Intraoperative intravenous lidocaine for prevention of chronic pain syndrome

Ya.I. Vasilev, N.G. Marova, A.E. Karelov, P.A. Grib, N.A. Timofeev

North-Western State Medical University named after I.I. Mechnikov, St. Petersburg

For correspondence: Yaroslav I. Vasilev, associate professor Vladimir L. Vanevskii anaesthesiology and reanimatology Department of North-Western State Medical University named after I.I. Mechnikov, St. Petersburg; e-mail: vasiliev.yar@gmail.com, yaroslav.vasilev@szgmu.ru

For citation: Vasilev YaI, Marova NG, Karelov AE, Grib PA, Timofeev NA. Intraoperative intravenous lidocaine for prevention of chronic pain syndrome. Alexander Saltanov Intensive Care Herald. 2019;2:92-97.

DOI: 10.21320/1818-474X-2019-2-92-97


Chronic pain after a laparoscopic cholecystectomia represents a considerable problem. One of the directions of prevention and treatment of a chronic pain syndrome are attempts of use of various adjuvants from which the most promising results showed antidepressants, antikonvulsant, antagonists of NMDA of receptors, α2-агонисты and local anesthetics.

The purpose of this single center randomized, and placebo-controlled study was to evaluate the impact of IV lidocaine on CPPS (Chronic Postoperative Pain Syndrome).

Materials and Methods. Following approval of the study protocol by the University ethics committee 96 patients were randomized into 2 groups for participation in this study. All patients were ASA class II and III, aged 21 years and older and undergoing elective laparoscopic cholecystectomy under general anesthesia. All patients were randomly allocated into 2 groups of equal size to receive either lidocaine infusion (Lidocaine group), or 0.9 % sodium chloride infusion (Control group).

Results. The incidence of CPPS after 3 months was significantly lower in the Lidocaine group than in the Control group (10 vs 37,3 %, Fisher’s Exact Test P = 0.0069) with an overall incidence of 29.2 %, and after 6 months 18.3 % (16 vs 19.3 % accordingly, Fisher’s Exact Test P = 1.0). Date evaluation of PRI NWC (total and in each of 3 category) 6 month and 12 month after surgery with Fisher’s Exact Test and t Mann Whitney test, could not find any difference in groups.

Conclusion. No differences between control group and lidocaine in 6 and 12 months were found after surgery.

Keywords: Chronic Postoperative Pain Syndrome, CPPS chronic pain, prevention of chronic pain, lidocaine, adjuvants for CPPS treatment, intraoperative administration of lidocaine

Received: 31.01.2019


References

  1. Macrae W.A. Chronic pain after surgery. Br. J. Anaesth. 2001; 87: 88–98. DOI: org/10.1093/bja/87.1.88
  2. Овечкин А.М. Хроническая послеоперационная боль — масштаб проблемы и способы профилактики. Российский журнал боли. 2016; 1: 3–13.[Ovechkin A.M. Chronic postoperative pain — the value of the problem and methods of prevention. Russian journal of pain. 2016; 1: 3–13 (In Russ)]
  3. Овечкин А.М. Клиническая фармакология местных анестетиков: классические представления и новые перспективы применения в интенсивной терапии. Регионарная анестезия и лечение острой боли. 2013; 3: 6–15.[Ovechkin A.M. Clinical pharmacology of local anesthetics: classical concepts and new perspectives of applying in intensive therapy. Regionarnaya anesteziya i lechenie ostroy boli. 2013; 3: 6–15. (In Russ)]
  4. Melzalzack R. The MacGill pain questionnaire: major properties and scoring metods. Pain. 1975; 1: 277–299. DOI: 10.1016/0304–3959(75)90044-5
  5. Lamberts M.P., Lugtenberg M., Rovers M.M., et al. Persistent and de novo symptoms after cholecystectomy: a systematic review of cholecystectomy effectiveness. Surg. Endosc. 2013; 27: 709–718. DOI: 10.1007/s00464-012-2516-9
  6. Perkins F.M., Kehlet H. Chronic pain as an outcome of surgery. A review of predictive factors. Anesthesiology. 2000; 93: 1123–1133.
  7. Kehlet H., Jensen T.S., Woolf C.J. Persistent postsurgical pain: Risk factors and prevention. Lancet. 2006; 367: 1618–1625. DOI: 10.1016/S0140–6736(06)68700-X
  8. Bennett G.J. Update on the neurophysiology of pain transmission and modulation: focus on the NMDA-receptor. J. Pain Symptom. Manage. 2000; 19: 2–6. DOI: 10.1016/S0885-3924(99)00120-7
  9. Chizh B.A., Headley P.M. NMDA antagonists and neuropathic pain: multiple drug targets and multiple uses. Curr. Pharm. Des. 2005; 11: 2977–2994. DOI: 10.2174/1381612054865082
  10. Eide P.K. Wind-up and the NMDA receptor complex from a clinical perspective. Eur. J. Pain. 2000; 4: 5–15. DOI: 10.1053/eujp.1999.0154
  11. Parsons C.G. NMDA receptors as targets for drug action in neuropathic pain. Eur. J. Pharmacol. 2001; 429: 71–78. DOI: 10.1016/S0014–2999(01)01307-3
  12. Ji R.R., Xu Z.Z., Gao Y.J. Emerging targets in neuroinflammation-driven chronic pain. Nature reviews Drug discovery. 2014; 13(7): 533–548. DOI: 10.1038/nrd4334
  13. Yardeni I., Beilin B., Mayburd E., et al. The Effect of Perioperative Intravenous Lidocaine on Postoperative Pain and Immune Function. Anesth. Analg. 2009; 109(5): 1464–1469. DOI: 10.1213/ANE.0b013e3181bab1bd
  14. De Oliveira C.M.B., Sakatad R.K., Slullitel A., et al. Issy Efecto de la lidocaina venosa intraoperatoria sobre el dolor e interleucina-6 plasmatica en pacientes sometidas a histerectomia Atenciуn Primaria. 2015; 65(2): 92–98. DOI: 10.1016/j.bjanes.2013.07.018
  15. Сивков О.Г., Устюжанин П.А., Чармадов С.И., Варданян М.А. Опыт безопиоидной анестезии при больших абдоминальных операциях. Медицинская наука и образование Урала. 2018; 4: 104–108.[Sivkov O.G., Ustyuzhanin P.A., Charmadov S.I., Vardanyan M.A. The experience of application of the opioid-free anesthesia during major abdominal surgery. Mediczinskaya nauka i obrazovanie Urala. 2018; 4: 104–108 (In Russ)]
  16. Овечкин А.М., Беккер А.А. Внутривенная инфузия лидокаина как перспективный компонент мультимодальной анальгезии, влияющий на течение раннего послеоперационного периода. Регионарная анестезия и лечение острой боли. 2017; 11(2): 73–83. DOI: 10.18821/1993-6508-2017-11-2-73-83 [Ovechkin A.M., Becker A.A. Intravenous lidocaine infusion as a perspective component of multimodal analgesia, which affects on early postoperative outcome. Regionarnaya anesteziya i lechenie ostroy boli. 2017; 11(2): 73–83. DOI: 10.18821/1993-6508-2017-11-2-73-83. (In Russ)]
  17. Ness T.J. Intravenous lidocaine inhibits visceral nociceptive reflexes and spinal neurons in the rat. Anesthesiology. 2000; 92: 1685–1691.
  18. Groudine S.B., Fisher H.A., Kaufman R.P.Jr., et al. Intravenous lidocaine speeds the return of bowel function, decreases postoperative pain, and shortens hospital stay in patients undergoing radical retropubic prostatectomy. Anesth. Analg. 1998; 86(2): 235–239. DOI: 10.1213/00000539-199802000-00003
  19. Kranke P., Jokinen J., Pace N.L., et al. Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery. The Cochrane database of systematic reviews. 2015; 7: CD009642. DOI: 10.1002/14651858.CD009642.pub2
  20. Grigoras A., Lee P., Sattar F., Shorten G. Perioperative Intravenous Lidocaine Decreases the Incidence of Persistent Pain After Breast Surgery. Clin. J. Pain. 2012; 28: 567–572. DOI: 10.1097/AJP.0b013e31823b9cc8.