Effect of Intravenous Infusion of Lidocaine and Remifentanil Perioperatively in Patients Undergoing Mastectomy
Condition: Postoperative Pain
MeSH terms: Pain, Postoperative
Study type: Interventional
Phase: Phase 4

Summary: 
      This study aims to compare quality of perioperative analgesia of lidocaine and remifentanil
      intravenously in surgical interventions for the treatment of breast cancer.
    

Detailed description: 
      The opioid analgesics are commonly used in clinical practice for pain management in the
      perioperative period. However, many side effects are associated with its use, such as
      respiratory depression, nausea, vomiting, drowsiness, itching, urinary retention,
      constipation, hyperalgesia and impaired immune function. Therefore, alternative techniques
      and drugs have been used to replace their use. One is the intravenous infusion of lidocaine,
      a local anesthetic widely used in anesthetic practice. Studies show that the use of lidocaine
      during surgery significantly decreased postoperative pain. The mechanisms of analgesia this
      local anesthetic in surgical trauma may be blocking neuronal transmission in the lesion site
      alleviating neurogenic response, and anti-inflammatory systemic intrinsic activity.
      Intraoperative lidocaine promotes, besides analgesia, decreased consumption of both
      inhalational anesthetic and opioids; faster return of bowel movements; decreasing the
      production of interleukins and reduction of airway reactivity. This anesthetic also has
      significant anti-inflammatory properties, reduces cytokine release both in vitro and in vivo
      by inhibiting neutrophil activation. Besides there are few studies with use of intravenous
      lidocaine during the perioperative period, the intravenous injection of local anesthetic
      still arouses oddity among professionals; therefore, the investigators interest in the
      subject.

      The patients underwent a prospective, randomized, double blind, in which the examiners
      responsible for intra and post operative will not know which group they were randomly
      allocated: Lidocaine group (n = 30) 3 mg / kg / h or Remifentanil group (n = 30) 0.1 mcg / kg
      / min.

      In the clinical record, the following information will be emphasized: Blood pressure and
      heart rate intraoperative, perioperative side effects, quantify pain by Visual Analogue Scale
      (VAS) (ranging from 0 to 10 cm, zero being found when the patient is no pain and ten, with
      maximum or unbearable pain), Verbal Rating Scale (VRS), consisting of a list of phrases (no
      pain, mild pain, moderate pain, intense pain, maximum pain) and qualification of pain
      assessed by the amount of analgesics required postoperatively and the time to request them.

      The results were analyzed statistically with the XLSTAT for Excel program using parametric
      and nonparametric tests, depending on the nature of the variables studied. Measures of
      central tendency (means) and dispersion (standard deviation) were used. The level of
      significance was set at < 0.05. The following tests were used: Mann-Whitney test for age,
      duration of anesthesia and surgery, time to first analgesic supplementation, total amount of
      analgesics, pain intensity; Student t-test for weight and height.
    

Intervention name(s): Lidocaine; Remifentanil
Intervention type(s): Drug; Drug
Intervention description(s): Patients in intravenous lidocaine group received an intravenous bolus injection of 2 mg/kg lidocaine followed by a continuous lidocaine infusion of 3 mg/kg/hr.; Patients in remifentanil group received an intravenous bolus injection of 2 mg/kg lidocaine followed by a continuous remifentanil infusion of 0,1 mcg/kg/min.
Intervention MeSH terms: Lidocaine; Remifentanil
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Prevention
Keywords: Intravenous lidocaine; Mastectomy; Pain