Ho Matthew Liang Jinn, Kerr Stephen John, Stevens Jennifer
Department of Anaesthesia, Concord Repatriation General Hospital, Camperdown NSW, Sydney, Australia.
The Kirby Institute, University of New South Wales, Kensington NSW, Sydney, Australia.
Korean J Anesthesiol. 2018 Feb;71(1):57-65. doi: 10.4097/kjae.2018.71.1.57. Epub 2018 Feb 1.
Although intravenous (i.v.) lidocaine is used as a perioperative analgesic in abdominal surgery, evidence of efficacy is limited. The infusion dose and duration remain unclear. This study aimed to investigate the effect of a longer low-dose 48-hour infusion regimen on these outcomes.
Fifty-eight adults undergoing elective open colorectal surgery were randomized into the lidocaine group (1.5 mg/kg bolus followed by 1 mg/kg/h infusion for 48 hours) and control group. After surgery, patients were given a fentanyl patient-controlled analgesia machine and time to first bowel movement (primary outcome) and flatus were recorded. Postoperative pain scores and fentanyl consumption were assessed for 72 hours.
There was no significant difference in time to first bowel movement (80.1 ± 42.2 vs. 82.5 ± 40.4 hours; P = 0.830), time to first flatus (64.7 ± 38.5 vs. 70.0 ± 31.2 hours; P = 0.568), length of hospital stay (9 [8-13] vs. 11 [9-14) days; P = 0.531], nor postoperative pain scores in the lidocaine vs. control groups. Cumulative opioid consumption was significantly lower in the lidocaine vs. the control group from 24 hours onwards. At 72 hours, cumulative opioid consumption (µg fentanyl) in the lidocaine group (1,570 [825-3,587]) was over 40% lower than in the placebo group (2,730 [1,778-5,327]; P = 0.039).
A 48-hour low-dose i.v. lidocaine infusion does not significantly speed the return of bowel function in patients undergoing elective open colorectal surgery. It was associated with reduced postoperative opioid consumption, but not with earlier hospital discharge, or lower pain scores.
尽管静脉注射利多卡因在腹部手术中用作围手术期镇痛药，但其疗效证据有限。输注剂量和持续时间仍不明确。本研究旨在探讨延长的低剂量48小时输注方案对这些结果的影响。
58例接受择期开放性结直肠手术的成年人被随机分为利多卡因组（静脉推注1.5mg/kg，随后以1mg/kg/h输注48小时）和对照组。术后，给患者配备芬太尼患者自控镇痛泵，并记录首次排便时间（主要结局）和排气时间。评估术后72小时的疼痛评分和芬太尼用量。
首次排便时间（80.1±42.2 vs. 82.5±40.4小时；P = 0.830）、首次排气时间（64.7±38.5 vs. 70.0±31.2小时；P = 0.568）、住院时间（9[8 - 13]天 vs. 11[9 - 14]天；P = 0.531）以及利多卡因组与对照组的术后疼痛评分均无显著差异。从术后24小时起，利多卡因组的累积阿片类药物用量显著低于对照组。在72小时时，利多卡因组的累积阿片类药物用量（微克芬太尼）为1570（825 - 3587），比安慰剂组（2730[1778 - 5327]）低40%以上（P = 0.039）。
48小时低剂量静脉输注利多卡因并不能显著加快择期开放性结直肠手术患者肠功能的恢复。它与术后阿片类药物用量减少有关，但与更早出院或更低疼痛评分无关。
