Acute Pain Clinical Trial
Official title:
Perioperative Epidural Versus Intravenous Local Anesthetic Infusion in Open Upper Abdominal Surgery
The study evaluates the efficacy of intravenous lidocaine as an analgesic modality in patients undergoing open upper abdominal surgery; when compared with thoracic epidural analgesia. Half of participants will receive intravenous lidocaine infusion, while the other half will receive thoracic epidural bupivacaine infusion.
Postoperative pain is one of the commonest problems encountered by anaesthesiologists,
especially after open abdominal surgeries, in which post-operative pain would cause a
restrictive respiratory dysfunction, which is associated with poor postoperative outcomes.
Despite the fact that epidural blocks provide superior analgesia; it is not often an ideal
option as it frequently causes hypotension that may require excessive intravenous fluid
administration, which is particularly deleterious after bowel surgery. Other complications
include epidural hematoma and higher failure rate. Furthermore epidural analgesia may be
contraindicated in some patients e.g. patients on certain anti-platelet therapy and patients
refusing the technique.
Other modalities to control postoperative pain are used e.g. intravenous analgesics and
continuous wound infiltration, but none of which was proven to be as effective as epidural
block.
Whether perioperative lidocaine infusion is as effective as epidural block in reducing
post-operative pain, is this study's concern.
Some researches studied the efficacy of lidocaine infusion in controlling neuropathic as well
as acute postoperative pain with encouraging results. Lidocaine infusion was found to reduce
postoperative pain, opioid consumption and the length of hospital stay. Although risks of
neurological and cardiac toxicity exist, these were not substantiated in the trials.
Lidocaine has been described to have both analgesic, and anti-hyperalgesic effects6, as well
as anti-inflammatory properties. It also accelerates the return of post-operative
gastrointestinal function, which is of particular importance after major abdominal surgery.
Opposite to opioids, which increase the incidence of nausea and vomiting, lidocaine decreases
their incidence.
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