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)

Conclusions

In summary, intraoperative lidocaine infusion decreases overall opioid requirement and postoperative pain intensity in patients undergoing laparoscopic TEP inguinal hernioplasty. It also lowers the incidence of PONV, improves the quality of recovery and patients satisfaction without any sedative effect.

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Abbreviations
TEP: Totally extraperitoneal; PONV: Postoperative nausea and vomiting; QoR: Quality of recovery; IQR: Interquartile range; IV: Intravenous; BPKIHS: BP Koirala Institute of Health Sciences; ASA: American Society of Anesthesiologists; NS: Normal Saline; NRS: Numerical rating scale; ETC02: Endtidal carbondioxide concentration; MAP: Mean arterial pressure; PACU: Post anesthesia care unit; CPSP: Chronic post-surgical pain; SMD: Standardized mean difference; MEQ: Morphine equivalent; VAS: Visual analogue scale

Acknowledgements
Not applicable.

Funding
None.

Availability of data and materials
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Ethics approval and consent to participate
The study was approved by the Institutional Review Committee (IRC), BP Koirala Institute of Health Sciences; reference number: IRC/520/015. Written informed consent was obtained from patients.

Consent for publication
Not applicable.

Table 1. Patient characteristics and surgical profiles of patients
Variables	Lidocaine group (n = 32)	Normal saline group (n = 32)	P-value
Age (years)	40 (30–52)	43 (33–52)	0.61
ASA PS (1/2)	28/4	27/5	0.71
BMI (kg/m²)	23.02 ± 2.85	22.01 ± 2.02	0.10
Surgical site: Unilateral/Bilateral	25/7	23/9	0.56
Mesh fixation (Yes/No)	31/1	32/0	0.50
Duration of surgery (min)	60 (48–90)	75 (60–90)	0.49
Intraoperative fentanyl supplement (μg)	0 (0–0)	20 (0–30)	< 0.001

Notes: Values are median (IQR), mean (SD), number.
Abbreviations: BMI body mass index; ASA PS American society of Anesthesiologist physical status

Table 2. Postoperative outcomes
	Lidocaine group (n = 32)	Saline group (n = 32)	p-value
Nausea	5 (16%)	14 (44%)	0.01
Vomiting	2 (6%)	8 (25%)	0.04
Antiemetic needed	3 (9%)	11 (34%)	0.01
Time to first void; h	3 (2–4)	3 (3–4)	0.18
Quality of recovery;QoR-40 scores	194 (194–196)	184 (183–186)	< 0.001
Patients with satisfaction scores 1/2/3/4/5^a	6/17/9/0/0	2/13/17/0/0	0.02

Notes: Values are number (proportion), or median (IQR)
^aSatisfaction scores for postoperative pain relief, 1-Highly satisfied, 2-Satisfied, 3-Neutral, 4-Not satisfied, 5-Strongly dissatisfied