Intravenous Lidocaine

Intravenous lidocaine may reduce acute nociceptive input, opioid requirements, neuroinflammation, and the transition to chronic neuropathic pain. In the trial protocol, both groups receive the same bolus and intraoperative lidocaine infusion; only the postoperative infusion differs, with the control group receiving normal saline. Intravenous lidocaine has multimodal analgesic, antihyperalgesic, and anti-inflammatory actions that make it a candidate for perioperative use. The proposed mechanisms of intravenous lidocaine include sodium-channel blockade, suppression of proinflammatory cytokines, and modulation of central sensitisation. Signs of systemic lidocaine toxicity that require immediate infusion cessation include ECG irregularities, drowsiness, metallic taste, perioral numbness, tinnitus, and seizure activity. Continuous ECG monitoring is required throughout the postoperative lidocaine infusion period. A 20% lipid emulsion is kept available as a rescue treatment for severe local anaesthetic systemic toxicity.