Department of Anesthesiology and Pain Medicine, National Health Insurance Service Ilsan Hospital, Goyang.
Departments of Anesthesiology and Pain Medicine.
Clin J Pain. 2021 Oct 12;38(1):1-7. doi: 10.1097/AJP.0000000000000995.
Arthroscopic rotator cuff repair (ARCR) is known to cause severe postoperative pain that may interfere with recovery. Intravenous (IV) lidocaine has analgesic, anti-inflammatory, and antihyperalgesic effects, and is being used in various types of surgeries. However, the effect of IV lidocaine in ARCR is not well-known.
Ninety patients undergoing ARCR were randomly allocated to receive IV lidocaine (1.5 mg/kg bolus of 1% lidocaine after anesthesia induction followed by a continuous infusion of 2 mg/kg/h up to 1 h after surgery) or an equal volume of saline. In both groups, an IV patient-controlled analgesia (PCA) device was used that contained fentanyl 10 µg/mL, infused at 1 mL/h with a 1 mL bolus dose. The primary outcome was fentanyl requirements given via IV PCA during the first 24 hours after surgery. Perioperative pain scores and functional recovery were assessed as secondary outcomes.
The amount of fentanyl administered via IV PCA up to 24 hours after surgery was significantly lower in the lidocaine group compared with the control group (329 [256.2 to 428.3] vs. 394.5 [287.0 to 473.0], P=0.037). The number of PCA bolus attempts were lower in the lidocaine group without statistical significance. There were no differences in postoperative pain scores or functional shoulder scores between the 2 groups.
IV lidocaine appears to be helpful in reducing opioid requirements during the acute postoperative period in patients undergoing ARCR. IV lidocaine may be a viable option as a component of multimodal analgesia in ARCR when regional analgesia is not possible.
关节镜下肩袖修复术（ARCR）会引起严重的术后疼痛，可能会影响康复。静脉内（IV）利多卡因具有镇痛、抗炎和抗痛觉过敏作用，并且正在各种类型的手术中使用。然而，IV 利多卡因在 ARCR 中的作用尚不清楚。
90 例行 ARCR 的患者被随机分配接受 IV 利多卡因（麻醉诱导后给予 1.5mg/kg 1%利多卡因推注，然后在手术结束后 1 小时内以 2mg/kg/h 的速度持续输注）或等量生理盐水。在两组中，都使用了包含 10μg/mL 芬太尼的 IV 患者自控镇痛（PCA）装置，以 1mL/h 的速度输注，每次 1mL 推注剂量。主要结局是术后 24 小时内通过 IV PCA 给予的芬太尼需求量。评估围手术期疼痛评分和功能恢复作为次要结局。
与对照组相比，利多卡因组在手术后 24 小时内通过 IV PCA 给予的芬太尼量显著降低（329[256.2 至 428.3]与 394.5[287.0 至 473.0]，P=0.037）。利多卡因组的 PCA 推注次数较低，但无统计学意义。两组术后疼痛评分或肩部功能评分无差异。
IV 利多卡因似乎有助于减少接受 ARCR 的患者在急性术后期间对阿片类药物的需求。当无法进行区域镇痛时，IV 利多卡因可能是 ARCR 多模式镇痛的可行选择。
