Journal
EJSO
Volume 49, Issue 3, Pages 597-603Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.ejso.2022.11.096
Keywords
Lidocaine; Epidural analgesia; Pain management; Opioid consumption; Cytoreductive surgery
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Intravenous lidocaine infusion may be a safe and effective analgesic approach in cytoreductive surgery (CRS) and is associated with a significant reduction of opioid use and postoperative nausea and vomiting (PONV) compared to opioid-containing thoracic epidural anesthesia (TEA).
Background: Intravenous (IV) lidocaine is a proven analgesic therapy but has not been evaluated in extensive procedures such as cytoreductive surgery (CRS). Our aim was to assess the effectiveness and safety of IV lidocaine in this setting.Methods: This is a retrospective hybrid case-cohort study investigating analgesic effectiveness and complications of perioperative IV lidocaine at 1.5 mg/kg/h for 48 h compared to thoracic epidural anaesthesia (TEA) among patients undergoing CRS in a high-volume centre.Results: Sixty patients were included, 20 received IV lidocaine and 40 underwent TEA. Pain scores were low (median <2) and similar in both groups (p = 0.88). At 72 h, the lidocaine group had a lower median pain score (p = 0.03). Overall opioid consumption in the first 48 h was lower in the lidocaine compared to the TEA group (median 0 (IQR 0-9.5) mg vs. 45.4 (0-62.4) MME respectively, p = 0.001). Opioid consumption was also lower in the lidocaine compared to the TEA group during the whole 5-day period (median 1 (IQR 1-13.5) mg vs. 112 (36.6-137.85) MME respectively, p = 0.000). The incidence of PONV was significantly lower in the lidocaine group (27.5% vs 5%, p = 0.047) with no difference in other complications or length of in-hospital stay.Conclusion: Intravenous lidocaine infusion may be a safe and effective analgesic approach in CRS and is associated with a significant reduction of opioid use and PONV compared to opioid-containing TEA.(c) 2022 Elsevier Ltd, BASO -The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
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