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Anästhesiol Intensivmed Notfallmed Schmerzther 2015; 50(5): 322-327
DOI: 10.1055/s-0041-102213
Fachwissen
Anästhesiologie
© Georg Thieme Verlag Stuttgart · New York

Adjuvanzien in der modernen Anästhesie – Lidocain

Adjuvants in modern anesthesia – lidocaine
Susanne Picardi
,
Philipp Lirk
,
Romy Boeckh
,
Markus W Hollmann
Further Information

Publication History

Publication Date:
27 May 2015 (online)

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Zusammenfassung

Neben ihren bekannten antinozizeptiven und antiarrhythmischen Eigenschaften, zeigen Lokalanästhetika sogenannte alternative natriumkanalunabhängige Effekte. Hierbei stehen ihre antiinflammatorischen Eigenschaften im Vordergrund, die zumindest teilweise ihre benefiziellen Effekte nach systemischer Gabe im perioperativen Bereich erklären könnten. So reduziert die kontinuierliche intravenöse Gabe von Lidocain postoperative Schmerzen, beschleunigt die Rückkehr der gastrointestinalen Funktion und verkürzt die Krankenhausverweildauer in abdominalchirurgischen Patienten.

Abstract

Local anesthetics (LA) are well known for their antinociceptive and antiarrhythmic properties, but exert alternative effects, i.e. anti-inflammatory activity, as well. These immunomodulatory properties might contribute to the beneficial effects observed in the clinical setting, when intravenous lidocaine is given perioperatively. Systemic LA were shown to attenuate postoperative pain, accelerate the return of bowel function and shorten length of hospital stay in patients undergoing abdominal surgery.

Kernaussagen

  • Lokalanästhetika zeigen benefizielle Effekte, wie z. B. Antiinflammation, in klinisch relevanten Konzentrationen und unabhängig von der Inhibition des Natriumkanals.

  • Ein potenziell zugrundeliegender Wirkmechanismus dieser Effekte scheint neben der Inhibition von Kalium- und Kalziumkanälen eine Modulation der Signalübertragung G-Protein-gekoppelter Rezeptoren sowie ionotroper Rezeptoren zu sein.

  • Viele positive Effekte der klassisch perineural oder epidural applizierten Lokalanästhetika lassen sich im klinischen Alltag durch die systemische Gabe von Lidocain reproduzieren.

  • Bei abdominalchirurgischen Patienten verbessert die perioperative i. v. Gabe von Lidocain die postoperative Qualität der Analgesie, reduziert postoperative Übelkeit und Erbrechen, beschleunigt die Rückkehr der gastrointestinalen Motilität und verkürzt die Krankenhausverweildauer.

  • Der zugrundliegende Wirkmechanismus dieser positiven Effekte nach viszeralchirurgischen Eingriffen scheint u. a. auf einer Reduktion der chirurgisch induzierten Überstimulation der inflammatorischen Antwort zu beruhen.

  • Die Evidenz der positiven Effekte einer systemischen Lidocaingabe in gynäkologischen, urologischen, kardiochirurgischen und orthopädischen Patienten wird kontrovers diskutiert.

  • Im ambulanten Bereich werden positive Effekte einer systemischen Lidocaingabe ebenfalls kontrovers diskutiert.

  • Bei Beachtung von Kontraindikationen, engmaschiger Überwachung und Auswahl des geeigneten Patienten ist die i. v. Gabe von Lidocain eine sichere Therapieoption im perioperativen Bereich.

  • Die systemische Toxizität von Lokalanästhetika beginnt bei Plasmaspiegeln um 5 μg/ml.

  • Die perioperative Gabe von i. v. Lokalanästhetika könnte theoretisch das postoperative Auftreten von Tumorrezidiven reduzieren. Bestätigende klinische Untersuchungen liegen jedoch bisher nicht vor.

Schlüsselwörter:

Lidocain - intravenöse Gabe - perioperativ - antiinflammatorische Effekte

Key words:

lidocaine - intravenous administration - perioperative - anti-inflammatory effects

Ergänzendes Material

 

  • Literatur

  • 1 Butterworth JF, Strichartz GR. Molecular mechanisms of local anesthesia: a review. Anesthesiology 1990; 72: 711-734
    CrossrefPubMedGoogle Scholar
  • 2 Hollmann MW, Durieux ME. Local anesthetics and the inflammatory response: a new therapeutic indication?. Anesthesiology 2000; 93: 858-875
    CrossrefPubMedGoogle Scholar
  • 3 Groeben H, Silvanus MT, Beste M et al. Both intravenous and inhaled lidocaine attenuate reflex bronchoconstriction but at different plasma concentrations. Am J RespirCrit Care Med 1999; 159: 530-535
    CrossrefPubMedGoogle Scholar
  • 4 Wang D, Wu X, Li J, Xiao F, Liu X, Meng M. The effect of lidocaine on early postoperative cognitive dysfunction after coronary artery bypass surgery. AnesthAnalg 2002; 95: 1134-1141
    PubMedGoogle Scholar
  • 5 Koppert W, Weigand M, Neumann F et al. Perioperative intravenous lidocaine has preventive effects on postoperative pain and morphine consumption after major abdominal surgery. AnesthAnalg 2004; 98: 1050-1055
    PubMedGoogle Scholar
  • 6 Herroeder S, Pecher S, Schonherr ME et al. Systemic lidocaine shortens length of hospital stay after colorectal surgery: a double-blinded, randomized, placebo-controlled trial. Ann Surg 2007; 246: 192-200
    CrossrefPubMedGoogle Scholar
  • 7 Gallos G, Jones DR, Nasr SH et al. Local anesthetics reduce mortality and protect against renal and hepatic dysfunction in murine septic peritonitis. Anesthesiology 2004; 101: 902-911
    CrossrefPubMedGoogle Scholar
  • 8 Hollmann MW, Wieczorek K, Smart M et al. Epidural anesthesia prevents postoperative hypercoagulation in patients undergoing major orthopedic surgery. RAPM 2001; 26: 215-222
    PubMedGoogle Scholar
  • 9 Cooke ED, Bowcock SA, Lloyd MJ, Pilcher MF. Intravenous lignocaine in prevention of deep venous thrombosis after elective hip surgery. Lancet 1977; 2: 797-799
    PubMedGoogle Scholar
  • 10 Picardi S, Cartillieri S, Hahnenkamp K et al. Local anesthetic induced inhibition of human neutrophil priming: the influence of structure, lipophilicity and charge. RegAnesth Pain Med 2013; 38: 9-15
    PubMedGoogle Scholar
  • 11 Berger C, Rossaint J, Van Aken H et al. Lidocaine reduces neutrophil recruitment by abolishing chemokine-induced arrest and transendothelial migration in septic patients. J Immunol 2014; 192: 367-376
    CrossrefPubMedGoogle Scholar
  • 12 Kiefer RT, Ploppa A, Krueger WA et al. Local anesthetics impair human granulocyte phagocytosis activity, oxidative burst, and CD11b expression in response to Staphylococcus aureus. Anesthesiology 2003; 98: 842-848
    CrossrefPubMedGoogle Scholar
  • 13 Hollmann MW, Gross A, Jelacin N et al. Local anesthetic effects on priming and activation of human neutrophils. Anesthesiology 2001; 95: 113-122
    CrossrefPubMedGoogle Scholar
  • 14 Hollmann MW, Wieczorek KS, Berger A et al. Local anesthetic inhibition of G protein-coupled receptor signaling by interference with Gq protein function. MolPharmacol 2001; 59: 294-301
    PubMedGoogle Scholar
  • 15 Wettschureck N, Offermanns S. Mammalian G proteins and their cell type specific functions. PhysiolRev 2005; 85: 1159-1204
    PubMedGoogle Scholar
  • 16 Werdehausen R, Kremer D, Brandenburger T et al. Lidocaine metabolites inhibit glycine transporter 1: a novel mechanism for the analgesic action of systemic lidocaine?. Anesthesiology 2012; 116: 147-158
    CrossrefPubMedGoogle Scholar
  • 17 Gronwald C, Vegh V, Hollmann MW et al. The inhibitory potency of local anesthetics on NMDA receptor signalling depends on their structural features. Eur J Pharmacol 2012; 674: 13-19
    CrossrefPubMedGoogle Scholar
  • 18 Drachman D, Strichartz G. Potassium channel blockers potentiate impulse inhibition by local anesthetics. Anesthesiology 1991; 75: 1051-1061
    CrossrefPubMedGoogle Scholar
  • 19 Meuth SG, Budde T, Kanyshkova T et al. Contribution of TWIK-related acid-sensitive K+ channel 1 (TASK1) and TASK3 channels to the control of activity modes in thalamocortical neurons. J Neurosci 2003; 23: 6460-6469
    PubMedGoogle Scholar
  • 20 Hollmann MW, Strumper D, Durieux ME. The poor man's epidural: systemic local anesthetics for improving postoperative outcomes. Med Hypotheses 2004; 63: 386-389
    CrossrefPubMedGoogle Scholar
  • 21 Marret E, Rolin M, Beaussier M, Bonnet F. Meta-analysis of intravenous lidocaine and postoperative recovery after abdominal surgery. Br J Surg 2000; 95: 1331-1338
    PubMedGoogle Scholar
  • 22 Vigneault L, Turgeon AF, Côté D et al. Perioperative intravenous lidocaine infusion for postoperative pain control: a meta-analysis of randomized controlled trials. Can J Anaesth 2011; 58: 22-37
    CrossrefPubMedGoogle Scholar
  • 23 Sun Y, Li T, Wang N, Yun Y, Gan TJ. Perioperative systemic lidocaine for postoperative analgesia and recovery after abdominal surgery: a meta-analysis of randomized controlled trials. Dis Colon Rectum 2012; 55: 1183-1194
    CrossrefPubMedGoogle Scholar
  • 24 McCarthy GC, Megalla SA, Habib AS. Impact of intravenous lidocaine infusion on postoperative analgesia and recovery from surgery: a systematic review of randomized controlled trials. Drugs 2010; 70: 1149-1163
    CrossrefPubMedGoogle Scholar
  • 25 Wuethrich PY, Romero J, Burkhard FC, Curatolo M. No benefit from perioperative intravenous lidocaine in laparoscopic renal surgery: a randomised, placebo-controlled study. Eur J Anaesthesiol 2012; 29: 537-534
    CrossrefPubMedGoogle Scholar
  • 26 Bryson GL, Charapov I, Krolczyk G et al. Intravenous lidocaine does not reduce length of hospital stay following abdominal hysterectomy. Can J Anaesth 2010; 57: 759-756
    CrossrefPubMedGoogle Scholar
  • 27 Basbaum AI, Bautista DM, Scherrer G et al. Cellular and molecular mechanisms of pain. Cell 2009; 139: 267-284
    CrossrefPubMedGoogle Scholar
  • 28 Little JW, Doyle T, Salvemini D. Reactive nitroxidative species and nociceptive processing: determining the roles for nitric oxide, superoxide, and peroxynitrite in pain. Amino Acids 2012; 42: 75-94
    CrossrefPubMedGoogle Scholar
  • 29 Sugimoto M, Uchida I, Mashimo T. Local anaesthetics have different mechanisms and sites of action at the recombinant N-methyl-D-aspartate (NMDA) receptors. Br J Pharmacol 2003; 138: 876-882
    CrossrefPubMedGoogle Scholar
  • 30 Werdehausen R, Kremer D, Brandenburger T et al. Lidocaine metabolites inhibit glycine transporter 1: a novel mechanism for the analgesic action of systemic lidocaine?. Anesthesiology 2012; 116: 147-158
    CrossrefPubMedGoogle Scholar
  • 31 Barreveld A, Witte J, Chahal H et al. Preventive analgesia by local anesthetics: the reduction of postoperative pain by peripheral nerve blocks and intravenous drugs. AnesthAnalg 2013; 116: 1141-1161
    PubMedGoogle Scholar
  • 32 Grigoras A, Lee P, Sattar F et al. Perioperative intravenous lidocaine decreases the incidence of persistent pain after breast surgery. Clin J Pain 2012; 28: 567-572
    CrossrefPubMedGoogle Scholar
  • 33 Farag E, Ghobrial M, Sessler DI et al. Effect of perioperative intravenous lidocaine administration on pain, opioid consumption, and quality of life after complex spine surgery. Anesthesiology 2013; 119: 932-940
    CrossrefPubMedGoogle Scholar
  • 34 Bauer AJ, Boeckxstaens GE. Mechanisms of postoperative ileus. NeurogastroenterolMotil 2004; 16 (Suppl. 02) 54-60
    PubMedGoogle Scholar
  • 35 Groudine SB, Fisher HAG, Kaufman RP et al. Intravenous lidocaine speeds the return of bowel function, decreases postoperative pain, and shortens hospital stay in patients undergoing radical retropubic prostatectomy. AnesthAnalg 1998; 86: 235-239
    PubMedGoogle Scholar
  • 36 Cruickshank AM, Fraser WD, Burns HJ et al. Response of serum interleukin-6 in patients undergoing elective surgery of varying severity. ClinSci (Lond) 1990; 79: 161-165
    PubMedGoogle Scholar
  • 37 McKay A, Gottschalk A, Ploppa A et al. Systemic lidocaine decreased the perioperative opioid analgesic requirements but failed to reduce discharge time after ambulatory surgery. AnesthAnalg 2009; 109: 1805-1808
    PubMedGoogle Scholar
  • 38 De Oliveira Jr GS, Fitzgerald P, Streicher LF et al. Systemic lidocaine to improve postoperative quality of recovery after ambulatory laparoscopic surgery. AnesthAnalg 2012; 115: 262-267
    PubMedGoogle Scholar
  • 39 Swenson BR, Gottschalk A, Wells LT et al. Intravenous lidocaine is as effective as epidural bupivacaine in reducing ileus duration, hospital stay, and pain after open colon resection: a randomized clinical trial. RegAnesth Pain Med 2010; 35: 370-376
    PubMedGoogle Scholar
  • 40 Wongyingsinn M, Baldini G, Charlebois P et al. Intravenous lidocaine versus thoracic epidural analgesia: a randomized controlled trial in patients undergoing laparoscopic colorectal surgery using an enhanced recovery program. RegAnesth Pain Med 2011; 36: 241-248
    PubMedGoogle Scholar
  • 41 Staikou C, Avramidou A, Ayiomamitis GD et al. Effects of intravenous versus epidural lidocaine infusion on pain intensity and bowel function after major large bowel surgery: a double-blind randomized controlled trial. J GastrointestSurg 2014; 18: 2155-2156
    PubMedGoogle Scholar
  • 42 Park WY, Thompson JS, Lee KK. Effect of epidural anesthesia and analgesia on perioperative outcome: a randomized, controlled Veterans Affairs cooperative study. Ann Surg 2001; 234: 560-569
    CrossrefPubMedGoogle Scholar
  • 43 Di Rosa M, Giroud JP, Willoughby DA. Studies on the mediators of the acute inflammatory response induced in rats in different sites by carrageenan and turpentine. J Pathol 1971; 104: 15-29
    CrossrefPubMedGoogle Scholar
  • 44 Powell DM, Rodehaever GT, Foresman PA et al. Damage to tissue defenses by EMLA cream. J Emerg Med 1991; 9: 205-9
    CrossrefPubMedGoogle Scholar
  • 45 Snyder GL, Greenberg S. Effect of anaesthetic technique and other perioperative factors on cancer recurrence. Br J Anaesth 2010; 105: 106-115
    CrossrefPubMedGoogle Scholar
  • 46 Schlagenhauff B, Ellwanger U, Breuninger H et al. Prognostic impact of the type of anaesthesia used during the excision of primary cutaneous melanoma. Melanoma Res 2000; 10: 165-159
    CrossrefPubMedGoogle Scholar
  • 47 Exadaktylos AK, Buggy DJ, Moriarty DC et al. Can anesthetic technique for primary breast cancer surgery affect recurrence or metastasis?. Anesthesiology 2006; 105: 660-664
    CrossrefPubMedGoogle Scholar
  • 48 Lirk P, Picardi S, Hollmann MW. Local anaesthetics: 10 essentials. Eur J Anaesthesiol 2014; 31: 575-585
    CrossrefPubMedGoogle Scholar
  • 49 Piegeler T, Votta-Velis EG, Bakhshi FR et al. Endothelial barrier protection by local: ropivacaine and lidocaine block tumor necrosis factor-alpha-induced endothelial cell Src activation. Anesthesiology 2014; 120: 1414-1428
    CrossrefPubMedGoogle Scholar
  • 50 Lirk P, Hollmann MW, Fleischer M et al. Lidocaine and ropivacaine, but not bupivacaine, demethylate deoxyribonucleic acid in breast cancer cells in vitro. Br J Anaesth 2014; 113 (Suppl. 01) 32-38
    CrossrefPubMedGoogle Scholar