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Effect of intravenous lignocaine on perioperative stress response and post‐surgical ileus in elective open abdominal surgeries: a double‐blind randomized controlled trial
Author(s) -
Sridhar Parnandi,
Sistla Sarath Chandra,
Ali Sheik Manwar,
Karthikeyan Vilvapathy Senguttuvan,
Badhe Ashok Shankar,
Ananthanarayanan Palghat Hariharan
Publication year - 2015
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.12783
Subject(s) - medicine , anesthesia , perioperative , analgesic , abdominal surgery , surgery , bolus (digestion) , vomiting , ileus , saline , randomized controlled trial , postoperative nausea and vomiting , intubation , nausea
Background Perioperative stress response can be detrimental if excessive and prolonged. Intravenous (i.v.) lignocaine, while being an effective analgesic, has the added benefit of anti‐inflammatory activity. This study was done to assess the effect of i.v. lignocaine on operative stress response and post‐surgical ileus after elective open abdominal surgeries. Methods Patients ( n = 134) were randomized into two groups ( n = 67 each) to receive an i.v. infusion of lignocaine (group L ) or saline (group S ) as a bolus of 1.5 mg/kg at intubation followed by an infusion of 1.5 mg/kg/h throughout the surgery until 1 h post‐surgery. Total leukocyte count ( TLC ), C ‐reactive protein ( CRP ) and interleukin‐6 ( IL ‐6) levels immediately and 24 h after surgery were compared with preoperative levels. Time to first passage of flatus and stools post‐operatively was noted. Post‐operative pain scores, analgesic requirements, and incidence of post‐operative nausea and vomiting ( PONV ) were assessed in the two groups. Results Post‐operative surge in TLC , CRP and IL ‐6 was attenuated in group L as compared to group S ( P < 0.001, 0.018, <0.001). Time to passage of flatus and stools was earlier in group L ( P = 0.04, 0.02). PONV was lesser in group L at 6 and 18 h post‐surgery (<0.001, 0.28). Post‐operative pain scores and post‐operative morphine requirement were significantly less in group L at each point of time post‐operatively ( P < 0.001, <0.001). Conclusion Perioperative i.v. lignocaine infusion attenuates the operative stress response, provides effective analgesia and reduces the need for opioids post‐operatively. Through these effects, it reduces post‐operative ileus and the incidence of PONV .