Intravenous Lidocaine Infusion Facilitates Acute Rehabilitation After Laparoscopic Colectomy

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Intravenous Lidocaine Infusion Facilitates Acute Rehabilitation After Laparoscopic Colectomy
Abdourahamane Kaba,* Stanislas R. Laurent,† Bernard J. Detroz,† Daniel I. Sessler,‡§ Marcel E. Durieux,∥ Maurice L. Lamy,* and Jean L. Joris*
(Anesthesiology, 106:11-18, 2007)
*Departments of Anesthesia and Intensive Care Medicine and †Abdominal Surgery and Transplantation, Centre Hospitalier Universitaire (CHU) de Liège, Liège, Belgium; ‡Department of Outcomes Research, Cleveland Clinic, Cleveland, OH; §Outcomes Research Institute, University of Louisville, Louisville, KY and ∥Departments of Anesthesiology and Neurological Surgery, University of Virginia Health System, Charlottesville, VA.
Intravenous infusion of lidocaine lessens postoperative pain and hastens the return of bowel function. The hypothesis that perioperative lidocaine infusion aids an acute rehabilitation protocol was tested in 40 patients scheduled to undergo laparoscopic colectomy. The patients were randomly allocated to received intravenous lidocaine (bolus injection of 1.5 mg/kg of lidocaine at induction of anesthesia, then a continuous infusion of 2 mg/kg per hour intraoperatively and 1.33 mg/kg per hour for 24 hours postoperatively) or an equal volume of saline. All patients received similar intensive postoperative rehabilitation. Postoperative pain scores, opioid consumption, and fatigue scores were measured. Times to first flatus, defecation, and hospital discharge were recorded. Postoperative endocrine (cortisol and catecholamines) and metabolic (leukocytes, C-reactive protein, and glucose) responses were measured for 48 hours. Data (presented as median [25%-75% interquartile range], lidocaine vs saline groups) were analyzed by Mann-Whitney tests, with P < 0.05 considered statistically significant. The 2 groups had similar patient demographics. Times to first flatus (17 [11-24] vs. 28 [25-33] hours), defecation (28 [24-37] vs. 51 [41-70] hours), and hospital discharge (2 [2-3] vs. 3 [3-4] days) were markedly shorter in patients who were given lidocaine, which dramatically reduced opioid consumption (8 [5-18] vs. 22 [14-36] mg) and postoperative and fatigue scores. By contrast, endocrine and metabolic responses were similar in both groups.

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