Functional walking capacity as an outcome measure of laparoscopic prostatectomy : the effect of lidocaine infusion

Background: Intravenous lidocaine infusion has been shown to affect postoperative pain intensity. This present study was performed to assess the effect of intra- and postoperative lidocaine infusion on postoperative functional walking capacity, as a measure of surgical recovery. Methods: Forty patients undergoing laparoscopic prostatectomy were randomized to receive an i.v. infusion of either lidocaine 2 mg kg-1 h-1 during surgery and 1 mg kg-1 min-1 for the first 24 postoperative hours (lidocaine group) or an equivalent volume of saline 0.9% (control group). All patients received postoperative patient-controlled analgesia with i.v. morphine. Primary outcome was functional walking capacity, as assessed by distance attained during the 2 min walking test (2MWT), recorded daily for the first 3 postoperative days. Morphine consumption and pain intensity were recorded. Results: 2MWT distance decreased by an average of 60% (P<0.01) in both groups on postoperative day 1 (from 150 m before surgery to 53 m), but the decrease was 26 m less in the lidocaine group (P=0.009). During postoperative days 2 and 3, the 2MWT distance increased to an average of 96 m, still 30% less than the preoperative values. There was a significant negative correlation on postoperative days 1 and 2 between the 2MWT distance, pain intensity and fatigue, and morphine consumption. Lidocaine infusion was an independent predictor of the degree of postoperative decrease in 2MWT distance. More patients in the lidocaine group were free from PCA on the second postoperative day (P=0.011). Conclusions: Infusion of lidocaine during surgery and for the first postoperative day attenuated the deterioration in functional walking capacity, and had an opioid sparing effect

Intraoperative infusion of lidocaine reduces postoperative fentanyl requirements in patients undergoing laparoscopic cholecystectomy

Background: Lidocaine has been shown to inhibit neural conduction and to have anti-inflammatory properties. The purpose of this study was to determine whether intraoperative lidocaine infusion reduces opioid consumption in the postanesthesia care unit (PACU). Methods: Fifty patients were enrolled in this prospective, randomized and observer-blinded study. At induction of anesthesia the control group (n = 25) received fentanyl 3 \u3bcg\ub7kg-1 while the lidocaine group received fentanyl 1.5 \u3bcg\ub7kg-1 and a bolus of lidocaine 1.5 mg\ub7kg-1 followed by a continuous infusion of lidocaine 2 mg\ub7kg-1\ub7hr-1. General anesthesia included propofol, rocuronium, and desflurane titrated to maintain blood pressure and heart rate within set parameters, and the bispectral index between 35 and 50. No supplemental opioids were given during surgery. All patients received acetaminophen, ketorolac, dexamethasone, droperidol and local anesthetics in the skin incision. Patients received fentanyl and ondansetron in the PACU. The primary outcome variable was the amount of fentanyl required in the PACU to establish and to maintain visual analogue scale pain scores 12 were attained by all patients in both groups within 30 min of their arrival in the PACU. Median time from arrival to the PACU to discharge home was similar in both groups, 167.5 min in the control group vs 180 min in the lidocaine group (P = 0.649). Conclusion: Intraoperative lidocaine infusion reduces opioid consumption in the PACU and intraoperative requirements of desflurane. Copyrigh

Intravenous lidocaine infusion reduces bispectral index-guided requirements of propofol only during surgical stimulation(dagger)

I.V. lidocaine reduces volatile anaesthetics requirements during surgery. We hypothesized that lidocaine would also reduce propofol requirements during i.v. anaesthesia. A randomized controlled study of 40 patients tested the effect of i.v. lidocaine (1.5 mg kg(-1) then 2 mg kg(-1) h(-1)) on propofol requirements. Anaesthesia was maintained with remifentanil and propofol target-controlled infusions (TCI) to keep the bispectral index (BIS) around 50. Effect-site concentrations of propofol and remifentanil and BIS values were recorded before and after skin incision. Data were analysed using anova and mixed effects analysis with NONMEM. Two dose-response studies were then performed with and without surgical stimulation. Propofol TCI titrated to obtain a BIS around 50 was kept constant. Then patients were randomized into four groups: A, saline; B, 0.75 mg kg(-1) bolus then infusion 1 mg kg(-1) h(-1); C, 1.5 mg kg(-1) bolus and infusion 2 mg kg(-1) h(-1); and D, 3 mg kg(-1) bolus and infusion 4 mg kg(-1) h(-1). Lidocaine administration coincided with skin incision. BIS values and haemodynamic variables were recorded. Data were analysed using linear regression and two-way anova. Lidocaine decreased propofol requirements (P <0.05) only during surgery. In the absence of surgical stimulation, lidocaine did not affect BIS nor haemodynamic variables, whereas it reduced BIS increase (P=0.036) and haemodynamic response (P=0.006) secondary to surgery. The sparing effect of lidocaine on anaesthetic requirements seems to be mediated by an anti-nociceptive action

Is ultra-short cold ischemia the key to ischemic cholangiopathy avoidance in DCD-LT?

Introduction: Donation after circulatory death (DCD) donors have been proposed to partially overcome the organ donor shortage. DCD-LT remains controversial, with reported increased risk of ischemic cholangiopathy leading to graft loss. The authors retrospectively reviewed a single centre experience with DCD-LT in a 9-year period. Patients and Methods: 70 DCD-LT were performed from 2003 to November 2012. All DCD procedures were performed in operative rooms. Median donor age was 59 years. Most grafts were flushed with HTK solution. Allocation was centre-based. Median total DCD warm ischemia was 19.5 min. Mean follow-up was 36 months. No patient was lost to follow-up. Results: Median MELD score at LT was 15. Median cold ischemia was 235 min. Median peak AST was 1,162 U/L. Median peak bilirubin was 31.2 mg/dL. Patient and graft survivals were 92.8% and 91.3% at one year and 79% and 77.7% at 3 years, respectively. One graft was lost due to hepatic artery thrombosis. No PNF or graft loss due to ischemic cholangiopathy was observed in this series. Causes of death were malignancies in 8 cases. Discussion: In this series, DCD LT appears to provide results equal to classical LT. Short cold ischemia and recipient selection with low MELD score may be the keys to good results in DCD LT, in terms of graft survival and avoidance of ischemic cholangiopathy