Page 18 - CASA Bulletin of Anesthesiology 2022; 9(5)

CASA Bulletin of Anesthesiology

Systemic Lidocaine Infusion as Intraoperative Opioid Sparing Technique:
Do We Have Evidence?

Evan Huang , Andrewston Ting, DO *
2
1
1. Carrollwood Day School, Tampa, FL
2. Anesthesiology, HCA Healthcare/USF Morsani College of Medicine GME/Oak Hill Hospital

*Corresponding Author

The opioid crisis has been steadily rising in the past 10 years. Approximately 650,000 opioid
prescriptions are dispensed in the United States daily even though opioid use is the leading cause
of unintentional death in the United States . Opioid-related deaths have more than quadrupled
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from 1999 to 2017 and increased by 285% between the time periods of 2002 to 2004, and 2011
to 2014 . Many studies demonstrated that the perioperative period is an important time frame for
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patients to develop an opioid use disorder (OUD) 3, 4, 5 .
OUD development is more likely for patients with a variety of nonmodifiable, psychiatric,
psychosocial, and personal history risk factors to develop OUD . It is important that anesthesia
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providers should consider OUD issues when generating postsurgical pain management plans.
Opioids can often target acute postsurgical pain effectively; however, despite their prevalent use,
opioids have not been shown to be effective for chronic postsurgical pain.

Enhanced Recovery after Surgery (ERAS) has been widely implemented. Multimodal pain
management is the key component of ERAS. Multimodal, opioid sparing analgesia is not a new
concept. It has been well known to our perioperative providers for more than 20 years. With the
increasing implementation of ERAS and opioid epidemic, opioid sparing analgesia has been
more widely adopted perioperatively .
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It has been reported that perioperative systemic lidocaine infusion has beneficial effects on the
bowel function recovery, pain control, narcotic sparing and reduced hospital stay after abdominal
surgeries 8, 9, 10 . Therefore, systemic lidocaine infusion has been adapted as a part of ERAS
perioperative protocol. However, evidence of systemic lidocaine infusion remained uncertain.

A systematic and meta-analysis study which included 68 trials (4525 randomized participants)
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to examine effects of systemic lidocaine infusion on postoperative pain control, narcotic
consumptions, bowel function recovery, and length of hospital stay.
They examined the effect of IV lidocaine on postoperative pain scores shows a reduction of pain
score at 1 to 4 hours (SMD -0.50, 95% confidence interval (CI) -0.72 to -0.28) and 24 hours
(SMD -0.14, 95% confidence interval (CI) -0.25 to -0.04), however the effect size lacks clinical
relevance. Additionally, at late time points of 48 hours, the effect size is clinically non-relevant
(SMD −0.11, 95% CI −0.25 to 0.04). An SMD of 0.11 fewer in pain score corresponds to 0.42
cm to 0.08 cm reduction on the VAS 0 to 10 cm scale. Essentially, the effect of pain reduction is
more pronounced in the early time points compared to later time points.
Another category of effect examined by the Cochrane meta-analysis study was the effect on
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bowel function such as time to first defecation/bowel movement and time to first flatus, as well
as postoperative nausea and vomiting at different time points. The study demonstrates a reduced

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