreasing postoperative pain after oral and maxillofacial surgeries. Methods Forty patients undergoing various oral and maxillofacial surgeries under general anesthesia were recruited in this prospective, randomized, double blinded controlled trial. Lidocaine group received Lidocaine 2.0%, whereas the control group received Normal saline 0.9% infusion. Pain intensity, sedation, vitals and side effects were assessed at 2 h, 4 h, 6 h, 12 h and 24 h postoperatively. Results Twenty patients were assigned to each group. There were no significant differences between the groups for the study variables at baseline. The median Numeric Rating Scale (NRS) pain scores were higher in normal saline group than lidocaine group at 2 h, 4 h and 6 h and same at 12and 24 h; however, the differences were not statistically significant. Mean (± SD) analgesic consumed in lidocaine group was 47.37 (± 42.80) mg and 69.47(± 36.13) mg in saline group, which was not significant either. Similarly, no statically significant difference was observed for sedation and vitals at all the time intervals. Conclusion Perioperative infusion of low dose lidocaine does not have significant effect on reduction in postoperative pain intensity and analgesic consumption, in patients undergoing oral and maxillofacial surgeries. Trail registered at clinicaltrials.gov (NCT03479320).
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Affiliation(s)
| | - Ashok Dongol
- Department of Oral and Maxillofacial Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Sunsari, 56700 Nepal
| | - Pradeep Acharya
- Department of Oral and Maxillofacial Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Sunsari, 56700 Nepal
| | - Anjani Kumar Yadav
- Department of Oral and Maxillofacial Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Sunsari, 56700 Nepal
| | - Asish Subedi
- Department of Ansethesiology and Critical Care, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Mehul R. Jaisani
- Department of Oral and Maxillofacial Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Sunsari, 56700 Nepal
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Mustafa MS, Shafique MA, Tabassum M, Rahman HAU, Syed AM, Kumar K, Haseeb A. Efficacy and safety of intravenous lidocaine infusion in postoperative pain management and surgical outcomes following laparoscopic colorectal surgery: A meta-analysis. Curr Probl Surg 2024; 61:101544. [PMID: 39098330 DOI: 10.1016/j.cpsurg.2024.101544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/16/2024] [Accepted: 06/16/2024] [Indexed: 08/06/2024]
Affiliation(s)
| | | | - Muzainah Tabassum
- Department of Surgery, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan
| | | | - Aina Marzia Syed
- Department of Surgery, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan
| | - Karan Kumar
- Department of Surgery, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan
| | - Abdul Haseeb
- Department of Surgery, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan
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Reichert M, Willis F, Post S, Schneider M, Vilz T, Willis M, Hecker A. Pharmacologic prevention and therapy of postoperative paralytic ileus after gastrointestinal cancer surgery: systematic review and meta-analysis. Int J Surg 2024; 110:4329-4341. [PMID: 38526522 PMCID: PMC11254286 DOI: 10.1097/js9.0000000000001393] [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: 12/29/2023] [Accepted: 03/10/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Postoperative paralytic ileus (POI) is a significant concern following gastrointestinal tumor surgery. Effective preventive and therapeutic strategies are crucial but remain elusive. Current evidence from randomized-controlled trials on pharmacological interventions for prevention or treatment of POI are systematically reviewed to guide clinical practice and future research. MATERIALS AND METHODS Literature was systematically searched for prospective randomized-controlled trials testing pharmacological interventions for prevention or treatment of POI after gastrointestinal tumor surgery. Meta-analysis was performed using a random effects model to determine risk ratios and mean differences with 95% CI. Risk of bias and evidence quality were assessed. RESULTS Results from 55 studies, involving 5078 patients who received experimental interventions, indicate that approaches of opioid-sparing analgesia, peripheral opioid antagonism, reduction of sympathetic hyperreactivity, and early use of laxatives effectively prevent POI. Perioperative oral Alvimopan or intravenous administration of Lidocaine or Dexmedetomidine, while safe regarding cardio-pulmonary complications, demonstrated effectiveness concerning various aspects of postoperative bowel recovery [Lidocaine: -5.97 (-7.20 to -4.74)h, P <0.0001; Dexmedetomidine: -13.00 (-24.87 to -1.14)h, P =0.03 for time to first defecation; Alvimopan: -15.33 (-21.22 to -9.44)h, P <0.0001 for time to GI-2 ] and length of hospitalization [Lidocaine: -0.67 (-1.24 to -0.09)d, P =0.02; Dexmedetomidine: -1.28 (-1.96 to -0.60)d, P =0.0002; Alvimopan: -0.58 (-0.84 to -0.32)d, P <0.0001] across wide ranges of evidence quality. Perioperative nonopioid analgesic use showed efficacy concerning bowel recovery as well as length of hospitalization [-1.29 (-1.95 to -0.62)d, P =0.0001]. Laxatives showed efficacy regarding bowel movements, but not food tolerance and hospitalization. Evidence supporting pharmacological treatment for clinically evident POI is limited. Results from one single study suggest that Neostigmine reduces time to flatus and accelerates bowel movements [-37.06 (-40.26 to -33.87)h, P <0.0001 and -42.97 (-47.60 to -38.35)h, P <0.0001, respectively] with low evidence quality. CONCLUSION Current evidence concerning pharmacological prevention and treatment of POI following gastrointestinal tumor surgery is limited. Opioid-sparing concepts, reduction of sympathetic hyperreactivity, and laxatives should be implemented into multimodal perioperative approaches.
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Affiliation(s)
- Martin Reichert
- Department of General, Visceral, Thoracic, and Transplant Surgery, University Hospital of Giessen, Giessen
| | - Franziska Willis
- Department of General, Visceral, Thoracic, and Transplant Surgery, University Hospital of Giessen, Giessen
| | - Stefan Post
- Faculty of Medicine Mannheim, University of Heidelberg, Mannheim
| | - Martin Schneider
- Department of General, Visceral, Thoracic, and Transplant Surgery, University Hospital of Giessen, Giessen
| | - Tim Vilz
- Department of General, Visceral, Thorax, and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - Maria Willis
- Department of General, Visceral, Thorax, and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - Andreas Hecker
- Department of General, Visceral, Thoracic, and Transplant Surgery, University Hospital of Giessen, Giessen
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Dai Y, Huang J, Liu J. Effects of intravenous lidocaine on postoperative pain and gastrointestinal function recovery following gastrointestinal surgery: a meta-analysis. Minerva Anestesiol 2024; 90:561-572. [PMID: 38869266 DOI: 10.23736/s0375-9393.24.17920-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
INTRODUCTION The full extent of intravenous lidocaine's effectiveness in alleviating postoperative pain and enhancing gastrointestinal function recovery remains uncertain. EVIDENCE ACQUISITION We conducted an exhaustive search of databases to identify randomized controlled trials that compared intravenous lidocaine infusion's efficacy to that of a placebo or routine care in patients undergoing gastrointestinal surgery. The primary outcome measure was resting pain scores 24 h postoperatively. We utilized a random-effects model based on the intention-to-treat principle for the overall results. EVIDENCE SYNTHESIS This study included twenty-four trials with 1533 patients. Intravenous lidocaine significantly reduced resting pain scores 24 h after gastrointestinal surgery (twenty trials, SMD -0.67, 95% CI -1.09 to -0.24, P=0.002, I2 = 90%). This finding was consistent in subgroup analyses and sensitivity analyses. The benefit was also observed at other resting and moving time points (1, 2, 4, and 12 h) postoperatively. Intravenous lidocaine significantly decreased opioid consumption within 24 h after surgery (eleven trials, SMD: -1.19; 95% CI: -1.99 to -0.39; P=0.003). Intravenous lidocaine also shortened the time to bowel sound (MD: -8.51; 95% CI: -14.59 to -2.44; P=0.006), time to first flatus (MD: -6.00; 95% CI: -9.87 to -2.13; P=0.002), and time to first defecation (MD: -9.77; 95% CI: -17.19 to -2.36; P=0.01). CONCLUSIONS Perioperative intravenous lidocaine can alleviate acute pain and expedite gastrointestinal function recovery in patients undergoing gastrointestinal surgery. However, the results should be interpreted with caution due to substantial heterogeneity. Further large-scale studies are necessary to validate these findings.
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Affiliation(s)
- Yu Dai
- Department of Anesthesiology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Jiao Huang
- Department of Anesthesiology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Jingchen Liu
- Department of Anesthesiology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China -
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Lirk P, Badaoui J, Stuempflen M, Hedayat M, Freys SM, Joshi GP. PROcedure-SPECific postoperative pain management guideline for laparoscopic colorectal surgery: A systematic review with recommendations for postoperative pain management. Eur J Anaesthesiol 2024; 41:161-173. [PMID: 38298101 DOI: 10.1097/eja.0000000000001945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
Colorectal cancer is the second most common cancer diagnosed in women and third most common in men. Laparoscopic resection has become the standard surgical technique worldwide given its notable benefits, mainly the shorter length of stay and less postoperative pain. The aim of this systematic review was to evaluate the current literature on postoperative pain management following laparoscopic colorectal surgery and update previous procedure-specific pain management recommendations. The primary outcomes were postoperative pain scores and opioid requirements. We also considered study quality, clinical relevance of trial design, and a comprehensive risk-benefit assessment of the analgesic intervention. We performed a literature search to identify randomised controlled studies (RCTs) published before January 2022. Seventy-two studies were included in the present analysis. Through the established PROSPECT process, we recommend basic analgesia (paracetamol for rectal surgery, and paracetamol with either a nonsteroidal anti-inflammatory drug or cyclo-oxygenase-2-specific inhibitor for colonic surgery) and wound infiltration as first-line interventions. No consensus could be achieved either for the use of intrathecal morphine or intravenous lidocaine; no recommendation can be made for these interventions. However, intravenous lidocaine may be considered when basic analgesia cannot be provided.
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Affiliation(s)
- Philipp Lirk
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital (PL, JB, MS), Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA (MH), Department of Surgery, DIAKO Ev. Diakonie-Krankenhaus, Bremen, Germany (SMF) and Department of Anesthesiology, UT Southwestern Medical Center, Dallas, Texas, USA (GPJ)
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Yang W, Yan S, Yu F, Jiang C. Appropriate Duration of Perioperative Intravenous Administration of Lidocaine to Provide Satisfactory Analgesia for Adult Patients Undergoing Colorectal Surgery: A Meta-Analysis of Randomized Controlled Trials. Anesth Analg 2023; 136:494-506. [PMID: 36727863 DOI: 10.1213/ane.0000000000006347] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Perioperative lidocaine infusion has been reported to alleviate pain intensity after colorectal surgery. However, there is no consensus on whether prolonged lidocaine infusion is more effective than short lidocaine infusion. This meta-analysis aimed to determine an appropriate duration of lidocaine infusion in patients undergoing colorectal surgery. METHODS We searched the PubMed, EMBASE, Web of Science, and Cochrane Library databases to identify articles published before December 17, 2021. Randomized controlled trials comparing intravenous lidocaine with placebo for pain relief in patients undergoing colorectal surgery were included. The primary outcome was pain scores (visual analog scale [VAS], 0-10 cm) at 24 hours postoperatively at rest and on movement. Secondary outcomes included pain scores at 12, 48, and 72 hours postoperatively, analgesic consumption (mg), gastrointestinal function return (hour), length of hospital stay (days), and incidence of complications. According to the duration of lidocaine infusion, studies were grouped into infusion for at least 24 hours (prolonged lidocaine infusion) and less than 24 hours (short lidocaine infusion) to assess the impact of lidocaine infusion duration on the outcomes of interests. Quantitative analyses were performed using a random effects model. RESULTS Eleven studies with 548 patients were included. Five studies used prolonged lidocaine infusion, while 6 studies used short lidocaine infusion. Prolonged lidocaine infusion reduced postoperative pain scores versus placebo at 24 hours at rest (mean difference [MD], -0.91 cm; 95% confidence interval [CI], -1.54 to -0.28; P = .02) and on movement (MD, -1.69 cm; 95% CI, -2.15 to -1.22; P < .001), while short lidocaine infusion showed no benefit. Compared with placebo, prolonged lidocaine infusion reduced pain scores at 12 hours at rest and at 12 and 48 hours on movement, but short lidocaine infusion did not. However, there was no significant difference in pain scores between the prolonged and short lidocaine infusion groups at these time points. Compared with placebo, prolonged lidocaine infusion shortened the length of hospital stay (MD, -1.30 days; 95% CI, -1.72 to -0.88; P < .001) and time to first postoperative defecation (MD, -12.51 hours; 95% CI, -22.67 to -2.34; P = .02). There were no differences between groups regarding the other outcomes. CONCLUSIONS The analgesic effect of intravenous lidocaine may depend on the duration of infusion, and our results suggest that lidocaine infusion should be administered for at least 24 hours after colorectal surgery. Since overall evidence quality was low, further high-quality, large-sample trials are needed to explore an optimal lidocaine infusion strategy in patients undergoing colorectal surgery.
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Affiliation(s)
- Wei Yang
- From the Department of Anesthesiology, West China Hospital, Sichuan University and The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
- Department of Anesthesiology and Translational Neuroscience Center, Laboratory of Anesthesia and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Siyu Yan
- From the Department of Anesthesiology, West China Hospital, Sichuan University and The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
- Department of Anesthesiology and Translational Neuroscience Center, Laboratory of Anesthesia and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Feng Yu
- From the Department of Anesthesiology, West China Hospital, Sichuan University and The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
- Department of Anesthesiology and Translational Neuroscience Center, Laboratory of Anesthesia and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Chunling Jiang
- From the Department of Anesthesiology, West China Hospital, Sichuan University and The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
- Department of Anesthesiology and Translational Neuroscience Center, Laboratory of Anesthesia and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
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Liu F, Xiong LL, Li TT, Chen YJ, Ma W, Li QJ, Li Q, Wang TH. Analgesic Effects and Adverse Reactions of Lidocaine for Patient-Controlled Intravenous Analgesia on Patients Undergoing Open Hepatectomy: A Retrospective Analysis. J Perianesth Nurs 2023; 38:39-44. [PMID: 35989234 DOI: 10.1016/j.jopan.2022.05.069] [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: 09/15/2021] [Revised: 05/10/2022] [Accepted: 05/13/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE The aim of this study was to investigate the effect of lidocaine for patient controlled intravenous analgesia (PCIA) in patients who underwent open hepatectomy. DESIGN A retrospective analysis. METHODS A total of 281 patients who underwent open hepatectomy from July 2018 to December 2018 were included. All patients were assigned into two groups: the lidocaine group (PCIA consisted of lidocaine, sufentanil, tramadol and granisetron) and the control group (PCIA consisted of sufentanil, tramadol and granisetron). The postoperative visual analogue scale (VAS) and complications (including respiratory depression, hypotension, nausea and vomiting, pruritus, numbness of the corners of the mouth, dizziness) between the groups were compared. FINDINGS There were no significant differences between the characteristics, duration of surgery and anesthesia, and recovery of postoperative activity between the two groups. In the first 3 days after the operation, the postoperative VAS score of the lidocaine group was lower than that of the control group at resting state, while after activity, the postoperative VAS contrast results were completely opposite. In particularly, the resting state at 48 hours (h) (1.05 ± 1.25 vs 1.57 ± 1.54) after surgery and the activity state at 72 h (3.02 ± 1.51 vs 2.2 ± 1.66) after surgery (P < 0.05). The incidence of mouth numbness and dizziness were significantly increased in the lidocaine group (P < 0.05). CONCLUSION The addition of lidocaine in PCIA was not beneficial to improve the pain during activities and increased the incidence of perioral numbness and dizziness.
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Affiliation(s)
- Fei Liu
- Department of Anesthesiology, Institute of Neurological Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Liu-Lin Xiong
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Ting-Ting Li
- Department of Anesthesiology, Institute of Neurological Disease, West China Hospital, Sichuan University, Chengdu, China; Department of Anesthesiology, West China Tianfu Hospital, Sichuan University, Chengdu, China
| | - Yan-Jun Chen
- Department of Anesthesiology, Institute of Neurological Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Ma
- Department of Anesthesiology, Institute of Neurological Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Qi-Jun Li
- Traditional Chinese Medicine, Southwest Medical University, Sichuan University, Luzhou, China
| | - Qian Li
- Department of Anesthesiology, Institute of Neurological Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Ting-Hua Wang
- Department of Anesthesiology, Institute of Neurological Disease, West China Hospital, Sichuan University, Chengdu, China.
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Ustun YB, Turunc E, Ozbalci GS, Dost B, Bilgin S, Koksal E, Kaya C. Comparison of Ketamine, Dexmedetomidine and Lidocaine in Multimodal Analgesia Management Following Sleeve Gastrectomy Surgery: A Randomized Double-Blind Trial. J Perianesth Nurs 2022; 37:820-826. [PMID: 35382963 DOI: 10.1016/j.jopan.2021.12.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/15/2021] [Accepted: 12/19/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE The aim of this study was to compare the effects of ketamine, dexmedetomidine, and lidocaine infusions added to the multimodal analgesia regimen on pain scores and analgesic requirement in laparoscopic sleeve gastrectomy. DESIGN A prospective randomized double-blind trial. Seventy-three patients aged 18 to 65 years (ASA II-III) undergoing laparoscopic sleeve gastrectomy were included. The patients were divided into 3 groups. Intravenous (IV) ketamine (0.5 mg/kg/h), dexmedetomidine (0.5 mcg/kg/h), and lidocaine (2 mg/kg/h) were administered to Groups K, D and L, respectively. Postoperative infusions were continued for 12 hours. METHODS Visual Analog Scale (VAS) scores (during rest and movement) in the admission to postanesthesia care unit, 1, 3, 6, 12, 24, 48 hours, and on day 15 were assessed postoperatively. Rescue analgesia requirement, the number of patients with nausea, retching, and vomiting, time to mobilization, and hospital length of stay (LOS) were recorded. FINDINGS VASrest values during all measurements in the first 24 hours, and VASmovement values in the first 6 hours and at 24 hours were lower in Group L when compared to Group K and Group D (P < .001, P < .001, P = .008, respectively). VASrest at 48 hours and VASmovement at 12 and 48 hours were lower in Group L when compared to Group K (P = .044, P = .001 and P = .011, respectively). There was no statistically significant difference between Group D compared to the other two groups at these times (P > .05). The requirement of rescue analgesia on postoperative day 1 was significantly higher in Group K (P < .001). Hospital LOS was shorter in Group L than in the other groups (P = .002). CONCLUSIONS IV lidocaine added to multimodal analgesia provided better pain control in the early postoperative period compared to dexmedetomidine and ketamine and decreased the hospital LOS.
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Affiliation(s)
- Yasemin Burcu Ustun
- Department of Anaesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Esra Turunc
- Department of Anaesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Gokhan Selcuk Ozbalci
- Department of General Surgery, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Burhan Dost
- Department of Anaesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey.
| | - Sezgin Bilgin
- Department of Anaesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Ersin Koksal
- Department of Anaesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Cengiz Kaya
- Department of Anaesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
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Sharma B, Garg R, Sahai C, Gupta AK, Gera A, Sood J. Effect of perioperative lignocaine infusion on postoperative pain relief for laparoscopic intraperitoneal onlay mesh repair: A randomized controlled study. Asian J Endosc Surg 2022; 15:765-773. [PMID: 35641878 DOI: 10.1111/ases.13089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 04/30/2022] [Accepted: 05/17/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The focus on enhanced recovery after surgery (ERAS) and opioid-free anesthesia has renewed interest in use of lignocaine. We evaluated postoperative pain relief following intravenous (IV) lignocaine administration in patients undergoing laparoscopic intraperitoneal onlay mesh repair (IPOM). METHODS Seventy patients were randomized into two groups. Group L patients were administered IV lignocaine infusion (1.5 mg/kg) at induction of anesthesia followed by infusion (1.5 mg/kg/h), until 1 hour in the post-anesthesia care unit (PACU). Group P patients received equal volumes of normal saline IV infusion. We recorded hemodynamics, perioperative analgesic consumption, postoperative visual analog scores (VAS), incidence of postoperative nausea and vomiting (PONV), bowel function, patient satisfaction and length of hospital stay (LOS). RESULTS The hemodynamics in both groups were maintained. Group L had lower VAS scores as compared to Group P (P < .05). Intraoperative fentanyl consumption in Group L was significantly less than Group P (P = .029). Group L patients scored lower on the Likert scale in comparison to the patients of Group P at 0 hour (P = .013). Recovery of bowel function as assessed by time to pass first flatus was significantly shortened by IV lignocaine (P = .001). The perioperative administration of IV lignocaine resulted in decreased postoperative analgesic requirement and greater patient satisfaction scores. CONCLUSIONS Perioperative IV lignocaine infusion provided good pain relief, hemodynamic stability and decreased perioperative analgesic consumption. PONV incidence decreased along with an early return of bowel function, reduced LOS and improved patient satisfaction in patients undergoing laparoscopic IPOM surgery.
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Affiliation(s)
- Bimla Sharma
- Institute of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Rashi Garg
- Institute of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Chand Sahai
- Institute of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Anjeleena Kumar Gupta
- Institute of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Anjali Gera
- Institute of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Jayashree Sood
- Institute of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
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Alderman J, Sharma A, Patel J, Gao-Smith F, Morgese C. Intrathecal diamorphine for perioperative analgesia during colorectal surgery: a cross-sectional survey of current UK practice. BMJ Open 2022; 12:e057407. [PMID: 35981781 PMCID: PMC9394208 DOI: 10.1136/bmjopen-2021-057407] [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: 11/04/2022] Open
Abstract
OBJECTIVES To describe current UK clinical practice around the use of intrathecal diamorphine as analgesia for major elective laparoscopic colorectal surgery. DESIGN Online self-administered survey. SETTING Acute public hospitals in the UK (National Health Service - NHS) . PARTICIPANTS Consultant anaesthetists involved in colorectal surgery lists. MAIN OUTCOME MEASURES Rate of intrathecal opioids used by anaesthetists for elective laparoscopic colorectal procedures; minimum, most common and maximum doses of intrathecal diamorphine used, timing of administration of intrathecal injection, and relationship between the number of patients anaesthetised for laparoscopic colorectal resections per month by each anaesthetist, and the doses of intrathecal diamorphine they administer. RESULTS In total, 479 responses were received. Of these, 399 (83%) use intrathecal opioid routinely: 351/399 (88%) use diamorphine, 35 (8.8%) use morphine, 8 (2%) use fentanyl, and 7 (1.3%) use other drugs. The median intrathecal diamorphine dose most commonly administered by anaesthetists was 500 µg (IQR 400-750 [(range 200-1500])). The median of the maximum dose administered by anaesthetists was 600 µg (IQR 500-1000 [(range 200-2000])). Greater intrathecal diamorphine dosing was positively associated with higher number of cases per month (rho=0.113, pp=0.033). CONCLUSIONS Intrathecal diamorphine is widely used by UK anaesthetists for patients undergoing major elective laparoscopic colorectal surgery. However, there is little consensus regarding optimal dosing. Therefore, high-quality randomised dose-response trials are needed to investigate the relationship between doses of intrathecal diamorphine and patient outcomes.
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Affiliation(s)
- Joseph Alderman
- Birmingham Acute Care Research Centre, University of Birmingham, Birmingham, UK
- Department of Anaesthesia and Intensive Care Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Amit Sharma
- Department of Anaesthesia and Intensive Care Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jaimin Patel
- Birmingham Acute Care Research Centre, University of Birmingham, Birmingham, UK
- Department of Anaesthesia and Intensive Care Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Fang Gao-Smith
- Birmingham Acute Care Research Centre, University of Birmingham, Birmingham, UK
- Department of Anaesthesia and Intensive Care Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ciro Morgese
- Birmingham Acute Care Research Centre, University of Birmingham, Birmingham, UK
- Department of Anaesthesia and Intensive Care Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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17
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Ultrasound-guided erector spinae plane block improves analgesia after laparoscopic hepatectomy: a randomised controlled trial. Br J Anaesth 2022; 129:445-453. [DOI: 10.1016/j.bja.2022.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/07/2022] [Accepted: 05/02/2022] [Indexed: 02/05/2023] Open
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Imani F, Bagheri AR, Arvin E, Gatt SP, Sarveazad A. Effects of Ketamine and Lidocaine Infusion on Acute Pain after Elective Open Abdominal Surgery, a Randomized, Double-Blinded Study. Med J Islam Repub Iran 2022; 36:60. [PMID: 36128312 PMCID: PMC9448502 DOI: 10.47176/mjiri.36.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/07/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Most patients suffer from moderate to severe pain after elective laparotomy. They often require opioids to alleviate their pain. Opiates invariably induce certain side effects and, occasionally, dependence. Intraoperative infusion of lidocaine and low-dose ketamine reduces postoperative pain and analgesic requirements. This study aims to evaluate the effects of simultaneous infusion of lidocaine and ketamine during open abdominal surgery on the postoperative pain severity and analgesic consumption. Methods: In this randomized, double-blinded, single-center study that was performed in Iran, 80 patients scheduled for elective open abdominal surgery under general anesthesia were enrolled in two LK and P groups. Group LK (n=40) received lidocaine-ketamine infusion, and group P (n=40) received placebo (normal saline). Both infusions were started thirty minutes after initiation of surgery and were terminated once the surgery was completed. For postoperative pain management, patient-controlled analgesia (PCA), including fentanyl and paracetamol, was administered for both groups. All patients were evaluated for pain visual analogue scale (VAS) and total adjunctive analgesic (diclofenac suppository) consumption within the first 24 hours after the surgery. The data were analyzed using SPSS. P values <0.05 were considered significant. Results: Intraoperative infusion of Lidocaine and Ketamine resulted in desirable postoperative pain control. Patients of LK group demonstrated a significant reduction in the pain score at 1, 6, 12, 18, and 24 hours after termination of surgery (p<0.001). It also resulted in a decreased requirement for postoperative analgesics, as cumulative analgesic consumption was decreased meaningfully in the patients of LK group (p<0.001). Conclusion: Intravenous infusion of lidocaine and ketamine during elective open abdominal surgery reduces pain intensity and analgesic requirements in the first 24 hours postoperatively, without major additional side effects.
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Affiliation(s)
- Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ali-Reza Bagheri
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Esmat Arvin
- Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Stephen P. Gatt
- Anestesi & Reanimasi, Udayana Universiti, Bali, Indonesia; Discipline of Anaesthesia, Critical Cate & Emergency Medicine, University New South Wales, Sydney, Australia
| | - Arash Sarveazad
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
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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: 34] [Impact Index Per Article: 11.3] [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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Jayaprabhu NB, Avula J, Chandy TT, Varghese G, Yadav B, Rebekah G. A Randomized Controlled Trial Comparing Intravenous Lidocaine Infusion With Thoracic Epidural for Perioperative Analgesia and Quality of Recovery After Surgery in Laparoscopic Left-Sided Colon and Sphincter-Sparing Rectal Resection Surgery. Cureus 2022; 14:e23758. [PMID: 35509732 PMCID: PMC9059900 DOI: 10.7759/cureus.23758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2022] [Indexed: 11/12/2022] Open
Abstract
Background Protocols for Enhanced Recovery after Surgery (ERAS) have been constantly evolving, and the best method of managing perioperative pain, especially in laparoscopic surgeries, is still debatable. The primary goal of these protocols is to steer toward opioid-sparing analgesia. Intravenous lidocaine, which has both analgesic and anti-inflammatory properties, may improve the overall recovery of patients. Objectives The aim of this randomized controlled trial was to compare the efficacy of intravenous lidocaine infusion (IVL) with thoracic epidural analgesia (TEA) in the management of perioperative pain and recovery in the laparoscopic left-sided colon and sphincter-sparing rectal surgery. Methods In this study, 37 patients were randomized to either the IVL group or the TEA group. IVL infusion was started before the surgical incision and stopped 30 minutes after transferring the patient to the postanesthesia care unit (PACU). Postoperative pain scores, opioid consumption, rescue analgesic doses, quality of recovery scores, time to discharge, and adverse events were recorded prospectively. Data were analyzed using two independent sample t-test and paired t-test, with p < 0.05 taken as statistically significant. Results The mean difference of overall NRS (numerical rating scale) pain scores in the ward was significantly higher in the IVL group as compared to the TEA group, which was 3.58 (2.29) vs 2.23 1.95) (p < 0.001). The IVL group required more mean rescue opioid boluses than the TEA group, which was 11.36 (8.684) vs 5.96 (6.215) (p < 0.001). However, both IVL and TEA groups had similar pain scores intraoperatively and in the PACU. Conclusions TEA provides better analgesia and decreased opioid requirements compared to intravenous lidocaine during the 24-hour period in the ward after laparoscopic left-sided colon and sphincter-sparing rectal surgery, although there was no difference in the quality of recovery between IVL and TEA groups.
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Affiliation(s)
| | - Jyothi Avula
- Anaesthetics, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, GBR
- Department of Anaesthesiology, Christian Medical College Vellore, Vellore, IND
| | - Tony T Chandy
- Department of Anaesthesiology, Christian Medical College Vellore, Vellore, IND
| | - Gigi Varghese
- Department of Colorectal Surgery, Royal Stoke University Hospital (RSUH) University Hospitals of North Midlands NHS Trust (UHNM), Stoke On Trent, GBR
- Department of Colorectal Surgery, Christian Medical College Vellore, Vellore, IND
| | - Bijesh Yadav
- Department of Biostatistics, Christian Medical College Vellore, Vellore, IND
| | - Grace Rebekah
- Department of Biostatistics, Christian Medical College Vellore, Vellore, IND
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Abstract
This article will focus on the perioperative management of hepatic resection for colorectal cancer (CRC) liver metastases (CLRMs) (the liver is the dominant metastatic site for CRC) within the context of the Enhanced Recovery After Surgery (ERAS) paradigm. It discusses the epidemiology and outcomes along with the history of hepatic resection surgery and pertinent anatomy. The discussion of the preoperative phase includes patient selection, assessment of liver functional status, and new developments in prehabilitation. The intraoperative phase details developments in surgical and anesthetic techniques to minimize liver hemorrhage and reduce the risk of postoperative hepatic failure. Newer analgesic options are included. Management of potential complications is outlined in the postoperative section followed by a description of current evidence for ERAS and future directions.
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Affiliation(s)
- Anton Krige
- Department of Anaesthesia and Critical Care, Royal Blackburn Teaching Hospital, Haslingden Road, Blackburn BB2 3HH, UK.
| | - Leigh J S Kelliher
- Department of Anaesthetics, Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, Surrey GU2 7AS, UK
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Salem AE, El-Mawy MG, Al-Kholy AF. Multimodal, non-opioid based analgesia for women presented for laparoscopic hysterectomy. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2031547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Ahmed E. Salem
- Department of Anesthesiology & ICU, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed G. El-Mawy
- Department of Anesthesiology & ICU, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Adel F. Al-Kholy
- Department of Medical Biochemistry, Faculty of Medicine, Benha University, Benha, Egypt
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Paterson HM, Cotton S, Norrie J, Nimmo S, Foo I, Balfour A, Speake D, MacLennan G, Stoddart A, Innes K, Cameron S, Aucott L, McCormack K. The ALLEGRO trial: a placebo controlled randomised trial of intravenous lidocaine in accelerating gastrointestinal recovery after colorectal surgery. Trials 2022; 23:84. [PMID: 35090535 PMCID: PMC8795946 DOI: 10.1186/s13063-022-06021-5] [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: 08/20/2021] [Accepted: 12/23/2021] [Indexed: 11/15/2022] Open
Abstract
Background Return of gastrointestinal (GI) function is fundamental to patient recovery after colorectal surgery and is required before patients can be discharged from hospital safely. Up to 40% of patients suffer delayed return of GI function after colorectal surgery, causing nausea, vomiting and abdominal discomfort, resulting in longer hospital stay. Small, randomised studies have suggested perioperative intravenous (IV) lidocaine, which has analgesic and anti-inflammatory effects, may accelerate return of GI function after colorectal surgery. The ALLEGRO trial is a pragmatic effectiveness study to assess the benefit of perioperative IV lidocaine in improving return of GI function after elective minimally invasive (laparoscopic or robotic) colorectal surgery. Methods United Kingdom (UK) multi-centre double blind placebo-controlled randomised controlled trial in 562 patients undergoing elective minimally invasive colorectal resection. IV lidocaine or placebo will be infused for 6–12 h commencing at the start of surgery as an adjunct to usual analgesic/anaesthetic technique. The primary outcome will be return of GI function. Discussion A 6–12-h perioperative intravenous infusion of 2% lidocaine is a cheap addition to usual anaesthetic/analgesic practice in elective colorectal surgery with a low incidence of adverse side-effects. If successful in achieving quicker return of gut function for more patients, it would reduce the rate of postoperative ileus and reduce the duration of inpatient recovery, resulting in reduced pain and discomfort with faster recovery and discharge from hospital. Since colorectal surgery is a common procedure undertaken in every acute hospital in the UK, a reduced length of stay and reduced rate of postoperative ileus would accrue significant cost savings for the National Health Service (NHS). Trial registration EudraCT Number 2017-003835-12; REC Number 17/WS/0210 the trial was prospectively registered (ISRCTN Number: ISRCTN52352431); date of registration 13 June 2018; date of enrolment of first participant 14 August 2018.
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Affiliation(s)
| | - Seonaidh Cotton
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Susan Nimmo
- Anaesthetics Department, Western General Hospital, Edinburgh, UK
| | - Irwin Foo
- Anaesthetics Department, Western General Hospital, Edinburgh, UK
| | - Angie Balfour
- Colorectal Surgery, Western General Hospital, Edinburgh, UK
| | - Doug Speake
- Colorectal Surgery, Western General Hospital, Edinburgh, UK
| | - Graeme MacLennan
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - Andrew Stoddart
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Karen Innes
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK.
| | - Sarah Cameron
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - Lorna Aucott
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - Kirsty McCormack
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
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Chen PC, Lai CH, Fang CJ, Lai PC, Huang YT. Intravenous Infusion of Lidocaine for Bowel Function Recovery After Major Colorectal Surgery: A Critical Appraisal Through Updated Meta-Analysis, Trial Sequential Analysis, Certainty of Evidence, and Meta-Regression. Front Med (Lausanne) 2022; 8:759215. [PMID: 35155463 PMCID: PMC8828648 DOI: 10.3389/fmed.2021.759215] [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: 08/16/2021] [Accepted: 12/10/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Intravenous infusion of lidocaine (IVF-Lido) during the perioperative period is an option to accelerate bowel function recovery after major colorectal surgery. However, previous meta-analyses have shown inconsistent conclusions. Recent randomized controlled trials (RCTs) have been reported after the publication of a previous meta-analysis. AIM We conducted an updated and comprehensive meta-analysis to determine the effects of IVF-Lido on time to first flatus and defecation after major colorectal surgery. METHODS We performed a systematic review according to the Preferred Reporting Items for the Systematic Reviews and Meta-Analysis Protocols 2020 guideline. Only RCTs were included. The revised Cochrane risk-of-bias tool was chosen for appraisal. Meta-analysis with meta-regression and trial sequential analysis was carried out. The Doi plot was presented to evaluate publication bias. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology was executed to evaluate the certainty of evidence (CoE). RESULTS Thirteen RCTs with 696 participants were enrolled. IVF-Lido significantly decreased the time to first flatus [mean difference (MD) = -6.03 h; 95% confidence interval (CI): (-8.80, -3.26)] and first defecation [MD = -10.49 h; 95% CI: (-15.58, -5.41)]. Trial sequential analysis yielded identical results and ampleness of required information sizes. No obviousness in publication bias was detected, and the CoE in GRADE was low in both outcomes. Meta-regression showed that a significantly shorter time to the first defecation was associated with studies with more improvement in pain control in comparison of two groups and better-improved analgesia in the control group. CONCLUSIONS We discretionarily suggest the use of IVF-Lido on postoperative bowel function recovery following major colorectal surgery. Beyond the analgesic effects, IVF-Lido might have additional benefits when postoperative pain relief has already been achieved. Considering the high heterogeneity in this updated meta-analysis, more RCTs are needed. SYSTEMATIC REVIEW REGISTRATION https://inplasy.com/inplasy-2020-7-0023/, INPLASY [202070023].
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Affiliation(s)
- Po-Chuan Chen
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chao-Han Lai
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Biochemistry and Molecular Biology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Ching-Ju Fang
- Medical Library, National Cheng Kung University, Tainan, Taiwan
- Department of Secretariat, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pei Chun Lai
- Education Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yen Ta Huang
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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25
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Daghmouri MA, Chaouch MA, Oueslati M, Rebai L, Oweira H. Regional techniques for pain management following laparoscopic elective colonic resection: A systematic review. Ann Med Surg (Lond) 2021; 72:103124. [PMID: 34925820 PMCID: PMC8648937 DOI: 10.1016/j.amsu.2021.103124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/24/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Pain management is an integral part of Enhanced Recovery After Surgery (ERAS) following laparoscopic colonic resection. A variety of regional and neuraxial techniques were proposed, but their efficacy is still controversial. This systematic review evaluates published evidence on analgesic techniques and their impact on postoperative analgesia and recovery for laparoscopic colonic surgery patients. Methods We conducted bibliographic research on May 10, 2021, through PubMed, Cochrane database, and Google scholar. We retained meta-analysis and randomized clinical trials. We graded the strength of clinical data and subsequent recommendations according to the Oxford Centre for Evidence-Based Medicine. Results Twelve studies were included. Thoracic epidural analgesia improved postoperative analgesia and bowel function following laparoscopic colectomy. However, it lengthens the hospital stay. Transversus abdominis plane block was as effective as thoracic epidural analgesia concerning pain control but with better postoperative recovery and lower length of hospital stay. Moreover, Lidocaine intravenous infusion improved postoperative pain management and recovery; Quadratus lumborum block provided similar postoperative analgesia and recovery. Finally, wound infiltration reduced postoperative pain without improving recovery of bowel function, and it could be proposed as an alternative to thoracic epidural analgesia. Conclusions Several analgesic techniques have been investigated. We found that abdominal wall blocks were as effective as thoracic epidural analgesia for pain management but with lower hospital stay and better recovery. We registered this review on PROSPERO (ID: CRD42021279228).
First systematic review assessing the efficacy of analgesic techniques following laparoscopic elective colonic resection. Only colonic resection was evaluated contrary to other studies, including rectal surgery. High-quality studies (randomized controlled trials and meta-analyses) were assessed.
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Affiliation(s)
| | - Mohamed Ali Chaouch
- Department of Visceral Surgery, Fattouma Bourguiba Hospital, University of Monastir, Tunisia
| | - Maroua Oueslati
- Department of Anesthesia, Trauma Center of Ben Arrous, University of Manar, Tunisia
| | - Lotfi Rebai
- Department of Anesthesia, Trauma Center of Ben Arrous, University of Manar, Tunisia
| | - Hani Oweira
- Department of Surgery, Universitätsmedizin Mannheim, S, Heidelberg University, Mannheim, Germany
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Sarakatsianou C, Perivoliotis K, Tzovaras G, Samara AA, Baloyiannis I. Efficacy of Intravenous Use of Lidocaine in Postoperative Pain Management After Laparoscopic Colorectal Surgery: A Meta-analysis and Meta-regression of RCTs. In Vivo 2021; 35:3413-3421. [PMID: 34697177 PMCID: PMC8627741 DOI: 10.21873/invivo.12641] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Current literature reports regarding the effect of lidocaine in laparoscopic colectomies are still inconclusive. The purpose of this study was to review the current literature and estimate the overall effect of intravenous lidocaine administration in postoperative recovery of patients submitted to laparoscopic colectomies. MATERIALS AND METHODS This study was completed based on the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. A systematic screening using scholar databases was performed (Medline, Scopus, Web of Science, CENTRAL). RESULTS In total, 8 studies and 407 patients were included in this meta-analysis. Introduction of intravenous lidocaine in the perioperative analgesia scheme did not improve hospitalization duration (p=0.23), morphine consumption (p=0.96), perioperative bowel function (first flatus p=0.40, first bowel opened p=0.13, first diet p=0.16), or the overall complication rates (p=0.42). Overall, high heterogeneity levels were identified. CONCLUSION Current evidence indicates that lidocaine does not improve rehabilitation after laparoscopic colectomies.
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Affiliation(s)
| | | | - George Tzovaras
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | - Athina A Samara
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
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27
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Schuler BR, Lupi KE, Szumita PM, Kovacevic MP. Evaluating the Safety of Continuous Infusion Lidocaine for Postoperative Pain. Clin J Pain 2021; 37:657-663. [PMID: 34265786 DOI: 10.1097/ajp.0000000000000960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 06/17/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aim was to evaluate the safety of intravenous lidocaine for postoperative pain and the impact on opioid requirements and pain scores. MATERIALS AND METHODS This was a single-center, retrospective, single-arm analysis of adult patients who received intravenous lidocaine for postoperative pain from January 2016 to December 2019. Patients were excluded if they received lidocaine for any indication other than pain or if lidocaine was only given intraoperatively. The primary outcome of this analysis was to determine the incidence of adverse effects (AEs) and the reason for discontinuation of lidocaine. Secondary outcomes included median daily pain scores (visual analog scale and Critical-Care Pain Observation Tool) and opioid consumption (daily morphine milligram equivalents) 24 hours before infusion and during day 1. RESULTS A total of 452 patients were evaluated of which 298 (65.9%) patients met inclusion criteria. Of the 154 patients excluded, 153 did not receive lidocaine postoperatively. The median duration of infusion was 34 [20:48] hours with a median initial and maintenance rate of 1 mg/kg/h dosed on ideal body weight. In our analysis, 174 (58.4%) patients had a documented AE during infusion and 38 (12.8%) had lidocaine discontinued because of an AE. The most common AE was nausea in 62 (20.8%) patients and the most common reason for discontinuation was confusion in 8 (2.7%) patients. Daily morphine milligram equivalents (P<0.001) and visual analog scale (P<0.001) significantly decreased when comparing 24 hours before infusion and day 1. CONCLUSION Although a majority of patients receiving lidocaine for postoperative pain experienced an AE, this did not result in discontinuation in most patients.
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Affiliation(s)
- Brian R Schuler
- Department of Pharmacy, Brigham and Women's Hospital, Boston, MA
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28
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Ji W, Zhang X, Sun G, Wang X, Liu J, Bian J, Bo L. Effect of perioperative intravenous lidocaine on postoperative outcomes in patients undergoing resection of colorectal cancer: a protocol for systematic review and meta-analysis. BMJ Open 2021; 11:e048803. [PMID: 34426465 PMCID: PMC8383864 DOI: 10.1136/bmjopen-2021-048803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Techniques using local anaesthetics provide high-quality analgesia, while the anti-inflammatory properties of these drugs may represent an additional advantage. Perioperative intravenous lidocaine has shown positive effects not only on postoperative pain but also on bowel function and duration of hospital stay, due to its analgesic, anti-inflammatory and opioid-sparing effects. However, these potential benefits are not well established in patients undergoing resection with colorectal cancer. This research aims to determine the effect of perioperative intravenous lidocaine on postoperative outcomes in patients undergoing resection of colorectal cancer. METHODS AND ANALYSIS PubMed, Embase, Web of Science, CNKI, SinoMed and WanFang Data databases were electronically retrieved to include the randomised controlled trials comparing perioperative intravenous lidocaine with placebo infusion in patients undergoing resection of colorectal cancer before August 2021. Registers of clinical trials, potential grey literature and abstracts from conferences will also be searched. Two reviewers will screen literature, extract data and assess risk of bias of studies included independently. The primary outcome variable will be long-term survival outcome, tumour recurrence and metastasis rate, and restoration of intestinal function. The secondary outcome variables will consist of the severity of postoperative pain at 4, 12, 24 and 48 hours after surgery, the incidence of postoperative nausea and vomiting, and the length of hospital stay. A meta-analysis will be performed using RevMan V.5.4 software provided by the Cochrane Collaboration and Stata V.12.0. subgroup and sensitivity analyses will be conducted. ETHICS AND DISSEMINATION Because the data used for this systematic review will be exclusively extracted from published studies, ethical approval and informed consent of patients will not be required. The systematic review will be published in a peer-reviewed journal, presented at conferences and shared on social media platforms. PROSPERO REGISTRATION NUMBER CRD42020216232.
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Affiliation(s)
- Wentao Ji
- Faculty of Anesthesiology, Changhai Hospital, Shanghai, China
| | - Xiaoting Zhang
- Faculty of Anesthesiology, Changhai Hospital, Shanghai, China
| | - Guolin Sun
- Faculty of Anesthesiology, Changhai Hospital, Shanghai, China
| | - Xiandong Wang
- Faculty of Anesthesiology, Changhai Hospital, Shanghai, China
| | - Jia Liu
- Faculty of Anesthesiology, Changhai Hospital, Shanghai, China
| | - Jinjun Bian
- Faculty of Anesthesiology, Changhai Hospital, Shanghai, China
| | - Lulong Bo
- Faculty of Anesthesiology, Changhai Hospital, Shanghai, China
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Ashcroft J, Singh AA, Ramachandran B, Habeeb A, Hudson V, Meyer J, Simillis C, Davies RJ. Reducing ileus after colorectal surgery: A network meta-analysis of therapeutic interventions. Clin Nutr 2021; 40:4772-4782. [PMID: 34242917 DOI: 10.1016/j.clnu.2021.05.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/21/2021] [Accepted: 05/27/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Several treatment strategies for avoiding post-operative ileus have been evaluated in randomised controlled trials. This network meta-analysis aimed to explore the relative effectiveness of these different therapeutic interventions on ileus outcome measures. METHODS A systematic literature review was performed to identify randomized controlled trials (RCTs) comparing treatments for post-operative ileus following colorectal surgery. A Bayesian network meta-analysis was performed using the Markov chain Monte Carlo method. Direct and indirect comparisons of all regimens were simultaneously compared using random-effects network meta-analysis. RESULTS A total of 48 randomised controlled trials were included in this network meta-analysis reporting on 3614 participants. Early feeding was found to be the best treatment for time to solid diet tolerance and length of hospital stay with a probability of P = 0.96 and P = 0.47, respectively. Early feeding resulted in significantly shorter time to solid diet tolerance (Mean Difference (MD) 58.85 h; 95% Credible Interval (CrI) -73.41, -43.15) and shorter length of hospital stay (MD 2.33 days; CrI -3.51, -1.18) compared to no treatment. Epidural analgesia was ranked best treatment for time to flatus (P = 0.29) and time to stool (P = 0.268). Epidural analgesia resulted in significantly shorter time to flatus (MD -18.88 h; CrI -33.67, -3.44) and shorter time to stool (MD -26.05 h; 95% CrI -66.42, 15.65) compared to no intervention. Gastrograffin was ranked best treatment to avoid the requirement for post-operative nasogastric tube insertion (P = 0.61) however demonstrated limited efficacy (OR 0.50; CrI 0.143, 1.621) compared to no intervention. Nasogastric and nasointestinal tube insertion, probiotics, and acupuncture were found to be least efficacious as interventions to reduce ileus. CONCLUSION This network meta-analysis identified early feeding as the most efficacious therapeutic intervention to reduce post-operative ileus in patients undergoing colorectal surgery, in addition to highlighting other therapies that require further investigation by high quality study. In patients undergoing colorectal surgery, emphasis should be placed on early feeding as soon as can be appropriately initiated to support the return of gastrointestinal motility.
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Affiliation(s)
- James Ashcroft
- Department of Surgery, University of Cambridge, Cambridge, UK
| | | | - Bhavna Ramachandran
- Cambridge Colorectal Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Amir Habeeb
- Cambridge Colorectal Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Victoria Hudson
- Cambridge Colorectal Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jeremy Meyer
- Cambridge Colorectal Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Constantinos Simillis
- Cambridge Colorectal Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Nandi R, Mishra S, Garg R, Kumar V, Gupta N, Bharati SJ, Bhatnagar S. Intravenous Lignocaine-Fentanyl Versus Epidural Ropivacaine-Fentanyl for Postoperative Analgesia After Major Abdominal Oncosurgery: A Pilot Prospective Randomised Study. Turk J Anaesthesiol Reanim 2021; 49:130-137. [PMID: 33997842 PMCID: PMC8098735 DOI: 10.5152/tjar.2020.23326] [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: 07/11/2019] [Accepted: 09/03/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Epidural injection of local anaesthetics and intravenous opioid injection are two common analgesic strategies following major abdominal oncosurgery. However, epidural local anaesthetics may cause haemodynamic instability while opioid injection is associated with sedation and postoperative ileus. Intravenous lignocaine is also used for postoperative analgesia, and combined use of opioids plus lignocaine can reduce the doses and adverse effects of the individual drugs. This study therefore compared the analgesic efficacy of intravenous lignocaine-fentanyl (IV) to epidural ropivacaine-fentanyl (EPI) after major abdominal oncosurgery. METHODS Sixty patients were randomised to IV and EPI groups. Patients in the IV group received preoperative intravenous bolus injections of lignocaine 1.5 mg kg-1 and fentanyl 0.5 μg kg-1, intraoperative infusions of lignocaine 1 mg kg-1 h-1 and fentanyl 0.5 μg kg-1 h-1, and postoperative infusions of lignocaine 0.5 mg kg-1 h-1 and fentanyl 0.25 μg kg-1 h-1. In the EPI group, patients received a 6-ml epidural bolus injection of ropivacaine 0.2% plus fentanyl 2 μg mL-1, intraoperative infusion of 5 mL·h-1 fentanyl and postoperative ropivacaine 0.1% plus fentanyl 1 μg mL-1 infusion at 5 mL h-1. All patients also received postoperative patient-controlled IV fentanyl as rescue analgesia. Patient-controlled fentanyl consumption was documented as the primary outcome for postoperative analgesic efficacy. Results were compared by Mann-Whitney U-test and Student's t-test using Statistical Package for Social Science (SPSS) software. RESULTS Median (min-max) rescue fentanyl requirement in the first 24 h postsurgery was comparable between IV and EPI groups [780 (340-2520) μg vs. 820 (140-2260) μg; p=0.6], as was postoperative pain score (p>0.05). The incidence of intraoperative hypotension requiring bolus mephenteramine injection was significantly higher in the EPI group than the IV group (36% vs. 17%; p<0.001). CONCLUSION Intravenous lignocaine-fentanyl and epidural ropivacaine-fentanyl have comparable postoperative analgesic efficacies after major open abdominal oncosurgery.
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Affiliation(s)
- Rudranil Nandi
- Department of Onco-anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Mishra
- Department of Onco-anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Garg
- Department of Onco-anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Kumar
- Department of Onco-anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Nishkarsh Gupta
- Department of Onco-anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sachidanand Jee Bharati
- Department of Onco-anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
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31
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Smith SA, Ghabra H, Dhaifallah DG, Rahnema A, Evans BM, Nossaman BD, Sumrall WD, Bardot SF, Canter DJ. Novel Opiate-Free Anesthetic Technique for Major Urologic Procedures. South Med J 2021; 113:499-504. [PMID: 33005965 DOI: 10.14423/smj.0000000000001159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES We postulated that an opiate-free (OF) general anesthesia (GA) technique could adequately control a patient's pain without adversely affecting recovery. We compared patients undergoing major urologic procedures with and without opiate-based GA. METHODS A propensity-matched analysis was performed comparing hospital length of stay, postoperative nausea and vomiting, ileus occurrence, postanesthesia care unit, and total opiate consumption, as well as sedation and hemodynamic variables. The data are expressed as medians and were analyzed with the Wilcoxon rank-sum test. P < 0.05 indicate statistical significance. RESULTS In total, 166 patients were evaluated in both the OF group and the opiate-based treatment group. American Society of Anesthesiologists classification and age were comparable, with most surgeries being laparoscopic and confined to the bladder, kidney, and prostate gland. The median opiate consumption in morphine equivalents in the postanesthesia care unit was 7.7 mg (range 5-11.7 mg) for the OF cohort versus 11.7 mg (range 5-17.3 mg) for the control group (P < 0.001). Similarly, the median total postoperative opiate consumption in morphine equivalents was 23.9 mg (range 13.8-42.4 mg) for the OF group compared with 32.1 mg (range 17.38-57.51 mg) for the control group (P = 0.0081). The median hospital length of stay for the OF group was 1.4 days (range 1.2-2.3 days) versus 1.3 days (range 1.2-2.4 days) for the control group (P = 0.8466). CONCLUSIONS There was a statistically significant difference in opiate consumption postoperatively for patients who underwent an OF technique compared with a conventional opiate-based technique. This technique appears to be a possible alternative approach, without any apparent untoward consequences during admission.
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Affiliation(s)
- Susan A Smith
- From the Department of Anesthesiology, Emory University, Atlanta, Georgia, the Departments of Anesthesiology and Urology, Ochsner Clinic Foundation, New Orleans, Louisiana, the Department of Anesthesiology, Critical Care, & Pain Medicine, St Elizabeth's Medical Center, Brighton, Massachusetts, and the Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - Hussam Ghabra
- From the Department of Anesthesiology, Emory University, Atlanta, Georgia, the Departments of Anesthesiology and Urology, Ochsner Clinic Foundation, New Orleans, Louisiana, the Department of Anesthesiology, Critical Care, & Pain Medicine, St Elizabeth's Medical Center, Brighton, Massachusetts, and the Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - Daniah G Dhaifallah
- From the Department of Anesthesiology, Emory University, Atlanta, Georgia, the Departments of Anesthesiology and Urology, Ochsner Clinic Foundation, New Orleans, Louisiana, the Department of Anesthesiology, Critical Care, & Pain Medicine, St Elizabeth's Medical Center, Brighton, Massachusetts, and the Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - Alexander Rahnema
- From the Department of Anesthesiology, Emory University, Atlanta, Georgia, the Departments of Anesthesiology and Urology, Ochsner Clinic Foundation, New Orleans, Louisiana, the Department of Anesthesiology, Critical Care, & Pain Medicine, St Elizabeth's Medical Center, Brighton, Massachusetts, and the Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - Bryan M Evans
- From the Department of Anesthesiology, Emory University, Atlanta, Georgia, the Departments of Anesthesiology and Urology, Ochsner Clinic Foundation, New Orleans, Louisiana, the Department of Anesthesiology, Critical Care, & Pain Medicine, St Elizabeth's Medical Center, Brighton, Massachusetts, and the Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - Bobby D Nossaman
- From the Department of Anesthesiology, Emory University, Atlanta, Georgia, the Departments of Anesthesiology and Urology, Ochsner Clinic Foundation, New Orleans, Louisiana, the Department of Anesthesiology, Critical Care, & Pain Medicine, St Elizabeth's Medical Center, Brighton, Massachusetts, and the Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - William D Sumrall
- From the Department of Anesthesiology, Emory University, Atlanta, Georgia, the Departments of Anesthesiology and Urology, Ochsner Clinic Foundation, New Orleans, Louisiana, the Department of Anesthesiology, Critical Care, & Pain Medicine, St Elizabeth's Medical Center, Brighton, Massachusetts, and the Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - Stephen F Bardot
- From the Department of Anesthesiology, Emory University, Atlanta, Georgia, the Departments of Anesthesiology and Urology, Ochsner Clinic Foundation, New Orleans, Louisiana, the Department of Anesthesiology, Critical Care, & Pain Medicine, St Elizabeth's Medical Center, Brighton, Massachusetts, and the Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - Daniel J Canter
- From the Department of Anesthesiology, Emory University, Atlanta, Georgia, the Departments of Anesthesiology and Urology, Ochsner Clinic Foundation, New Orleans, Louisiana, the Department of Anesthesiology, Critical Care, & Pain Medicine, St Elizabeth's Medical Center, Brighton, Massachusetts, and the Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock
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The Effect of Perioperative Lidocaine Infusion on Postoperative Pain and Postsurgical Recovery Parameters in Gynecologic Cancer Surgery. Clin J Pain 2020; 37:126-132. [DOI: 10.1097/ajp.0000000000000900] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 11/03/2020] [Indexed: 11/25/2022]
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Foo I, Macfarlane AJR, Srivastava D, Bhaskar A, Barker H, Knaggs R, Eipe N, Smith AF. The use of intravenous lidocaine for postoperative pain and recovery: international consensus statement on efficacy and safety. Anaesthesia 2020; 76:238-250. [PMID: 33141959 DOI: 10.1111/anae.15270] [Citation(s) in RCA: 126] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2020] [Indexed: 12/15/2022]
Abstract
Intravenous lidocaine is used widely for its effect on postoperative pain and recovery but it can be, and has been, fatal when used inappropriately and incorrectly. The risk-benefit ratio of i.v. lidocaine varies with type of surgery and with patient factors such as comorbidity (including pre-existing chronic pain). This consensus statement aims to address three questions. First, does i.v. lidocaine effectively reduce postoperative pain and facilitate recovery? Second, is i.v. lidocaine safe? Third, does the fact that i.v. lidocaine is not licensed for this indication affect its use? We suggest that i.v. lidocaine should be regarded as a 'high-risk' medicine. Individual anaesthetists may feel that, in selected patients, i.v. lidocaine may be beneficial as part of a multimodal peri-operative pain management strategy. This approach should be approved by hospital medication governance systems, and the individual clinical decision should be made with properly informed consent from the patient concerned. If i.v. lidocaine is used, we recommend an initial dose of no more than 1.5 mg.kg-1 , calculated using the patient's ideal body weight and given as an infusion over 10 min. Thereafter, an infusion of no more than 1.5 mg.kg-1 .h-1 for no longer than 24 h is recommended, subject to review and re-assessment. Intravenous lidocaine should not be used at the same time as, or within the period of action of, other local anaesthetic interventions. This includes not starting i.v. lidocaine within 4 h after any nerve block, and not performing any nerve block until 4 h after discontinuing an i.v. lidocaine infusion.
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Affiliation(s)
- I Foo
- Western General Infirmary, Edinburgh, UK
| | | | | | - A Bhaskar
- Imperial College Healthcare NHS Trust, London, UK
| | - H Barker
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | - R Knaggs
- University of Nottingham, Nottingham, UK
| | - N Eipe
- Ottowa Hospital, Ottowa, Canada
| | - A F Smith
- Royal Lancaster Infirmary, Lancaster, UK
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Jones JH, Aldwinckle R. Interfascial Plane Blocks and Laparoscopic Abdominal Surgery: A Narrative Review. Local Reg Anesth 2020; 13:159-169. [PMID: 33122942 PMCID: PMC7591028 DOI: 10.2147/lra.s272694] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 09/23/2020] [Indexed: 11/23/2022] Open
Abstract
Laparoscopic abdominal surgery has become a mainstay of modern surgical practice. Postoperative analgesia is an integral component of recovery following laparoscopic abdominal surgery and may be improved by regional anesthesia or intravenous lidocaine infusion. There is inconsistent evidence supporting the use of interfascial plane blocks, such as transversus abdominis plane (TAP) blocks, for patients undergoing laparoscopic abdominal surgery as evidenced by variable patterns of local anesthetic spread and conflicting results from studies comparing TAP blocks to local anesthetic infiltration of laparoscopic port sites and multimodal analgesia. Quadratus lumborum (QL) and erector spinae plane (ESP) blocks may provide greater areas of somatic analgesia as well as visceral analgesia, which may translate to more significant clinical benefits. Aside from the locations of the surgical incisions, it is unclear what other factors should be considered when choosing one regional technique over another or deciding to infuse lidocaine intravenously. We reviewed the current literature in attempt to clarify the roles of various regional anesthesia techniques for patients undergoing laparoscopic abdominal surgery and present one possible approach to evaluating postoperative pain.
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Affiliation(s)
- James Harvey Jones
- Department of Anesthesiology and Pain Medicine, University of California Davis Medical Center, Sacramento, CA, USA
| | - Robin Aldwinckle
- Department of Anesthesiology and Pain Medicine, University of California Davis Medical Center, Sacramento, CA, USA
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35
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Mujukian A, Truong A, Tran H, Shane R, Fleshner P, Zaghiyan K. A Standardized Multimodal Analgesia Protocol Reduces Perioperative Opioid Use in Minimally Invasive Colorectal Surgery. J Gastrointest Surg 2020; 24:2286-2294. [PMID: 31515761 DOI: 10.1007/s11605-019-04385-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 08/27/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Multimodal analgesia protocols are becoming a common part of enhanced recovery pathways after colorectal surgery. However, few protocols include a robust intraoperative component in addition to pre-operative and post-operative analgesics. METHOD A prospective cohort study was performed in an urban teaching hospital in patients undergoing minimally invasive colorectal surgery before and after implementation of a multimodal analgesia protocol consisting of pre-operative (gabapentin, acetaminophen, celecoxib), intraoperative (lidocaine and magnesium infusions, ketorolac, transversus abdominis plane block), and post-operative (gabapentin, acetaminophen, celecoxib) opioid-sparing elements. The main outcome measure was use of morphine equivalents in the first 24-h post-operative period. RESULTS The study cohort (n = 71) included 41 patients before and 30 patients after implementation of a multimodal analgesia protocol. Mean age of the entire study cohort was 47 ± 19.7 years and 46% were male. Patients undergoing surgery post-multimodal analgesia vs. pre-multimodal analgesia had significantly lower use of IV morphine equivalents in first 24-h post-operative period (5.8 ± 6.4 mg vs. 22.8 ± 21.3 mg; p = 0.005) and first 48-h post-operative period (7.6 ± 9.4 mg vs. 42 ± 52.9 mg; p = 0.0008). This reduction in IV morphine equivalent use post-multimodal analgesia was coupled with improved pain scores in the post-operative period. Post-operative hospital length of stay, post-operative ileus, and overall complications were not significantly different between groups. CONCLUSIONS Multimodal analgesia incorporating pre-operative, intraoperative, and post-operative opioid-sparing agents is an effective method for reducing perioperative opioid utilization and pain after minimally invasive colorectal surgery.
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Affiliation(s)
- Angela Mujukian
- Division of Colon & Rectal Surgery, Cedars Sinai Medical Center, 8737 Beverly Blvd., Suite 101, Los Angeles, CA, 90048, USA
| | - Adam Truong
- Division of Colon & Rectal Surgery, Cedars Sinai Medical Center, 8737 Beverly Blvd., Suite 101, Los Angeles, CA, 90048, USA
| | - Hai Tran
- Department of Pharmacy, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Rita Shane
- Department of Pharmacy, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Phillip Fleshner
- Division of Colon & Rectal Surgery, Cedars Sinai Medical Center, 8737 Beverly Blvd., Suite 101, Los Angeles, CA, 90048, USA
| | - Karen Zaghiyan
- Division of Colon & Rectal Surgery, Cedars Sinai Medical Center, 8737 Beverly Blvd., Suite 101, Los Angeles, CA, 90048, USA.
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Elvir-Lazo OL, White PF, Yumul R, Cruz Eng H. Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review. F1000Res 2020; 9. [PMID: 32913634 PMCID: PMC7429924 DOI: 10.12688/f1000research.21832.1] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 01/10/2023] Open
Abstract
Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) remain common and distressing complications following surgery. The routine use of opioid analgesics for perioperative pain management is a major contributing factor to both PONV and PDNV after surgery. PONV and PDNV can delay discharge from the hospital or surgicenter, delay the return to normal activities of daily living after discharge home, and increase medical costs. The high incidence of PONV and PDNV has persisted despite the introduction of many new antiemetic drugs (and more aggressive use of antiemetic prophylaxis) over the last two decades as a result of growth in minimally invasive ambulatory surgery and the increased emphasis on earlier mobilization and discharge after both minor and major surgical procedures (e.g. enhanced recovery protocols). Pharmacologic management of PONV should be tailored to the patient’s risk level using the validated PONV and PDNV risk-scoring systems to encourage cost-effective practices and minimize the potential for adverse side effects due to drug interactions in the perioperative period. A combination of prophylactic antiemetic drugs with different mechanisms of action should be administered to patients with moderate to high risk of developing PONV. In addition to utilizing prophylactic antiemetic drugs, the management of perioperative pain using opioid-sparing multimodal analgesic techniques is critically important for achieving an enhanced recovery after surgery. In conclusion, the utilization of strategies to reduce the baseline risk of PONV (e.g. adequate hydration and the use of nonpharmacologic antiemetic and opioid-sparing analgesic techniques) and implementing multimodal antiemetic and analgesic regimens will reduce the likelihood of patients developing PONV and PDNV after surgery.
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Affiliation(s)
| | - Paul F White
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.,The White Mountain Institute, The Sea Ranch, Sonoma, CA, 95497, USA.,Instituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy
| | - Roya Yumul
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.,David Geffen School of Medicine-UCLA, Charles R. Drew University of Medicine and Science, Los Angeles, CA, 90095, USA
| | - Hillenn Cruz Eng
- Department of Anesthesiology, PennState Hershey Medical Center, Hershey, PA, 17033, USA
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Gu X, Xiao C. Pre-, Peri-, and Postoperative Intravenous Ropivacaine versus that of Lidocaine for Analgesia after Hand-Assisted Laparoscopic Surgery of Left Colon Cancer: A Retrospective Analysis. J INVEST SURG 2020; 34:1322-1328. [PMID: 32772588 DOI: 10.1080/08941939.2020.1801913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSES Pre-, peri-, and postoperative intravenous lidocaine are reported effective in the management of postoperative pain in laparoscopic colorectal surgery but until the time, that of ropivacaine is not tested for the same. The objectives of the study were to evaluate the effectiveness of pre-, peri-, and postoperative intravenous ropivacaine against that of lidocaine on the postoperative pain, bowel function recoveries, and hospital stays in patients who underwent surgery of left colon cancer. MATERIALS AND METHODS Data regarding total doses of fentanyl required, bowel function recoveries, surgical-related complications, and hospital stays of 367 patients who underwent hand-assisted laparoscopic surgery of left colon cancer were retrospectively collected and analyzed. Patients received pre-, peri-, and postoperative intravenous normal saline (NS cohort, n = 104), or that of lidocaine (LC cohort, n = 145), or that of ropivacaine (RC cohort, n = 118). RESULTS Fewer dose of fentanyl was required in patients of RC cohort than those of NS (9 doses/patient vs. 11 doses/patient, p < .0001, q = 27.445) and LC (9 doses/patient vs. 10 doses/patient, p < .0001, q = 9.911) cohorts. Patients of the RC cohort had less time to first drink, first bowel movement, full diet, and hospital stay than those of NS and LC cohorts (p < .05 and q > 3.329 for all). CONCLUSIONS Pre-, peri-, and postoperative intravenous ropivacaine are safe and effective than that of normal saline or lidocaine in hand-assisted laparoscopic surgery of left colon cancer.
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Affiliation(s)
- Xiafang Gu
- Department of Anesthesiology, The No. 2 People's Hospital of Suzhou Xiangcheng District, Suzhou, China
| | - Chengjiao Xiao
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China
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38
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Rollins KE, Javanmard-Emamghissi H, Scott MJ, Lobo DN. The impact of peri-operative intravenous lidocaine on postoperative outcome after elective colorectal surgery: A meta-analysis of randomised controlled trials. Eur J Anaesthesiol 2020; 37:659-670. [PMID: 32141934 DOI: 10.1097/eja.0000000000001165] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND There has recently been increasing interest in the use of peri-operative intravenous lidocaine (IVL) due to its analgesic, anti-inflammatory and opioid-sparing effects. However, these potential benefits are not well established in elective colorectal surgery. OBJECTIVES To examine the effect of peri-operative IVL infusion on postoperative outcome in patients undergoing elective colorectal surgery. DESIGN A meta-analysis of randomised controlled trials (RCTs) comparing peri-operative IVL with placebo infusion in elective colorectal surgery. The primary outcome measure was postoperative pain scores up to 48 h. The secondary outcome measures included time to return of gastrointestinal function, postoperative morphine requirement, anastomotic leak, local anaesthetic toxicity and hospital length of stay. DATA SOURCES PubMed, Scopus and the Cochrane Library databases were searched on 5 November 2018. ELIGIBILITY CRITERIA Studies were included if they were RCTs evaluating the role of peri-operative IVL vs. placebo in adult patients undergoing elective colorectal surgery. Exclusion criteria were paediatric patients, noncolorectal or emergency procedures, non-RCT methodology or lack of relevant outcome measures. RESULTS A total of 10 studies were included (n = 508 patients; 265 who had undergone IVL infusion, 243 who had undergone placebo infusion). IVL infusion was associated with a significant reduction in time to defecation (mean difference -12.06 h, 95% CI -17.83 to -6.29, I = 93%, P = 0.0001), hospital length of stay (mean difference -0.76 days, 95% CI -1.32 to -0.19, I = 45%, P = 0.009) and postoperative pain scores at early time points, although this difference does not meet the threshold for a clinically relevant difference. There was no difference in time to pass flatus (mean difference -5.33 h, 95% CI -11.53 to 0.88, I = 90%, P = 0.09), nor in rates of surgical site infection or anastomotic leakage. CONCLUSION This meta-analysis provides some support for the administration of peri-operative IVL infusion in elective colorectal surgery. However, further evidence is necessary to fully elucidate its potential benefits in light of the high levels of study heterogeneity and mixed quality of methodology.
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Affiliation(s)
- Katie E Rollins
- From Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, UK (KER, HJE, DNL), Department of Anesthesiology, Virginia Commonwealth University Health System, Richmond, Virginia and Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA (MJS), MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK (DNL)
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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: 0.2] [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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40
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Wei S, Yu‐han Z, Wei‐wei J, Hai Y. The effects of intravenous lidocaine on wound pain and gastrointestinal function recovery after laparoscopic colorectal surgery. Int Wound J 2020; 17:351-362. [PMID: 31837112 PMCID: PMC7949458 DOI: 10.1111/iwj.13279] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/24/2019] [Indexed: 02/05/2023] Open
Abstract
To evaluate the efficacy of intravenous lidocaine in relieving postoperative pain and promoting rehabilitation in laparoscopic colorectal surgery, we conducted this meta-analysis. The systematic search strategy was performed on PubMed, EMBASE, Chinese databases, and Cochrane Library before September 2019. As a result, 10 randomised clinical trials were included in this meta-analysis (n = 527 patients). Intravenous lidocaine significantly reduced pain scores at 2, 4, 12, 24, and 48 hours on movement and 2, 4, and 12 hours on resting-state and reduced opioid requirement in first 24 hours postoperatively (weighted mean difference [WMD] = -5.02 [-9.34, -0.70]; P = .02). It also decreased the first flatus time (WMD: -10.15 [-11.20, -9.10]; P < .00001), first defecation time (WMD: -10.27 [-17.62, -2.92]; P = .006), length of hospital stay (WMD: -1.05 [-1.89, -0.21]; P = .01), and reduced the incidence of postoperative nausea and vomiting (risk ratio: 0.53 [0.30, 0.93]; P = .03) when compared with control group. However, it had no effect on pain scores at 24 and 48 hours at rest, the normal dietary time, and the level of serum C-reactive protein. In summary, perioperative intravenous lidocaine could alleviate acute pain, reduce postoperative analgesic requirements, and accelerate recovery of gastrointestinal function in patients undergoing laparoscopic colorectal surgery.
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Affiliation(s)
- Shi Wei
- Department of Anesthesiology, West China HospitalSichuan UniversityChengduChina
| | - Zhang Yu‐han
- Department of Anesthesiology, West China HospitalSichuan UniversityChengduChina
| | - Jing Wei‐wei
- Department of Anesthesiology, West China HospitalSichuan UniversityChengduChina
| | - Yu Hai
- Department of Anesthesiology, West China HospitalSichuan UniversityChengduChina
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42
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Kim DH, Park JY, Yu J, Lee SA, Park S, Hwang JH, Koh GH, Kim YK. Intravenous Lidocaine for the Prevention of Postoperative Catheter-Related Bladder Discomfort in Male Patients Undergoing Transurethral Resection of Bladder Tumors: A Randomized, Double-Blind, Controlled Trial. Anesth Analg 2019; 131:220-227. [DOI: 10.1213/ane.0000000000004405] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Wang T, Liu H, Sun JH, Wang L, Zhang JY. Efficacy of intravenous lidocaine in improving post-operative nausea, vomiting and early recovery after laparoscopic gynaecological surgery. Exp Ther Med 2019; 17:4723-4729. [PMID: 31086606 DOI: 10.3892/etm.2019.7497] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 02/28/2019] [Indexed: 12/15/2022] Open
Abstract
Post-operative nausea and vomiting (PONV) is a major peri-operative complication. It has numerous adverse consequences that seriously affect the post-operative recovery of patients. The aim of the present study was to investigate the efficacy of intravenous lidocaine in improving PONV and recovery after laparoscopic gynaecological surgery. A total of 40 patients were randomly assigned to 2 groups: Group L (lidocaine group) and Group C (control group). The patients in Group L received intravenous lidocaine throughout the operation, while patients in Group C were given a saline infusion. Vital signs, recovery time, extubation time, dosage of remifentanil, first flatus time and defecation time of each patient were recorded. The incidence of PONV after surgery was also recorded. The recovery of the patients was evaluated by using the quality of recovery score (QoR-40). The total dose of remifentanil was significantly lower in Group L (P<0.05). However, the recovery time and extubation time were shorter in Group C (P<0.05). The first flatus time and defecation time were longer in Group C (P<0.05). The mean arterial pressure and heart rate in Group L were lower and more stable (P<0.05). At 6 h after surgery, the incidence of PONV was significantly lower in Group L vs. that in Group C (P<0.05). The QoR-40 score in Group C was significantly lower at 1 and 3 days after the operation compared with that in Group C (P<0.05). In conclusion, intravenous lidocaine administered to patients undergoing laparoscopic gynaecological surgery may reduce PONV and supports their early recovery [trial registration number in Chinese Clinical Trial Registry: ChiCTR-IOR-17010782 (March 5, 2017)].
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Affiliation(s)
- Tao Wang
- Department of Anesthesia, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu 225000, P.R. China
| | - Hui Liu
- Department of Endocrinology, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu 225000, P.R. China
| | - Jian Hong Sun
- Department of Anesthesia, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu 225000, P.R. China
| | - Lin Wang
- Department of Anesthesia, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu 225000, P.R. China
| | - Jian You Zhang
- Department of Anesthesia, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu 225000, P.R. China
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Gustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N, Rockall TA, Young-Fadok TM, Hill AG, Soop M, de Boer HD, Urman RD, Chang GJ, Fichera A, Kessler H, Grass F, Whang EE, Fawcett WJ, Carli F, Lobo DN, Rollins KE, Balfour A, Baldini G, Riedel B, Ljungqvist O. Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS ®) Society Recommendations: 2018. World J Surg 2019; 43:659-695. [PMID: 30426190 DOI: 10.1007/s00268-018-4844-y] [Citation(s) in RCA: 1185] [Impact Index Per Article: 197.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND This is the fourth updated Enhanced Recovery After Surgery (ERAS®) Society guideline presenting a consensus for optimal perioperative care in colorectal surgery and providing graded recommendations for each ERAS item within the ERAS® protocol. METHODS A wide database search on English literature publications was performed. Studies on each item within the protocol were selected with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohorts and examined, reviewed and graded according to Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. RESULTS All recommendations on ERAS® protocol items are based on best available evidence; good-quality trials; meta-analyses of good-quality trials; or large cohort studies. The level of evidence for the use of each item is presented accordingly. CONCLUSIONS The evidence base and recommendation for items within the multimodal perioperative care pathway are presented by the ERAS® Society in this comprehensive consensus review.
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Affiliation(s)
- U O Gustafsson
- Department of Surgery, Danderyd Hospital and Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - M J Scott
- Department of Anesthesia, Virginia Commonwealth University Hospital, Richmond, VA, USA
- Department of Anesthesiology, University of Pennsylvania, Philadelphia, USA
| | - M Hubner
- Department of Visceral Surgery, CHUV, Lausanne, Switzerland
| | - J Nygren
- Department of Surgery, Ersta Hospital and Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - N Demartines
- Department of Visceral Surgery, CHUV, Lausanne, Switzerland
| | - N Francis
- Colorectal Unit, Yeovil District Hospital, Higher Kingston, Yeovil, BA21 4AT, UK
- University of Bath, Wessex House Bath, BA2 7JU, UK
| | - T A Rockall
- Department of Surgery, Royal Surrey County Hospital NHS Trust, and Minimal Access Therapy Training Unit (MATTU), Guildford, UK
| | - T M Young-Fadok
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - A G Hill
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland Middlemore Hospital, Auckland, New Zealand
| | - M Soop
- Irving National Intestinal Failure Unit, The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - H D de Boer
- Department of Anesthesiology, Pain Medicine and Procedural Sedation and Analgesia, Martini General Hospital, Groningen, The Netherlands
| | - R D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - G J Chang
- Department of Surgical Oncology and Department of Health Services Research, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - A Fichera
- Division of Gastrointestinal Surgery, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - H Kessler
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Ohio, USA
| | - F Grass
- Department of Visceral Surgery, CHUV, Lausanne, Switzerland
| | - E E Whang
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - W J Fawcett
- Department of Anaesthesia, Royal Surrey County Hospital NHS Foundation Trust and University of Surrey, Guildford, UK
| | - F Carli
- Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, QC, Canada
| | - D N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - K E Rollins
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - A Balfour
- Department of Colorectal Surgery, Surgical Services, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - G Baldini
- Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, QC, Canada
| | - B Riedel
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - O Ljungqvist
- Department of Surgery, Örebro University and University Hospital, Örebro & Institute of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Cooke C, Kennedy ED, Foo I, Nimmo S, Speake D, Paterson HM, Ventham NT. Meta-analysis of the effect of perioperative intravenous lidocaine on return of gastrointestinal function after colorectal surgery. Tech Coloproctol 2019; 23:15-24. [PMID: 30721376 PMCID: PMC6394718 DOI: 10.1007/s10151-019-1927-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/16/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Return of normal gastrointestinal (GI) function is a critical determinant of recovery after colorectal surgery. The aim of this meta-analysis was to evaluate whether perioperative intravenous (IV) lidocaine benefits return of gastrointestinal function after colorectal resection. METHODS A comprehensive search of Ovid Medline, PubMed, Embase, Cochrane library, and clinicaltrials.org was performed on 1st July 2018. A manual search of reference lists was also performed. Inclusion criteria were as follows: randomized controlled trials (RCTs) of intravenous (IV) lidocaine administered perioperatively compared to placebo (0.9% saline infusion) as part of a multimodal perioperative analgesic regimen, human adults (> 16 years), and open or laparoscopic colorectal resectional surgery. EXCLUSION CRITERIA non-colorectal surgery, non-placebo comparator, children, non-general anaesthetic, and pharmacokinetic studies. The primary endpoint was time to first bowel movement. Secondary endpoints were time to first passage of flatus, time to toleration of diet, nausea and vomiting, ileus, pain scores, opioid analgesia consumption, and length of stay. RESULTS One hundred and ninety one studies were screened, with 9 RCTs meeting inclusion criteria (405 patients, four laparoscopic and five open surgery studies). IV lidocaine reduced time to first bowel movement compared to placebo [seven studies, 325 patients, mean weighted difference - 9.54 h, 95% CI 18.72-0.36, p = 0.04]. Ileus, pain scores, and length of stay were reduced with IV lidocaine compared with placebo. CONCLUSIONS Perioperative IV lidocaine may improve recovery of gastrointestinal function after colorectal surgery. Large-scale effectiveness studies to measure effect size and evaluate optimum dose/duration are warranted.
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Affiliation(s)
- C Cooke
- Department of Colorectal Surgery, Western General Hospital, Edinburgh, UK
| | - E D Kennedy
- Department of Colorectal Surgery, Western General Hospital, Edinburgh, UK
| | - I Foo
- Department of Anaesthesia, Western General Hospital, Edinburgh, UK
| | - S Nimmo
- Department of Anaesthesia, Western General Hospital, Edinburgh, UK
| | - D Speake
- Department of Colorectal Surgery, Western General Hospital, Edinburgh, UK
| | - H M Paterson
- Department of Colorectal surgery, Western General Hospital, University of Edinburgh Academic Coloproctology, Crewe Road South, Edinburgh, EH4 2XU, UK.
| | - N T Ventham
- Department of Colorectal Surgery, Western General Hospital, Edinburgh, UK
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46
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The Effect of Anaesthetic and Analgesic Technique on Oncological Outcomes. CURRENT ANESTHESIOLOGY REPORTS 2018. [DOI: 10.1007/s40140-018-0299-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Andjelković L, Novak-Jankovič V, Požar-Lukanovič N, Bosnić Z, Spindler-Vesel A. Influence of dexmedetomidine and lidocaine on perioperative opioid consumption in laparoscopic intestine resection: a randomized controlled clinical trial. J Int Med Res 2018; 46:5143-5154. [PMID: 30209962 PMCID: PMC6300946 DOI: 10.1177/0300060518792456] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective The consumption of opioid analgesics could be reduced by the use of analgesics with different mechanisms of action. We investigated whether additional treatment with dexmedetomidine or lidocaine could reduce opioid consumption. Methods We randomized 59 study participants into three groups and examined: (i) fentanyl consumption, (ii) consumption of piritramide, and (iii) cognitive function and neuropathic pain. The control group received continuous propofol infusion and fentanyl boluses. Continuous intravenous infusion of dexmedetomidine (0.5 µg/kg/h) was administered to the dexmedetomidine group and lidocaine (1.5 mg/kg/h) was administered to the lidocaine group. Results No reduction in fentanyl consumption was observed among the groups. However, we noted a significantly lower consumption of piritramide on the first and second postoperative day in the lidocaine group. Total consumption of piritramide was significantly lower in the lidocaine group compared with the control group. Conclusions Lidocaine and dexmedetomidine reduced intraoperative propofol consumption, while lidocaine reduced postoperative piritramide consumption. Clinical trial registration: NCT02616523
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Affiliation(s)
- Lea Andjelković
- 1 Department of Anaesthesiology and Surgical Intensive Therapy, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Vesna Novak-Jankovič
- 1 Department of Anaesthesiology and Surgical Intensive Therapy, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Neva Požar-Lukanovič
- 1 Department of Anaesthesiology and Surgical Intensive Therapy, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Zoran Bosnić
- 2 Faculty of Computer and Information Science, University of Ljubljana, Ljubljana, Slovenia
| | - Alenka Spindler-Vesel
- 1 Department of Anaesthesiology and Surgical Intensive Therapy, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Zhu J, Liu J, Shen G, Zhong T, Yu X. Comparison of Efficacy Outcomes of Lidocaine Spray, Topical Lidocaine Injection, and Lidocaine General Anesthesia in Nasal Bone Fractures Surgeries: A Randomized, Controlled Trial. Med Sci Monit 2018; 24:4386-4394. [PMID: 29941861 PMCID: PMC6050998 DOI: 10.12659/msm.908468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Lidocaine is widely used as a general and local anesthetic in minor or major surgeries. The objective of the study was to compare postoperative pain relief and adverse events using different forms of lidocaine administration in patients following closed nasal bone reduction surgery. Material/Methods A total of 381 patients with a solitary nasal fracture that could be managed with closed reduction were included in this study and divided into 3 groups of 127 patients in each group. Patients had received 1% lidocaine HCl with epinephrine (LL group), inserted a mesh impregnated with lidocaine spray (TL group), or 1 mg/kg/h lidocaine infusion (GL group) before surgeries. Patients also received morphine when the pain was not controlled. The postoperative pain was assessed at 6 hours and 48 hours after surgery. Postoperative vomiting and nausea were evaluated. Repeated ANOVA/Tukey-Kramer multiple comparisons test was performed at 95% confidence level. Results At 6 hours after surgery, patients in the general lidocaine (GL) group reported decreased postoperative pain compared with those in the topical lidocaine (TL) group (P<0.001, q=6.633) and LL group (P<0.001, q=8.056). The morphine consumption within 48 hours was least in GL group than TL group (P<0.001, q=172.9) and LL group (P<0.001, q=226.42). Lidocaine infusion caused nausea (P<0.001, q=6.742) and vomiting (P<0.001, q=4.306). Conclusions Topical lidocaine anesthesia had the same postoperative pain relief and the least adverse events as local and general lidocaine anesthesia.
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Affiliation(s)
- Jihong Zhu
- Department of Anesthesiology, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Jian Liu
- Department of General Surgery, Wuyi Traditional Chinese Medical Hospital, Jinhua, Zhejiang, China (mainland)
| | - Guoying Shen
- Our-Patient Department, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Taidi Zhong
- Department of Anesthesiology, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Xin Yu
- Department of Anesthesiology, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, Zhejiang, China (mainland)
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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: 151] [Impact Index Per Article: 21.6] [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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Efficacy of intravenous lidocaine on pain relief in patients undergoing laparoscopic cholecystectomy: A meta-analysis from randomized controlled trials. Int J Surg 2018; 50:137-145. [DOI: 10.1016/j.ijsu.2018.01.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 12/13/2017] [Accepted: 01/02/2018] [Indexed: 12/14/2022]
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