Effects of an intravenous lidocaine bolus before tracheal extubation on recovery after breast surgery – Lidocaine at the End (LATE) study: a randomized controlled clinical trial

Abstract

Aim To investigate whether IV lidocaine improves emer-gence, early recovery, and late recovery after general anesthesia in women who undergo breast surgery. Methods Sixty-seven women with American Society of Anesthesiologists physical status I-II, scheduled for breast surgery were randomized to receive an IV lidocaine 1.5 mg/kg bolus (n = 34) or saline placebo (n = 33) before tracheal extubation. Anesthesia was induced with thiopental, vecuronium, and fentanyl, and maintained with sevoflu-rane ~ 1 MAC and 50% nitrous-oxide in oxygen. No postoperative nausea and vomiting (PONV) prophylaxis was given. Time to extubation, bucking before extubation, and quality of emergence, as well as early and late recovery (coughing post-extubation, sore throat, PONV, and pain scores) within 24 hours postoperatively were evaluated. Diclofenac and meperidine were used for the treatment of pain and metoclopramide for PONV. Results The groups did not significantly differ in demo-graphics, intraoperative data, or PONV risk scores. Extubation was ~ 8 minutes in both groups. Patients who received IV lidocaine had significantly smoother recovery, both sta-tistically and clinically; they had better extubation quality scores (1.5 [1-3] vs 3 [1-5], P < 0.001), less bucking before extubation (38% vs 91%, P < 0.001), less coughing after ex-tubation (at 1 min 18% vs 42%, P = 0.026; and at 24 hours 9% vs 27%, P = 0.049), and less sore throat (6% vs 48%, P < 0.001). Late PONV decreased (3% vs 24%, P = 0.013). There were no differences in pain scores and treatment. Conclusion In women who underwent breast surgery, IV lidocaine bolus administered just before extubation at-tenuated bucking, cough and sore throat, and PONV for 24 hours after general anesthesia, without prolonging the emergence.