title: Effect of intravenous lignocaine on perioperative stress response and post-surgical ileus in elective open abdominal surgeries: a double-blind randomized controlled trial.
abstract: BACKGROUND
  Perioperative stress response can be detrimental if excessive and prolonged. Intravenous (i.v.) lignocaine, while being an effective analgesic, has the added benefit of anti-inflammatory activity. This study was done to assess the effect of i.v. lignocaine on operative stress response and post-surgical ileus after elective open abdominal surgeries.
  
  
  METHODS
  Patients (n = 134) were randomized into two groups (n = 67 each) to receive an i.v. infusion of lignocaine (group L) or saline (group S) as a bolus of 1.5 mg/kg at intubation followed by an infusion of 1.5 mg/kg/h throughout the surgery until 1 h post-surgery. Total leukocyte count (TLC), C-reactive protein (CRP) and interleukin-6 (IL-6) levels immediately and 24 h after surgery were compared with preoperative levels. Time to first passage of flatus and stools post-operatively was noted. Post-operative pain scores, analgesic requirements, and incidence of post-operative nausea and vomiting (PONV) were assessed in the two groups.
  
  
  RESULTS
  Post-operative surge in TLC, CRP and IL-6 was attenuated in group L as compared to group S (P < 0.001, 0.018, <0.001). Time to passage of flatus and stools was earlier in group L (P = 0.04, 0.02). PONV was lesser in group L at 6 and 18 h post-surgery (<0.001, 0.28). Post-operative pain scores and post-operative morphine requirement were significantly less in group L at each point of time post-operatively (P < 0.001, <0.001).
  
  
  CONCLUSIONS
  Perioperative i.v. lignocaine infusion attenuates the operative stress response, provides effective analgesia and reduces the need for opioids post-operatively. Through these effects, it reduces post-operative ileus and the incidence of PONV.
authors: Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
authors: Parnandi
authors: P
authors: Sridhar
authors: Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
authors: Sarath Chandra
authors: SC
authors: Sistla
authors: Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
authors: Sheik Manwar
authors: SM
authors: Ali
authors: Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
authors: Vilvapathy Senguttuvan
authors: VS
authors: Karthikeyan
authors: Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
authors: Ashok Shankar
authors: AS
authors: Badhe
authors: Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
authors: Palghat Hariharan
authors: PH
authors: Ananthanarayanan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000494:pharmacology / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000494:pharmacology / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D045823:Ileus / Q000209:etiology / Q000517:prevention & control*; D007262:Infusions, Intravenous; D015850:Interleukin-6 / Q000097:blood; D007958:Leukocyte Count; D008012:Lidocaine / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D013312:Stress, Physiological / Q000187:drug effects* / Q000502:physiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000700:Analgesics; D000893:Anti-Inflammatory Agents; D015415:Biomarkers; C508600:IL6 protein, human; D015850:Interleukin-6; D002097:C-Reactive Protein; D008012:Lidocaine
keywords: abdominal surgery; ileus; intravenous lignocaine; post-operative pain; stress response