Anesthetic management and post-operative anesthesia for patients who underwent extended liver resection: the role of intravenous lidocaine

Authors

  • R. A. Zatsarynnyi SI “Shalimov’s National Institute of Surgery and Transplantation” of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0002-1430-9856
  • A. Yu. Lysenko SI “Shalimov’s National Institute of Surgery and Transplantation” of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0003-0150-3948
  • O. O. Pidopryhora SI “Shalimov’s National Institute of Surgery and Transplantation” of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0002-1657-2973

DOI:

https://doi.org/10.14739/2310-1210.2022.3.239692

Keywords:

anesthesia, lidocaine, intravenous administration, extended liver resection, pain syndrome

Abstract

Aim. To examine effectiveness of intraoperative lidocaine administration in the intraoperative period as a component of combined anesthesia and in the early postoperative period in patients after extended liver resection.

Materials and methods. There were 86 patients with various pathologies enrolled after hepatic resection with 30–60 % of parenchymal preservation. The patients were divided into three groups depending on the complex anesthesia used. The control group (ІІІ) consisted of 10 patients who received standard complex anesthesia and pain management including opioid and non-opioid analgesics in the post-operative period. The main group (ІІ) comprised 9 patients who received the method developed, and there was the additional comparison group (І) composed of 67 patients who received standard complex anesthesia with thoracic epidural anesthesia (TEA).

Results. Having elaborated the fentanyl mean cumulation dose during the operation, we herewith declare that patients of group I received in general 1005.2 ± 417.8 µgr, group II – 1771.1 ± 735.5 µgr and III group – 2090.0 ± 636.7 µgr of fentanyl. When detailing and comparing the groups with each other, we see significantly lower usage of fentanyl intraoperatively in TEA group in comparison to both other groups (I vs II, 76 % greater need in group II, and I vs III, 108 % greater need in group ІІI). At the same time, the difference in the need for intraoperative fentanyl between patients of the intravenous lidocaine group and the control group was only 18 % – there was a tendency to a decrease in the dose when using intravenous lidocaine. Based on the data comparison results between groups, it could be asserted that between patients of groups I and II, the difference in the VAS score on day one after surgery was only 10 %. On the first day postoperatively, patients in group I noted maximum daily value of 4.5 ± 2.0 points on the VAS scale, in group II – 5.0 ± 2.3 and in group III – 7.6 ± 1.0 points. In contrast, there was a significantly higher level of pain in group III patients compared to both groups I and II. The intergroup difference in the time of the first dose of analgesics administration after surgery was insignificant: in group I – after 313.5 ± 128.9 minutes, in group II – 287.7 ± 101.6 minutes, and in group III – 217.0 ± 120.3 minutes. The provided data confirm the efficacy of the pain management method in patients after hepatic resection.

Conclusions. Both the use of TEA and intravenous lidocaine are safe methods of pain management in patients after liver resection. In the postoperative period, intravenous use of lidocaine is not inferior in its effectiveness to TEA and can be recommended for use. TEA has a greater efficiency in intraoperative analgesia, however, if it is contraindicated for administration, intraoperative use of lidocaine is a potentially effective alternative. Further studies in a larger group of patients are needed to confirm or disprove this trend.

Author Biographies

R. A. Zatsarynnyi, SI “Shalimov’s National Institute of Surgery and Transplantation” of the National Academy of Medical Sciences of Ukraine, Kyiv

MD, Head of the Department of Intensive Therapy

A. Yu. Lysenko, SI “Shalimov’s National Institute of Surgery and Transplantation” of the National Academy of Medical Sciences of Ukraine, Kyiv

MD, anesthesiologist

O. O. Pidopryhora, SI “Shalimov’s National Institute of Surgery and Transplantation” of the National Academy of Medical Sciences of Ukraine, Kyiv

MD, surgeon

References

Tzimas, P., Prout, J., Papadopoulos, G., & Mallett, S. V. (2013). Epidural anaesthesia and analgesia for liver resection. Anaesthesia, 68(6), 628-635. https://doi.org/10.1111/anae.12191

Tsoris, A., & Marlar, C. A. (2021). Use Of The Child Pugh Score In Liver Disease. StatPearls Publishing. https://www.statpearls.com/ArticleLibrary/viewarticle/19534

Hawker, G. A., Mian, S., Kendzerska, T., & French, M. (2011). Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care & Research, 63(S11), S240-S252. https://doi.org/10.1002/acr.20543

Page, A., Rostad, B., Staley, C. A., Levy, J. H., Park, J., Goodman, M., Sarmiento, J. M., Galloway, J., Delman, K. A., & Kooby, D. A. (2008). Epidural Analgesia in Hepatic Resection. Journal of the American College of Surgeons, 206(6), 1184-1192. https://doi.org/10.1016/j.jamcollsurg.2007.12.041

Brown, E. N., Pavone, K. J., & Naranjo, M. (2018). Multimodal General Anesthesia: Theory and Practice. Anesthesia & Analgesia, 127(5), 1246-1258. https://doi.org/10.1213/ANE.0000000000003668

Tomozawa, A., Ishikawa, S., Shiota, N., Cholvisudhi, P., & Makita, K. (2015). Perioperative risk factors for acute kidney injury after liver resection surgery: an historical cohort study. Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 62(7), 753-761. https://doi.org/10.1007/s12630-015-0397-9

Weinger, M. B., & Lee, L. A. (2011). No Patient Shall Be Harmed By Opioid-Induced Respiratory Depression. APSF Newsletter, 26(2), 21-40. https://www.apsf.org/article/no-patient-shall-be-harmed-by-opioid-induced-respiratory-depression/

Beverly, A., Kaye, A. D., Ljungqvist, O., & Urman, R. D. (2017). Essential Elements of Multimodal Analgesia in Enhanced Recovery After Surgery (ERAS) Guidelines. Anesthesiology Clinics, 35(2), e115-e143. https://doi.org/10.1016/j.anclin.2017.01.018

Marret, E., Rolin, M., Beaussier, M., & Bonnet, F. (2008). Meta-analysis of intravenous lidocaine and postoperative recovery after abdominal surgery. British Journal of Surgery, 95(11), 1331-1338. https://doi.org/10.1002/bjs.6375

Dunn, L. K., & Durieux, M. E. (2017). Perioperative Use of Intravenous Lidocaine. Anesthesiology, 126(4), 729-737. https://doi.org/10.1097/ALN.0000000000001527

Beaussier, M., Delbos, A., Maurice-Szamburski, A., Ecoffey, C., & Mercadal, L. (2018). Perioperative Use of Intravenous Lidocaine. Drugs, 78(12), 1229-1246. https://doi.org/10.1007/s40265-018-0955-x

Sun, Y., Li, T., Wang, N., Yun, Y., & Gan, T. J. (2012). Perioperative Systemic Lidocaine for Postoperative Analgesia and Recovery after Abdominal Surgery: A Meta-analysis of Randomized Controlled Trials. Diseases of the Colon & Rectum, 55(11), 1183-1194. https://doi.org/10.1097/DCR.0b013e318259bcd8

Daykin, H. (2017). The efficacy and safety of intravenous lidocaine for analgesia in the older adult: a literature review. British Journal of Pain, 11(1), 23-31. https://doi.org/10.1177/2049463716676205

Lauretti, G. R. (2008). Mechanisms of Analgesia of Intravenous Lidocaine. Revista Brasileira de Anestesiologia, 58(3), 280-286. https://doi.org/10.1590/s0034-70942008000300011

Kranke, P., Jokinen, J., Pace, N. L., Schnabel, A., Hollmann, M. W., Hahnenkamp, K., Eberhart, L. H., Poepping, D. M., & Weibel, S. (2015). Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery. Cochrane Database of Systematic Reviews, (7), Article CD009642. https://doi.org/10.1002/14651858.CD009642.pub2

Weibel, S., Jokinen, J., Pace, N. L., Schnabel, A., Hollmann, M. W., Hahnenkamp, K., Eberhart, L. H., Poepping, D. M., Afshari, A., & Kranke, P. (2016). Efficacy and safety of intravenous lidocaine for postoperative analgesia and recovery after surgery: a systematic review with trial sequential analysis. British Journal of Anaesthesia, 116(6), 770-783. https://doi.org/10.1093/bja/aew101

Earls, B., & Bellil, L. (2018). Systemic Lidocaine: An Effective and Safe Modality for Postoperative Pain Management and Early Recovery. APSF Newsletter, 33(1), 1-32. https://www.apsf.org/article/systemic-lidocaine-an-effective-and-safe-modality-for-postoperative-pain-management-and-early-recovery/

Karcioglu, O., Topacoglu, H., Dikme, O., & Dikme, O. (2018). A systematic review of the pain scales in adults: Which to use? The American Journal of Emergency Medicine, 36(4), 707-714. https://doi.org/10.1016/j.ajem.2018.01.008

Thong, I., Jensen, M. P., Miró, J., & Tan, G. (2018). The validity of pain intensity measures: what do the NRS, VAS, VRS, and FPS-R measure? Scandinavian Journal of Pain, 18(1), 99-107. https://doi.org/10.1515/sjpain-2018-0012

Seok, H. S., Choi, B. M., Noh, G. J., & Shin, H. (2019). Postoperative Pain Assessment Model Based on Pulse Contour Characteristics Analysis. IEEE Journal of Biomedical and Health Informatics, 23(6), 2317-2324. https://doi.org/10.1109/JBHI.2018.2890482

Logier, R., Jeanne, M., De Jonckheere, J., Dassonneville, A., Delecroix, M., & Tavernier, B. (2010). PhysioDoloris: a monitoring device for analgesia / nociception balance evaluation using heart rate variability analysis. Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference, 2010, 1194-1197. https://doi.org/10.1109/IEMBS.2010.5625971

Hasanin, A., Mohamed, S., & El-Adawy, A. (2017). Evaluation of perfusion index as a tool for pain assessment in critically ill patients. Journal of Clinical Monitoring and Computing, 31(5), 961-965. https://doi.org/10.1007/s10877-016-9936-3

Downloads

Published

2022-05-30

How to Cite

1.
Zatsarynnyi RA, Lysenko AY, Pidopryhora OO. Anesthetic management and post-operative anesthesia for patients who underwent extended liver resection: the role of intravenous lidocaine. Zaporozhye medical journal [Internet]. 2022May30 [cited 2024Apr.23];24(3):310-6. Available from: http://zmj.zsmu.edu.ua/article/view/239692

Issue

Vol. 24 No. 3 (2022)

Section

Original research

License

Authors who publish with this journal agree to the following terms:

    1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.  Лицензия Creative Commons
    2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
    3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)