EFFICACY OF INTRAOPERATIVE INTRAVENOUS LIDOCAINE INFUSION FOR POSTOPERATIVE PAIN RELIEF AND OPIOID CONSUMPTION IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY

Abstract

Background: Postoperative pain after laparoscopic cholecystectomy is driven by port-site somatic pain, visceral pain, and referred shoulder pain. Opioid-heavy analgesia can slow recovery and increase adverse effects, creating a role for inexpensive opioid-sparing adjuvants such as intravenous lidocaine. Objective: To evaluate whether intraoperative intravenous lidocaine improves postoperative pain outcomes and reduces rescue opioid consumption in adults undergoing laparoscopic cholecystectomy. Methods: This prospective randomized controlled trial was conducted at Jinnah Postgraduate Medical Centre, Karachi, from April 8, 2022, to October 7, 2022. One hundred adults aged 22 to 65 years were randomized to an experimental lidocaine group (n = 50) or a control group (n = 50). The experimental group received lidocaine 1.5 mg/kg as a pre-induction bolus followed by 1 mg/kg/h infusion during surgery with reduced-dose nalbuphine. The control group received standard anesthesia without systemic lidocaine. Postoperative pain was assessed using the Numerical Rating Scale or Visual Analog Scale, and rescue opioid use was recorded. Results: Rescue opioid consumption was lower in the lidocaine group (0.05 ± 0.00 mg) than in the control group (0.09 ± 0.02 mg; P = 0.0001). However, the predefined pain target of NRS/VAS ≤ 3 was achieved more often in the control group than in the lidocaine group (54.0% versus 34.0%; P = 0.044). Exploratory subgroup analyses suggested possible effect heterogeneity by residence, body mass index, operative duration, and ASA class, but these findings should be interpreted cautiously. Conclusion: Intraoperative intravenous lidocaine was associated with lower rescue opioid consumption, but it did not consistently improve pain-score endpoints. It should be viewed as an adjunct within multimodal analgesia when reducing opioid exposure is a priority.