Intravenöse Lidocaingabe als Alternative zur thorakalen Peridualanalgesie bei der postoperativen Schmerztherapie von Patientinnen und Patienten nach größeren abdominalchirurgischen und gynäkologischen Eingriffen
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Philipps-Universität Marburg
Abstract
When comparing epidural analgesia with perioperative intravenous lidocaine
infusion in combination with a metamizole and piritramide as needed in patients
without chronic pain syndrome continuous lidocaine i.v. is an effective, safe and
inexpensive therapeutic option.
During perioperative lidocaine administration continuous monitoring of
electrocardiography, pulse oximetry and noninvasive arterial blood pressure is
mandatory.
For continuous perioperative lidocaine administration, special skills or abilities
as needed for the insertion of an epidural catheter are not required, a 24-hour
acute pain service is not mandatory.
Patients receiving intravenous lidocaine infusion required additional intravenous
opioids, however, this did not have a negative effect on recovery of bowl
function and the incidence of adverse effects.
It was noted that there was a trend to decrease the incidence of PONV. No
serious adverse effects were observed, the occurrence of disorientation or
metallic taste were controlled within 2 h by ending the lidocaine application.
Continuous lidocaine administration was characterized by a high level of patient
satisfaction. In combination with metamizole and piritramide a median pain
scorel ≤ 3 out of 10 was achieved.
Furthermore, after hospital discharge and three months after surgery only very
low pain scores (NRS ≤ 3) were noted, after six months all patients were free of
pain. A chronification of postoperative pain was not observed.
Full recovery of physical function and the resumption of everyday life took place
in the same time interval as in the patients with epidural analgesia.
It remains to mention that all patients included in this study were adults and
capable ASA I-III patients without chronic pain syndrome or hyperalgesia of
other genesis.
Further studies are needed to investigate an effective efficiency of perioperative
lidocaine administration in patients with opioid habituation or hospitalization due
to chronic diseases.
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This item has been published with the following license: In Copyright