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A Comparative Study of Effect of Intravenous Lidocaine Infusion, Gabapentin and Their Combination on Postoperative Analgesia after Thyroid Surgery

DOI: 10.4236/ojanes.2017.79030, PP. 296-314

Keywords: Lidocaine, Gabapentin, Thyroidectomy, Analgesia

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Objective: This prospective randomized study aimed to evaluate the effect of IV lidocaine infusion or gabapentin and their combination in providing efficient analgesia after thyroid surgery. Methods: Eighty-eight patients scheduled for thyroidectomy were randomized into four equal groups (n = 22). Group P (placebo) patients received placebo capsules 1 h preoperatively and intravenous (IV) saline infusion. Group L (Lidocaine): patients received placebo capsules 1 h preoperatively and IV bolus lidocaine 1.0 mg/kg followed by infusion 2 mg/kg/h. Group G (Gabapentin) patients received 600 mg gabapentin capsules 1 h preoperatively and IV saline infusion. Group LG (Lidocaine-Gabapentin) patients received 600 mg gabapentin capsules 1 h preoperatively and IV bolus of 1.0 mg/kg lidocaine followed by infusion 2 mg/kg/h. (lidocaine or saline infusion started before induction of anesthesia and continued until the end of surgery). Intraoperative fentanyl consumption and hemodynamic changes were recorded. Postoperative total tramadol consumption, time to first analgesic request, visual analog scale (VAS) of pain, sedation level, and side effects were assessed for 24 hours. Results: (LG) group had significant lower intraoperative fentanyl and lower postoperative tramadol consumption (p < 0.001) compared to (P), (L) and (G) groups, with prolonged time of first analgesic request (p < 0.001) compared to (P) and (L) groups, and lower VAS compared to other groups (p < 0.001 or p < 0.01). There was significantly lower postoperative nausea and vomiting (PONV) in G & LG groups compared to (P) group (p < 0.01). Conclusion: The combination of preoperative gabapentin and intraoperative lidocaine infusion provided more analgesic effect than either drug alone with lower and more delayed postoperative analgesic requirements and lower VAS. (PONV) was lower in groups received gabapentin.


[1]  Kalmovich, L.M., Cote, V., Sands, N., Black, M., Payne, R. and Hier, M. (2010) Thyroidectomy Exactly How Painful Is It? Journal of Otolaryngology - Head & Neck Surgery, 39, 277-283.
[2]  Rutledge, J., Siegel, E, Belcher, R., Bodenner, D. and Stack, B.C. (2014) Barriers to Same-Day Discharge of Patients Undergoing Total and Completion Thyroidectomy. Otolaryngology-Head and Neck Surgery, 150, 770-774.
[3]  Singh, M. (2003) Stress Response and Anesthesia Altering the Peri and Post-Operative Management. Indian Journal of Anaesthesia, 47, 427-434.
[4]  Fourcade, O., Sanchez, P., Kern, D., Mazoit, J.X., Minville, V. and Samii, K. (2005) Propacetamol and Ketoprofen after Thyroidectomy. European Journal of Anaesthesiology, 22, 373-377.
[5]  Mathiesen, O., Wetterslev, J., Kontinen, V.K., Pommergaard, H.C., Nikolajsen, L., Rosenberg, J., et al. (2014) Adverse Perioperative Paracetamol, NSAIDs, Glucocorticoids, Gabapentinoids and Their Combinations: A Topical Review. Acta Anaesthesiologica Scandinavica, 58, 1182-1198.
[6]  Motamed, C., Merle, J.C., Yakhou, L., Combes, X., Vodinh, J., Kouyoumoudjian, C., et al. (2006) Postoperative Pain Scores and Analgesic Requirements after Thyroid Surgery: Comparison of Three Intraoperative Opioid Regimens. International Journal of Medical Sciences, 3, 11-13.
[7]  Porreca, F. and Ossipov, M.H. (2009) Nausea and Vomiting Side Effects with Opioid Analgesics during Treatment of Chronic Pain: Mechanisms, Implications, and Management Options. Pain Medicine, 10, 654-662.
[8]  White, P.F. (2005) The Changing Role of Non Opioid-Analgesic Techniques in the Management of Postoperative Pain. Anesthesia & Analgesia, 101, S5-S22.
[9]  Ziemann-Gimmel, P., Hensel, P., Koppman, J. and Robert, M. (2013) Multimodal Analgesia Reduces Narcotic Requirements and Antiemetic Rescue Medication in Laparoscopic Roux-en-Y Gastric Bypass Surgery. Surgery for Obesity and Related Diseases, 9, 975-980.
[10]  Hollman, M. and Durieux, M.E. (2000) Local Anesthetics and the Inflammatory Response: A New Therapeutic Indication? Anesthesiology, 93, 858-875.
[11]  Hollmann, M.W., Strumper, D., Herroeder, S. and Durieux, M. (2005) Receptors, G Proteins, and Their Interactions. Anesthesiology, 103, 1066-1078.
[12]  Sugimoto, M., Uchida, I. and Mashimo, T. (2003) Local Anaesthetics Have Different Mechanisms and Sites of Action at the Recombinant N-Methyl-D-Aspartate (NMDA) Receptors. British Journal of Pharmacology, 138, 876-882.
[13]  Yardeni, I.Z., Beilin, B., Mayburd, E., Levinson, Y. and Bessler, H. (2009) The Effect of Perioperative Intravenous Lidocaine on Postoperative Pain and Immune Function. Anesthesia & Analgesia, 109, 1464-1469.
[14]  Lauwick, S., Kim do, J., Michelagnoli, G., Mistralett, G., Feldman, L., Fried, G., et al. (2008) Intraoperative Infusion of Lidocaine Reduces Postoperative Fentanyl Requirements in Patients Undergoing Laparoscopic Cholecystectomy. Canadian Journal of Anesthesia, 55, 754-760.
[15]  McKay, A., Gottschalk, A., Ploppa, A., Durieux, M. and Groves, D. (2009) Systemic Lidocaine Decreased the Perioperative Opioid Analgesic Requirements But Failed to Reduce Discharge Time after Ambulatory Surgery. Anesthesia & Analgesia, 109, 1805-1808.
[16]  Kuo, C.P., Jao, S.W., Chen, K.M., Wong, C.S., Yeh, C.C., Sheen, M.J., et al. (2006) Comparison of the Effects of Thoracic Epidural Analgesia and i.v. Infusion with Lidocaine on Cytokine Response, Postoperative Pain and Bowel Function in Patients Undergoing Colonic Surgery. British Journal of Anaesthesia, 97, 640-646.
[17]  Maneuf, Y.P., Gonzalez, M.I., Sutton, K.S., Chung, F.Z., Pinnock, R.D. and Lee, K. (2003) Cellular and Molecular Action of the Putative GABA-Mimetic, Gabapentin. Cellular and Molecular Life Sciences, 60, 742-750.
[18]  Backonja, M., Beydoun, A., Edwards, K.R., Schwartz, S.L., Fonseca, V., Hes, M., et al. (1998) Gabapentin for the Symptomatic Treatment of Painful Neuropathy in Patients with Diabetes Mellitus: A Randomized Controlled Trial. JAMA, 280, 1831-1836.
[19]  Rowbotham, M., Harden, N., Stacey, B., Bernstein, P. and Magnus-Miller, L. (1998) Gabapentin for the Treatment of Postherpetic Neuralgia: A Randomized Controlled Trial. JAMA, 280, 1837-1842.
[20]  Eckhardt, K., Ammon, S., Hofmann, U., Riebe, A., Gugeler, N. and Mikus, G. (2000) Gabapentin Enhances the Analgesic Effect of Morphine in Healthy Volunteers. Anesthesia & Analgesia, 91, 185-191.
[21]  Hurley, R.W., Cohen, S.P., Williams, K.A., Rowlingson, A.J., Wu, C.L. (2006) The Analgesic Effects of Perioperative Gabapentin on Postoperative Pain: A Meta-Analysis. Regional Anesthesia and Pain Medicine, 31, 237-247.
[22]  Mathiesen, O., Moiniche, S. and Dahl, J.B. (2007) Gabapentin and Postoperative Pain: A Qualitative and Quantitative Systematic Review with Focus on Procedure. BMC Anesthesiology, 7, 7-16.
[23]  Saadawy, I.M., Kaki, A.M., Abd El Latif, A.A., Abd-Elmaksoud, A.M. and Tolba, O.M. (2010) Lidocaine vs. Magnesium: Effect on Analgesia after a Laparoscopic Cholecystectomy. Acta Anaesthesiologica Scandinavica, 54, 549-556.
[24]  Al-Mujadi, H., A-Refai, A.R., Katzarov, M.G., Dehrab, N.A., Batra, Y.K. and Al-Qattan, A.R. (2006) Preemptive Gabapentin Reduces Postoperative Pain and Opioid Demand Following Thyroid Surgery. Canadian Journal of Anesthesia, 53, 268-273.
[25]  Ventham, N.T., Kennedy, E.D., Brady, R.R., Paterson, H.M., Speake, D., Foo, I., et al. (2015) Efficacy of Intravenous Lidocaine for Postoperative Analgesia Following Laparoscopic Surgery: A Meta-Analysis. World Journal of Surgery, 39, 2220-2234.
[26]  Koppert, W., Weigand, M., Neumann, F., Sittl, R., Schuettler, J., Schmelz, M., et al. (2004) Perioperative intravenous Lidocaine Has Preventive Effects on Postoperative Pain and Morphine Consumption after Major Abdominal Surgery. Anesthesia & Analgesia, 98, 1050-1055.
[27]  Dahl, J.B., Mathiesen, O. and Moiniche, S. (2004) ‘Protective Premedication’: An Option with Gabapentin and Related Drugs? A Review of Gabapentin and Pregabalin in the Treatment of Post-Operative Pain. Acta Anaesthesiologica Scandinavica, 48, 1130-1136.
[28]  Wu, C.T., Borel, C.O., Lee, M.S., Yu, J.C., Liou, H.S., Yi, H.D., et al. (2005) The Interaction Effect of Perioperative Co-Treatment with Dextromethorphan and Intravenous Lidocaine on Pain Relief and Recovery of Bowel Function after Laparoscopic Cholecystectomy. Anesthesia & Analgesia, 100, 448-453.
[29]  Kaba, A., Laurent, S.R., Detroz, B.J., Sessler, D.I., Durieux, M.E., Lamy, M.L., et al. (2007) Intravenous Lidocaine Infusion Facilitates Rehabilitation after Laparoscopic Colectomy. Anesthesiology, 106, 11-18.
[30]  Farag, E., Ghobrial, M., Sessler, D.I., Dalton, J.E., Liu, J., Lee, J.H., et al. (2013) Effect of Perioperative Intravenous Lidocaine Administration on Pain, Opioid Consumption, and Quality of Life after Complex Spine Surgery. Anesthesiology, 119, 932-940.
[31]  Martin, F., Cherif, K., Gentili, M.E., Enel, D., Abe, E., Alvarez, J.C., et al. (2008) Lack of Impact of Intravenous Lidocaine on Analgesia, Functional Recovery, and Nociceptive Pain Threshold after Total Hip Arthroplasty. Anesthesiology, 109, 118-123.
[32]  De Oliveira, C.M.B., Sakata, R.K., Slullitel, A., Salomão, R., Lanchote, V.L. and Issy, AM. (2015) Effect of Intraoperative Intravenous Lidocaine on Pain and Plasma Interleukin-6 in Patients Undergoing Hysterectomy. Brazilian Journal of Anesthesiology, 65, 92-98.
[33]  Bryson, G.L., Charapov, I., Krolczyk, G., Taljaard, M. and Reid, D. (2010) Intravenous Lidocaine Does Not Reduce Length of Hospital Stay Following Abdominal Hysterectomy. Canadian Journal of Anesthesia, 57, 759-766.
[34]  Menezes, C., Luciana, C.L., Lee, M.C. and Marcelo, M.V. (2015) Intravenous Lidocaine for Postmastectomy Pain Treatment; Randomized Blind Placebo Controlled Clinical Trial. Brazilian Journal of Anesthesiology, 65, 207-212.
[35]  Grigoras, A., Lee, P., Sattar, F. and Shorten, G. (2012) Perioperative Intravenous Lidocaine Decreases the Incidence of Persistent Pain after Breast Surgery. The Clinical Journal of Pain, 28, 567-572.
[36]  Mikkelsen, S., Hilsted, K.L., Andersen, P.J., Hjortso, N.C., Enggaard, T.P., Jorgensen, D.G., et al. (2006) The Effect of Gabapentin on Post-Operative Pain Following Tonsillectomy in Adults. Acta Anaesthesiologica Scandinavica, 50, 809-815.
[37]  Jeon, E.J., Park, Y.S., Park, S.S., Lee, S.K. and Kim, D.H. (2009) The Effectiveness of Gabapentin on Post-Tonsillectomy Pain Control. European Archives of Oto-Rhino-Laryngology, 266, 1605-1609.
[38]  Sen, H., Sizlan, A., Yanarates, O., Emirkadi, H., Ozkan, S., Dagli, G. and Turan, A. (2009) A Comparison of Gabapentin and Ketamine in Acute and Chronic Pain after Hysterectomy. Anesthesia & Analgesia, 109, 1645-1650.
[39]  Turan, A., Karamanlioglu, B., Memis, D., Usar, P., Pamukçu, Z. and Türe, M. (2004) The Analgesic Effects of Gabapentin after Total Abdominal Hysterectomy. Anesthesia & Analgesia, 98, 1370-1373.
[40]  Pandey, C.K., Priye, S., Singh, S., Singh, U., Singh, R.B. and Singh, P.K (2004) Preemptive Use of Gabapentin Significantly Decreases Postoperative Pain and Rescue Analgesic Requirements in Laparoscopic Cholecystectomy. Canadian Journal of Anesthesia, 51, 358-363.
[41]  Moore, A., Costello, J., Wieczorek, P., Shah, V., Taddio, A. and Carvalho, J.C. (2011) Gabapentin Improves Postcesarean Delivery Pain Management: A Randomized, Placebo-Controlled Trial. Anesthesia & Analgesia, 112, 167-173.
[42]  Menigaux, C., Adam, F., Guignard, B., Sessler, D.I. and Chauvin, M. (2005) Preoperative Gabapentin Decreases Anxiety and Improves Early Functional Recovery from Knee Surgery. Anesthesia & Analgesia, 100, 1394-1399.
[43]  Pandey, C.K., Sahay, S., Gupta, D., Ambesh, S.P., Singh, R.B., Raza Raza, M., et al. (2004) Preemptive Gabapentin Decreases Postoperative Pain after Lumbar Discoidectomy. Canadian Journal of Anesthesia, 51, 986-989.
[44]  Bartholdy, J., Hilsted, K.L., Hjortsoe, N.C., Engbaek, J. and Dahi, J. (2006) Effect of Gabapentin on Morphine Demand and Pain after Laparoscopic Sterilization Using Filshie Clips. A Double Blind Randomized Clinical Trial. BMC Anesthesiology, 6, 12.
[45]  Short, J., Downey, K., Bernstein, P., Shah, V. and Carvalho, J. (2012) A Single Preoperative Dose of Gabapentin Does Not Improve Postcesarean Delivery Pain Management: A Randomized, Double-Blind, Placebo-Controlled Dose-Finding Trial. Anesthesia & Analgesia, 115, 1336-1342.
[46]  Gauger, P.G., Shanks, A., Morris, M., Greenfield, M.L., Burney, R.E. and O’Reilly, M. (2008) Propofol Decreases Early Postoperative Nausea and Vomiting in Patients Undergoing Thyroid and Parathyroid Operations. World Journal of Surgery, 32, 1525-1534.
[47]  Pandey, C., Priye, S., Ambesh, S., Singh, S., Singh, U. and Singh, P. (2006) Prophylactic Gabapentin for Prevention of Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopic Cholecystectomy: A Randomized, Double-Blind, Placebo-Controlled Study. Journal of Postgraduate Medicine, 52, 97-100.
[48]  Achuthan, S., Singh, I., Varthya, S.B., Srinivasan, A., Chakrabarti, A. and Hota, D. (2015) Gabapentin Prophylaxis for Postoperative Nausea and Vomiting in Abdominal Surgeries: A Quantitative Analysis of Evidence from Randomized Controlled Clinical Trials. British Journal of Anaesthesia, 114, 588-597.
[49]  Ghai, A., Gupta, M., Hooda, M., Singla, D. and Wadhera, R. (2011) A Randomized Controlled Trial to Compare Pregabalin with Gabapentin for Postoperative Pain in Abdominal Hysterectomy. Saudi Journal of Anaesthesia, 5, 252-257.


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