Intravenöse Lidocaingabe als Alternative zur thorakalen Peridualanalgesie bei der postoperativen Schmerztherapie von Patientinnen und Patienten nach größeren abdominalchirurgischen und gynäkologischen Eingriffen

When comparing epidural analgesia with perioperative intravenous lidocaine infusion in combination with a metamizole and piritramide as needed in patients without chronic pain syndrome continuous lidocaine i.v. is an effective, safe and inexpensive therapeutic option. During perioperative lidocaine administration continuous monitoring of electrocardiography, pulse oximetry and noninvasive arterial blood pressure is mandatory. For continuous perioperative lidocaine administration, special skills or abilities as needed for the insertion of an epidural catheter are not required, a 24-hour acute pain service is not mandatory. Patients receiving intravenous lidocaine infusion required additional intravenous opioids, however, this did not have a negative effect on recovery of bowl function and the incidence of adverse effects. It was noted that there was a trend to decrease the incidence of PONV. No serious adverse effects were observed, the occurrence of disorientation or metallic taste were controlled within 2 h by ending the lidocaine application. Continuous lidocaine administration was characterized by a high level of patient satisfaction. In combination with metamizole and piritramide a median pain scorel ≤ 3 out of 10 was achieved. Furthermore, after hospital discharge and three months after surgery only very low pain scores (NRS ≤ 3) were noted, after six months all patients were free of pain. A chronification of postoperative pain was not observed. Full recovery of physical function and the resumption of everyday life took place in the same time interval as in the patients with epidural analgesia. It remains to mention that all patients included in this study were adults and capable ASA I-III patients without chronic pain syndrome or hyperalgesia of other genesis. Further studies are needed to investigate an effective efficiency of perioperative lidocaine administration in patients with opioid habituation or hospitalization due to chronic diseases.