Intravenous lidocaine is as effective as epidural bupivacaine in reducing ileus duration, hospital stay, and pain after open colon resection: a randomized clinical trial.
BACKGROUND
Both postoperative epidural analgesia and intravenous (IV) infusion of local anesthetic have been shown to shorten ileus duration and hospital stay after colon surgery when compared with the use of systemic narcotics alone. However, they have not been compared directly with each other.


METHODS
Prospective, randomized clinical trial was conducted comparing the 2 treatments in open colon surgery patients. Before induction of general anesthesia, patients were randomized either to epidural analgesia (bupivacaine 0.125% and hydromorphone 6 microg/mL were started at 10 mL/hr within 1 hr of the end of surgery) or IV lidocaine (1 mg/min in patients < 70 kg, 2 mg/min in patients > or = 70 kg). Markers of return of bowel function, length of stay, postoperative pain scores, systemic analgesic requirements, and adverse events were recorded and compared between the 2 groups in an intent-to-treat analysis.


RESULTS
Study enrollment took place from April 2005 to July 2006. Twenty-two patients were randomized to IV lidocaine therapy and 20 patients to epidural therapy. No statistically significant differences were found between groups in time to return of bowel function or hospital length of stay. The median pain score difference was not statistically significant. No statistically significant differences were found in pain scores for any specific postoperative day or in analgesic consumption.


CONCLUSIONS
No differences were observed between groups in terms of return of bowel function, duration of hospital stay, and postoperative pain control, suggesting that IV infusion of local anesthetic may be an effective alternative to epidural therapy in patients in whom epidural anesthesia is contraindicated or not desired.
Swenson
Brian R
BR
Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA.
Gottschalk
Antje
A
Wells
Lynda T
LT
Rowlingson
John C
JC
Thompson
Peter W
PW
Barclay
Margaret
M
Sawyer
Robert G
RG
Friel
Charles M
CM
Foley
Eugene
E
Durieux
Marcel E
ME
D000328:Adult; D015360:Analgesia, Epidural; D000700:Analgesics / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects; D003082:Colectomy / Q000009:adverse effects*; D005260:Female; D005769:Gastrointestinal Motility / Q000187:drug effects; D006801:Humans; D045823:Ileus / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D007262:Infusions, Intravenous; D007902:Length of Stay; D008012:Lidocaine / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome; D014768:Virginia
D000700:Analgesics; D000779:Anesthetics, Local; D008012:Lidocaine; D002045:Bupivacaine