Lidocaine Provides Efficient Post-Hysterectomy Analgesia

By John Henry Dreyfuss, MDalert.com staff.

Save to PDF AnesthesiologyPerformance-Based MedicineSurgery By
  • Both intravenous and intraperitoneal lidocaine provide effective analgesia for elective hysterectomy.
  • Intravenous and intraperitoneal lidocaine significantly reduce postop opioid requirements.
  • Double-blind placebo controlled study included 109 patients.
  • Study compared I.V and intraperitoneal lidocaine versus saline placebo.
  • Patients in the lidocaine group experienced less vomiting.
  • Trial tracked postoperative opioid analgesic requirement.

Intravenous and intraperitoneal lidocaine are highly effective techniques for analgesia following elective hysterectomy, according to a trial published recently in the Journal of Family and Reproductive Health (2015 Nov;9[4]:193-8).

Visual Analogue Scale (VAS) pain scores were significantly lower in the groups that received intraperitoneal and intravenous lidocaine (Figures 1 and 2) compared with placebo (P=0.001). The total consumption of morphine was significantly lower in the intraperitoneal and intravenous lidocaine groups (P=0.001). The time to first request for morphine as a recue analgesic was lower in the intraperitoneal and intravenous lidocaine groups analgesic versus the group that received placebo (P=0.001).

 

Figure 1. Intravenous lidocaine.

 

Figure 2. The lidocaine molecule.

This study showed that lidocaine administration both intravenously and intraperitoneally are effective in reducing postoperative pain, also have opioid sparing effects, and can be used safely in elective abdominal hysterectomy (Figure 3) without significant adverse effects, the authors explained.

“We have demonstrated, using of lidocaine both intravenously and intraperitoneally are effective and safe for relieving pain after elective abdominal hysterectomy,” the authors wrote. These methods were also demonstrated to reduce postoperative opioid consumption on day 1.

 

Figure 3. Laparoscopic hysterectomy.

The study limitations included the fact that only women undergoing elective abdominal hysterectomy were studied. and evaluated pain at rest thus our results may not attributable to: pain intensity at movement, men, emergency surgeries and other types of procedures, therefore more studies are needed.

The Analysis

This double-blind, randomized, placebo-controlled study compared the efficacy of intravenous and intraperitoneal injection of lidocaine versus normal saline placebo for the relief of pain following abdominal hysterectomy.

The researchers enrolled 109 patients undergoing elective abdominal hysterectomy. Subjects were randomly assigned to 1 of 3 groups. Group 1 received an intravenous injection of lidocaine 2% as an I.V. bolus at a dosage of 1.5mg/kg 30 minutes before incision. Lidocaine 2mg/kg was then administered as a continuous infusion before wound closure. They also received an intraperitoneal injection of normal saline. Group 2, the intraperitoneal group, received I.V. normal saline plus intraperitoneal 2% lidocaine 3mg/kg. Group 3 received normal saline placebo both intravenously and intraperitoneally.

 

Figure 4. Intravenous morphine.

 

Figure 5. The morphine molecule.
 Visual Analogue Pain Scale pain scores were recorded at rest, as was total morphine consumption (Figures 4 and 5), and the time to requirement of first rescue analgesic. The researchers also recorded the incidence of lidocaine-related adverse effects, as well as rates of postoperative nausea and vomiting (PONV). These outcomes were recorded at 0, 2, 4, 8, 12 and 24 hours postoperatively.

Incidence of vomiting was comparable between groups (P<0.05) but nausea was higher in control group (P>0.05). There were no significant lidocaine-related adverse effects. No statistically significant differences were detected between intraperitoneal and intravenous groups for all examined variables.

 


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