Intravenous lidocaine in the prevention of postoperative ileus

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Postoperative ileus (POI) is a common sequelae of abdominal surgery and is characterised by a period of gastrointestinal dysmotility. Common symptoms include nausea, vomiting, inability to tolerate oral diet and inability to pass flatus or stool. Patients with POI commonly have abdominal distension, they may require nasogastric tube (NGT) insertion to relieve gastric distension. POI interferes with patient mobility post operatively and evidence suggests that more than 50% of patients who develop POI will also develop further complications, significantly increasing their postoperative length of stay and mortality. POI is a common condition, a recent series at Auckland City Hospital identified 26.9% of patients as having prolonged postoperative ileus. This is an issue which places a significant burden on healthcare resources and spending; a recent study estimates an annual economic burden of over $1.4 billion in the United States alone. The exact mechanism of POI is unclear, however important factors in its development include use of pharmacological agents (particularly opiates), neural mechanisms, and intestinal inflammation. Anti-inflammatory drugs such as COX-2 inhibitors have shown some effect in animal and human models in preventing and reducing the duration of POI. Lidocaine is a local anaesthetic medication. Similar local anaesthetic medications are routinely used in elective surgery for analgesia via epidural or local infiltration. There is evidence that epidural local anaesthetic is effective in the prevention of POI. It has recently been suggested that the clinical effect is due to systemic absorption of the local anaesthetic, studies have shown that intravenously administered local anaesthetic is effective at reducing rates of POI. The mechanism of action may be due to reduced opiate consumption post operatively due to the analgesic effect of lidocaine, however studies have shown a significant attenuation of the post-surgical inflammatory response following administration of parenteral lidocaine, and this may also contribute to its’ effect. This study aims to assess the duration of POI following the administration of parenteral lidocaine intraoperatively and up to 2 hours post operatively, compared to placebo. Primary end points will include, time to resolution of POI as defined by established criteria. Secondary end points will include pain scores, markers of systemic inflammation, complication rates and length of hospital stay.

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