Clinical surgery-American
Can intravenous lidocaine decrease postsurgical ileus and shorten hospital stay in elective bowel surgery? A pilot study and literature review

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Abstract

Background

This study examined whether systemic infusion of lidocaine, a local anesthetic with anti-inflammatory properties, can decrease surgical pain, length of postsurgical ileus, and hospital stay.

Methods

Twenty-two patients at a community hospital were randomized into 2 groups. Subjects were allocated to receive either lidocaine or a placebo infusion for the first 24 hours after surgery.

Results

Patients in the lidocaine group appeared to report less pain as reflected by a decrease in overall visual analogue scale pain scores 24 hours after surgery. The return of flatus after surgery was not considered significant (lidocaine 68.2 ± 9.7 hours vs placebo 86.9 ± 13.6 hours; P = .2802). The return of bowel movement after surgery was considered significant (lidocaine 88.3 ± 6.08 hours vs placebo group 116 ± 10.1 hours; P = .0286). The lidocaine group was discharged by mean day 3.76 ± .24 versus placebo at mean day 4.93 ± .42; P = .0277.

Conclusions

Patients in the lidocaine group had bowel movements >24 hours earlier than those in the placebo group and were discharged earlier.

Section snippets

Materials and Methods

A randomized, double-blinded, placebo-controlled, prospective study was implemented to assess the effectiveness of systemic lidocaine versus placebo in patients receiving morphine patient-controlled analgesia (PCA) after bowel surgery. After elective bowel surgery, patients were placed on a morphine PCA pump and either normal saline placebo or lidocaine infused at 1 mg/min for 24 hours. The lidocaine infusion was discontinued 24 hours after surgery. The morphine PCA was to be continued at the

Results

Twenty-two patients underwent elective bowel surgery. Table 1 shows patient demographics. The procedures were as follows: 12 right colectomies, 2 left colectomies, 3 low anterior sigmoid resections, and 5 small-bowel resections. The populations were similar with regard to ASA scores, and none of the patients had a score >III (lidocaine 2.18 ± .18 vs control 2.00 ± .19; P = .498). The mean ages of the patients were 60 and 65 years in the lidocaine and placebo groups, respectively.

None of the

Comments

First, the results of the current study contribute to the literature showing that IV lidocaine may be safely used to combat POI. Lidocaine is an amide and a less commonly used antiarrhythmic that exerts its effects by decreasing conductance on nerve axon sodium channels. Lidocaine toxicity follows a predictable progression and can be divided into central nervous system and cardiovascular effects. At low plasma concentrations, these include numbness of the tongue and circumoral tissues. If

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