Anesthetic management and post-operative anesthesia for patients who underwent extended liver resection: the role of intravenous lidocaine

Abstract

Aim. To examine effectiveness of intraoperative lidocaine administration in the intraoperative period as a component of combined anesthesia and in the early postoperative period in patients after extended liver resection. Materials and methods. There were 86 patients with various pathologies enrolled after hepatic resection with 30–60 % of parenchymal preservation. The patients were divided into three groups depending on the complex anesthesia used. The control group (ІІІ) consisted of 10 patients who received standard complex anesthesia and pain management including opioid and non-opioid analgesics in the post-operative period. The main group (ІІ) comprised 9 patients who received the method developed, and there was the additional comparison group (І) composed of 67 patients who received standard complex anesthesia with thoracic epidural anesthesia (TEA). Results. Having elaborated the fentanyl mean cumulation dose during the operation, we herewith declare that patients of group I received in general 1005.2 ± 417.8 µgr, group II – 1771.1 ± 735.5 µgr and III group – 2090.0 ± 636.7 µgr of fentanyl. When detailing and comparing the groups with each other, we see significantly lower usage of fentanyl intraoperatively in TEA group in comparison to both other groups (I vs II, 76 % greater need in group II, and I vs III, 108 % greater need in group ІІI). At the same time, the difference in the need for intraoperative fentanyl between patients of the intravenous lidocaine group and the control group was only 18 % – there was a tendency to a decrease in the dose when using intravenous lidocaine. Based on the data comparison results between groups, it could be asserted that between patients of groups I and II, the difference in the VAS score on day one after surgery was only 10 %. On the first day postoperatively, patients in group I noted maximum daily value of 4.5 ± 2.0 points on the VAS scale, in group II – 5.0 ± 2.3 and in group III – 7.6 ± 1.0 points. In contrast, there was a significantly higher level of pain in group III patients compared to both groups I and II. The intergroup difference in the time of the first dose of analgesics administration after surgery was insignificant: in group I – after 313.5 ± 128.9 minutes, in group II – 287.7 ± 101.6 minutes, and in group III – 217.0 ± 120.3 minutes. The provided data confirm the efficacy of the pain management method in patients after hepatic resection. Conclusions. Both the use of TEA and intravenous lidocaine are safe methods of pain management in patients after liver resection. In the postoperative period, intravenous use of lidocaine is not inferior in its effectiveness to TEA and can be recommended for use. TEA has a greater efficiency in intraoperative analgesia, however, if it is contraindicated for administration, intraoperative use of lidocaine is a potentially effective alternative. Further studies in a larger group of patients are needed to confirm or disprove this trend.

Keywords

• anesthesia
• lidocaine
• intravenous administration
• extended liver resection
• pain syndrome