Intravenous lidocaine in liver surgery—a randomized double-blind trial

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Abstract Introduction Perioperative intravenous (IV) lidocaine can reduce postoperative pain, opioid use, bowel recovery time and the length of stay, but is rarely tested in liver surgery. This study evaluated the postoperative analgesic efficacy and safety of IV lidocaine in patients undergoing minor liver surgery. Methods Patients undergoing minor liver surgery were randomized 1:1 to receive either perioperative IV lidocaine, administered as a 1.5 mg/kg bolus followed by an infusion of 1.5 mg/kg/h until 1 h after surgery, or placebo. Patients received postoperative opioid analgesia via a patient-controlled analgesia device. The primary outcome was postoperative opioid consumption during the first 24 h after surgery. Secondary outcomes included postoperative pain scores, quality of recovery, adverse events, length of stay, and plasma lidocaine concentrations. Results In total, 124 subjects were included. Postoperative opioid consumption during the first 24 h after surgery was 97 (60–135) mg oral morphine equivalents (OME) in the placebo group, and 83 (50–129) mg OME in the lidocaine group, P = 0.429. Patients in the lidocaine group experienced lower early pain scores, but not from postoperative day 1 onward. Quality of recovery score did not differ, and adverse events were similar between groups. In two cases, plasma concentrations of lidocaine were transiently above 5 µg/ml after bolus administration, without clinical toxicity. Plasma concentrations after resection and at end of infusion were safely below. Discussion Perioperative intravenous lidocaine did not reduce postoperative opioid consumption after minor liver surgery but conferred transient early analgesic benefits and was found to be safe.

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