From the Guidelines
Intraoperative lidocaine infusion can affect muscle strength, potentially causing temporary muscle weakness, as evidenced by its mechanism of action as a local anesthetic that blocks sodium channels in nerve fibers 1. Lidocaine infusion during surgery is typically administered at a dose of 1-2 mg/kg/hr after an initial bolus of 1-1.5 mg/kg, with plasma concentrations ranging from 1.1 to 2.6 μg/ml, as shown in studies 1. This regimen should be adjusted based on patient factors and the specific surgical procedure, taking into account the potential for reduced muscle strength in the immediate postoperative period. When using lidocaine infusion intraoperatively, be aware that:
- It may prolong the effects of neuromuscular blocking agents.
- Patients may experience reduced muscle strength in the immediate postoperative period.
- Close monitoring of neuromuscular function is essential, especially during emergence from anesthesia. The effect on muscle strength occurs because lidocaine, as a local anesthetic, blocks sodium channels in nerve fibers, which not only provides pain relief but can also interfere with normal muscle function by reducing nerve conduction 1. The impact is usually temporary and resolves as the lidocaine is metabolized and eliminated from the body. To mitigate risks, ensure proper dosing, monitor for signs of systemic toxicity, and be prepared to adjust postoperative care plans if prolonged muscle weakness is observed, following guidelines that suggest a bolus dose of IV lidocaine 1-2 mg.kg-1 followed by a continuous infusion of 1 to 2 mg/kg-1h-1 1.
From the Research
Intraoperative Lidocaine Infusion and Muscle Strength
- There is no direct evidence in the provided studies that specifically addresses the effect of intraoperative lidocaine infusion on muscle strength 2, 3, 4, 5, 6.
- The studies primarily focus on the impact of lidocaine infusion on postoperative pain, recovery, and analgesic requirements, without explicitly discussing muscle strength.
- However, it is worth noting that lidocaine is a local anesthetic that can affect muscle function by blocking nerve conduction, but its systemic effects during intraoperative infusion are not directly related to muscle strength in the provided evidence.
Related Effects of Lidocaine Infusion
- Lidocaine infusion has been shown to reduce postoperative pain and opioid consumption in patients undergoing various surgical procedures 3, 4, 6.
- It also appears to enhance recovery by reducing the time to first flatus, first bowel movement, and shortening the length of hospital stay 3, 4, 6.
- The optimal dosing, timing, and duration of lidocaine infusion, as well as its potential adverse effects, are areas that require further investigation 4, 5, 6.
Study Limitations
- The majority of the studies focused on the effects of lidocaine infusion on postoperative outcomes, rather than its intraoperative effects on muscle strength 2, 3, 4, 5, 6.
- The evidence provided does not allow for a definitive conclusion regarding the impact of intraoperative lidocaine infusion on muscle strength due to the lack of direct investigation into this specific outcome.