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Effects of Intravenous Lidocaine in Total Knee Joint Arthroplasty

Shun-Yu WONG1, David LAM1, Henry MAK1, Chi-Wai CHEUNG2, Timmy CHAN1
1Queen Mary Hospital, Hong Kong, 2The University of Hong Kong, Hong Kong

Background: We hypothesized that a single preemptive bolus dose of IV lidocaine (IV lidocine) would result in better analgesia, reduced total opioid consumption, shortened hospitalization, and better functional outcomes after total knee arthroplasty (TKA).

Methods: 62 adults undergoing unilateral primary TKA were enrolled in this prospective, randomised, double-blind, placebo-controlled trial. They either received IV lidocaine ( or saline placebo before skin incision. All received standardized spinal anesthesia, local infiltration analgesia and post-op analgesia. Primary endpoints were postoperative pain during rest and movement, measured by Numerical Rating Scale (NRS). Cumulative opioid consumption was also charted. Secondary outcomes included hospital length of stay (LOS), walking distance, active and passive range of movement of knee (ROM), occurrence of local anesthetic systemic toxicity (LAST), constipation, nausea and vomiting (PONV), dizziness and Modified Barthel Index (MBI).

Results: While not statistically significant, on both postoperative day 1 and 2, the lidocaine group demonstrated lower NRS (at rest & upon movement) and longer walking distance averaged 6 metres (p=0.325, mean [96% C.I.] 61.00 [52.91-69.09] vs. 55.00 [45.66 - 64.34]). Noticeably, the lidocaine group had significantly shorter LOS (p=0.0313, median [inter-quartile range] 3 days [3.00-4.00] vs 4 days [3.00-5.00]). The 2 groups did not differ significantly regarding cumulative opioid consumption, ROM, constipation, PONV, dizziness and MBI. No LAST was recorded.

Conclusions: The lidocaine group had lower NRS and better mobilization in the initial postoperative period. Although not statistically significant, they may have cumulatively contributed to a statistically significant shorter LOS of 1 day in the lidocaine group.