Evaluation of the outcomes of patients receiving intravenous lidocaine and its effect on reducing postoperative pain and opioid requirements compared to patients who do not receive intravenous lidocaine is an important clinical issue to implement a practice change in hospitals that do not currently utilize IV lidocaine. Opioids are extensively used as analgesics for moderate to severe acute and chronic pain during surgical procedures (Paul et al., 2021; Steele et al., 2022). Nonetheless, these analgesic medication groups have several potential drawbacks since they create various adverse effects. Paul et al. (2021) claim that analgesic tolerance, physical dependence, constipation, respiratory depression, and nausea and vomiting (N/V) are among them. Respiratory depression occurs less commonly than other adverse effects, yet it can be fatal in some cases (Paul et al., 2021). Bateman et al. (2021) acknowledge that opioid-induced respiratory depression is characterized by slow, shallow, and irregular breathing, which can progress to respiratory arrest in severe instances, such as sustained apnoea. Additionally, opioids cause muscle stiffness and impede chemoreflex and upper airway patency.
Intravenous lidocaine (IVL) can be an alternative because it can be advantageous in a perioperative environment due to its properties. Beaussier et al. (2018) inform that lidocaine is a Class 1b antiarrhythmic agent and a local amide anesthetic. A meta-analysis of abdominal surgery showed that lidocaine improved pain management, opiate use, postoperative ileus, the incidence of PONV, and duration of hospital stay (Beaussier et al., 2018). Aside from its well-known analgesic and anti-inflammatory qualities, IVL may also improve bronchial reactivity, the incidence of venous thrombosis, and recovery from postsurgical ileus (Beaussier et al., 2018). Moreover, with the generally prescribed doses, lidocaine’s therapeutic efficacy remains very high, and plasma concentrations continue to stay well below the cardiotoxic and neurotoxic permissible levels, which clinicians may use to conclude the benefit-risk profile of IVL in comparison to other analgesic methods.
Theoretical Framework: Middle Range Theory of Acute Pain
A middle-range theory of acute pain management has been used to train nurses about pain management. According to the original hypothesis, in individuals with moderate to severe acute pain, the healthcare professional should administer effective pain medicine and pharmacologic and nonpharmacologic adjuvants to strike a balance between analgesia and side effects (Good, 1998). Moreover, the nurse should routinely check pain and side effects and educate patients on how to engage. The balance of analgesia and side effects is critical because when opioids are taken, the risk of adverse impacts develops and should be mitigated.
Therefore, several studies suggest that intravenous lidocaine helps treat acute pain. For instance, Li et al. (2018) emphasize that lidocaine is utilized to impede neural conductions and has anti-inflammatory qualities during the perioperative phase. The findings of the meta-analysis revealed that intravenous lidocaine was related to lower pain ratings (Li et al., 2018). Furthermore, lidocaine was linked to a decrease in the occurrence of nausea and vomiting, ileus, and pruritus. Following a laparoscopic cholecystectomy (LC), intravenous lidocaine minimizes initial postoperative pain, overall opioid needs, and opioid-related side effects.
Effective pain management after surgery is critical for functional recovery and preventing postoperative complications. Li et al. (2018) assert that post-surgery pain is caused by various variables, including psychological, emotional, surgical, and anesthetic aspects. Although numerous analgesic approaches have been studied and utilized in the past, the best analgesic method remains debatable, with any single mode of analgesia not deemed sufficient to produce adequate outcomes. Li et al. (2018) mention that previous research has shown intravenous lidocaine is helpful in morphine-sparing treatment following abdominal surgery. Pain treatment following a LC is frequently aimed at lowering pain and morphine needs using multimodal analgesia approaches (Li et al., 2018). Lidocaine is a local anesthetic that should be extensively used for acute pain management to avoid adverse effects.
The second research selected demonstrates intravenous lidocaine’s safety and effectiveness in treating acute pain. According to De Oliveira and Eipe (2020), the data gathered in their retrospective analysis included demographics, operation type, infusion length, pain ratings, analgesic usage, and side effects. During this time, five hundred forty-four individuals received intravenous lidocaine, and three hundred ninety-four were included in the final study (De Oliveira & Eipe, 2020). Intravenous lidocaine was found to minimize pain and analgesic needs in gastrointestinal, spinal, trauma, and vascular surgery patients. In the acute postoperative phase, intravenous lidocaine is also an excellent rescue analgesic strategy (De Oliveira & Eipe, 2020). Consequently, postoperative intravenous opioid usage was reduced more in opioid-naive patients than in opioid-dependent individuals. This study, conducted at a single facility with an APS policy for intravenous lidocaine in the postoperative phase, reveals the advantages.
Opioid use after surgery can lead to opioid dependency and tolerance, both of which have been recognized as risk factors for developing persistent postsurgical pain. De Oliveira and Eipe (2020) inform that all of these adverse effects, together with the rising prevalence of opioid misuse and diversion, have accelerated the transition in postoperative pain treatment away from opioids. Ongoing studies identify patients and procedures where non-opioid analgesic adjuvants, such as lidocaine, are being explored and exhibiting promising effects (De Oliveira & Eipe, 2020). Intravenous lidocaine can treat acute postoperative pain in a wide range of individuals, procedures, and clinical situations.
References
Bateman, J. T., Saunders, S. E., & Levitt, E. S. (2021). Understanding and countering opioid‐induced respiratory depression. British Journal of Pharmacology. Web.
Beaussier, M., Delbos, A., Maurice-Szamburski, A., Ecoffey, C., & Mercadal, L. (2018). Perioperative use of intravenous lidocaine. Drugs, 78(12), 1229–1246. Web.
De Oliveira, K., & Eipe, N. (2020). Intravenous lidocaine for acute pain: A single-institution retrospective study. Drugs – Real World Outcomes, 7, 205-212. Web.
Good, M. (1998). A middle-range theory of acute pain management: use in research. Nursing Outlook, 46(3), 120-124. Web.
Li, J., Wang, G., Xu, W., Ding, M., & Yu, W. (2018). Efficacy of intravenous lidocaine on pain relief in patients undergoing laparoscopic cholecystectomy: A meta-analysis from randomized controlled trials. International Journal of Surgery, 50, 137–145. Web.
Paul, A. K., Smith, C. M., Rahmatullah, M., Nissapatorn, V., Wilairatana, P., Spetea, M., Gueven, N., & Dietis, N. (2021). Opioid analgesia and opioid-induced adverse effects: A review. Pharmaceuticals, 14(11), 1-22. Web.
Steele, J., Spencer, R., Emery, S., & Pereira, K. (2022). Evaluation of an opioid-free anesthesia protocol for elective abdominal surgery in a community hospital. AANA Journal, 90(3), 215–223. Web.