The Effect of Intraoperative Lidocaine Infusion on Opioid Consumption and Pain After Totally Extraperitoneal Laparoscopic Inguinal Hernioplasty

A Randomized Controlled Trial

Anup Ghimire; Asish Subedi; Balkrishna Bhattarai; Birendra Prasad Sah


BMC Anesthesiol. 2020;20(137) 

In This Article


Inadequate pain relief after surgery causes undesirable effects. On the other hand, excessive use of opioids produces several adverse effects and might delay recovery.[1,2] Therefore, a multimodal analgesia regimen is recommended in the perioperative setting as it provides superior analgesia and reduces opioid requirement.[3] Intravenous (IV) lidocaine is a widely studied drug for multimodal analgesia. IV lidocaine at the doses between 1.5–3 mg. kg− 1. h− 1 produces analgesic, anti-hyperalgesic, and anti-inflammatory effects.[4] Besides, a low dose of lidocaine is relatively safe and more feasible for perioperative use.[4–7] Additional benefits of lidocaine infusion include a reduction in the incidence of postoperative nausea and vomiting, early return of bowel motility and improved quality of recovery.[8]

Several studies have shown that perioperative lidocaine infusion reduces postoperative pain intensity and opioid consumption, while others have found lidocaine to be ineffective.[8] These inconsistent findings may be due to variation in surgical procedure, dose and duration of lidocaine infused. Interestingly, a current update from Cochrane based meta-analysis found a weak evidence for IV lidocaine compared to placebo on early postoperative pain scores and overall opioid requirements.[9] On the contrary, other recently published meta-analyses have shown improvement in postoperative pain-related outcomes with lidocaine infusion during laparoscopic clolecystectomy.[10,11]

Although lidocaine infusion was effective for postoperative analgesia in open inguinal hernia surgery,[12] its use has not been reported in totally extraperitoneal (TEP) laparoscopic inguinal hernioplasty. Therefore, the primary objective of our study was to compare the effects of intraoperative lidocaine infusion on postoperative opioid consumption following TEP laparoscopic inguinal hernioplasty.