Lidocaine Infusion Helps to Reduce Pain and Opioid Use in THA Patients
In patients undergoing primary total hip arthroplasty (THA), regional anesthesia with lidocaine infusion reduces postoperative pain and opioid consumption, possibly because of decreased immune cell signaling, according to research from Stanford University.
The study received a Best of Meeting Award and a Resident/Fellow Travel Award at the 44th Annual Regional Anesthesiology and Acute Pain Medicine Meeting.
Anesthesiologists are increasingly using intravenous lidocaine as a perioperative analgesic in regional anesthesia, particularly in opioid-minimizing regimens. In addition to its analgesic properties, lidocaine has poorly understood anti-inflammatory properties.
To examine those immune-modulating effects, the researchers conducted a randomized clinical trial of 20 patients who underwent primary THA and received either standard anesthesia care combined with an intraoperative lidocaine infusion or saline placebo.
They found that compared with patients in the placebo group, patients who received the lidocaine infusion had, on average:
- 30% less postoperative pain
- 48% less maximum pain after surgery
- 39% less total opioid consumption
Blood analysis showed that lidocaine reduced the pro-inflammatory marker interleukin 6, which 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 had shown that enhanced NF-kB activity in innate immune cells in patients undergoing THA is strongly associated with extended postoperative pain, so lidocaine’s reduction of NF-kB explains some of its analgesic effects. 
Baca Q, McNeil L, Okada R, Tingle M, Aghaeepour N, Gaudilliere B, Angst M. Lidocaine infusion during hip arthroplasty modulates the surgical immune response and decreases postoperative pain (Abstract 7368). Presented at the 44th Annual Regional Anesthesiology and Acute Pain Medicine Meeting, April 11-13, 2019, in Las Vegas, Nevada.
- Fragiakakis GK, Gaudilliere B, Ganio EA, et al. Patient-specific immune states before surgery are strong correlates of surgical recovery. Anesthesiology. 2015 Dec;123(6):1241-55. doi: 10.1097/ALN.0000000000000887.