Department of Anesthesiology and Reanimation, Bağcilar Training and Research Hospital, İstanbul.
Department of Anesthesiology and Reanimation, University of Health Sciences, Dr AY Oncology Training and Research Hospital, Ankara, Turkey.
Clin J Pain. 2021 Feb 1;37(2):126-132. doi: 10.1097/AJP.0000000000000900.
The primary objective of this prospective nonblinded randomized study was to investigate the effect of perioperative systemic lidocaine infusion on pain control after major gynecologic oncology surgery. Patient-reported outcomes, postoperative recovery parameters, and complications were secondary endpoints of the study.
Seventy-five patients with American Society of Anesthesiologists I-III were divided into 3 groups based on perioperative analgesia methods-(1) opioid group: patient-controlled analgesia (PCA) with morphine; (2) lidocaine group: perioperative intravenous lidocaine infusion, plus PCA with morphine; and (3) the epidural group: PCA with bupivacaine. The Visual Analog Scale (VAS) was recorded postoperatively. In addition, nausea-vomiting, time to first oral intake, time to first ambulation, time to first flatus, and length of hospital stay were recorded.
VAS scores (rest) at 24 hours and VAS scores (cough) at 12 and 24 hours were significantly lower in the epidural group than in the opioid group (P<0.05). VAS scores were found to be similar between the lidocaine and epidural group. The nausea-vomiting incidence was lower in the lidocaine group than in the opioid group (P˂0.05). Compared with the other 2 groups, the first flatus time was shorter in the lidocaine group (P<0.05).
Perioperative lidocaine infusion is effective as epidural analgesia, which is often advocated as the gold-standard analgesic technique for abdominal surgery and is superior to the others in terms of time to first flatus and the incidence of nausea-vomiting.
本前瞻性非盲随机研究的主要目的是研究围手术期全身利多卡因输注对妇科肿瘤大手术后疼痛控制的影响。患者报告的结果、术后恢复参数和并发症是该研究的次要终点。
根据围手术期镇痛方法，将 75 名美国麻醉医师协会 I-III 级患者分为 3 组-(1)阿片类药物组：患者自控镇痛（PCA）用吗啡；(2)利多卡因组：围手术期静脉内利多卡因输注，加 PCA 用吗啡；和(3)硬膜外组：布比卡因 PCA。术后记录视觉模拟评分（VAS）。此外，还记录了恶心呕吐、首次口服摄入时间、首次下床时间、首次排气时间和住院时间。
硬膜外组 24 小时 VAS 评分（休息时）和 12 小时和 24 小时 VAS 评分（咳嗽时）均明显低于阿片类药物组（P<0.05）。利多卡因组与硬膜外组的 VAS 评分相似。利多卡因组恶心呕吐发生率低于阿片类药物组（P<0.05）。与其他 2 组相比，利多卡因组首次排气时间更短（P<0.05）。
围手术期利多卡因输注与硬膜外镇痛一样有效，硬膜外镇痛通常被认为是腹部手术的金标准镇痛技术，在首次排气时间和恶心呕吐发生率方面优于其他技术。
