PERIOPERATIVE INTRAVENOUS LIDOCAINE INFUSION IN SPINE SURGERY: A RANDOMISED, PROSPECTIVE, DOUBLE‑BLIND, PLACEBO‑CONTROLLED STUDY

Background: Spine surgery is frequently followed by high‑intensity pain and substantial opioid exposure during the first postoperative day. Intravenous lidocaine is being reconsidered as an opioid‑sparing adjunct within multimodal analgesia and enhanced recovery pathways, with growing spine‑specific evidence [1–6].

Methods: This single‑centre, randomised, prospective, double‑blind, placebo‑controlled study was conducted at Yashoda Hospital, Secunderabad (June 2017 to June 2018). Forty adults (ASA I–II) scheduled for elective spine surgery were randomised to receive either perioperative intravenous lidocaine infusion (2 mg/kg/h; Group I, n=20) or equal‑volume 0.9% normal saline (Group II, n=20). General anaesthesia and postoperative rescue analgesia were standardised. Pain was measured using a 0–10 visual analogue scale (VAS) at 0, 1, 2, 4, 8, 12 and 24 hours. Secondary outcomes included intraoperative fentanyl consumption, total fentanyl requirement over 24 hours, number of rescue fentanyl boluses, postoperative nausea and vomiting (PONV) scores, Ramsay sedation scores, patient satisfaction score and adverse events.

Results: Baseline characteristics were comparable between groups. Intraoperative fentanyl requirement was lower in Group I (133.00±22.73 µg) than Group II (232.00±35.33 µg; p=0.00). Total fentanyl requirement over 24 hours was also reduced (208.50±40.68 µg vs 365.00±71.77 µg; p=0.00). VAS scores were lower in Group I at every postoperative time point from 1 to 24 hours (all p<0.001), with similar baseline (0 hour) scores. PONV and sedation scores were lower during the first 12 hours (all p<0.001) and were similar at 24 hours. Group I required fewer rescue boluses (p=0.005) and had a lower (better) satisfaction score (p=0.000). No toxicity symptoms or clinically important haemodynamic events were noted.

Conclusion: Perioperative intravenous lidocaine infusion at 2 mg/kg/h reduced opioid requirement and improved early recovery‑relevant outcomes after spine surgery in this cohort, without safety concerns. The results support its role as a practical component of opioid‑sparing multimodal and ERAS‑aligned perioperative care.