title: The effect of perioperative intravenous lidocaine and ketamine on recovery after abdominal hysterectomy.
abstract: BACKGROUND
  Perioperative ketamine infusion reduces postoperative pain; perioperative lidocaine infusion reduces postoperative narcotic consumption, speeds recovery of intestinal function, improves postoperative fatigue, and shortens hospital stay. However, it is unknown whether perioperative IV lidocaine and/or ketamine enhances acute functional recovery. We therefore tested the primary hypothesis that perioperative IV lidocaine and/or ketamine in patients undergoing open abdominal hysterectomy improves rehabilitation as measured by a 6-minute walk distance (6-MWD) on the second postoperative morning.
  
  
  METHODS
  Women having open hysterectomy were anesthetized with sevoflurane, followed by patient-controlled morphine. Patients were factorially randomized to one of the following groups: (1) lidocaine and placebo, (2) placebo and ketamine, (3) placebo and placebo, or (4) lidocaine and ketamine. Lidocaine was given as a bolus (1.5 mg/kg), followed by lidocaine infusion of 2 mg/kg/h for the first 2 hours, and then 1.2 mg/kg/h for 24 postoperative hours. Ketamine was given as a bolus (0.35 mg/kg), followed by ketamine infusion of 0.2 mg/kg/h for the first 2 hours, and then 0.12 mg/kg/h for 24 postoperative hours. The primary double-blind outcome was 6-MWD on the second postoperative morning; secondary outcomes included pain scores, opioid consumption, postoperative nausea and vomiting, and fatigue score.
  
  
  RESULTS
  The study was stopped after a planned interim analysis of 64 patients showed that lidocaine crossed the preplanned futility boundary, with mean ± SD of 202 ± 66 m versus 202 ± 73 m for lidocaine versus placebo, respectively, and mean difference (interim adjusted 97.5% confidence interval) of 0.93 m (-52, 54) (P = 0.96); the ketamine effect also crossed the futility boundary, with mean ± SD of 193 ± 77 m versus 210 ± 61 m for ketamine versus placebo, respectively, and mean difference (interim adjusted 97.5% confidence interval) of -11 m (-65, 44) (P = 0.54). No interaction between the 2 intervention effects was observed (P = 0.96). Neither intervention significantly influenced any of the secondary outcomes.
  
  
  CONCLUSIONS
  Our results do not support use of lidocaine or ketamine for improving 6-MWD on the second postoperative day after open hysterectomy.
authors.affiliation: Department of Outcomes Research, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Martin V
authors.initials: MV
authors.lastname: Grady
authors.forename: Edward
authors.initials: E
authors.lastname: Mascha
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Sessler
authors.forename: Andrea
authors.initials: A
authors.lastname: Kurz
mesh_terms: D000328:Adult; D000762:Anesthesia Recovery Period; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D007262:Infusions, Intravenous; D007649:Ketamine / Q000008:administration & dosage*; D008012:Lidocaine / Q000008:administration & dosage*; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D010149:Postoperative Pain / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D019990:Perioperative Care / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D007649:Ketamine; D008012:Lidocaine