International journal of obstetric anesthesia · 2025
Intravenous lidocaine infusion reduces intrathecal opioid-induced pruritus after cesarean delivery: a randomized controlled trial and proof-of-concept.
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Eldemrdash Ayman Mohamady, Alazhary Mohamed A, Hammad Soudy S, Hemaida Tarek S, Reda Ragheb Ahmed Mohamed, Shams Gamal Hendawy, Dardeer Taha Tairy, Zaher Zaher Zaki
Аннотация
BACKGROUND: Pruritus is a common adverse effect of neuraxial morphine after cesarean delivery. We tested whether intravenous lidocaine infusion reduces the incidence and severity of neuraxial morphine-induced pruritus.
METHODS: In this double-blind randomized trial at a single center, 160 women undergoing elective cesarean delivery under spinal anesthesia with intrathecal morphine 150 μg and were randomized to either intravenous lidocaine (bolus 1.5 mg/kg followed by infusion 1.5 mg/kg/h for 6 h) or saline placebo. The primary outcome was the incidence of pruritus within 24 h. Secondary outcomes included pruritus severity over time, rescue nalbuphine use, and adverse events. Analyses used modified intention-to-treat.
RESULTS: Data on 136 patients were analyzed (n = 69 lidocaine vs. n = 67 controls). Pruritus occurred in 36.2% receiving lidocaine vs 73.1% in the control group (absolute risk reduction 36.9%, 95% CI 21.4, 52.4), resulting in a number needed to treat of 3 (95% CI 2, 5). Rescue nalbuphine was given in 23.2% of patients in the lidocaine group vs. 56.7% in the control group (absolute risk reduction 33.5%, 95% CI 18.0, 49.0), with a number needed to treat of 3 (95% CI 2, 6). Pruritus severity was lower in the lidocaine group during the first 12 h postoperatively; differences were not significant at 16 and 24 h. No symptoms of lidocaine toxicity or increased adverse events were observed.
CONCLUSIONS: Intravenous lidocaine infusion reduced the incidence and early severity of neuraxial morphine-induced pruritus after cesarean delivery without increased adverse events. Further work should define lower effective doses and shorter infusion durations compatible with enhanced recovery pathways.
METHODS: In this double-blind randomized trial at a single center, 160 women undergoing elective cesarean delivery under spinal anesthesia with intrathecal morphine 150 μg and were randomized to either intravenous lidocaine (bolus 1.5 mg/kg followed by infusion 1.5 mg/kg/h for 6 h) or saline placebo. The primary outcome was the incidence of pruritus within 24 h. Secondary outcomes included pruritus severity over time, rescue nalbuphine use, and adverse events. Analyses used modified intention-to-treat.
RESULTS: Data on 136 patients were analyzed (n = 69 lidocaine vs. n = 67 controls). Pruritus occurred in 36.2% receiving lidocaine vs 73.1% in the control group (absolute risk reduction 36.9%, 95% CI 21.4, 52.4), resulting in a number needed to treat of 3 (95% CI 2, 5). Rescue nalbuphine was given in 23.2% of patients in the lidocaine group vs. 56.7% in the control group (absolute risk reduction 33.5%, 95% CI 18.0, 49.0), with a number needed to treat of 3 (95% CI 2, 6). Pruritus severity was lower in the lidocaine group during the first 12 h postoperatively; differences were not significant at 16 and 24 h. No symptoms of lidocaine toxicity or increased adverse events were observed.
CONCLUSIONS: Intravenous lidocaine infusion reduced the incidence and early severity of neuraxial morphine-induced pruritus after cesarean delivery without increased adverse events. Further work should define lower effective doses and shorter infusion durations compatible with enhanced recovery pathways.