Comparison of intraoperative intravenous lidocaine infusion and transversus abdominis plane block for postoperative analgesia following laparoscopic cholecystectomy: a randomized controlled trial.

Abstract

Background: Laparoscopic cholecystectomy has been associated with moderate to severe intensity pain, especially in the early postoperative period. Among pain modalities, the transversus abdominis plane (TAP) block has favorable results and fewer associated adverse effects. Current evidence also reports that intravenous lidocaine infusion is effective in reducing acute postoperative pain and decreases overall opioid requirement. This study aimed to compare intravenous lidocaine infusion and bilateral subcostal TAP block for postoperative analgesia following laparoscopic cholecystectomy.

Methods: Thirty patients were randomly classified into the control, lidocaine, and TAP block groups. Intravenous lidocaine infusion was used in the lidocaine arm intraoperatively, while bilateral subcostal TAP block was placed in the TAP block arm as an intervention. The primary outcome was 24 h average pain score. Secondary outcomes included rescue analgesic consumption, postoperative nausea and vomiting, and patient satisfaction.

Results: Comparative analysis between groups showed that the 24 h mean pain score on the visual analog scale score was significantly decreased in the lidocaine group than the control group (mean difference with 95% confidence interval [CI], 2.47 (1.94, 3.00); P < 0.001). Furthermore, the mean pain score was significantly decreased in the lidocaine group than in the TAP block group (mean difference with 95% CI, 1.14 (0.56, 1.72); P < 0.001).

Conclusions: Intravenous lidocaine infusion is a superior modality for postoperative pain management in laparoscopic cholecystectomy than TAP block or routine management. Lidocaine also helped decrease rescue analgesic consumption and achieved better patient satisfaction.