Effect of adding metoclopramide to lidocaine on post-surgery pain in lower abdominal operations.

Background: Effective postoperative pain management remains a critical challenge, particularly in lower abdominal surgeries where multimodal approaches are underexplored. This study aimed to evaluating the efficacy of this combination in reducing pain and analgesic requirements.

Methods: In this double-blind, randomized controlled trial, 59 patients undergoing elective lower abdominal surgery were randomly assigned to receive either subcutaneous metoclopramide plus lidocaine or lidocaine alone after surgery. Postoperative pain scores were assessed at 1, 6, 12, and 24 hours using the Visual Analog Scale (VAS), and analgesic consumption was recorded over the first 24 hours.

Results: 59 patients (mean age: 41.8 ± 11.8 years; 43.1% male, 56.9% female) receiving the metoclopramide-lidocaine combination demonstrated significantly lower pain scores at all assessed time points compared to lidocaine alone, with values of 5.2 ± 1.1 versus 7.7 ± 0.8 at 1 hour, 3.8 ± 0.9 versus 6.2 ± 0.9 at 6 hours (p = 0.004), 2.9 ± 1.0 versus 5.4 ± 1.4 at 12 hours, and 2.1 ± 0.7 versus 4.4 ± 1.1 at 24 hours postoperatively (p < 0.001). Furthermore, the combination group showed a 28.6% reduction in analgesic requirements during the first 24 hours (47.4 ± 18.1 mg vs 66.3 ± 25.2 mg, p = 0.002), highlighting the opioid-sparing effect of this approach.

Conclusion: The addition of metoclopramide to subcutaneous lidocaine resulted in improved postoperative pain control and reduced analgesic requirements following lower abdominal surgeries under general anesthesia.

Clinical trial registration: Iranian Registry of Clinical Trials identifier is IRCT20231228060548N1.