Background and aims Chronic postoperative pain (CPP) may represent a significant problem for surgical patients. We assessed the efficacy of perioperative lidocaine and dexmedetomidine in preventing CPP.
Methods In this double-blind study, 51 women, 30–70y, ASA I-II, scheduled for abdominal hysterectomy/myomectomy, were randomized to receive lidocaine or dexmedetomidine or placebo. Before anaesthesia induction, a loading dose was given to all patients as an intravenous infusion at a rate of 0.9ml/kg/h for 10 minutes, followed by a rate of 0.15ml/kg/h until last suture. Syringes were identical, containing either lidocaine 10mg/ml (loading dose 1.5mg/kg, maintenance dose 1.5mg/kg/h), or dexmedetomidine 4μg/ml (loading dose 0.6mcg/kg, maintenance dose 0.6mcg/kg/h), or NaCl 0.9%. After a close 48h postoperative observation, the patients were evaluated for CPP at 3, 6 and 12 months.
Results Data from 42 women were analyzed. Regardless of group, higher NRS (numerical rating scale) cough scores at 48h were associated with higher NRS scores at 3 (p=0.01) and 6 months (p=0.03). Lidocaine was associated with superior (p=0.014) and earlier pain reduction (at 6 months) compared with dexmedetomidine (p=0.005) and placebo (p=0.001) at 12 months. Regarding neuropathic pain, higher NRS cough values at 48h were associated with higher DN4 values at 6 (p=0.02) and 12 months (p=0.04). Finally, DN4 values were significantly reduced at 12 months compared to the 3-month values for both lidocaine (p=0.007) and dexmedetomidine groups (p=0.029).
Conclusions Lidocaine was superior regarding the duration and intensity of CPP, while both dexmedetomidine and lidocaine exhibited a protective effect against the neuropathic elements of CPP.
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