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summary
1
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%.
BARTLETT EE HUTSERANI O. Xylocaine for the relief of postoperative pain. Anesth. Analg. 1961 May 1; 40: 296304296-304.
  Daniel Jolley
comment
1
Whilst evidently valid findings is this not a case of stating the bleeding obvious?
Loughnan TE, Gunasekera E, Tan TP. Improving the C-MAC video laryngoscopic view when applying cricoid pressure by allowing access of assistant to the video screen. Anaesth Intensive Care. 2012 Jan 1;40(1):128-30.
  Allan Palmer
comment
1
Pretty clear cut summary though have to watch for the bradycardias. Looks like Ephedrine is definitely out as a routine in LSCS
Veeser M, Hofmann T, Roth R et al. Vasopressors for the management of hypotension after spinal anesthesia for elective caesarean section. Systematic review and cumulative meta-analysis. Acta Anaesthesiol Scand. 2012 Aug 1; 56 (7): 810-6.
  Allan Palmer
comment
0
I find this study a little perplexing:
1. A 40 IU oxytocin infusion over 30 minutes is uncommon practice in Australia. (This strikes me as a study used to disprove strange local obstetric dogma!)
2. Investigating the benefits of a 5 IU bolus in addition to this is hardly likely to produce a significant effect, given this essentially compares 45 IU to 40 IU over ~35 minutes.
40 IU over 30 minutes is an infusion with 'bolus-like' characteristics! 1.7 IU per minute!
King KJ, Douglas MJ, Unger W et al. Five unit bolus oxytocin at cesarean delivery in women at risk of atony: a randomized, double-blind, controlled trial. Anesth. Analg. 2010 Dec 1;111(6):1460-6.
  Daniel Jolley
comment
1
Excellent review article on interactions between Regional anaesthesia and the newer oral anticoagulants
Benzon HT, Avram MJ, Green D et al. New oral anticoagulants and regional anaesthesia. Br J Anaesth. 2013 Dec 1;111 Suppl 1:i96-113.
  Allan Palmer
summary
1
Collection: Does intravenous lidocaine/lignocaine improve post-operative recovery?
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.
  Daniel Jolley
comment
1
"Xenopus is a genus of highly aquatic frogs native to sub-Saharan Africa. Twenty species are in the Xenopus genus" – interesting animal to use really.
Okura D, Horishita T, Ueno S et al. Lidocaine Preferentially Inhibits the Function of Purinergic P2X7 Receptors Expressed in Xenopus Oocytes. Anesth. Analg. 2015 Mar 1; 120 (3): 597-605.
  pdg.50
comment
1
Caveat - the Cochrane review noted low level evidence for changes in length of hospital stay or reduced complications, 2' to poor blinding in some studies. Safe as fasting though.
Nygren J, Thorell A, Ljungqvist O. Preoperative oral carbohydrate therapy. Curr Opin Anaesthesiol. 2015 Jun 1;28(3):364-9.
  pdg.50
summary
1
This meta-analysis investigated the benefits and risks of intrathecal morphine and fentanyl, concluding that:
Intrathecal morphine prolongs post-operative analgesia on average more than 8 hours, but at cost of:
• Nausea & vomiting (NNH 10 each)
• Urinary retention (NNH 7)
• Pruritus (NNH 4)
• Respiratory depression (NNH 38-59 for IT morphine 0.05-0.5 mg)
Intrathecal fentanyl prolongs post-operative analgesia on average almost 2 hours, but at a cost of pruritus (NNH 3).
Pöpping DM, Elia N, Marret E et al. Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: a meta-analysis of randomized trials. Pain. 2012 Apr 1;153(4):784-93.
  Daniel Jolley
comment
1
Queen Victoria writing in her journal, reflecting on the birth of Prince Leopold with chloroform:
Dr Snow gave that blessed chloroform and the effect was soothing, quieting and delightful beyond measure.
Caton D. John Snow's practice of obstetric anesthesia. Anesthesiology. 2000 Jan 1;92(1):247-52.
  Daniel Jolley