Intraoperative lidocaine infusion reduces analgesic and anesthetic requirements in patients with high body mass index undergoing laparoscopic cholecystectomy

Background: Intravenous (IV) lidocaine has analgesic, antihyperalgesic, and anti-inflammatory properties. Intraoperative use of lidocaine infusion reduces the analgesic and anesthetic requirement during laparoscopic cholecystectomy surgeries. Aims: Our study was designed to analyze the effect of intraoperative infusion of lidocaine, on perioperative opioid, anesthetic and neuromuscular agent requirements, and the incidence of side effects in patients with high body mass index undergoing laparoscopy cholecystectomy. Methods: This is a randomized double-blinded prospective study conducted at a tertiary hospital. Of the 38 patients enrolled in the study, due to cancellation and conversion to open surgery, only 33 patients completed the study (16 in the control group [C] and 17 in the lidocaine group [L]). Patients from both the groups received the test drug (lidocaine or normal saline) as 2 mg/kg bolus during induction and continued as an infusion at a rate of 2 mg/kg/h throughout the surgery which was terminated 30 min after extubation. The patients were analyzed for perioperative analgesic, anesthetic, muscle relaxant requirement, and adverse effects. Results: The mean visual analog scale (VAS) score in 1st and 2nd hour after surgery was less in the group receiving IV lidocaine infusion (7.5 +/- 7.8* vs. 10.5 +/- 11.8; 12.5 +/- 8.1* vs. 23 +/- 24.6 [*denotes lidocaine group]); compared to the control group the intraoperative opioid requirement decreased by 43% in the lidocaine group. There was a reduction of 13%-21% in the minimum alveolar concentration of isoflurane in the lidocaine group. The cumulative dose of rocuronium was found to be 53% lesser in the lidocaine group. There was no difference in the sedation scores and there were no adverse effects in either of the groups. Conclusions: The study demonstrates the usefulness of IV lidocaine infusion as an adjunct to provide anesthesia with decreased requirements of opioid, inhalation, and neuromuscular-blocking agents.