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ESRA19-0624 Perioperative administration of lidocaine and dexmedetomidine for the prevention of chronic postoperative pain
  1. M Rekatsina,
  2. P Theodosopoulou and
  3. C Staikou
  1. Aretaieion University Hospital, A’ Anaesthesiology Clinic, Pain Therapy and Palliative Care Centre, National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece

Abstract

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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