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Intravenös verabreichtes Lidocain zur perioperativen Schmerztherapie

Übersicht und praktische Handlungsempfehlungen

Intravenous administration of lidocaine for perioperative analgesia

Review and recommendations for practical usage

  • Klinische Pharmakologie
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Zusammenfassung

Lidocain ist ein Lokalanästhetikum vom Amidtyp, das zur Regionalanästhesie und zur i.v.-Behandlung ventrikulärer Herzrhythmusstörungen zugelassen ist. Inzwischen haben zahlreiche Studien gezeigt, dass eine perioperative i.v.-Lidocain-Infusion bei großen chirurgischen Operationen auch zu einer deutlichen postoperativen Schmerzreduktion mit vermindertem Opioidverbrauch und einer verbesserten Darmmotilität führen kann. In der vorliegenden Übersichtsarbeit werden Wirkmechanismen, mögliche Nebenwirkungen und die bisherigen klinischen Erfahrungen bei der Anwendung von Lidocain zur postoperativen Schmerztherapie dargestellt sowie praktische Hinweise zum klinischen Einsatz gegeben.

Abstract

Lidocaine is commonly used for regional anesthesia and nerve blocks. However, recent clinical studies demonstrated that intravenous perioperative administration of lidocaine can lead to better postoperative analgesia, reduced opioid consumption and improved intestinal motility. It can therefore be used as an alternative when epidural analgesia is contraindicated, not possible or not feasible. Apart from the sodium channel blocking effects relevant for regional anesthesia, lidocaine also has anti-inflammatory properties. Lidocaine can obviously inhibit the priming of resting neutrophilic granulocytes, which, simplified, may reduce the liberation of superoxide anions, a common pathway of inflammation after multiple forms of tissue trauma. At the authors’ institutions intravenous lidocaine is primarily used for postoperative pain relief following abdominal surgery and is given as a bolus dose of 1.5–2.0 mg/kg body weight (BW) injected over 5 min followed by an infusion of 1.5 mg/kg BW/h intraoperatively and 1.33 mg/kg BW/h postoperatively in the recovery room or in the intensive care unit (ICU). The lidocaine infusion is stopped in the recovery room 30 min before discharge or in the ICU at the latest after 24 h. Lidocaine is not used on normal wards. This overview summarizes the current evidence for the intravenous administration of lidocaine for patients undergoing different types of surgery and gives practical advice for its use.

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Interessenkonflikt

Die Autoren weisen auf folgende Beziehungen hin: W. Wilhelm hat für die Firmen Aspect, AstraZeneca, Baxter, B.Braun Melsungen, Dräger, Essex Pharma, Fresenius, GlaxoSmithKline, Narcotrend Monitortechnik, Storz u. a. Vorträge gehalten und/oder „consulting“ durchgeführt. André Gottschalk hat Vortragshonorare der Firmen AstraZeneca, B.Braun Melsungen, Baxter und MSD erhalten. Anna Herminghaus, Mario Wachowiak, Katharina Eggert und Antje Gottschalk haben keine Industriekontakte mit potenziellem Interessenkonflikt.

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Authors and Affiliations

  1. Klinik für Anästhesiologie und operative Intensivmedizin, Klinikum Lünen – St.-Marien-Hospital, 44534, Lünen, Deutschland

    A. Herminghaus DESA, M. Wachowiak, W. Wilhelm & K. Eggert

  2. Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Münster, Münster, Deutschland

    A. Gottschalk

  3. Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Knappschaftskrankenhaus Bochum-Langendreer, Universitätsklinikum der Ruhr-Universität Bochum, Bochum, Deutschland

    A. Gottschalk

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  1. A. Herminghaus DESA
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  2. M. Wachowiak
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  3. W. Wilhelm
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  4. A. Gottschalk
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  5. K. Eggert
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  6. A. Gottschalk
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Correspondence to A. Herminghaus DESA.

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Herminghaus, A., Wachowiak, M., Wilhelm, W. et al. Intravenös verabreichtes Lidocain zur perioperativen Schmerztherapie. Anaesthesist 60, 152–160 (2011). https://doi.org/10.1007/s00101-010-1829-0

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