全身利多卡因未能改善术后疼痛，但可缩短日间手术腹腔镜绝育患者的出院准备时间：一项双盲、随机、安慰剂对照试验。

Systemic Lidocaine Fails to Improve Postoperative Pain, But Reduces Time to Discharge Readiness in Patients Undergoing Laparoscopic Sterilization in Day-Case Surgery: A Double-Blind, Randomized, Placebo-Controlled Trial.

作者信息

Dewinter Geertrui Barbara Erika, Teunkens An, Vermeulen Kristien, Al Tmimi Layth, Van de Velde Marc, Rex Steffen

机构信息

From the *Department of Anesthesiology, University Hospitals of the KU Leuven; and †Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium.

出版信息

Reg Anesth Pain Med. 2016 May-Jun;41(3):362-7. doi: 10.1097/AAP.0000000000000398.

DOI:10.1097/AAP.0000000000000398

PMID:27076370

Abstract

BACKGROUND AND OBJECTIVES

Perioperative systemic lidocaine provides postoperative analgesia, decreases opioid consumption, and facilitates rehabilitation in abdominal surgery. We hypothesized that systemic lidocaine has analgesic effects in women undergoing day-case laparoscopic sterilization.

METHODS

Eighty women were randomized in this prospective, double-blind trial to receive either lidocaine (intravenous bolus of 1.5 mg/kg at induction of anesthesia, followed by an infusion of 1.5 mg · kg · h, which was continued until 30 minutes after arrival at the postanesthesia care unit [PACU]) or placebo. The primary end point was the proportion of patients with a numeric rating scale (NRS) of greater than 3, 30 minutes after arrival at the PACU. Secondary outcomes included total opioid consumption, postoperative pain scores, incidence of postoperative nausea and vomiting, and time to readiness for discharge. This clinical trial was registered (Eudra CT 2011-001315-31).

RESULTS

Thirty minutes after PACU admission, the proportion of patients with an NRS score of greater than 3 did not differ between the groups (lidocaine group: 59% vs placebo group: 58%). The postoperative NRS for pain over the entire observation period was not significantly different between lidocaine and placebo groups (mean, 3.1 [SD, 0.7] vs 2.8 [SD, 0.6]; P = 0.4). Groups did not differ with respect to perioperative opioid consumption. Patients in the placebo group suffered significantly less from nausea (NRS: 0.1 [SD, 0.1] [placebo] vs 0.3 [SD, 0.1] [lidocaine]; P = 0.02) and required less postoperative nausea and vomiting rescue medication (1 patient in the placebo group vs 7 in the lidocaine group; P = 0.03). The time to meet hospital discharge criteria was significantly lower in the lidocaine group (median, 177 minutes [range, 96-408 minutes] vs 221 minutes [range, 121-420 minutes]; P = 0.02). The mean lidocaine plasma levels at the end of IV lidocaine infusion was 2.5 (SD, 1.1) μg/mL.

CONCLUSIONS

In laparoscopic sterilization, systemic lidocaine reduces time to readiness for hospital discharge.

摘要

背景与目的

围手术期全身使用利多卡因可提供术后镇痛，减少阿片类药物的用量，并促进腹部手术患者的康复。我们推测全身使用利多卡因对日间腹腔镜绝育术女性患者具有镇痛作用。

方法

在这项前瞻性双盲试验中，80名女性被随机分组，分别接受利多卡因（麻醉诱导时静脉推注1.5mg/kg，随后以1.5mg·kg·h的速度持续输注，直至到达麻醉后护理单元[PACU]后30分钟）或安慰剂。主要终点是到达PACU 30分钟后数字评分量表（NRS）评分大于3的患者比例。次要结局包括阿片类药物总用量、术后疼痛评分、术后恶心呕吐发生率以及准备出院的时间。该临床试验已注册（Eudra CT 2011-001315-31）。

结果

进入PACU 30分钟后，两组中NRS评分大于3的患者比例无差异（利多卡因组：59% vs安慰剂组：58%）。在整个观察期内，利多卡因组和安慰剂组的术后疼痛NRS评分无显著差异（均值分别为3.1[标准差，0.7]和2.8[标准差，0.6]；P = 0.4）。两组围手术期阿片类药物用量无差异。安慰剂组患者恶心症状明显较轻（NRS评分：0.1[标准差，0.1][安慰剂组] vs 0.3[标准差，0.1][利多卡因组]；P = 0.02），且术后恶心呕吐抢救用药需求较少（安慰剂组1例患者 vs利多卡因组7例患者；P = 0.03）。利多卡因组达到出院标准的时间显著缩短（中位数分别为177分钟[范围，96 - 408分钟]和221分钟[范围，121 - 420分钟]；P = 0.02）。静脉输注利多卡因结束时，利多卡因的平均血浆浓度为2.5（标准差，1.1）μg/mL。