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Ist eine intravenöse Lidocaininfusion zur Therapie postoperativer Schmerzen geeignet?

Is intravenous lidocaine infusion suitable for postoperative pain management?

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Abstract

Intravenous administration of local anaesthetics has repeatedly been recommended for the treatment of chronic pain. Some authors have also reported on their use in postoperative pain management. However, most of these publications are case reports or refer to rather old studies or investigations based on study designs that fail to meet present scientific standards. We therefore performed a randomized prospective, double-blind study in 40 patients undergoing elective tonsillectomy, 20 of whom received an infusion of lidocaine at a dose of 1.5 mg/kg body weight (over 10 min) 30 min before the beginning of surgery, followed by 2 mg/kg body weight per h over 6 h and 0.5 mg/kg body weight per h for another 18 h. The patients in the control group received identical volumes of 0.9% NaCl solution. Mean lidocaine plasma concentrations determined 30 min and 3, 6, and 24 h after the beginning of surgery ranged between 2.29 and 0.58 μg/ml. Postoperative pain evaluation on the visual analogue scale and the 101-point numerical rating scale did not reveal,significantly lower pain scores in the lidocaine group than in the control group. During the first 24 h after surgery 12 patients in the lidocaine group required a total of 550 mg meperidine in addition, while 8 patients in the control group required a total of 300 mg meperidine. The postoperative meperidine consumption was not significantly diffent between the lidocaine group and the control group. Intravenous lidocaine infusion did not significantly reduce postoperative pain after tonsillectomy in the dosage used.

Zusammenfassung

In einer randomisierten, prospektiven Doppelblindstudie wurden 40 Patientenuntersucht, die sich einer elektiven Tonsillektomie unterziehen mußten. Bei den 20 Patienten der Lidocaingruppe wurden 30 min or Operationsbeginn über einen Zeitraum von 10 min 1,5 mg Lidocain/kg KG infundiert. Anschließend wurden über 6 h 2 mg/kg KG·h und danach über weitere 18 h 0,5 mg Lidocain/kg KG·h infundiert. Die, Kontrollgruppe erhielt entsprechende Volumina an 0,9% iger NaCl-Lösung. Die 30 min sowie 3, 6 und 24 h nach Operationsbeginn bestimmten Lidocainplasmaspiegel lagen im Mittel zwischen 2,29 und 0,58 μg/ml. Weder bei der postoperativen Schmerzevaluation mittels visueller Analogskala noch mittels numerischer 101-Schätzskala konnte eine signifikant niedrigere Schmerzintensität in der Lidocaingruppe nachgewiesen werden. Bei 12 Patienten der Lidocaingruppe wurden postoperativ zusätzliche Pethidingaben von insgesamt 550 mg notwendig. In der Kontrollgruppe mußten bei 8 Patienten zusätzlich insgesamt 300 mg Pethidin, verabreicht werden. Bezüglich des Pethidinbedarfs bestand kein statistisch signifikanter Gruppenunterschied. Mittels intravenöser Lidocaininfusion konnte nach Tonsillektomien in der verabreichten Dosierung keine signifikante Reduktion der postoperativen Schmerzintensität nachgewiesen werden.

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Striebel, H.W., Klettke, U. Ist eine intravenöse Lidocaininfusion zur Therapie postoperativer Schmerzen geeignet?. Schmerz 6, 245–250 (1992). https://doi.org/10.1007/BF02527813

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