Authors: Vin Shen Ban, MD; Matthew MacAllister, MD; Jia Romito, MD; James Caruso, MD; Babu Welch, MD; Vishal Patel, MD; David McDonagh, MD; Tarek El Ahmadieh, MD; H. Hunt Batjer, MD; Salah Aoun, MD (Dallas, TX)

Introduction:

Opioid abuse is a crisis in the United States. Opportunities exist in the perioperative period for alternative modes of analgesia to minimize opioid utilization. The aim of this study is to explore the use of lidocaine infusions in the setting of cranial surgery, with a focus on feasibility and safety.

Methods:

Patients who received a lidocaine infusion associated with cranial surgery between 2015 and 2017 were identified through an electronic health record search. Postoperative opioid pain medication consumption in the first and second days were converted into oral morphine milligram equivalents (MME). Non-parametric distributions were compared with the Mann-Whitney U or Wilcoxon signed-rank tests as appropriate.

Results:

A total of 55 eligible patients were identified (69.1% female, median age 47, median BMI 30.4). The average length of stay was 4.7 days, with an average ICU length of stay of 1.5 days. The median lidocaine infusion time was 17 hours (IQR: 13-22) in the intraoperative +/- immediate postoperative period, with a median cumulative dosage of 1084 mg (IQR: 785-1703). In the first postoperative day, a median of 60 morphine milligram equivalent (IQR: 34.5-85) was consumed. This declined to 36.5 MME (IQR: 16-70) by the second day (p=0.016).

There was no difference in the lidocaine infusion duration, total dose, MME at 24 or 48 hours between the sexes or smoking status. No correlation was found between BMI and MME at 24 or 48 hours. Preoperative opioid use was associated with a higher MME in the second (70.0 v 30.5, p = 0.009) but not the first (64.0 v 54.8, p = 0.124) postoperative day. No adverse events or complications related to the lidocaine infusion were identified.

Conclusion:

Lidocaine infusions appear to be a promising and safe adjunct in perioperative analgesia for cranial surgery. Future steps include prospective randomized controlled trials.