Effect of Perioperative Intravenous Lidocaine Administration on Pain, Opioid Consumption, and Quality of Life after Complex Spine Surgery

*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. Current affiliation: Fairview Hospital, a Cleveland Clinic hospital, Cleveland, Ohio.
Anesthesiology (Impact Factor: 6.17). 05/2013; 119(4). DOI: 10.1097/ALN.0b013e318297d4a5
Source: PubMed

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 post-anesthesia 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:: Adjusted mean pain scores were 4.4 (4.2-4.7) points on the verbal response scale for lidocaine and 5.3 (5.0-5.5) points for placebo (P < 0.001). Adjusted mean morphine equivalents were 55 (36-84) mg for lidocaine and 74 (49-111) mg for placebo (P = 0.12). 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. CONCLUSION:: IV lidocaine significantly improves postoperative pain after complex spine surgery.

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