Perioperative 24-Hour Lidocaine Infusion Does Not Prevent Chronic Postthoracotomy Pain: A Triple-Blinded Randomized Controlled Trial.

Abstract

Managing chronic postsurgical pain is challenging. Evidence supporting the use of perioperative lidocaine to prevent it is inconsistent, potentially due to insufficient infusion duration. To determine the effect of extending lidocaine infusion to 24 hours for treating chronic postsurgical pain in patients undergoing video-assisted thoracoscopic surgery. Triple-blind, controlled randomized trial. A tertiary center in a university hospital. Seventy-one patients undergoing elective video-assisted thoracoscopic surgery were randomized 1:1 to receive either 2% lidocaine or placebo infusion at a speed of 4 mL/h started after anesthesia induction and continued for 24 hours. Primary outcomes were chronic postsurgical pain at 3 months defined as present pain score > 0 on an 11-point Numeric Rating Scale. Secondary outcomes included acute pain and opioid use during the first postsurgical 48 hours, and chronic postsurgical pain for up to 6 months. The incidences of chronic postsurgical pain at either 3 or 6 months did not differ significantly between the placebo and lidocaine groups (50% vs 50%, P = 1.0; 27% vs 32%, P = 0.63, respectively). There were no significant differences in acute pain scores or opioid consumption between the groups. Dizziness was more frequent during lidocaine infusion (47% vs 14% in the placebo group, P < 0.01). No serious adverse events were reported. The follow-up period was limited to 6 months and there was a small number of patients. A perioperative lidocaine infusion for 24 hours added to multimodal analgesia did not prevent chronic postthoracotomy pain.