Nah, then I'd be Blade. But okay.
Reg Anesth Pain Med. 2011 May-Jun;36(3):241-8. doi: 10.1097/AAP.0b013e31820d4362.
Intravenous lidocaine versus thoracic epidural analgesia: a randomized controlled trial in patients undergoing laparoscopic colorectal surgery using an enhanced recovery program.
Wongyingsinn M1,
Baldini G,
Charlebois P,
Liberman S,
Stein B,
Carli F.
- 1Departments of Anesthesia and Surgery, McGill University Health Centre, Montreal, Quebec, Canada. [email protected]
Abstract
BACKGROUND AND OBJECTIVE:
Laparoscopy, thoracic epidural analgesia, and enhanced recovery program (ERP) have been shown to be the major elements to facilitate the postoperative recovery strategy in open colorectal surgery. This study compared the effect of intraoperative and postoperative intravenous (IV) lidocaine infusion with thoracic epidural analgesia on postoperative restoration of bowel function in patients undergoing laparoscopic colorectal resection using an ERP.
METHODS:
Sixty patients scheduled for elective laparoscopic colorectal surgery were prospectively randomized to receive either thoracic epidural analgesia (TEA group) or IV lidocaine infusion (IL group) (1 mg/kg per hour) with patient-controlled analgesia morphine for the first 48 hours after surgery. All patients received a similar ERP. The primary outcome was time to return of bowel function. Postoperative pain intensity, time out of bed, dietary intake, duration of hospital stay, and postoperative complications were also recorded.
RESULTS:
Mean times and SD (95% confidence interval) to first flatus (TEA, 24 [SD, 11] [19-29] hrs vs IL, 27 [SD, 12] [22-32] hrs) and to bowel movements (TEA, 44 ±19 [35-52] hrs vs IL, 43 [SD, 20] [34-51] hrs) were similar in both groups (P = 0.887). Thoracic epidural analgesia provided better analgesia in patients undergoing rectal surgery. Time out of bed and dietary intake were similar. Patients in the TEA and IL groups were discharged on median day 3 (interquartile range, 3-4 days), P = 0.744. Sixty percent of patients in both groups left the hospital on day 3.
CONCLUSIONS:
Intraoperative and postoperative IV infusion of lidocaine in patients undergoing laparoscopic colorectal resection using an ERP had a similar impact on bowel function compared with thoracic epidural analgesia.
Intravenous Lidocaine Is as Effective as Epidural Bupivacaine in Reducing Ileus Duration, Hospital Stay, and Pain After Open Colon Resection: A Randomized Clinical Trial
Swenson, Brian R. MD, MS*; Gottschalk, Antje MD†; Wells, Lynda T. MBBS†; Rowlingson, John C. MD†; Thompson, Peter W. MS‡; Barclay, Margaret ACNP*; Sawyer, Robert G. MD*§; Friel, Charles M. MD*; Foley, Eugene MD, FASCRS*; Durieux, Marcel E. MD, PhD†
Author Information
From the Departments of *Surgery and †Anesthesiology, University of Virginia Health System; ‡School of Medicine, University of Virginia; and §Department of Health Evaluation Sciences, University of Virginia Health System, Charlottesville, VA.
Accepted for publication November 13, 2009.
Address correspondence to: Marcel E. Durieux, MD, PhD, Department of Anesthesiology, PO Box 800710, Charlottesville, VA 22908-0710 (e-mail:
[email protected]).
This clinical trial has been registered with the US National Institutes of Health, ClinicalTrials.gov identifier: NCT00600158.
Abstract
Background: Both postoperative epidural analgesia and intravenous (IV) infusion of local anesthetic have been shown to shorten ileus duration and hospital stay after colon surgery when compared with the use of systemic narcotics alone. However, they have not been compared directly with each other.
Methods: Prospective, randomized clinical trial was conducted comparing the 2 treatments in open colon surgery patients. Before induction of general anesthesia, patients were randomized either to epidural analgesia (bupivacaine 0.125% and hydromorphone 6 µg/mL were started at 10 mL/hr within 1 hr of the end of surgery) or IV lidocaine (1 mg/min in patients <70 kg, 2 mg/min in patients >=70 kg). Markers of return of bowel function, length of stay, postoperative pain scores, systemic analgesic requirements, and adverse events were recorded and compared between the 2 groups in an intent-to-treat analysis.
Results: Study enrollment took place from April 2005 to July 2006. Twenty-two patients were randomized to IV lidocaine therapy and 20 patients to epidural therapy. No statistically significant differences were found between groups in time to return of bowel function or hospital length of stay. The median pain score difference was not statistically significant. No statistically significant differences were found in pain scores for any specific postoperative day or in analgesic consumption.
Conclusions: No differences were observed between groups in terms of return of bowel function, duration of hospital stay, and postoperative pain control, suggesting that IV infusion of local anesthetic may be an effective alternative to epidural therapy in patients in whom epidural anesthesia is contraindicated or not desired.
