Best of Meeting Abstract: Lidocaine’s Postoperative Pain Management Effects May Be Immune Related

Newswise — In patients undergoing primary hip arthroplasty, regional anesthesia with lidocaine infusion reduces postoperative pain and opioid consumption, possibly because of decreased immune cell signaling, according to research from Stanford University in Stanford, CA.

Quentin Baca, Leslie McNeil, Robin Okada, Martha Tingle, Nima Aghaeepour, Brice Gaudilliere, and Martin Angst received both a Best of Meeting Award and Resident/Fellow Travel Award for their abstract of the study, “Lidocaine infusion during hip arthroplasty modulates the surgical immune response and decreases postoperative pain,” which will be presented on Thursday, April 11, 2019, during the 44th Annual Regional Anesthesiology and Acute Pain Medicine Meeting in Las Vegas, NV.

Regional anesthesia is increasingly using intravenous lidocaine as a perioperative analgesic, particularly in opioid-minimizing regimens. In addition to its analgesic properties, lidocaine has poorly understood anti-inflammatory properties.

To examine those immune-modulating effects, researchers conducted a randomized clinical trial of 20 patients who underwent primary hip arthroplasty. They received either standard anesthesia care combined with an intraoperative lidocaine infusion or saline placebo.

Lidocaine infusion decreased average postoperative pain by 30%, maximum pain after surgery by 48%, and total opioid consumption by 39%. Blood analysis showed that lidocaine reduced a pro-inflammatory marker called interleukin 6 that affected pain signaling, particularly in key transcription factors STAT 3 and NF-kB.

“This study is the first to report clinically relevant pain reduction and decreased opioid consumption in patients undergoing primary hip arthroplasty and receiving a perioperative lidocaine infusion,” the authors noted. Their previous research has shown that enhanced NF-kB activity in innate immune cells in patients undergoing hip arthroplasty is strongly associated with extended postoperative pain, so lidocaine’s reduction of NF-kB explains some of its analgesic effects.

The 44th Annual Regional Anesthesiology and Acute Pain Medicine Meeting will be held April 11–13, 2019, in Las Vegas, NV. The conference brings together worldwide experts in acute pain medicine to discuss standard and novel techniques, new pain targets, and strategies to address the opioid epidemic.