Journal of anesthesia, analgesia and critical care •
Previous studies have demonstrated that perioperative use of lidocaine effectively reduces opioid requirements in various surgical procedures. Our objective was to evaluate the effect of postoperative intravenous lidocaine infusion on opioid consumption following pelvic bone tumor surgery. This single center randomized controlled trial in a tertiary teaching hospital containing a total of 70 patients, aged 18 to 65 years, with American Society of Anesthesiologists(ASA) physical status classifications of I to III, who were scheduled to undergo pelvic bone tumor surgery. Participants were randomly assigned in a 1:1 ratio to either the lidocaine group(L Group) or the control group(C Group). The L Group received lidocaine for postoperative analgesia, whereas the C Group was administered a placebo saline infusion.The primary outcome was postoperative opioid consumption. Secondary outcomes included the time to first bowel movement, the incidence of postoperative nausea and vomiting(PONV), and pain scores at rest and during movement on postoperative days. A significant difference was observed in the cumulative 72-h morphine equivalent consumption between the L Group (n = 33) and the C Group (n = 33). Patients in the L Group required significantly less morphine equivalent consumption compared to the C Group (13 (0-52) mg vs. 25 (14-85) mg, P = 0.043). Additionally, the proportion of patients experiencing breakthrough pain was significantly lower in the L Group compared to the C Group (33.33% vs. 75.76%, P = 0.001). No significant differences were noted between the groups in secondary outcomes, including the incidence of PONV, numerical pain scores at rest or during movement, time to first bowel evacuation, or time to first oral intake. Postoperative intravenous lidocaine infusion is effective in reducing opioid consumption and the incidence of breakthrough pain following pelvic bone tumor surgery. This single-center, prospective RCT was registered with the Chinese Clinical Trial Registry (ChiCTR2100051207, 15/09/2021). The first research participant was enrolled in September 20, 2021.
International journal of surgery (London, England) •
Lumbar surgery is often associated with significant postoperative pain, high opioid consumption, and delayed bowel function recovery. This study aimed to assess whether intravenous lidocaine infusion could enhance bowel function recovery in patients undergoing lumbar surgery. This multicenter, randomized, controlled, double-blinded study was conducted across three tertiary university hospitals. A total of 96 patients, aged 60-80 years, with an American Society of Anesthesiologists (ASA) classification of I-III, scheduled for lumbar spinal surgery, were randomly assigned to either the lidocaine group (L group) or the control group (C group) in a 1:1 ratio. Patients in the L group received perioperative intravenous lidocaine infusion and, postoperatively, lidocaine as a component of the multimodal patient-controlled analgesia regimen, whereas patients in the C group received normal saline in place of lidocaine under the same regimen. The primary outcome was the time to first evacuation. Secondary outcomes included the time to first defecation, intraoperative opioid consumption, incidence of postoperative nausea and vomiting (PONV), numerical rating scale (NRS) pain scores at rest and during movement, postoperative opioid consumption, and length of hospital stay. Patients in the L group had a significantly shorter evacuation time compared to the C group [(17 hours; 95% CI, 14-20 hours) vs (23 hours; 95% CI, 19-28 hours); P = 0.013)]. Intraoperative opioid consumption was significantly lower in the L group than in the C group, including sufentanil (18 [15, 20] µg vs. 25 [17, 30] µg, P < 0.001) and remifentanil (760 [450, 1040] µg vs. 1000 [760, 1440] µg, P = 0.002). Additionally, propofol usage was significantly lower in the L group compared to the C group (591.57 ± 206.39 mg vs. 692.96 ± 229.50 mg, P = 0.027). No significant differences were observed between the groups for other secondary outcomes. Intravenous lidocaine infusion in patients undergoing lumbar surgery accelerates postoperative bowel function recovery and reduces intraoperative opioid consumption.
Febrile infection-related epilepsy syndrome (FIRES) is a catastrophic, drug-resistant epileptic encephalopathy characterized by acute onset following febrile illness and progression to (super-)refractory status epilepticus. We report a case of FIRES in a previously healthy 5-year-and-11-month-old boy who developed super-refractory status epilepticus (SRSE) on day 6 of a nonspecific febrile illness. The seizures were characterized by upward eye deviation, generalized tonic posturing, perioral cyanosis, and persistent impairment of consciousness. Despite comprehensive treatments including multiple immunotherapies (intravenous immunoglobulin administration, methylprednisolone pulse therapy, tocilizumab, and anakinra), ketogenic diet, multiple anti-seizure medications, and management of complications (intracranial pressure control, anti-infective therapy, and respiratory support), seizures remained refractory. Due to refractory seizures, intravenous lidocaine (3 mg/kg/h) was initiated after failed trials of midazolam, propofol and chloral hydrate, and only partial response to ketamine. With a consecutive 35-day infusion (cumulative duration >45 days), this regimen produced substantial reductions in both seizure frequency and severity, with clinically significant improvement in seizure control. Electroencephalogram (EEG) monitoring showed a decrease in the frequency and intensity of epileptic discharges, and improved background activity. The patient's level of consciousness also showed signs of improvement. This case is notable as few reports exist on the use of lidocaine in FIRES patients. It highlights the potential of lidocaine as a valuable anti-seizure option in FIRES management, suggesting the need for further investigation into its safety, efficacy, optimal dosage, and treatment duration in a larger cohort of FIRES patients.
