Effect of Perioperative Intravenous Lidocaine Administration on Pain, Opioid Consumption, and Quality of Life after Complex Spine Surgery
Ehab Farag,Michael Ghobrial,Daniel I. Sessler,Jarrod E. Dalton,Jinbo Liu,Jae Ho Lee,Sherif Zaky,Edward C. Benzel,William Bingaman,Andrea Kurz +9 more
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TLDR
IV lidocaine significantly improves postoperative pain after complex spine surgery, and is significantly superior to placebo on mean verbal response scale pain scores.Abstract:
Background: The authors tested the primary hypothesis that perioperative IV lidocaine administration during spine surgery (and in the postanesthesia care unit for no more than 8 h) decreases pain and/or opioid requirements in the initial 48 postoperative hours. Secondary outcomes included major complications, postoperative nausea and vomiting, duration of hospitalization, and quality of life. Methods: One hundred sixteen adults having complex spine surgery were randomly assigned to perioperative IV lidocaine (2 mg·kg −1 ·h −1 ) or placebo during surgery and in the post anesthesia care unit. Pain was evaluated with a verbal response scale. Quality of life at 1 and 3 months was assessed using the Acute Short-form (SF) 12 health survey. The authors initially evaluated multivariable bidirectional noninferiority on both outcomes; superiority on either outcome was then evaluated only if noninferiority was established. Results: Lidocaine was significantly superior to placebo on mean verbal response scale pain scores (P < 0.001; adjusted mean [95% CI] of 4.4 [4.2-4.7] and 5.3 [5.0-5.5] points, respectively) and significantly noninferior on mean morphine equivalent dosage (P = 0.011; 55 [36-84] and 74 [49-111] mg, respectively). Postoperative nausea and vomiting and the duration of hospitalization did not differ significantly. Patients given lidocaine had slightly fewer 30-day complications than patients given placebo (odds ratio [95% CI] of 0.91 [0.84–1.00]; P = 0.049). Patients given lidocaine had significantly greater SF-12 physical composite scores than placebo at 1 (38 [31–47] vs. 33 [27–42]; P = 0.002) and 3 (39 [31–49] vs. 34 [28–44]; P = 0.04) months, postoperatively. Conclusion: IV lidocaine significantly improves postoperative pain after complex spine surgery.read more
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Management of postoperative pain: A clinical practice guideline from the american pain society, the american society of regional anesthesia and pain medicine, and the american society of anesthesiologists' committee on regional anesthesia, executive committee, and administrative council.
Roger Chou,Debra B. Gordon,Oscar A. de Leon-Casasola,Jack M. Rosenberg,Stephen W. Bickler,Timothy J. Brennan,Todd Carter,Carla L. Cassidy,Eva Chittenden,Ernest Degenhardt,Scott R. Griffith,Renee C.B. Manworren,Bill McCarberg,Robert R. Montgomery,Jamie D. Murphy,Melissa F. Perkal,Santhanam Suresh,Kathleen A. Sluka,Scott A. Strassels,Richard C. Thirlby,Eugene R. Viscusi,Gary A. Walco,Lisa Warner,Steven J. Weisman,Christopher L. Wu +24 more
TL;DR: The American Pain Society, with input from the American Society of Anesthesiologists, developed a clinical practice guideline to promote evidence-based, effective, and safer postoperative pain management in children and adults.
Journal ArticleDOI
Poorly controlled postoperative pain: prevalence, consequences, and prevention
TL;DR: Several new opioids have been developed that modulate μ-receptor activity by selectively engaging intracellular pathways associated with analgesia and not those associated with adverse events, creating a wider therapeutic window than unselective conventional opioids.
Journal ArticleDOI
Chronic Opioid Use After Surgery: Implications for Perioperative Management in the Face of the Opioid Epidemic.
TL;DR: An analysis of the extent to which opioid-sparing perioperative interventions have been shown to reduce the risk of chronic opioid use after surgery and a discussion of future research directions are presented.
Journal ArticleDOI
Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery
Peter Kranke,Johanna Jokinen,Nathan L. Pace,Alexander Schnabel,Markus W. Hollmann,Klaus Hahnenkamp,Leopold Eberhart,Daniel M. Poepping,Stephanie Weibel +8 more
TL;DR: Evidence of effect for intravenous lidocaine on the reduction of postoperative pain is found at 'early time points' in participants undergoing laparoscopic abdominal surgery and at 'intermediate time points (24 hours)' after surgery, but no evidence of effect was found for lidocane to reduce pain at 'late time points '(48 hours) after surgery.
Journal ArticleDOI
Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery in adults
Stephanie Weibel,Yvonne Jelting,Nathan L. Pace,Antonia Helf,Leopold Eberhart,Klaus Hahnenkamp,Markus W. Hollmann,Daniel M. Poepping,Alexander Schnabel,Peter Kranke +9 more
TL;DR: 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 are assessed.
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