Journal of PeriAnesthesia Nursing 38 (2023) 39−44

Contents lists available at ScienceDirect

Journal of PeriAnesthesia Nursing

jo urn a l h om ep ag e: ww w.j o pa n. org

Research

Analgesic Effects and Adverse Reactions of Lidocaine for Patient-

Controlled Intravenous Analgesia on Patients Undergoing Open
Hepatectomy: A Retrospective Analysis
Fei Liu, MDa,y, Liu-Lin Xiong, MDb,y, Ting-Ting Li, MSa,c, Yan-Jun Chen, MSa, Wei Ma, MSa,
Qi-Jun Li, BSd, Qian Li, MDa, Ting-Hua Wang, MD, PhDa,*
a
Department of Anesthesiology, Institute of Neurological Disease, West China Hospital, Sichuan University, Chengdu, China
b
Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
c
Department of Anesthesiology, West China Tianfu Hospital, Sichuan University, Chengdu, China
d
Traditional Chinese Medicine, Southwest Medical University, Sichuan University, Luzhou, China

A B S T R A C T

Keywords: Purpose: The aim of this study was to investigate the effect of lidocaine for patient controlled intravenous
lidocaine analgesia (PCIA) in patients who underwent open hepatectomy.
postoperative analgesia Design: A retrospective analysis.
patient-controlled intravenous analgesia Methods: A total of 281 patients who underwent open hepatectomy from July 2018 to December 2018 were
(PCIA) included. All patients were assigned into two groups: the lidocaine group (PCIA consisted of lidocaine, sufen-
pain
tanil, tramadol and granisetron) and the control group (PCIA consisted of sufentanil, tramadol and granise-
open hepatectomy
tron). The postoperative visual analogue scale (VAS) and complications (including respiratory depression,
hypotension, nausea and vomiting, pruritus, numbness of the corners of the mouth, dizziness) between the
groups were compared.
Findings: There were no significant differences between the characteristics, duration of surgery and anesthe-
sia, and recovery of postoperative activity between the two groups. In the first 3 days after the operation, the
postoperative VAS score of the lidocaine group was lower than that of the control group at resting state,
while after activity, the postoperative VAS contrast results were completely opposite. In particularly, the rest-
ing state at 48 hours (h) (1.05 § 1.25 vs 1.57 § 1.54) after surgery and the activity state at 72 h (3.02 § 1.51 vs
2.2 § 1.66) after surgery (P < 0.05). The incidence of mouth numbness and dizziness were significantly
increased in the lidocaine group (P < 0.05).
Conclusion: The addition of lidocaine in PCIA was not beneficial to improve the pain during activities and
increased the incidence of perioral numbness and dizziness.
© 2022 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

Hepatic carcinoma is one of the most common malignant tumors
with a high incidence in clinical practice. Surgery (such as radical
hepatectomy and palliative treatment) is an important and effective
method for patients to obtain long-term survival. In clinical practice,
75% of patients experience severe pain after open abdominal sur-
gery.1 Inadequate postoperative pain control was associated with
poor clinical outcomes including increased length-of-stay, sleep
Conflict of Interest: None to report.
Funding: This study was supported by Research Grant from the 1.3.5. Project for dis-
ciplines of excellence, West China Hospital, Sichuan University (Zy2016101).
* Address correspondence to Ting-hua Wang, Institute of Neurological Disease, West
China Hospital, Sichuan University, No. 88 Keyuan South Road, Chengdu 610041,
China.
E-mail address: Wangth_email@163.com (T.-H. Wang).
y These authors contributed equally to this paper.
disturbance, prolonged time to first mobilization and increased
opioids use.2 Adequate pain management has been emphasized as a
key to the success of an enhanced recovery after surgery program in
liver resection.3 Effective analgesia can improve the stress response
caused by surgical stimulation.4 It is of great importance to find the
optimal postoperative pain management plan for clinical practice.
Patient-controlled analgesia (PCA) is the most commonly used
method in postoperative analgesia. However, it is controversial
whether patient-controlled epidural analgesia (PCEA) could be rou-
tinely used for postoperative analgesia since patients may have blood
coagulation dysfunction after liver surgery.5 So, patient-controlled
intravenous analgesia (PCIA) is commonly used at present, and the
opioids analgesics such as pethidine, fentanyl or tramadol are
mostly used. But, the use of a long-term opioid after surgery was not
good for patients' health.6 Several studies have highlighted, as an

https://doi.org/10.1016/j.jopan.2022.05.069
1089-9472/© 2022 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.
F. Liu et al.
7 8,9
amide local anesthetic, lidocaine compound on analgesia, anti-
inflammatory,10,11 and anti-tumor12 have attracted more and more
attention. The perioperative systemic lidocaine could assist the man-
agement of postoperative pain by reducing the intensity of postoper-
ative pain, reducing the consumption of opioids, and promoting
gastrointestinal function.13 However, the analgesic effects and safety
of PCIA combined with lidocaine in patients undergoing open hepa-
tectomy still need further research. Therefore, this retrospective anal-
ysis was conducted to evaluate the postoperative analgesia effects of
lidocaine on patients underwent open hepatectomy.
Materials and Methods
Ethics
This study was approved by the Ethics Committee of West China
Hospital, Sichuan University (Approval No.2020518). The data were
anonymous, and the requirement for informed consent was therefore
waived.14 The application for exemption from informed consent was
approved by the ethics committee. This study was conducted in
accordance with the principles of the Declaration of Helsinki.
Patients and Analgesia Strategies
From July to December 2018, a total of 281 patients underwent
open hepatectomy at West China hospital were included into this ret-
rospective study. All these patients satisfied the following inclusion
criteria: (1) age ≥18 years old; (2) American Society of Anesthesiolo-
gists (ASA) physical status classification system: II-III; and (3) patients
who underwent open hepatectomy. Exclusion criteria: (1) patients
with hypertension, diabetes and cognitive dysfunction; (2) postoper-
ative pathological examination revealed distant metastasis; and (3)
patients transferred to intensive care after surgery.
After surgery, all patients were transferred to the postanesthesia
care unit (PACU). PACU care consists of close attention to the changes
of patients' breathing, circulation and consciousness state, dealing
with adverse reactions in time, and instructions to patients on how
to use PCIA correctly. According to the postoperative use of PCIA,
patients were divided into two groups: control group and lidocaine
Figure 1. Characteristics of patients (N = 281). Lidocaine group n = 186; control group n = 95. (A) Number of patients in different genders. (B) Percentage of patients in different genders.
(C) Age of patients (years). (D) Weight of patients (kg). (E) Duration of anesthesia (h). (F) Duration of open hepatectomy (h). This figure is available in color online at www.jopan.org.
40
Journal of PeriAnesthesia Nursing 38 (2023) 39−44
group. The patients in the control group received basic postoperative
PCIA. The basic postoperative PCIA was consisted of sufentanil
200 mcg, tramadol 1000 mg and granisetron 12 mg, which were
diluted to a total of 200 ml. The patients in the lidocaine group
received basic postoperative PCIA combined with lidocaine (lidocaine
32 mg/kg, sufentanil 200 mcg, tramadol 1000 mg and granisetron
12 mg, which were diluted to a total of 200 ml). The background dose
was 2 ml/h, and the additional dose was 0.5 ml/15 min. When PCIA
effect was not satisfactory, patients were given other analgesics (such
as dezocine) for rescue analgesia. Unsatisfactory PCIA effect refers to
the fact that the visual analogue scale (VAS) score (a range from 0 to
10) was still greater than 3 after 10 § 3 minutes of additional dose
analgesia through PCIA.
Data Collection
All data were collected from the hospital information system. The
information collected included: (1) characteristics of patient, includ-
ing sex, age, weight, duration of surgery and anesthesia; (2) VAS
score at 24 hours (h) (primary outcome), 48 h and 72 h after surgery;
(3) incidence of complications on days 1, 2 and 3 after surgery,
including respiratory depression (respiratory frequency was lower
than 8 breaths/min), hypotension (systolic blood pressure < 90
mmHg and diastolic blood pressure < 60 mmHg), nausea and vomit-
ing, pruritus, dizziness and numbness of the corners of the mouth;
(4) use of postoperative rescue analgesia; and (5) time from the end
of the operation to the first bowel movement (or flatus when speak-
ing of gas), ambulation, and discharge from hospital.
Statistical Analysis
Based on the purpose of this study and the primary outcome (VAS
scores at 24 h after surgery), we calculated the sample size from the
initial 40 samples collected. Based on the initial included cases, the
VAS scores at 24 h after surgery were as follows: the resting state:
2.00 § 1.95 (lidocaine group) vs 2.90 § 2.25 (control group); the
movement states: 5.60 § 1.43 (lidocaine group) vs 4.85 § 2.21 (con-
trol group). For 80% power and a type I error rate of 5%, each group
required a minimum of 92 participants.15,16 Statistical analysis was
F. Liu et al. Journal of PeriAnesthesia Nursing 38 (2023) 39−44

Table 1
The Characteristics of Patients (N = 281)

Characteristics Lidocaine Group, n = 186 Control Group, n = 95 P value

Gender, n (%) 0.711

Female 49 (26.3%) 27 (28.4%)
Male 137 (73.7%) 68 (71.6%)
Age, years 52.91 § 11.9 49.94 § 12.9 0.055
Weight, kg 63.86 § 12.30 61.62 § 10.1 0.127
Anesthesia time, h 281.49 § 87.82 280.40 § 86.25 0.922
Duration of surgery, h 209.44 § 80.47 210.26 § 75.81 0.935
Lidocaine group, patient-controlled intravenous analgesia (PCIA) with lidocaine; Control group, PCIA without lidocaine; h, hours.
Data are shown as mean § SD (independent sample t test) or the numbers of patients and percentages (x2 test).

performed with SPSS version 21.0. The continuous data was analyzed Postoperative Analgesia Effect
by t test and expressed as mean § standard deviation. The categorical
data was measured by x2 test and expressed as number with per- In the first 3 days after surgery, postoperative VAS score of the lido-
centage. P < 0.05 was considered as statistically significant. caine group was lower than that of the control group at the resting state
(24 h: 1.94 § 1.78 vs 2.36 § 1.82, P = 0.064. 48 h: 1.05 § 1.25 vs 1.57 §
1.54, P = 0.005. 72 h: 0.98 § 1.16 vs 1.22 § 1.28, P = 0.132). But after the
Findings
activity, the postoperative VAS contrast results were completely oppo-
site (24 h: 4.16 § 2.03 vs 3.75 § 1.99, P = 0.111. 48 h: 3.20 § 1.62 vs 2.91
Patients who underwent open hepatectomy at West China hospi-
§ 1.98, P = 0.064. 72 h: 3.20 § 1.62 vs 2.20 § 1.66, P < 0.001). In particu-
tal, Sichuan University between July and December 2018 were
lar, the resting state at 48 h after surgery and the activity state at 72 h
included in this study. Through the inclusion and exclusion criteria,
after surgery (Figure 2A and Table 2A). The proportion of patients in the
we identified 281 patients underwent gastrointestinal surgery,
two groups using rescue analgesics within 3 days after surgery was
66.19% of whom (n = 186) received PCIA with lidocaine (lidocaine
2.1% (2/95) and 3.8% (7/186) respectively, and the difference was not
group), and 33.81% of whom (n = 95) received PCIA without lidocaine
statistically significant (P = 0.455).
(control group).

Characteristics of Patients Postoperative Complications Associated With Analgesics

There were no significant differences were observed in gender
(Figure 1A-B, P = 0.711), age (Figure 1C, P = 0.055), weight (Figure 1D,
P = 0.127), time of anesthesia (Figure 1E, P = 0.922), and duration of
surgery (Figure 1F, P = 0.935) between the lidocaine group and con-
trol group (Table 1).
There were no statistically significant differences in the incidence
of postoperative nausea and vomiting (24 h: P = 0.362. 48 h: P =
0.541. 72 h: P = 0.824), respiratory depression (24 h: P = 0.708. 48 h:
P = 0.213. 72 h: P = 0.310), pruritus (24 h: P = 0.065. 48 h: P = 0.085.
72 h: P = 0.085), and hypotension (24 h: P = 0.077. 48 h: P = 0.72 h:

Figure 2. Postoperative VAS and complications associated with analgesics (N = 281). Lidocaine group n = 186; control group n = 95. (A) Postoperative VAS. (B) Number of anaesthe-
sia related complications. (C) Percentage of anaesthesia related complications. *The difference between the two groups was statistically significant, P < 0.05. VAS, visual analogue
scale; h, hour(s); D, day(s). This figure is available in color online at www.jopan.org.
41
F. Liu et al. Journal of PeriAnesthesia Nursing 38 (2023) 39−44

Table 2
The Postoperative VAS Scores and Complications Associated With Analgesics (N = 281)

Items Lidocaine Group, n = 186 Control Group, n = 95 P value

A: VAS scores
At rest
24 h 1.94 § 1.78 2.36 § 1.82 0.064
48 h 1.05 § 1.25* 1.57 § 1.54 0.005
72 h 0.98 § 1.16 1.22 § 1.28 0.132
At movement
24 h 4.16 § 2.03 3.75 § 1.99 0.111
48 h 3.20 § 1.62 2.91 § 1.98 0.222
72 h 3.02 § 1.51* 2.20 § 1.66 <0.001
B: Complications associated with analgesics
Nausea and vomiting
D1 42 (22.6%) 17 (17.9%) 0.362
D2 19 (10.2%) 12 (12.6%) 0.541
D3 11 (5.3%) 5 (5.9%) 0.824
Respiratory depression
D1 3 (1.6%) 1 (1.1%) 0.708
D2 3 (1.6%) 0 (0%) 0.213
D3 2 (1.1%) 0 (0.0%) 0.310
Pruritus
D1 17 (9.1%) 3 (3.2%) 0.065
D2 13 (7.0%) 2 (2.1%) 0.085
D3 2 (1.1%) 4 (4.2%) 0.085
Numbness of the corners of the mouth
D1 35 (18.8%)* 2 (2.1%) <0.001
D2 22 (11.8%)* 1 (1.1%) 0.002
D3 10 (5.4%)* 0 (0.0%) 0.021
Hypotension
D1 6 (3.2%) 0 (0.0%) 0.077
D2 0 (0.0%) 0 (0.0%) -
D3 1 (0.5%) 0 (0.0%) 0.474
Dizziness
D1 33 (17.7%)* 1 (1.1%) <0.001
D2 28 (15.1%)* 1 (1.1%) <0.001
D3 15 (8.1%)* 1 (1.1%) 0.016
Lidocaine group, patient-controlled intravenous analgesia (PCIA) with lidocaine; Control group, PCIA without lidocaine; h, hours; D, days.
* Compared with Control group, P < 0.05. Data are shown as mean § SD (independent sample t test) or the numbers of patients and percentages (x2 test).

P = 0.474) between the two groups (Figure 2B-C and Table 2B). It was
worth noting that the rate of patients with numbness of the corners
of the mouth (24 h: P < 0.001. 48 h: P = 0.002. 72 h: P = 0.021) and
dizziness (24 h: P < 0.001. 48 h: P < 0.001. 72 h: P = 0.016) in the lido-
caine group were significantly higher than that in the control
group (Figure 2B-C and Table 2B).
Postoperative Activities
The time from the end of the operation to the first bowel move-
ment (or flatus when speaking of gas) (Figure 3A, P = 0.588), to ambu-
lation (Figure 3B, P = 0.244) and to discharge from hospital
(Figure 3C, P = 0.483) in the lidocaine group were all less than those
in the control group. But the differences were not statistically signifi-
cant (Table 3).
Discussion
A total of 281 patients underwent open hepatectomy were
included in this study. All patients were treated with PCIA for postop-
erative analgesia. When the analgesic effect was not satisfactory, res-
cue analgesia was given. The difference between the two groups in
postoperative analgesia was whether lidocaine was contained in
PCIA. The results showed that within 3 days after open hepatectomy,
compared with patients who received PCIA without lidocaine,
patients receiving PCIA containing lidocaine had lower VAS scores at
rest and higher VAS scores at movement. In particular, the resting

Figure 3. The resumption of postoperative activities (N = 281). Lidocaine group n = 186; control group n = 95. (A) The time from the end of surgery to the first bowel movement (or
flatus when speaking of gas). (B) The time from the end of surgery to ambulation. (C) Length of hospital stay after surgery. Note: h, hour(s). This figure is available in color online at
www.jopan.org.

42
F. Liu et al.
Table 3
The Resumption of Postoperative Activities (N = 281).
Time From the End of the Surgery to the Resumption of Activity
First bowel movement (or flatus when speaking of gas), hours
Ambulation, hours
Discharge from hospital, days
Lidocaine group, patient-controlled intravenous analgesia (PCIA) with lidocaine; Control group, PCIA without lidocaine; h, hours.
Data are shown as mean § SD (independent sample t-test).
state at 48 h after surgery and the activity state at 72 h after surgery.
However, the mean differences of postoperative VAS assessment
were all less than 1, which did not meet the requirements of minimal
clinical important differences (MIC). In addition, patients receiving
lidocaine for PCIA were more likely to experience numbness of the
corners of the mouth and dizziness. And the use of lidocaine in com-
bination with PCIA did not significantly accelerate postoperative
activity recovery.
Effect of Lidocaine on Postoperative Analgesia
The intravenous use of lidocaine had a certain effect on the
improvement of postoperative resting pain at 48 h after surgery, but
it is invalid to the pain relief during the activity of patient at 72 h after
surgery. Sen et al reported that the addition of paracetamol during
intravenous regional anesthesia with lidocaine decreased tourniquet
pain, increased anesthesia quality.17 Khan et al demonstrated that
continuous intravenous lidocaine infusion during intestinal surgery
could reduce VAS score in resting state of patients at 48 h and 72 h
after surgery.18 Similar studies had shown that lidocaine was more
effective in postoperative rest analgesia.19 However, some studies
have shown that the analgesic effect of intravenous lidocaine is not
clear.13 Compared with analgesic effect, the anti-inflammatory effect
of intravenous lidocaine was more prominent.9,20 The prominent
anti-inflammatory effect of intravenous lidocaine may be the reason
why it was more effective for resting pain. Chang et al conducted a
meta-analysis of randomized controlled trials showed that lidocaine
appears to reduce the risk of chronic pain after breast surgery, but
has no significant effect on postoperative acute pain.8 These results
help us understand that postoperative use of lidocaine in combina-
tion with PCIA may more effective for resting pain in this study. How-
ever, based on the perspective of MIC, the addition of lidocaine to the
existing PCIA did not significantly increase postoperative analgesia in
patients with hepatectomy. So, based on the current assessment of
postoperative pain, we need to further optimize PCIA and conduct
more studies to improve the analgesic effect after hepatectomy.
Effect of Lidocaine on Numbness at Corners of the Mouth and Dizziness
The addition of lidocaine to PCIA for postoperative sustained
analgesia did not significantly increase the incidence of nausea and
vomiting, respiratory depression, pruritus and hypotension, while
significantly increased the incidence of the perioral numbness and
dizziness. Perioral numbness was a manifestation of systemic lido-
caine poisoning,21 which explained the increased probability of
postoperative numbness at corners of the mouth caused by the
addition of lidocaine to PCIA. Song et al found that intravenous
lidocaine could eliminate the vascular pain caused by hypertonic
saline infusion. The analgesic effect of larger dose of lidocaine was
better, but the incidence of dizziness was significantly increased.22
Iacob et al in a retrospective study of neuropathic pain showed
that the side effects of prolonged intravenous lidocaine infusion
were usually mild and transient, including perioral tingling and
dizziness.23 These results were consistent with the increased likeli-
hood of postoperative perioral numbness and dizziness in patients
Journal of PeriAnesthesia Nursing 38 (2023) 39−44
Lidocaine Group, n = 186 Control Group, n = 95 P value
68.25 § 23.96 70.07 § 2.50 0.588
38.12 § 14.93 40.70 § 16.35 0.244
8.71 § 3.50 9.01 § 2.99 0.483
who were continuously sedated with lidocaine in the present
study.
Strengths and Limitations
In this study, PCIA combined with lidocaine was used in patients
after open hepatectomy. The results showed that continuous intra-
venous infusion of lidocaine had a certain effect on the analgesic
effect of patients in the resting state, but was not conducive to the
analgesia of patients in the active state. However, this study was a
retrospective study. The results of this study may only apply to this
study. In addition, due to the use of mechanical analgesic instru-
ment, detailed analgesic dosage during pain assessment was not
recorded, and the use of rescue analgesics was only roughly
recorded. So, further prospective studies are needed to clarify the
analgesic effect and safety of continuous intravenous infusion of
lidocaine in patients after hepatectomy.
Conclusion
The addition of lidocaine to PCIA was beneficial to the improve-
ment of postoperative rest pain in patients with open hepatectomy.
However, it was not beneficial to improve the pain during activities
and increase the incidence of perioral numbness and dizziness. The
results of this study provides a certain value for the application of
systemic lidocaine after surgery.
References
1. Donovan BD. Patient attitudes to postoperative pain relief. Anaesth Intensive Care.
1983;11:125–129.
2. Horn R, Kramer J. Postoperative Pain Control. StatPearls. Treasure Island (FL): Stat-
Pearls Publishing Copyright Ó 2022, StatPearls Publishing LLC; 2022.
3. Dieu A, Huynen P, Lavand'homme P, et al. Pain management after open liver resec-
tion: Procedure-Specific Postoperative Pain Management (PROSPECT) recommen-
dations. Reg Anesth Pain Med. 2021;46:433–445.
4. Li Y, Dong H, Tan S, Qian Y, Jin W. Effects of thoracic epidural anesthesia/analgesia
on the stress response, pain relief, hospital stay, and treatment costs of patients
with esophageal carcinoma undergoing thoracic surgery: a single-center, random-
ized controlled trial. Medicine (Baltimore). 2019;98:e14362.
5. Intagliata N, Caldwell S. Changes in hemostasis in liver disease. J Hepatol. 2017;67
(6):1332–1333.
6. Colvin L, Bull F, Hales T. Perioperative opioid analgesia-when is enough too much?
A review of opioid-induced tolerance and hyperalgesia. Lancet (London, England).
2019;393:1558–1568.
7. McCleane G. Intravenous lidocaine: an outdated or underutilized treatment for
pain? J Palliat Med. 2007;10:798–805.
8. Chang Y, Liu C, Liu T, Yang P, Chen M, Cheng S. Effect of perioperative intravenous
lidocaine infusion on acute and chronic pain after breast surgery: a meta-analysis
of randomized controlled trials. Pain Pract. 2017;17:336–343.
9. Herminghaus A, Wachowiak M, Wilhelm W, Gottschalk A, Eggert K, Gottschalk A.
[Intravenous administration of lidocaine for perioperative analgesia. Review and
recommendations for practical usage]. Anaesthesist. 2011;60:152–160.
10. Song X, Sun Y, Zhang X, Li T, Yang B. Effect of perioperative intravenous lidocaine
infusion on postoperative recovery following laparoscopic Cholecystectomy-A ran-
domized controlled trial. Int J Surg (London, England). 2017;45:8–13.
11. Giudice V, Lauwick S, Kaba A, Joris J. [Proven and expected benefits of intravenous lido-
caine administered during the perioperative period]. Rev Med Liege. 2012;67:81–84.
12. Jurj A, Tomuleasa C, Tat T, Berindan-Neagoe I, Vesa S, Ionescu D. Antiproliferative
and apoptotic effects of lidocaine on human hepatocarcinoma cells. A preliminary
study. J Gastrointestin Liver Dis. 2017;26:45–50.
43
F. Liu et al.
13. Kranke P, Jokinen J, Pace N, et al. Continuous intravenous perioperative lidocaine
infusion for postoperative pain and recovery. Cochrane Database Syst Rev.
2015;16:1–222.
14. Filion KB, Azoulay L, Platt RW, et al. A multicenter observational study of incretin-
based drugs and heart failure. N Engl J Med. 2016;374:1145–1154.
15. Machin D, Campbell M, Fayers P, Pinol A. Sample Size Tables for Clinical Studies.
2nd ed. Oxford: Blackwell Science; 1997.
16. Biostatistical Analysis. 2nd ed Englewood Cliffs, New Jersey: Prentice-Hall; 1984.
17. Sen H, Kulahci Y, Bicerer E, Ozkan S, Dagli G, Turan A. The analgesic effect of para-
cetamol when added to lidocaine for intravenous regional anesthesia. Anesth
Analg. 2009;109:1327–1330.
18. Khan J, Yousuf M, Victor J, Sharma A, Siddiqui N. An estimation for an appropriate
end time for an intraoperative intravenous lidocaine infusion in bowel surgery: a
comparative meta-analysis. J Clin Anesth. 2016;28:95–104.
44
Journal of PeriAnesthesia Nursing 38 (2023) 39−44

19. Tikuisis R, Miliauskas P, Samalavicius N, Zurauskas A, Samalavicius R, Zabulis V.
Intravenous lidocaine for post-operative pain relief after hand-assisted laparo-
scopic colon surgery: a randomized, placebo-controlled clinical trial. Tech Colo-
proctol. 2014;18:373–380.
20. Ortiz M, Godoy M, Schlosser R, et al. Effect of endovenous lidocaine on analgesia and
serum cytokines: double-blinded and randomized trial. J Clin Anesth. 2016;35:70–77.
21. Moore J, Liu S, Neal J. Premedication with fentanyl and midazolam decreases the
reliability of intravenous lidocaine test dose. Anesth Analg. 1998;86:1015–1017.
22. Song Z, Liu Z, Zhang Y. The analgesic efficacy and duration of lidocaine on vascular
pain induced by hypertonic saline infusion: a double-blinded, randomized control
trial. J Anesth. 2019;33:311–316.
23. Iacob E, Hagn E, Sindt J, et al. Tertiary care clinical experience with intravenous
lidocaine infusions for the treatment of chronic pain. Pain Med. 2018;19:1245–
1253.