The effect of intravenous lidocaine infusion on subarachnoid anesthesia in patients undergoing total knee replacement: a randomised controlled trial.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2025;13(10):10 J Anesth . 2025 Feb;39(1):75-82.What this means for my practice?
Intravenous lidocaine infusion during total knee replacement under spinal anesthesia prolongs sensory block duration, reduces pain scores, and delays the need for postoperative analgesia, suggesting it can be an effective adjunct in multimodal perioperative pain management. Clinically, this may improve early recovery and comfort in patients. However, the study’s small sample size and lack of long-term outcomes limit the generalizability of the findings.
Study Summary
Twenty-eight patients undergoing unilateral total knee replacement under spinal anesthesia were randomized to receive either intravenous lidocaine infusion (n=14) or normal saline (n=14). The primary outcome was the duration of sensory block after spinal anesthesia. Secondary outcomes included onset time of sensory and motor block, duration of motor block, time to first postoperative analgesic request, postoperative pain scores (VAS), and the requirement for additional analgesia in the first 24 hours. Outcomes were assessed during surgery and up to 24 hours postoperatively. Overall, the study showed that intravenous lidocaine significantly prolonged the sensory block and motor block duration, delayed the first postoperative analgesic request, and reduced postoperative pain scores and additional analgesia needs. These findings suggest that intravenous lidocaine infusion is a useful perioperative analgesic adjunct in total knee replacement.
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