| dc.description.abstract | Postoperative pain still occurs in more than 50% of surgical procedures. It s known that
inappropriate treatment of postoperative pain can worsen patient s outcome, either for
increasing systemic surgical stress response, increasing cardiologic events, or even by
the development of chronic pain. New multimodal analgesia strategies have been
employed, based on the use of different drugs, by different administration methods and at
different times, trying to reduce the amount of opioids and, consequently, their side
effects. In this setting, continuous intravenous lidocaine used during perioperative period
has shown to be promising. This trial aimed to compare postoperative analgesia in
patients who underwent laparoscopic cholecystectomies, under general anesthesia, and
received endovenous lidocaine in comparison to a control group. Opioid consumption,
time of ileus, time to discharge and levels of interleukin 1, 6, 10, tumoral necrosis factor
and interferon gamma were also compared. Forty-four patients undergoing laparoscopic
cholecystectomies were randomly allocated in two groups. The first one received
endovenous lidocaine bolus of 1.5 mg.kg-1 followed by continuous infusion of 3 mg.kg-1
during intraoperative period until one hour after the end of the procedure. The second
one received saline, intravenously, at the same infusion rate (ml.h-1), during the same
period. It was a double-blind intervention. In the postoperative period, both groups
received dipyrone and morphine patient controlled analgesia (PCA). Pain was assessed
by VNS (Visual Numeric Scale), both at rest and when coughing at the 1st, 2nd, 4th, 12th
and 24th hour after the end of the surgery. Blood samples for cytokines measurement
were taken at the end of procedure and 24 hours later. The total morphine PCA demand,
the time for the first flatus and the length of hospital stay were also recorded and
compared. Groups were similar relating to gender (p = 0,2), age (p = 0,5), weight (p =
0,08) and length of surgery (p = 0,6). No differences were observed regarding the
intensity of postoperative pain between the groups, either at rest (p = 0,76) or when
coughing (p = 0,31), in morphine consumption (p = 0,9) and in the duration of ileus (p =
0,5) or length of hospital stay (p = 0,9). The inflammatory markers, IL-1 (p = 0,02), IL-6 (p
< 0,01), γ IFN (p < 0,01) and α TNF (p < 0,01), showed significant reduction in lidocaine
group against placebo group, except IL-10 (p = 0,01), that, because of its antiinflammatory
effects, increased its concentration. Thus, intravenous lidocaine in the
perioperative period of laparoscopic cholecystectomies was not able to reduce
postoperative pain, opioid consumption, and duration of ileus or length of hospital stay.
However, its anti-inflammatory effect was evidenced by the significant changes in the
studied cytokines. | |
