Efficacy of Intraoperative Intravenous Lidocaine Infusion for Postoperative Quality of Recovery in Laparoscopic Gynecological Surgery: a Triple-Blind, Randomized Controlled Trial

Abstract

Objective: To evaluate whether intraoperative continuous intravenous lidocaine infusion improves postoperative quality of recovery, pain, and opioid consumption in patients undergoing elective laparoscopic gynecological surgery. Materials and methods: This prospective, triple-blind, randomized controlled trial enrolled patients aged 18-65 yr undergoing elective laparoscopic benign gynecologic surgery. Patients were randomized to receive either lidocaine 1.5 mg/kg intravenous bolus followed by continuous infusion at 1.5 mg/kg/h until the end of surgery, or an equivalent volume of normal saline. The primary outcome was quality of recovery assessed by the Thai QoR-35 questionnaire at 24 h postoperatively. Secondary outcomes included pain scores in the post-anesthesia care unit and at 4, 8, 12, and 24 h, incidence of severe pain, total morphine consumption within 24 h, ondansetron doses, and Ramsay sedation scores. Results: Sixty-three patients completed the study. Baseline characteristics were comparable between groups. The mean QoR-35 score in the lidocaine group was 162.68 ± 8.43 versus 160.38 ± 7.60 in the saline group (P = 0.259). Pain scores, morphine consumption, and antiemetic requirements did not differ significantly. However, the incidence of severe pain was lower in the saline group than in the lidocaine group (16.1% vs. 43.8%; P = 0.035). No differences were observed in sedation scores Conclusion: Perioperative intravenous lidocaine infusion did not significantly improve postoperative quality of recovery, pain scores, and opioid consumption, but was associated with a reduced incidence of severe pain.