Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2013.07.017
Brazilian Journal of Anesthesiology
Scientific Article

Effect of intraoperative intravenous lidocaine on pain and plasma interleukin-6 in patients undergoing hysterectomy

Efeito da lidocaína venosa intraoperatória sobre dor e interleucina-6 plasmática em pacientes submetidas a histerectomia

Caio Marcio Barros de Oliveira; Rioko Kimiko Sakata; Alexandre Slullitel; Reinaldo Salomão; Vera Lucia Lanchote; Adriana Machado Issy

Downloads: 1
Views: 691

Abstract

BACKGROUND AND OBJECTIVES: Interleukin-6 is a predictor of trauma severity. The purpose of this study was to evaluate the effect of intravenous lidocaine on pain severity and plasma interleukin-6 after hysterectomy. METHOD: A prospective, randomized, comparative, double-blind study with 40 patients, aged 18-60 years. G1 received lidocaine (2 mg kg-1 h-1) or G2 received 0.9% saline solution during the operation. Anesthesia was induced with O2/isoflurane. Pain severity (T0: awake and 6, 12, 18 and 24 h), first analgesic request, and dose of morphine in 24 h were evaluated. Interleukin-6 was measured before starting surgery (T0), 5 h after the start (T5), and 24 h after the end of surgery (T24). RESULTS: There was no difference in pain severity between groups. There was a decrease in pain severity between T0 and other measurement times in G1. Time to first supplementation was greater in G2 (76.0 ± 104.4 min) than in G1 (26.7 ± 23.3 min). There was no difference in supplemental dose of morphine between G1 (23.5 ± 12.6 mg) and G2 (18.7 ± 11.3 mg). There were increased concentrations of IL-6 in both groups from T0 to T5 and T24. There was no difference in IL-6 dosage between groups. Lidocaine concentration was 856.5 ± 364.1 ng mL-1 in T5 and 30.1 ± 14.2 ng mL-1 in T24. CONCLUSION: Intravenous lidocaine (2 mg kg-1 h-1) did not reduce pain severity and plasma levels of IL-6 in patients undergoing abdominal hysterectomy.

Keywords

Lidocaine, Intravenously, Postoperative pain, Hysterectomy, Interleukin-6

Resumo

JUSTIFICATIVA E OBJETIVOS: A interleucina-6 (IL-6) é preditora de intensidade no trauma. O objetivo deste estudo foi avaliar o efeito da lidocaína por via venosa sobre a intensidade da dor e IL-6 após histerectomia. MÉTODO: O estudo foi prospectivo, randomizado, comparativo e duplo-encoberto em 40 pacientes, entre 18 e 60 anos. Foi administrada lidocaína (2 mg.kg-1.h-1) no G1 ou solução salina a 0,9% no G2 durante a operação. A anestesia foi com O2/isoflurano. Foi avaliada a intensidade da dor (T0: despertar e seis, 12, 18 e 24 horas), a primeira solicitação de analgésico, a dose de morfina nas 24 horas. A IL-6 foi medida antes do início da operação (T0), após cinco horas do início (T5) e 24 horas após o término (T24). RESULTADOS: Não houve diferença na intensidade da dor entre os grupos. Ocorreu diminuição da intensidade da dor entre T0 e os outros momentos avaliados no G1. O tempo para primeira complementação foi maior no G2 (76,0 ± 104,4 min) do que no G1 (26,7 ± 23,3 min). Não houve diferença na dose de morfina complementar entre G1 (23,5 ± 12,6 mg) e G2 (18,7 ± 11,3 mg). Houve aumento das concentrações de IL-6 em ambos os grupos de T0 para T5 e T24. Não houve diferença na dosagem de IL-6 entre os grupos. A concentração de lidocaína foi 856,5 ± 364,1 ng.mL-1 em T5 e 30,1 ± 14,2 ng.mL-1 em T24. CONCLUSÃO: A lidocaína (2 mg.kg-1.h-1) por via venosa não promoveu redução da intensidade da dor e dos níveis plasmáticos de IL-6 em pacientes submetidas a histerectomia abdominal.

Palavras-chave

Lidocaína, Via venosa, Dor pós-operatória, Histerectomia, Interleucina-6

References

Lin E, Calvano SE, Lowry SF. Inflammatory cytokines and cell response in surgery. Surgery.. 2000;127:117-26.

Gebhard F, Pfetsch H, Steinbach G. Is interleukin 6 an early marker of injury severity following major trauma in humans?. Arch Surg.. 2000;135:291-5.

Kuo CP, Jao SW, Chen KM, et al. Comparison of the effects of thoracic epidural analgesia and iv. infusion with lidocaine on cytokine response, postoperative pain, and bowel function in patients undergoing colonic surgery. Br J Anaesth.. 2006;97:640-6.

Herroeder S, Pecher S, Schonherr ME. Systemic lidocaine shortens length of hospital stay after colorectal surgery: a double-blinded, randomized, placebo-controlled trial. Ann Surg.. 2007;246:192-200.

Lauwick S, Kim J, Michelagnoli G. Intraoperative infusion of lidocaine reduces postoperative fentanyl requirements in patients undergoing laparoscopic cholecystectomy. Can J Anaesth.. 2008;55:754-60.

Koppert W, Weigand M, Neumann F. Perioperative intravenous lidocaine has preventive effects on postoperative pain and morphine consumption after major abdominal surgery. Anesth Analg.. 2004;98:1050-5.

Kaba A, Laurent SR, Detroz BJ. Intravenous lidocaine infusion facilitates acute rehabilitation after laparoscopic colectomy. Anesthesiology.. 2007;106:11-8.

Wu CT, Borel CO, Lee MS. The interaction effect of perioperative cotreatment with dextromethorphan and intravenous lidocaine on pain relief and recovery of bowel function after laparoscopic cholecystectomy. Anesth Analg.. 2005;100:448-53.

Koppert W, Ostermeier N, Sittl R. Low-dose lidocaine reduces secondary hyperalgesia by a central mode of action. Pain.. 2000;85:217-24.

Kawamata M, Takahashi T, Kozuka Y. Experimental incision-induced pain in human skin: effects of systemic lidocaine on flare formation and hyperalgesia. Pain.. 2002;100:77-89.

Amir R, Argoff CE, Bennett GJ. The role of sodium channels in chronic inflammatory and neuropathic pain. J Pain.. 2006;7:S1-29.

Canavero S, Bonicalzi V. Drug therapy of trigeminal neuralgia. Expert Rev Neurother.. 2006;6:429-40.

McLure HA, Rubin AP. Review of local anaesthetic agents. Min Anesth.. 2005;71:59-74.

Heavner JE. Local anesthetics. Curr Opin Anaesthesiol.. 2007;20:336-42.

Kindler CH, Yost CS. Two-pore domain potassium channels: new sites of local anesthetic action and toxicity. Reg Anesth Pain Med.. 2005;30:260-74.

Werdehausen R, Kremer D, Brandenburger T. Lidocaine metabolites inhibit glycine transporter 1: a novel mechanism for the analgesic action of systemic lidocaine?. Anesthesiology.. 2012;116:147-58.

Martin F, Cherif K, Gentili ME. Lack of impact of intravenous lidocaine on analgesia, functional recovery, and nociceptive pain threshold after total hip arthroplasty. Anesthesiology.. 2008;109:118-23.

Bryson GL, Charapov I, Krolczyk G. Intravenous lidocaine does not reduce length of hospital stay following abdominal hysterectomy. Can J Anaesth.. 2010;57:759-66.

Moher D, Schulz KF, Altman DG. The Consort statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Lancet.. 2001;357:1191-4.

Katz J. Pre-emptive analgesia: importance of timing. Can J Anaesth.. 2001;48:105-14.

Omote K. Intravenous lidocaine to treat postoperative pain management. Anesthesiology.. 2007;106:5-6.

Tanelian DL, MacIver MB. Analgesic concentrations of lidocaine suppress tonic A-delta and C fiber discharges produced by acute injury. Anesthesiology.. 1991;74:934-6.

Cui W, Li Y, Li S. Systemic administration of lidocaine reduces morphine requirements and postoperative pain of patients undergoing thoracic surgery after propofol-remifentanil-based anaesthesia. Eur J Anaesthesiol.. 2010;27:41-6.

Yardeni IZ, Beilin B, Mayburd E. The effect of perioperative intravenous lidocaine on postoperative pain and immune function. Anesth Analg.. 2009;109:1464-9.

Kang H, Kim BG. Intravenous lidocaine for effective pain relief after inguinal herniorrhaphy: a prospective, randomized, double-blind, placebo-controlled study. J Int Med Res.. 2011;39:435-45.

Kim TH, Kang H, Hong JH. Intraperitoneal and intravenous lidocaine for effective pain relief after laparoscopic appendectomy: a prospective, randomized, double-blind, placebo-controlled study. Surg Endosc.. 2011;25:3183-90.

Swenson BR, Gottschalk A, Wells LT. Intravenous lidocaine is as effective as epidural bupivacaine in reducing ileus duration, hospital stay, and pain after open colon resection: a randomized clinical trial. Reg Anesth Pain Med.. 2010;35:370-6.

Hong JY, Lim KT. Effect of preemptive epidural analgesia on cytokine response and postoperative pain in laparoscopic radical hysterectomy for cervical cancer. Reg Anesth Pain Med.. 2008;33:44-51.

Muth-Selbach U, Hermanns H, Stegmann JU. Antinociceptive effects of systemic lidocaine: involvement of the spinal glycinergic system. Eur J Pharmacol.. 2009;613:68-73.

Dickey EJ, McKenzie HC 3rd, Brown KA. Serum concentrations of lidocaine and its metabolites after prolonged infusion in healthy horses. Equine Vet J.. 2008;40:348-52.

McCleane G. Intravenous lidocaine: an outdated or underutilized treatment for pain?. J Palliat Med.. 2007;10:798-805.

Marret E, Rolin M, Beaussier M. Meta-analysis of intravenous lidocaine and postoperative recovery after abdominal surgery. Br J Surg.. 2008;95:1331-8.

McCarthy GC, Megalla SA, Habib AS. Impact of intravenous lidocaine infusion on postoperative analgesia and recovery from surgery: a systematic review of randomized controlled trials. Drugs.. 2010;70:1149-63.

Vigneault L, Turgeon AF, Côté D. Perioperative intravenous lidocaine infusion for postoperative pain control: a meta-analysis of randomized controlled trials. Can J Anaesth.. 2011;58:22-37.

5dd30e0b0e88257739c63493 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections