Perioperative Use of Intravenous Lidocaine.

TLDR: This article will focus on the use of perioperative lidocaine infusion for attaining postoperative benefits; intraoperative indications are outside the scope of this article, although several exist.

Abstract: <zdoi;10.1097/ALN.0000000000001527> Anesthesiology, V 126 • No 4 729 April 2017 C ONCERN about opioid risks in the postoperative period1 has spurred an increased interest in the use of nonopioid analgesic adjuncts. One drug of potential interest is IV lidocaine, which can be administered intraand/or postoperatively in order to decrease postoperative pain and improve other outcomes. A number of studies and metaanalyses of these studies have been published and show that perioperative lidocaine infusion is indeed effective but that evidence supporting its use varies by surgical procedure. This makes it difficult for anesthesiologists to decide when use of the compound would be clinically indicated. This article will address this issue. First, a brief overview will be provided of the mechanisms that could explain a prolonged postoperative benefit of perioperative lidocaine infusion. Although these mechanisms are poorly understood, it is important for the clinician to understand how such effects conceivably could happen. The clinical literature on perioperative IV lidocaine will then be reviewed, providing evidence for when this approach may and may not be clinically useful. This article will focus on the use of perioperative lidocaine infusion for attaining postoperative benefits; intraoperative indications are outside the scope of this article, although several exist. For example, it is effective in blunting cerebral hemodynamic responses to airway manipulation2 and prevents airway reactivity on emergence in smokers. It also reduces anesthetic requirements by approximately onethird3 and may reduce neuropathic pain through inhibition of activity in injured afferent nerves.4