title: Intraperitoneal and intravenous lidocaine for effective pain relief after laparoscopic appendectomy: a prospective, randomized, double-blind, placebo-controlled study.
abstract: BACKGROUND
  The preemptive intravenous and intraperitoneal application of local anesthetics is known to improve the postoperative outcome in abdominal surgery. The aim of this study was to compare the analgesic effect of intravenous lidocaine injection to that of intraperitoneal lidocaine instillation in patients who were undergoing laparoscopic appendectomy (LA).
  
  
  METHODS
  Sixty-eight patients who were undergoing LA for unperforated appendicitis were randomly divided into three groups. Group IP (the intraperitoneal instillation group) received intraperitoneal instillation of lidocaine and intravenous normal saline injection. Group IV (the intravenous injection group) received intravenous lidocaine injection and intraperitoneal instillation of normal saline. In group C (the placebo control group), normal saline was given both intravenously and intraperitoneally. The visual analog scale (VAS) of pain scores was measured after surgery. The needs for additional intravenous fentanyl were evaluated and the integrated fentanyl consumption (PCA delivered + additional fentanyl) was assessed. The incidence of shoulder tip pain and postoperative nausea and vomiting (PONV) were noted.
  
  
  RESULTS
  Reduction of the VAS score and of fentanyl consumption was noted in the IV and IP groups and compared to that of group C (P < 0.05). The shoulder tip pain and PONV were reduced in groups IP and IV compared to that in group C (P < 0.05). However, no significant differences were found between the IP and IV groups for all the studied variables. There was no adverse effect from intravenous lidocaine throughout the study.
  
  
  CONCLUSIONS
  Intravenous lidocaine injection is as effective as intraperitoneal instillation for reducing pain and fentanyl consumption. The major benefit of intravenous injection is that this is an easily and universally applicable procedure compared to that of intraperitoneal instillation. Lidocaine intravenous administration is a better alternative for reducing the pain of patients who are undergoing laparoscopic surgery.
authors.affiliation: Department of Surgery, College of Medicine, Chung-Ang University, Seoul, Korea.
authors.forename: Tae Han
authors.initials: TH
authors.lastname: Kim
authors.forename: Hyun
authors.initials: H
authors.lastname: Kang
authors.forename: Joon Hwa
authors.initials: JH
authors.lastname: Hong
authors.forename: Jun Seok
authors.initials: JS
authors.lastname: Park
authors.forename: Chong Wha
authors.initials: CW
authors.lastname: Baek
authors.forename: Jin Yun
authors.initials: JY
authors.lastname: Kim
authors.forename: Yong Hun
authors.initials: YH
authors.lastname: Jung
authors.forename: Hyang Kyoung
authors.initials: HK
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001062:Appendectomy / Q000379:methods*; D016009:Chi-Square Distribution; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D015994:Incidence; D007274:Injections, Intraperitoneal; D007275:Injections, Intravenous; D007322:Instillation, Drug; D010535:Laparoscopy / Q000379:methods*; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control*; D010919:Placebos; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D011446:Prospective Studies; D018709:Statistics, Nonparametric
chemical_list: D000779:Anesthetics, Local; D010919:Placebos; D008012:Lidocaine