Evaluating the Impact of Perioperative Lidocaine Infusion on Postoperative Pain Management in Upper Abdominal Surgery

Author(s): Rubaiyat Rahman, Fahmida Nargis, Md Mazharul Alam, Muhammad Shamsul Arefin, AKM Akhtaruzzaman

Background: Postoperative pain management is crucial in anesthesia, particularly for fast-track surgeries. Effective pain management is essential for patient comfort, satisfaction, early mobilization, and recovery. It can also reduce postoperative cognitive impairment, chronic pain, and clinical expenses. As postoperative analgesia, Lidocaine has anti-nociceptive, antihyperalgesic, and anti-inflammatory properties that make it effective in various settings, including the ICU and surgical wards. Lidocaine may reduce pain and postoperative nausea and vomiting (PONV). Despite its benefits, concerns about its therapeutic window and toxicity persist. Aim of the study: This study aimed to determine the efficacy of perioperative intravenous lidocaine infusion on postoperative pain intensity and analgesic requirements in patients undergoing upper abdominal surgery. Methods: This prospective case-control study was conducted at the Department of Anaesthesia and Pain Medicine, Anwer Khan Modern Medical College, Dhaka, Bangladesh, over one year. It involved 108 patients scheduled for upper abdominal surgery under general anesthesia, divided into two groups: 54 patients in the study group received lidocaine, and 54 in the control group received saline. Inclusion criteria included patients aged 18-60 undergoing elective upper abdominal surgery, excluding those with specific health conditions. Pain was measured using the Visual Analogue Scale (VAS). Statistical analysis used SPSS, with significant results defined as P <0.05. Result: The study compared demographic and clinical characteristics between the two groups. The study group had a higher mean age (41.65±11.75 years) and more females (85.19%) than the control group (38.42±10.21 years; 75.93% females). Both groups had comparable weights (53.09±10.11kg vs. 50.79±9.67kg) and ASA classifications, with a higher percentage of ASA Type I in the control group (85.19%). Surgery durations and anesthesia times were similar, but extubation was faster in the control group (7.21±1.69 vs. 14.82±3.3 minutes). The study group required less post-operative analgesic (145.36±38.64mg vs. 189.42±41.58mg) and experienced delayed onset of pain relief needs. Pain levels fluctuated less in the study group. Conclusion: The study shows that perioperative intravenous lidocaine infusion reduces postoperative pain and analgesic needs in upper abdominal surgery patients. Lidocaine group patients had lower pain levels and required less diclofenac without needing rescue medication. Despite higher nausea and vomiting rates, lidocaine infusion proves beneficial for multimodal pain management.