Comparison of the effect of lidocaine infusion applied in different doses during lumbar stabilization surgery on postoperative pain and intraoperative hemodynamics

Aim: Lumbar stabilization surgery is among the surgical procedures with a high incidence of postoperative pain. Controlling postoperative pain and ensuring early recovery are important for early neurological evaluation. The aim of this study is to investigate the effects of intravenous infusion of different doses of lidocaine in the intraoperative period on postoperative pain, postoperative opioid use, opioid-related side effects and intraoperative hemodynamics in patients undergoing lumbar stabilization. Materials and Methods: 80 patients who would undergo lumbar stabilization were divided into two groups: L1 group (39 patients) and L2 group (41 patients). After induction, 1 mg/kg/h lidocaine infusion was applied to the L1 group, and 2 mg/kg/h lidocaine infusion was applied to the L2 group. Demographic information of both groups, blood pressure, heart rate, saturation values during the operation, and postoperative surgical time were recorded. Modified Aldrete Score was evaluated in the patients at the 15th minute in the recovery unit. In the postoperative period, patients underwent subjective pain evaluation using the VAS score at the 30th minute, 2nd, 3rd, 6th and 12th hour. In the postoperative period, patients received patient-controlled analgesia (PCA) using fentanyl, and opioid consumption and opioid-related side effects were recorded. Results: A total of 80 patients, 46 women (57.5%) and 34 men (42.5%) were included in the study. There was no significant difference between the L1 and L2 groups in terms of gender, BMI, ASA and surgical time (p >0.05). Systolic blood pressure, diastolic blood pressure and mean blood pressure values were found to be significantly lower in the patient group where lidocaine infusion rate was applied as 2 mg/kg/h compared to the patient group where lidocaine infusion rate was applied as 1 mg/kg/h (p<0.05). The number of patients using rescue analgesics in the recovery unit was found to be higher in the L1 group than in the L2 group (p<0.001). In the L2 group, postoperative 30th minute, 2nd, 3rd, 6th. It was observed that the VAS scores at the 12th and 12th hours were significantly lower than the L1 group (p<0.05). The amount of postoperative fentanyl use was higher in the L1 group than in the L2 group in the hours followed, and this difference was statistically significant at times other than the 12th hour (p<0.05). When postoperative opioid-related side effects were evaluated at the 30th minute, 2nd hour, 3rd hour, 6th hour and 12th hour, there was no significant difference between the groups in the first 3 hours in terms of the number of patients experiencing nausea, vomiting and itching. No side effects were observed in either group at the 6th and 12th hours. No significant difference was observed between the groups in terms of Modified Aldrete Score (p=0.053). Conclusion: When the application of lidocaine at an infusion dose of 2 mg/kg/h was compared with the application of lidocaine at an infusion dose of 1 mg/kg/h in the intraoperative period in patients undergoing lumbar stabilization surgery, better hemodynamic stability was achieved by preventing blood pressure increases with 2 mg/kg/h infusion doses. At the same time, more effective postoperative analgesia was provided and postoperative opioid use was reduced. Key words: lidocain, postoperative pain, analgesia, mutimodal, stabilisation, lidocain infusion, intraoperative