title: Effect of perioperative intravenous lidocaine administration on pain, opioid consumption, and quality of life after complex spine surgery.
abstract: BACKGROUND
  The authors tested the primary hypothesis that perioperative IV lidocaine administration during spine surgery (and in the postanesthesia care unit for no more than 8 h) decreases pain and/or opioid requirements in the initial 48 postoperative hours. Secondary outcomes included major complications, postoperative nausea and vomiting, duration of hospitalization, and quality of life.
  
  
  METHODS
  One hundred sixteen adults having complex spine surgery were randomly assigned to perioperative IV lidocaine (2 mg·kg·h) or placebo during surgery and in the postanesthesia care unit. Pain was evaluated with a verbal response scale. Quality of life at 1 and 3 months was assessed using the Acute Short-form (SF) 12 health survey. The authors initially evaluated multivariable bidirectional noninferiority on both outcomes; superiority on either outcome was then evaluated only if noninferiority was established.
  
  
  RESULTS
  Lidocaine was significantly superior to placebo on mean verbal response scale pain scores (P < 0.001; adjusted mean [95% CI] of 4.4 [4.2-4.7] and 5.3 [5.0-5.5] points, respectively) and significantly noninferior on mean morphine equivalent dosage (P = 0.011; 55 [36-84] and 74 [49-111] mg, respectively). Postoperative nausea and vomiting and the duration of hospitalization did not differ significantly. Patients given lidocaine had slightly fewer 30-day complications than patients given placebo (odds ratio [95% CI] of 0.91 [0.84-1.00]; P = 0.049). Patients given lidocaine had significantly greater SF-12 physical composite scores than placebo at 1 (38 [31-47] vs. 33 [27-42]; P = 0.002) and 3 (39 [31-49] vs. 34 [28-44]; P = 0.04) months, postoperatively.
  
  
  CONCLUSIONS
  IV lidocaine significantly improves postoperative pain after complex spine surgery.
authors.affiliation: * Associate Professor, Departments of General Anesthesiology and Outcomes Research, ‡ Michael Cudahy Professor and Chair, ‖ Research Fellow, # Research Coordinator, §§ Professor and Vice Chair, Department of Outcomes Research, § Senior Biostatistician, Departments of Quantitative Health Sciences and Outcomes Research, ** Assistant Professor, Department of General Anesthesiology, †† Professor, Chairman, Department of Neurosurgery, ‡‡ Professor and Vice Chair, Department of Neurological Institute, Cleveland Clinic, Cleveland, Ohio. † Clinical Research Fellow, Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio. Current affiliation: Internal Medicine Resident, Fairview Hospital, A Cleveland Clinic Hospital, Cleveland, Ohio.
authors.forename: Ehab
authors.initials: E
authors.lastname: Farag
authors.forename: Michael
authors.initials: M
authors.lastname: Ghobrial
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Sessler
authors.forename: Jarrod E
authors.initials: JE
authors.lastname: Dalton
authors.forename: Jinbo
authors.initials: J
authors.lastname: Liu
authors.forename: Jae H
authors.initials: JH
authors.lastname: Lee
authors.forename: Sherif
authors.initials: S
authors.lastname: Zaky
authors.forename: Edward
authors.initials: E
authors.lastname: Benzel
authors.forename: William
authors.initials: W
authors.lastname: Bingaman
authors.forename: Andrea
authors.initials: A
authors.lastname: Kurz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D017558:Elective Surgical Procedures / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay / Q000706:statistics & numerical data; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D016017:Odds Ratio; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement / Q000379:methods; D019990:Perioperative Care / Q000379:methods*; D011182:Postoperative Care / Q000379:methods; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced; D011788:Quality of Life; D013131:Spine / Q000601:surgery*; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D008012:Lidocaine