Vol. 5, Special Issue 4, Part J (2019)

Material and Methods: This was prospective non-randomized, controlled clinical trial done in the Department of Anesthesia, Metro Hospital and Cancer Research Center, Jabalpur, Madhya Pradesh, India. Total 100 patients were included in this study. All surgeries were performed under general anesthesia and patients were divided into two groups. Group I (Controlled Fentanyl Group) and Group II (Opioid Free Anesthesia Group). Intraoperative fentanyl consumption and visual analog scale (VAS) pain score assessment at immediate recovery time as well as after 24 hours postoperatively were assessed and analgesic requirements were recorded.

Results: In the current study there were no significant differences between the 2 groups as regarding age, sex, body weight, BMI, and ASA physical status. Therefore, mentioned variables would have minimal influence on the assessed parameters when comparing the safety and efficacy of perioperative lidocaine infusion with or without fentanyl adjustment at the induction of anesthesia. Comparison between the groups showed a significant difference in amount of Propofol during induction and difference in intraoperative fentanyl requirements. Patients in group I; supplemental fentanyl was needed in 4 cases (8%) while in group II fentanyl was needed in 16 cases (32%). In group II, 72% of cases i.e. in 36 patients’ anesthesia were opioid-free. In group I propofol dose for induction of anesthesia was significantly lower than in group II. These differences were statistically significant. In group II patients; there was more hyperdynamic reactions to skin incision (rise of heart rate and mean arterial blood pressure more than 30% above baseline) and there was a need of higher MAC (1.41) of sevoflurane during the first 30 minutes of surgery. After 8 hours of continuous lidocaine infusion, there was a low VAS of pain score and minimal or no need of additional opioid or non-opioid analgesia during 24hours. After laparoscopic colorectal and cholecystectomy surgery postoperative bowel sound recovery time in both groups of patients was clinically equal. There were neither perioperative complications nor clinical signs of lidocaine toxicity detected perioperatively.

Conclusion: Safety and efficacy of perioperative lidocaine infusion have been demonstrated. Opioid free anesthesia (OFA) is possible in 70% of cases. Post-operative lidocaine infusion for 5-8 hours was sufficient for pain relieve with minimal non opioid analgesia for 24 hours.