Effect Of Intravenous Lidocaine On Postoperative Analgesia In The Patients Undergoing Laparoscopic Gynecological Surgery

Objective The purpose of this trial was to determine the effect of intravenous lidocaine intraoperatively on postoperative analgesia in the patients with laparoscopic gynecological surgery.Methods Patients who were supposed to undergo laparoscopic gynecological surgeries in Tongji Hospital were randomly assigned to lidocaine and control groups. And each group was further divided into two subgroups, namely the benign group and the malignant group, according to the types of the surgeries. Patients in both groups received general anesthesia,maintained with sevoflurane, propofol and remifentanil. Patients in the lidocaine group were administered an intravenous bolus dose of lidocaine 1.5 mg/kg before induction of anesthesia, followed by an infusion of 2mg/kg/h till the end of the surgery, while control subjects received normal saline as matching placebo. All the patients received general anesthesia and standardized multimodal postoperative analgesia. The primary outcome of this trial were postoperative opioid use, numeric rating scores for pain, postoperative nausea and vomiting, time to first flatus passage and the length of hospital stay.Results The lidocaine group and the control group were similar in age, weight,body mass index,and duration of operation(p > 0.05). At 1 hour after surgery,the VAS scores of the lidocaine group( benign group 1.50±1.07; malignant group 1.10±0.65)were significantly lower than the control group(benign group 2.85±1.66;malignant group 3.00±1.29)(p < 0.05).At 24 and 48 hours after surgery,the VAS scores of malignant subgroup in the lidocaine group(respectively 1.90±1.07 and 1.50±0.83)were also significantly lower than that in the control group(respectively 3.41±1.94 and 2.68±1.89)(p < 0.05).The background doses of sufentanil between groups were similar. But the patients in the control group required more rescue sufentanil(benign group 1.94±1.08 μg;malignant group 3.10±1.69 μg)than the patients in the lidocaine group(benign group 0.94±0.56 μg;malignant group 1.58±1.03 μg)(p < 0.05).But there were no significant differences between groups in recovery of bowel function, time to first flatus passage and length of hospital stay.Conclusions Intraoperative lidocaine infusion improves postoperative analgesia and reduces postoperative opioid consumption in patients undergoing laparoscopic gynecological surgery. However,it did not accelerate the return of bowel function or shorten the length of hospital stay.