Effect of intravenous lidocaine on catheter‑related bladder discomfort, postoperative pain and opioid requirement in complex fusion lumbar spinal surgery: a randomized, double blind, controlled trial

Abstract Background: Catheter-related bladder discomfort (CRBD) and pain commonly arises postoperatively among patients experiencing intra-operative urinary catheterization. The study aims to demonstrate the effectiveness of intravenous lidocaine to prevent CRBD and postoperative pain in complex lumbar spinal surgery. Methods: Sixty male patients, aged 20-79 years, scheduled for undergoing elective fusion spine surgery at least 2 levels were randomly assigned to obtain intravenous lidocaine (1.5 mg/kg then 2 mg/kg/h) (group L) or a parallel volume of normal saline (group C). The primary outcome was incidence of moderate to severe CRBD in a postanesthetic care unit (PACU) between group comparison. The secondary outcomes were postoperative pain and the postoperative 24-hour of opioid requirement, mild and moderate to severe CRBD at 1-, 2-, 6- and 24-hours postoperative periods, patient satisfaction the adverse effects of lidocaine and surgical complications. Results: Group L showed a significantly lower incidence of moderate-to-severe CRBD compared with that of group C at PACU (P = 0.002) and at 1 hour (P = 0.039). Moreover, group L experienced a significantly reduced average pain score compared with that of group C in all time periods (P<0.001, P<0.001, P=0.001, P<0.001 and P<0.001 at 0, 1, 2, 6 and 24 hours, respectively and significantly lower postoperative opioid requirement compared with that of group C at 2, 6 and 24 hours postoperatively (P=0.0022, P<0.001 and P<0.001, respectively). Group L experienced significant more satisfaction regarding GPES scores than group C (P< 0.001). No adverse outcome was found in both groups. Conclusion: Intravenous lidocaine administration exhibited significantly reduced moderate-to-severe CRBD at PACU and 1-hr post operative period. Moreover, the use of intravenous lidocaine during complex spine surgery resulted in reduction of postoperative pain, opioid requirement and improved patient satisfaction without side effects.