No benefit from perioperative intravenous lidocaine in laparoscopic renal surgery:  a randomised, placebo-controlled study.
BACKGROUND
There is evidence that perioperative intravenous lidocaine administration can reduce analgesic requirement, improve recovery of bowel function and shorten the length of hospital stay. Its effect in laparoscopic renal surgery has not been investigated.


OBJECTIVE
To evaluate the effect of systemic lidocaine on the length of hospital stay, readiness for discharge, opioid requirement, bowel function and inflammatory and stress response after laparoscopic renal surgery.


METHODS
Randomised, double-blind, placebo-controlled study.


METHODS
Single tertiary centre where the study was carried out between July 2009 and February 2011.


METHODS
Sixty-four patients completed the study. Inclusion criteria were laparoscopic renal surgery and American Society of Anesthesiologists physical status I to III. Exclusion criteria were steroid therapy, chronic opioid therapy, allergy to lidocaine, pre-existing bowel dysfunction and arrhythmia.


METHODS
Lidocaine was given as a 1.5 mg kg(-1) bolus during induction of anaesthesia, followed by an intraoperative infusion of 2 and 1.3 mg kg(-1) h(-1) for 24 h postoperatively. Primary outcome was the length of hospital stay. Secondary outcomes were readiness for discharge, opioid consumption, sedation, incidence of postoperative nausea and vomiting (PONV), return of bowel function and inflammatory and stress responses.


METHODS
Length of hospital stay.


RESULTS
The length of hospital stay did not differ between the groups [6 days for the lidocaine group, interquartile range (IQR) 5 to 7, range 2 to 8 vs. 5 days for the placebo group, IQR 5 to 6, range 2 to 11; P = 0.24). Lidocaine had no effect on readiness for discharge [4 days for the lidocaine group (IQR 5 to 7, range 2 to 8) vs. 4 days for the placebo group (IQR 5 to 7, range 2 to 11); P = 0.26], opioid consumption, postoperative sedation, PONV, return of bowel function and plasma concentrations of C-reactive protein, procalcitonin and cortisol.


CONCLUSIONS
Systemic perioperative lidocaine administration over 24 h did not influence the length of the hospital stay, readiness for discharge, opioid consumption, return of bowel function or inflammatory and stress responses after laparoscopic renal surgery.


BACKGROUND
ClinicalTrials.gov identifier NCT00789620.
University Department of Anaesthesiology and Pain Therapy, University Hospital, Bern, Switzerland. patrick.wuethrich@insel.ch
Patrick Y
PY
Wuethrich
Jacobo
J
Romero
Fiona C
FC
Burkhard
Michele
M
Curatolo
D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007262:Infusions, Intravenous; D007430:Intraoperative Care / Q000379:methods; D007668:Kidney / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011498:Protein Precursors / Q000097:blood; D020127:Recovery of Function; D013997:Time Factors
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D008012:Lidocaine; D015740:Calcitonin Gene-Related Peptide; D006854:Hydrocortisone