A Comparison between Pre-Incisional and Intraoperative Lidocaine Infiltration on Post-Incisional Surgical Pain in Microdiscectomy Surgery: A Randomized Clinical Trial Study

Document Type : RESEARCH PAPER

Authors

1 Department of Neurosurgery, Faculty of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran

2 2 Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran 3 Clinical Research Development Unit, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Department of Operating Room, School of Nursing, North Khorasan University of Medical Sciences, Bojnurd, Iran

4 Department of Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran

5 Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

6 Department of Nursing, School of Nursing, North Khorasan University of Medical Sciences, Bojnurd, Iran

10.22038/abjs.2023.63374.3059

Abstract

Objectives: Effective postoperative pain control in microdiscectomy surgery is crucial to managing the 
disease and improving the patient's quality of life. Therefore, this study aimed to assess the potential 
effectiveness of 2% lidocaine in reducing pain immediately after discectomy surgery.
Methods: A total of 60 patients who underwent microdiscectomy surgery were enrolled in this randomized clinical 
trial study. They were randomly assigned to three groups: one group received lidocaine just before the incision, 
another group received lidocaine just before closing the incision, and the third group served as the control. Pain 
scores were measured at 1, 2, 3, 4, 8, and 12 h after the surgery using a Visual Analogue Scale.
Results: The demographic and clinical characteristics of the study population, including age, weight, length of 
surgery, gender, and history of diabetes, hypertension, and previous surgery, were comparable across all three 
groups (P>0.05). There was a significant reduction in pain scores over time in the groups that received lidocaine 
before (P<0.001) and during surgery (P=0.002). Moreover, there were significant differences in pain scores at all 
time points among the three groups. Both groups receiving lidocaine showed significantly lower pain scores than 
the control group (Pbefore surgery=0.005 and Pduring surgery<0.001). However, no significant difference was 
observed between the groups receiving lidocaine (P=0.080).
Conclusion: These findings highlight the effectiveness of a local injection of 2% lidocaine either before or during 
the surgery in managing post-incisional surgical pain after discectomy.
 Level of evidence: II

Keywords

Main Subjects


  1. Dydyk AM, Ngnitewe Massa R, Mesfin FB. Disc Herniation. StatPearls. Treasure Island (FL): StatPearls Publishing; 2023.
  2. Jordan JL, Konstantinou K, O'Dowd J. Herniated lumbar disc. BMJ Clin Evid. 2011; 2011: 1118.
  3. Othman YA, Verma R, Qureshi SA. Artificial disc replacement in spine surgery. Ann Transl Med. 2019; 7(Suppl 5):S170-S170. doi:10.21037/atm.2019.08.26.
  4. Chaudhary SB, Vives MJ, Basra SK, Reiter MF. Postoperative spinal wound infections and postprocedural diskitis. J Spinal Cord Med. 2007; 30(5):441-451. doi:10.1080/10790268.2007.11753476.
  5. Epstein NE. More nerve root injuries occur with minimally invasive lumbar surgery: Let's tell someone. Surg Neurol Int. 2016; 7(Suppl 3):S96-S101. doi:10.4103/2152-7806.174896.
  6. Cho JH, Lee JH, Song K-S, Hong J-Y. Neuropathic Pain after Spinal Surgery. Asian Spine J. 2017; 11(4):642-652. doi:10.4184/asj.2017.11.4.642.
  7. Mashhadinejad H, Sarabi E, Mashhadinezhad S, Ganjeifar B. Clinical Outcomes after Microdiscectomy for Recurrent Lumbar Disk Herniation: A Single-Center Study. Arch Bone Jt Surg. 2018;6(5):397-401. doi:10.22038/abjs.2017.24932.1666.
  8. Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017; 10:2287-2298. doi:10.2147/JPR.S144066.
  9. Gupta A, Kaur K, Sharma S, Goyal S, Arora S, Murthy RSR. Clinical aspects of acute post-operative pain management & its assessment. J Adv Pharm Technol Res. 2010; 1(2):97-108.
  10. Gaufberg SV, Walta MJ, Workman TP. Expanding the use of topical anesthesia in wound management: sequential layered application of topical lidocaine with epinephrine. Am J Emerg Med. 2007; 25(4):379-84. doi:10.1016/j.ajem.2006.11.013.
  11. Gordh T, Gordh TE, Lindqvist K, Warner DS. Lidocaine: The Origin of a Modern Local Anesthetic. Anesthesiology. 2010; 113(6):1433-1437. doi:10.1097/ALN.0b013e3181fcef48.
  12. Nafisi S. Effects of epidural lidocaine analgesia on labor and delivery: a randomized, prospective, controlled trial. BMC Anesthesiol. 2006;6:15-15. doi:10.1186/1471-2253-6-15.
  13. Downing JW, Johnson HV, Gonzalez HF, Arney TL, Herman NL, Johnson RF. The Pharmacokinetics of Epidural Lidocaine and Bupivacaine during Cesarean Section. Anesth Analg. 1997; 84(3):527-532. doi: 10.1097/00000539-199703000-00011.
  14. Cassuto J, Wallin G, Högström S, Faxén A, Rimbäck G. Inhibition of postoperative pain by continuous low-dose intravenous infusion of lidocaine. Anesth Analg. 1985; 64(10):971-4.
  15. Kawamata M, Takahashi T, Kozuka Y, et al. Experimental incision-induced pain in human skin: effects of systemic lidocaine on flare formation and hyperalgesia. Pain. 2002; 100(1-2):77-89. doi: 10.1016/s0304-3959(02)00233-6.
  16. Koppert W, Zeck S, Sittl R, Likar R, Knoll R, Schmelz M. Low-dose lidocaine suppresses experimentally induced hyperalgesia in humans. Anesthesiology. 1998; 89(6):1345-53. doi: 10.1097/00000542-199812000-00011.
  17. Groudine SB, Fisher HA, Kaufman RP, Jr., et al. Intravenous lidocaine speeds the return of bowel function, decreases postoperative pain, and shortens hospital stay in patients undergoing radical retropubic prostatectomy. Anesth Analg. 1998; 86(2):235-9. doi: 10.1097/00000539-199802000-00003.
  18. Mendelson G, Selwood TS. Measurement of chronic pain: A correlation study of verbal and nonverbal scales. Journal of behavioral assessment. 1981; 3(4):263-269. doi: 10.1007/BF01350830.
  19. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011; 63 Suppl 11:S240-52. doi:10.1002/acr.20543.
  20. Vickers ER, Cousins MJ, Woodhouse A. Pain description and severity of chronic orofacial pain conditions. Aust Dent J. 1998; 43(6):403-9. doi:10.1111/j.1834-7819.1998.tb00200.x.
  21. Rezvani Amin M, Siratinayer M, Abadi A, Moradyan T. Correlation between Visual Analogue Scale and Short form of McGill Questionnaire in Patients with Chronic Low Back Pain. Original Article. Qom Univ Med Sci J. 2012; 6(1):31-34.
  22. Ejlersen E, Andersen HB, Eliasen K, Mogensen T. A comparison between preincisional and postincisional lidocaine infiltration and postoperative pain. Anesth Analg. 1992; 74(4):495-8. doi: 10.1213/00000539-199204000-00004.
  23. Mansour Ghenaee M, Rahmani S, Jafarabadi M. Local lidocaine 2% in postoperative pain management in cesarean delivery. J Family Reprod Health. 2015; 9(1):19-21.
  24. Shady NW, Sallam HF, Ali SS, Abbas AM. Effect of intraperitoneal and incisional port site lidocaine on pain relief after gynecological laparoscopic surgery: A randomized controlled study. Middle East Fertility Society Journal. 2018; 23(1):63-67. doi:10.1016/j.mefs.2017.08.005.
  25. Mouhtadi A, Khateminia G, Akhondzadeh R, Jannatmakan F, Alari A, Zamani F. The effect of anterior chamner lidocaine injecion on pain reduction after cataract surgery under general anesthesia. Journal of Iranian Society Anesthesiology and Intensive Care. 2015; 37(2):90.
  26. Chandra S, Sugiarto A, Hotasi R, Chrysantia Melati A, Harmani B. The Effectiveness of 2% Lidocaine Gel Compared to 0.5% Tetracaine Eye Drop As Topical Anesthetic Agent for Phacoemulsification Surgery. Anesth Pain Med. 2018; 8(2):e68383. doi:10.5812/aapm.68383.
  27. Kim KH. Use of lidocaine patch for percutaneous endoscopic lumbar discectomy. Korean J Pain. 2011; 24(2):74-80. doi:10.3344/kjp.2011.24.2.74.
  28. Elsayed AR, Elharty MA, Elgebaly AS. Efficacy and Safety of Lidocaine Patch 5% Supplementation to Intra-articular Bupivacaine Dexmedetomidine after Knee Arthroscopy under General Anesthesia: A Randomized Controlled Study. Egyptian Journal of Anaesthesia. 2021; 37(1):69-76. doi:10.1080/11101849.2021.1885955.
  29. Lee W, Hahn K, Hur J, Kim Y. Effect of Topical Lidocaine Patch on Postoperative Pain Management in Laparoscopic Appendectomy: A Randomized, Double-Blind, Prospective Study. J Laparoendosc Adv Surg Tech A. 2018; 28(9):1061-1067. doi:10.1089/lap.2018.0013.
  30. Lau LL, Li CY, Lee A, Chan SK. The use of 5% lidocaine medicated plaster for acute postoperative pain after gynecological surgery: A pilot randomized controlled feasibility trial. Medicine (Baltimore). 2018; 97(39):e12582. doi:10.1097/md.0000000000012582.
  31. Zmora O, Stolik-Dollberg O, Bar-Zakai B, et al. Intraperitoneal bupivacaine does not attenuate pain following laparoscopic cholecystectomy. JSLS. 2000; 4(4):301-304.

32.              Ali PB, Cotton BR, Williamson KM, Smith G. Intraperitoneal bupivacaine or lidocaine does not provide analgesia after total abdominal hysterectomy. Br J Anaesth. 1998; 80(2):245-7. doi:10.1093/bja/80.2.245.

Volume 11, Issue 10
October 2023
Pages 635-640
  • Receive Date: 16 February 2022
  • Revise Date: 10 August 2023
  • Accept Date: 12 August 2023
  • First Publish Date: 23 September 2023