Effect of intra operative intravenous lidocaine infusion on control of pain and recovery of Intestinal function following surgical appendectomy

Abstract

ppendectomy is one of the most common surgical procedures. Conventional (open) appendectomy is one of open abdominal surgery which associated with post-operative pain, nausea, ileus, and prolonged hospital stay. So, a multimodal analgesia regimen is recommended in the perioperative setting as it provides superior analgesia and reduces opioid requirement. IV lidocaine injection is one of multimodal analgesics. It has analgesic, antihyperalgesic, and anti-inflammatory effects through several potential mechanisms. Intravenous lidocaine increases acetylcholine concentration at the spinal level through an activation of both muscarinic and nicotinic receptors, and thereby prolongs the pain threshold. Also, by activating central glycine (an inhibitory neurotransmitter) receptor, systemic lidocaine inhibits glutamate-induced excitatory response on the wide dynamic response in the spinal neurons. The anti-hyperalgesic effect of IV lidocaine is due to blockade of NMDA receptor signaling and it is mediated indirectly by inhibition of the protein kinase C pathway. In addition to this, the anti-infammatory effect caused by the reduction of cytokines such as IL-6, IL-1β and TNFα. In addition, lidocaine infusion include a reduction in the incidence of postoperative nausea and vomiting, early return of bowel motility and improved quality of recovery.