Perioperative Intravenous Lidocaine
CA-2 · II.D.3.f.4
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6 points
The Cochrane review of 68 trials and 4,525 patients found the evidence for lidocaine on early postoperative pain very low quality, with infusion regimens varying from 1 to 5 mg/kg/h and no consistent stopping point.
PMID 29864216
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In the ALLEGRO trial, 2% intravenous lidocaine did not improve return of gut function at 72 hours after minimally invasive colon resection (57.3% versus 59.0%) and none of eleven secondary outcomes differed.
PMID 39602290
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Systemic lidocaine has antinociceptive effects in both acute and chronic pain states, acting via multiple mechanisms beyond sodium channel blockade, including silencing ectopic discharges and suppressing inflammation.
PMID 31303268
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In abdominal and ambulatory surgery, lidocaine infusion reduced pain and opioid use, brought first flatus up to 23 hours earlier and shortened stay by about 1.1 days, but had no effect in tonsillectomy, hip arthroplasty or coronary bypass.
PMID 20518581
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Perioperative lidocaine in breast cancer surgery reduced persistent pain at three months from 47.4% to 11.8% and reduced the area of secondary hyperalgesia.
PMID 22699129
kept
At commonly recommended doses lidocaine's therapeutic index is very high and plasma concentrations stay well below cardiotoxic and neurotoxic thresholds, which is the basis for judging its benefit-risk against other analgesic strategies.
PMID 30117019
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