Article Notes
Bartlett and Hutaserani published the first description of the intravenous use of lignocaine for postoperative pain management in 1961.
"THE SEARCH for a nondepressant, long-acting drug to control postoperative pain has gone on for many years. Like many other institutions, ours has run the gamut of drugs as they have been released: nupercaine-in-oil, intravenous procaine, efocaine, intravenous alcohol, d-tubocurarine-in-oil, etc. All have had their drawbacks."
The researchers investigated a progressive range of administration routes and dosages, ultimately reaching 1000 mg lignocaine in 1L IVF given over the duration of surgery. 302 patients receiving intravenous lignocaine were compared to matched controls, finding:
"...during the first 3 postoperative days 83 per cent of the patients who received Xylocaine experienced either no pain or 1+ pain (soreness only) as contrasted with 25 per cent of the controls."
Intravenous lignocaine also dramatically reduced post-operative opioid consumption.
Another group (N=60) received 500 mg lignocaine into the rectus muscles after laparotomy, improving no-pain or 1+ pain incidence to 95%.
There is some evidence supporting the benefit of perioperative intravenous lignocaine/lidocaine infusion in both laparoscopic and open abdominal surgery.
The strongest evidence supports both improved analgesia and reduction in nausea, with weaker evidence suggesting faster improvement in GIT function and earlier discharge from hospital.
Safety data is reassuring but far from conclusive due to the small size of most studies.