Though the majority of surgery on the spine is done to help alleviate pain, an immediate consequence of having surgery is significant postoperative pain from the surgical trauma itself. Spine patients in particular often have histories of chronic pain and opioid tolerance, which makes controlling post-surgical pain more difficult, and ways of ameliorating this may help patients recover faster and reduce health care expenditures. Lidocaine is a readily available anesthesic with anti-inflammatory, angalgesic and antihyperalgesic properties. Perioperative lidocaine administration has been shown to benefit patients undergoing major abdominal surgery, but not in cardiac or hip arthroplasty surgery. Its effects on spine surgery have not been studied.
Farag, et al from the Cleveland Clinic have recently reported results of a single institution randomized, placebo controlled trial investigating perioperative administration of IV lidocaine in pateints undergoing complex spinal surgery and its effects on post-operative pain and opoid use (Anesthesia, May, 2013, online first). A total of 116 adult patients were randomized with the study group receiving IV lidocaine beginning at induction and lasting through PACU recovery to a maximum of 8 hours at a dose of 2 mg/kg/hr or placebo. Outcome measures included VRS (verbal response score) pain scores, opioid use in the first 48 hours, nausea/vomiting rates, and Acute SF-12 scores. VRS pain scores were measured every 30 minutes in the PACU, and every 4-6 hours until discharge.
Adjusted mean pain scores were 4.4 (4.2-4.7) in the lidocaine group and 5.3 (5.0-5.5) for placebo (P < .001). Opioid use trended lower in the lidocaine group but was statistically different than placebo, and nausea/vomiting rates were no different between groups. Interestingly, SF-12 physical composite scores were statistically better in the lidocaine group at 1 and 3 months compared to placebo (P = .04). There were no complications related to the use of lidocaine in this study reported.
Effectively managing pain in patients in the hospital and undergoing surgery has become a tenant of medical care over the past 30 years. There is an increasing expectation of doctors and hospitals to minimize pain, even in complex surgeries, while use and abuse of narcotics is also becoming an increasing socio-medical problem.
This study represents a fairly easy and low-cost intervention that could have benefit in helping minimize pain in spinal surgery. Though opoid use was not significantly reduced, further adjustments to perioperative cocktails of medicines and interventions may achieve even more dramatic improvements in pain scores and outcomes. Hopefully, this can lead to lower narcotic use, faster mobilization, improved patient perceived outcome and shorter hospital stays.