J Gynecol Oncol.
2023 Sep;34(5):e61. 10.3802/jgo.2023.34.e61.
Effect of continuous post-operative lidocaine infusion in an enhanced recovery program on opioid use following gynecologic oncology surgery
- Affiliations
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- 1Albert Einstein College of Medicine, Division of Gynecologic Oncology, Montefiore Medical Center, Department of Obstetrics and Gynecology and Women’s Health, Bronx, NY, USA
- 2Department of Obstetrics and Gynecology, Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA
- 3Northwestern University, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chicago, IL, USA
- 4Robert H Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
- 5Surgical Outcomes and Quality Improvement Center, Institute for Public Health in Medicine, Chicago, IL, USA
- 6Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cleveland, OH, USA
- KMID: 2552641
- DOI: http://doi.org/10.3802/jgo.2023.34.e61
Abstract
Objective
To determine the effectiveness of implementing an Enhanced Recovery After Surgery (ERAS) program, including continuous intraoperative and postoperative intravenous (IV) lidocaine infusion, on perioperative opioid use.
Methods
This was a single-institution retrospective pre- post- cohort study. Consecutive patients undergoing planned laparotomy for known or potential gynecologic malignancy were identified after implementation of an ERAS program and compared to a historical cohort. Opioid use was calculated as morphine milligram equivalents (MMEs). Cohorts were compared using bivariate tests.
Results
A total of 215 patients were included in the final analysis, 101 patients received surgery before ERAS implementation and 114 received surgery after. A reduction in total opioid use was observed in ERAS patients compared with historical controls (MME 26.5 [9.6–60.8] versus 194.5 [123.8–266.8], p<0.001). Length of stay (LOS) was reduced by 25% in the ERAS cohort (median 3 days, range 2–26, versus 4 days, range 2–18; p<0.001). Within the ERAS cohort, 64.9% received IV lidocaine for the planned 48 hours, and 5.6% had the infusion discontinued early. Within the ERAS cohort, patients who received IV lidocaine infusion used less opioids compared to those who did not (median 16.9, range 5.6–55.1, versus 46.2, range 23.2–76.1; p<0.002).
Conclusion
An ERAS program including a continuous IV lidocaine infusion as the opioid-sparing analgesic strategy was noted to be safe and effective, leading to decreased opioid consumption and LOS compared with a historic cohort. Additionally, lidocaine infusion was noted to decrease opioid consumption even among patients already receiving other ERAS interventions.
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