DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20210741

Preemptive use of adjunctive IV lidocaine for enhanced recovery after abdominal hysterectomy for overweight and obese women: a prospective, randomized, double-blind, placebo-controlled study

Nahla Waer Shady, Hassan Ahmed Farouk, Hany Farouk Sallam

Abstract


Background: This investigation planned to evaluate the clinical results of adjunctive IV lidocaine bolus dose plus infusion for one hour after surgery in patients who underwent an abdominal hysterectomy in obese and overweight women.

Methods: We performed a double-blind, placebo-controlled study, (ClinicalTrials.gov identifier: NC03748108), with patients undergoing abdominal hysterectomy divided into 2 groups: one group received intravenous lidocaine single bolus dose preoperatively and IV infusions till one hour after the surgical procedure, and the opposite received normal saline infusion (placebo). We assessed postoperative results, including pain scores rankings on a visual analog scale (VAS) in rest and movement, administration frequency of pethidine. Postoperative nausea and vomiting, the period of hospital stay (LOS), time to ambulate, and patient satisfaction at forty-eight hours had been evaluated. Chi-square test and Monte Carlo test have been used for comparison among groups.

Results: There were 120 patients in our study. The visual analog scale (VAS), pain scores, length of hospital stay (LOS), and administration frequency of pethidine were significantly lower in the lidocaine group. The total amount of consumed pethidine was significantly lower in the lidocaine than the placebo group. There was a significant reduction in post-operative pain which was assessed by visual analog scale (VAS) after 2,4,8,12, and 24 hours either during movement or during rest in the lidocaine group compared to the placebo group, p=(0. 0001,0.0001,0.0001,0.0001 and 0.0001).

Conclusions: The administration of adjuvant intravenous lidocaine infusion reduces pain during the postoperative period after abdominal hysterectomy, is associated with early recovery, decreased postoperative opioid analgesic requirement, and better patient satisfaction in overweight and obese women undergoing abdominal hysterectomy.

 




Keywords


Abdominal hysterectomy, Enhanced recovery, IV lidocaine

Full Text:

PDF

References


Aarts JWM, Nieboer TE, Johnson N, Tavender E, Garry R, Mol BWJ, Kluivers KB. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2015;8:3677.

Nelson G, Altman AD, Nick A.. Guidelines for postoperative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations--Part II. Gynecol Oncol. 2016;140(2):323-32.

Lamvu G, Zolnoun D, Boggess J, Steege JF. Obesity: Physiologic changes and challenges during laparoscopy. Am J Obstet Gynecol. 2004;191:669-74.

McMahon MD, Scott DM, Saks E, Tower A, Raker CA, Matteson KA. Impact of obesity on outcomes of hysterectomy. J Minim Invasive Gynecol. 2014;21:259-65.

Shah DK, Voorhis BJ, Vitonis AF, Missmer SA. Association between body mass index, uterine size, and operative morbidity in women undergoing minimally invasive hysterectomy. J Minim Invasive Gynecol. 2016;23:1113-22.

Tyan P, Amdur R, Berrigan M. Differences in postoperative morbidity among obese patients undergoing abdominal versus laparoscopic hysterectomy for benign indications. J Minim Invasive Gynecol. 2020;27:464-72.

Emad M. Association between obesity and the trends of routes of hysterectomy performed for benign indications. Obst Gynecol. 2015;125(4):912-8.

Shah A, Hayes CJ, Martin BC. Characteristics of initial prescription episodes and likelihood of long-term opioid use-United States, 2006-2015. Morbidity Mortality. 2017;66(10):265.‏

Marret E. Meta‐analysis of intravenous lidocaine and postoperative recovery after abdominal surgery. British J Surgery. 2008;95(11):1331-8.‏

Markus WH. Inhibition of M3 muscarinic acetylcholine receptors by local anaesthetics. British J Pharmacol. 2001;133(1):207-16.‏

Gabriele B, Sotgiu ML. Central effects of systemic lidocaine mediated by glycine spinal receptors: An iontophoretic study in the rat spinal cord." Brain Res. 1993;603(2):201-6.‏

McCarthy GC, Megalla SA, Habib AS. Impact of intravenous lidocaine infusion on postoperative Analgesia and recovery from surgery. Drugs. 2010;70:1149-63.

Vigneault L, Turgeon AF, Côté D. Perioperative intravenous lidocaine infusion for postoperative pain control: a meta-analysis of randomized controlled trials. J Can Anesth. 2011;58:22-37.

Klaver, Manuela JM, Buckingham MG, George F. Lidocaine attenuates cytokine-induced cell injury in endothelial and vascular smooth muscle cells. Anesthesia Analgesia. 2003;97(2):465-70.‏

Nagy, Istvan, Clifford J. Lignocaine selectively reduces C fibre-evoked neuronal activity in rat spinal cord in vitro by decreasing N-methyl-D-aspartate and neurokinin receptor-mediated post-synaptic depolarizations; Implications for the development of novel centrally acting analgesics. Pain. 1996;64(1):59-70.‏

Fin P, Bernard O, Sesay M. Benefits of intravenous lidocaine on post-operative pain and acute rehabilitation after laparoscopic nephrectomy. J Anaesthesiol Clin Pharmacol. 2014;30(3):366-72.

Kim KT, Cho DC, Sung JK, Kim YB, Kang H, Song KS. Intraoperative systemic infusion of lidocaine reduces postoperative pain after lumbar surgery: A double blinded, randomized, placebo controlled clinical trial. Spine J. 2014;14:1559-66.

Yon JH, Choi GJ, Kang H, Park JM, Yang HS. Intraoperative systemic lidocaine for pre-emptive analgesics in subtotal gastrectomy: a prospective, randomized, double-blind, placebo-controlled study. Can J Surg. 2014;57(3):175-82.

Barbara C. The hypothesis that antagonism of fentanyl analgesia by 2-chloroprocaine is mediated by direct action on opioid receptors. Regional Anesthesia Pain Med. 1997;22(1):43-52.‏

Cohen SP, Mao J. Is the analgesic effect of systemic lidocaine mediated through opioid receptors? Acta Anaesthesiologica Scandinavica. 2003;47(7)910-1.‏

Klaver, Manuela JM, Buckingham MG, Rich GF. Lidocaine attenuates cytokine-induced cell injury in endothelial and vascular smooth muscle cells. Anesthesia Analgesia. 2003;97(2):465-70.

Istvan N, Woolf CJ. Lignocaine selectively reduces C fibre-evoked neuronal activity in rat spinal cord in vitro by decreasing N-methyl-D-aspartate and neurokinin receptor-mediated post-synaptic depolarizations; implications for the development of novel centrally acting analgesics. Pain. 1996;64(1):59-70.‏

Tauzin P, Bernard O, Sesay M. Benefits of intravenous lidocaine on post-operative pain and acute rehabilitation after laparoscopic nephrectomy. J Anaesthesiol Clin Pharmacol. 2014;30(3):366-72.

Snyder GL, Greenberg S. Effect of anaesthetic technique and other perioperative factors on cancer recurrence. Br J Anaesth. 2010;105:106-15.

Fletcher D, Martinez V. Opioid-induced hyperalgesia in patients after surgery: a systematic review and a meta-analysis. Br J Anaesth. 2014;112:991-1004.

Kumar L, Barker C, Emmanuel A. Opioid-induced constipation: pathophysiology, clinical consequences, and management. Gastroenterol Res Pract. 2014;1417-37.

Herroeder S, Pecher S, Schönherr ME. Systemic lidocaine shortens length of hospital stay after colorectal surgery: a double-blinded, randomized, placebo-controlled trial. Ann Surg. 2009;249(4):701.

Choi SJ, Kim MH, Jeong HY, Lee JJ. Effect of intraoperative lidocaine on anesthetic consumption, and bowel function, pain intensity, analgesic consumption and hospital stay after breast surgery. Korean J Anesthesiol. 2012;62(5):429-34.

Wuethrich PY, Romero J, Burkhard FC, Curatolo M. No benefit from perioperative intravenous lidocainein laparoscopic renal surgery: A randomised, placebo controlled study. Eur J Anaesthesiol. 2012;29:537-43.

Myles PS, Weitkamp B, Jones K, Melick J, Hensen S. Validity and reliability of a postoperative quality of recovery score: The QoR 40. Br J Anaesth. 2000;84:11-5.

Oliveira GS, Duncan K, Fitzgerald P. Systemic lidocaine to improve quality of recovery after laparoscopic bariatric surgery: a randomized double-blinded placebo-controlled trial. Obes Surg. 2014;24:212-8 .