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Lidocaine Use in Vaginal Surgery and Risk of Toxicity

Willis-Gray, Marcella G., MD; Husk, Katherine E., MD; Brueseke, Taylor J., MD; Connolly, AnnaMarie, MD; Geller, Elizabeth J., MD

Female Pelvic Medicine & Reconstructive Surgery: October 19, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/SPV.0000000000000622
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Objectives The primary objective of this study was to compare the amount of lidocaine administered for vaginal reconstruction with versus without hysterectomy. The secondary objective was to assess the risk of lidocaine toxicity.

Methods This retrospective cohort study compares lidocaine dose in 2 cohorts: women who underwent vaginal hysterectomy with additional vaginal reconstruction (VH + VR) versus those who underwent vaginal reconstruction without hysterectomy (VR only). Total intraoperative lidocaine dose included the intravenous dose from anesthesia and the vaginally injected dose from the surgeon. The risk of toxicity was defined as total dose greater than 7 mg/kg. The primary outcome was the difference in total lidocaine dose for VH + VR versus VR only.

Results Among 372 women included, 140 (37.6%) were in the VH + VR group, and 232 (62.4%) in the VR-only group. For the primary outcome of total lidocaine dose between groups, VH + VR received more total lidocaine than did VR only (228 ± 105 vs 168 ± 78 mg, P < 0.001). This difference was due to the vaginal lidocaine dose (P < 0.001), with no significant difference in the intravenous lidocaine dose (P = 0.68). In a logistic regression model controlling for age, anesthesia type, sling, and anterior repair, posterior repair, and anesthesia type, VH remained an independent risk factor for increased lidocaine dose (P < 0.001). Two women received a toxic dose of lidocaine, and both were in the VH + VR group.

Conclusions Women undergoing vaginal hysterectomy with additional vaginal reconstructive procedures are more likely to receive a higher dose of lidocaine compared with women undergoing vaginal reconstruction alone. The risk of lidocaine toxicity is increased with concomitant procedures.

From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, Chapel Hill, NC.

Correspondence: Marcella G. Willis-Gray, MD, University of North Carolina, Chapel Hill, 3032 Old Clinic Bldg, CB#7570 Chapel Hill, NC 27599. E-mail: marcella_willis-gray@med.unc.edu.

The authors have declared they have no conflicts of interest.

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