Growing evidence suggests that intravenous lidocaine as a component of multimodal analgesia improves recovery after major colorectal surgery. There is little published data regarding ideal dosing and target plasma concentration in this context, and we wanted to establish our dosing schedule was safe by measuring blood levels of lidocaine.

Return of normal gastrointestinal (GI) function is a critical determinant of recovery after colorectal surgery. The aim of this meta-analysis was to evaluate whether perioperative intravenous (IV) lidocaine benefits return of gastrointestinal function after colorectal resection.

BACKGROUND:Combined oral modified-release oxycodone-naloxone may reduce opioid-induced postoperative gut dysfunction. This study examined the feasibility of a randomized trial of oxycodone-naloxone within the context of enhanced recovery for laparoscopic colorectal resection.METHODS:In a single-centre open-label phase II feasibility study, patients received analgesia based on either oxycodone-naloxone or oxycodone. Primary endpoints were recruitment, retention and protocol compliance. Secondary endpoints included a composite endpoint of gut function (tolerance of solid food, low nausea/vomiting score, passage of flatus or faeces).RESULTS:Eighty-two patients were screened and 62 randomized (76 per cent); the attrition rate was 19 per cent (12 of 62), leaving 50 patients who received the allocated intervention with 100 per cent follow-up and retention (modified intention-to-treat cohort). Protocol compliance was more than 90 per cent. Return of gut function by day 3 was similar in the two groups: 13 (48 per cent) of 27 in the oxycodone-naloxone group and 15 (65 per cent) of 23 in the control group (95 per cent c.i. for difference -10·0 to 40·7 per cent; P = 0·264). However, patients in the oxycodone-naloxone group had a shorter time to first bowel movement (mean(s.d.) 87(38) h versus 111(37) h in the control group; 95 per cent c.i. for difference 2·3 to 45·4 h, P = 0·031) and reduced total (oral plus parenteral) opioid consumption (mean(s.d.) 78(36) versus 94(56) mg respectively; 95 per cent c.i. for difference -10·2 to 42·8 mg, P = 0·222).CONCLUSION:High participation, retention and protocol compliance confirmed feasibility. Potential benefits of oxycodone-naloxone in reducing time to bowel movement and total opioid consumption could be tested in a randomized trial. Registration number: NCT02109640 (https://www.clinicaltrials.gov/).

European Journal of Pain SupplementsVolume 4, Issue S1 p. 65-65 222 PAIN OF PREDOMINANTLY NEUROPATHIC ORIGIN (POPNO) IN THE ACUTE POSTOPERATIVE PERIOD — AN UNDER-RECOGNISED PROBLEM? L. Green, L. Green Department of Anaesthesia, Critical Care & Pain Medicine, Western General HospitalSearch for more papers by this authorS. Carty, S. Carty Department of Anaesthesia, Critical Care & Pain Medicine, Western General HospitalSearch for more papers by this authorL. Dickson, L. Dickson Department of Anaesthesia, Critical Care & Pain Medicine, Western General HospitalSearch for more papers by this authorR. Osman, R. Osman Department of Anaesthesia, Critical Care & Pain Medicine, Western General HospitalSearch for more papers by this authorD. Watt, D. Watt Department of Anaesthesia, Critical Care & Pain Medicine, Western General HospitalSearch for more papers by this authorS. Nimmo, S. Nimmo Department of Anaesthesia, Critical Care & Pain Medicine, Western General HospitalSearch for more papers by this authorL. Colvin, L. Colvin Department of Anaesthesia, Critical Care & Pain Medicine, Western General Hospital University of Edinburgh, Edinburgh, UKSearch for more papers by this author L. Green, L. Green Department of Anaesthesia, Critical Care & Pain Medicine, Western General HospitalSearch for more papers by this authorS. Carty, S. Carty Department of Anaesthesia, Critical Care & Pain Medicine, Western General HospitalSearch for more papers by this authorL. Dickson, L. Dickson Department of Anaesthesia, Critical Care & Pain Medicine, Western General HospitalSearch for more papers by this authorR. Osman, R. Osman Department of Anaesthesia, Critical Care & Pain Medicine, Western General HospitalSearch for more papers by this authorD. Watt, D. Watt Department of Anaesthesia, Critical Care & Pain Medicine, Western General HospitalSearch for more papers by this authorS. Nimmo, S. Nimmo Department of Anaesthesia, Critical Care & Pain Medicine, Western General HospitalSearch for more papers by this authorL. Colvin, L. Colvin Department of Anaesthesia, Critical Care & Pain Medicine, Western General Hospital University of Edinburgh, Edinburgh, UKSearch for more papers by this author First published: 06 January 2012 https://doi.org/10.1016/S1754-3207(10)70227-3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume4, IssueS1April 2010Pages 65-65 RelatedInformation

BACKGROUND:For colorectal surgery, evidence suggests that optimal management includes: no pre-operative fasting, a thoracic epidural analgesia continued for 2 days post-operatively, and avoidance of fluid overload. In addition, no long-acting benzodiazepines on the day of surgery and use of short-acting anaesthetic medication may be beneficial. We examined whether these strategies have been adopted in five northern-European countries.METHODS:In 2003, a questionnaire concerning peri-operative anaesthetic routines in elective, open colonic cancer resection was sent to the chief anaesthesiologist in 258 digestive surgical centres in Scotland, the Netherlands, Denmark, Sweden and Norway.RESULTS:The response rate was 74% (n = 191). Although periods of pre-operative fasting up to 48 h were reported, most (> 85%) responders in all countries declared to adhere to guidelines for pre-operative fasting and oral clear liquids were permitted until 2-3 h before anaesthesia. Solid food was permitted up to 6-8 h prior to anaesthesia. In all countries more than 85% of the responders indicated that epidural anaesthesia was routinely used. Except for Denmark, long-acting benzodiazepines were still widely used. Short-acting anaesthetics were used in all countries except Scotland where isoflurane is the anaesthetic of choice. With the exception of Denmark, intravenous fluids were used unrestrictedly.CONCLUSION:In northern Europe, most anaesthesiologists adhere to evidence-based optimal management strategies on pre-operative fasting, thoracic epidurals and short-acting anaesthetics. However, premedication with longer-acting agents is still common. Avoidance of fluid overload has not yet found its way into daily practice. This may leave patients undergoing elective colonic surgery at risk of oversedation and excessive fluid administration with potential adverse effects on surgical outcome.