Pre- and Intraoperative Lidocaine Injection for Preemptive Analgesics in Laparoscopic Gastrectomy: A Prospective,Randomized,Double-Blind,Placebo-Controlled Study
Restricted accessResearch articleFirst published online August, 2013
Pre- and Intraoperative Lidocaine Injection for Preemptive Analgesics in Laparoscopic Gastrectomy: A Prospective,Randomized,Double-Blind,Placebo-Controlled Study
The preemptive intravenous injection of local anesthetics is known to improve postoperative pains in abdominal surgery. The aim of this study is to assess the effect of intravenous lidocaine injection and analyze the precise amount of pain by computerized patient-controlled analgesia (PCA) in patients who had undergone laparoscopy-assisted distal gastrectomy (LADG).
Patients and Methods:
A double-blind placebo control study was designed, and 34 patients undergoing LADG for early gastric cancer were divided into two groups. Preoperatively and throughout the surgery, Group I received intravenous lidocaine injection, and Group C received normal saline injection for placebo. Postoperative outcomes, including the visual analog scale (VAS), the button hit counts (BHC) from PCA, and amount of fentanyl consumed, were measured.
Results:
The demographic data were similar between the groups. The VAS score, BHC, and fentanyl consumption were lower in Group I compared with Group C (P<.05). In particular, fentanyl consumption and BHC in Group I showed a significant decrease during the first 12 hours of the study (P<.05). Postoperative adverse events showed no difference except that nausea was more frequent in the placebo group (P=.039).
Conclusions:
In this study, intravenous lidocaine injection showed a significant reduction in fentanyl consumption and pain during the earlier postoperative time with more favorable outcomes.
HerroederS, PecherS, SchonherrME, KaulitzG, HahnenkampKet al.Systemic lidocaine shortens length of hospital stay after colorectal surgery: A double-blinded, randomized, placebo-controlled trial. Ann Surg, 2007; 246:192–200.
3.
KimTH, KangH, HongJH, ParkJS, BaekCWet al.Intraperitoneal and intravenous lidocaine for effective pain relief after laparoscopic appendectomy: A prospective, randomized, double-blind, placebo-controlled study. Surg Endosc, 2011; 25:3183–3190.
4.
KoppertW, WeigandM, NeumannF, SittlR, SchuettlerJet al.Perioperative intravenous lidocaine has preventive effects on postoperative pain and morphine consumption after major abdominal surgery. Anesth Analg, 2004; 98:1050–1055.
5.
KirillovaI, TelibanA, GorodetskayaN, GrossmannL, BartschFet al.Effect of local and intravenous lidocaine on ongoing activity in injured afferent nerve fibers. Pain, 2011; 152:1562–1571.
6.
WatkinsLR, MaierSF, GoehlerLE. Immune activation: The role of pro-inflammatory cytokines in inflammation, illness responses and pathological pain states. Pain, 1995; 63:289–302.
7.
MartinF, CherifK, GentiliME, EnelD, AbeEet al.Lack of impact of intravenous lidocaine on analgesia, functional recovery, and nociceptive pain threshold after total hip arthroplasty. Anesthesiology, 2008; 109:118–123.
8.
MarretE, RolinM, BeaussierM, BonnetF. Meta-analysis of intravenous lidocaine and postoperative recovery after abdominal surgery. Br J Surg, 2008; 95:1331–1338.
9.
HayashiH, OchiaiT, ShimadaH, GunjiY. Prospective randomized study of open versus laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection for early gastric cancer. Surg Endosc, 2005; 19:1172–1176.
10.
LeeJH, YomCK, HanHS. Comparison of long-term outcomes of laparoscopy-assisted and open distal gastrectomy for early gastric cancer. Surg Endosc, 2009; 23:1759–1763.
11.
KawamuraH, HommaS, YokotaR, WataraiH, YokotaKet al.Assessment of pain by face scales after gastrectomy: Comparison of laparoscopically assisted gastrectomy and open gastrectomy. Surg Endosc, 2009; 23:991–995.
WerdehausenR, KremerD, BrandenburgerT, SchlosserL, JadaszJet al.Lidocaine metabolites inhibit glycine transporter 1: A novel mechanism for the analgesic action of systemic lidocaine?Anesthesiology, 2012; 116:147–158.
14.
KawamataM, TakahashiT, KozukaY, NawaY, NishikawaKet al.Experimental incision-induced pain in human skin: Effects of systemic lidocaine on flare formation and hyperalgesia. Pain, 2002; 100:77–89.
15.
JanigW. What is the mechanism underlying treatment of pain by systemic application of lidocaine?Pain, 2008; 137:5–6.
16.
Muth-SelbachU, HermannsH, StegmannJU, KolloscheK, FreynhagenRet al.Antinociceptive effects of systemic lidocaine: Involvement of the spinal glycinergic system. Eur J Pharmacol, 2009; 613:68–73.
17.
Ni ChoileainN, RedmondHP. Cell response to surgery. Arch Surg, 2006; 141:1132–1140.
18.
MokartD, CapoC, BlacheJL, DelperoJR, HouvenaeghelGet al.Early postoperative compensatory anti-inflammatory response syndrome is associated with septic complications after major surgical trauma in patients with cancer. Br J Surg, 2002; 89:1450–1456.
19.
KoppertW, OstermeierN, SittlR, WeidnerC, SchmelzM. Low-dose lidocaine reduces secondary hyperalgesia by a central mode of action. Pain, 2000; 85:217–224.
20.
SommerC, KressM. Recent findings on how proinflammatory cytokines cause pain: Peripheral mechanisms in inflammatory and neuropathic hyperalgesia. Neurosci Lett, 2004; 361:184–187.
21.
MacGregorRR, ThornerRE, WrightDM. Lidocaine inhibits granulocyte adherence and prevents granulocyte delivery to inflammatory sites. Blood, 1980; 56:203–209.
22.
KawasakiT, KawasakiC, SataT, ChaudryIH. Lidocaine suppresses mouse Peyer's patch T cell functions and induces bacterial translocation. Surgery, 2011; 149:106–113.
23.
MacGregorRR. The effect of anti-inflammatory agents and inflammation on granulocyte adherence. Evidence for regulation by plasma factors. Am J Med, 1976; 61:597–607.
24.
GoldsteinIM, LindS, HoffsteinS, WeissmannG. Influence of local anesthetics upon human polymorphonuclear leukocyte function in vitro. Reduction of lysosomal enzyme release and superoxide anion production. J Exp Med, 1977; 146:483–494.
25.
HildebrandtU, KesslerK, PlusczykT, PistoriusG, VollmarBet al.Comparison of surgical stress between laparoscopic and open colonic resections. Surg Endosc, 2003; 17:242–246.
26.
KobayashiE, YoshidaT, YamauchiH, SuminagaY, MiyataM. Immune function in patients undergoing open vs laparoscopic cholecystectomy. Arch Surg, 1995; 130:676.
27.
HalevyA, LinG, Gold-DeutschR, LaviR, NegriMet al.Comparison of serum C-reactive protein concentrations for laparoscopic versus open cholecystectomy. Surg Endosc, 1995; 9:280–282.
28.
ChoJM, LaPortaAJ, ClarkJR, SchofieldMJ, HammondSLet al.Response of serum cytokines in patients undergoing laparoscopic cholecystectomy. Surg Endosc, 1994; 8:1380–1383discussion 1383–1384.
29.
BellowsCF, BergerDH. Infiltration of suture sites with local anesthesia for management of pain following laparoscopic ventral hernia repairs: A prospective randomized trial. JSLS, 2006; 10:345–350.
30.
KhanMR, RazaR, ZafarSN, ShamimF, RazaSAet al.Intraperitoneal lignocaine (lidocaine) versus bupivacaine after laparoscopic cholecystectomy: Results of a randomized controlled trial. J Surg Res, 2012; 178:662–669.
31.
SaberAA, ElgamalMH, RaoAJ, ItawiEA, MartinezRL. Early experience with lidocaine patch for postoperative pain control after laparoscopic ventral hernia repair. Int J Surg, 2009; 7:36–38.
32.
GroudineSB, FisherHA, KaufmanRPJr., PatelMK, WilkinsLJet al.Intravenous lidocaine speeds the return of bowel function, decreases postoperative pain, and shortens hospital stay in patients undergoing radical retropubic prostatectomy. Anesth Analg, 1998; 86:235–239.
33.
WilliamsDR, StarkRJ. Intravenous lignocaine (lidocaine) infusion for the treatment of chronic daily headache with substantial medication overuse. Cephalalgia, 2003; 23:963–971.
34.
RaphaelJH, SouthallJL, KitasGD. Adverse effects of intravenous lignocaine therapy in fibromyalgia syndrome. Rheumatology (Oxford), 2003; 42:185–186.
35.
Gil-GouveiaR, GoadsbyPJ. Neuropsychiatric side-effects of lidocaine: Examples from the treatment of headache and a review. Cephalalgia, 2009; 29:496–508.
