Evaluation of Plasma Concentrations of Intravenous Lidocaine and Epidural Ropivacaine When Used in Combination in Major Abdominal Surgery

Centre Hospitalier Universitaire, Amiens51 enrolled

Overview

Thoracic epidural analgesia (TEA) is the gold standard analgesia of the laparotomy in major abdominal surgery and can be associated with intravenous lidocaine or subtituted by intravenous lidocaine when TEA is contraindicated and in order to reduce the use of the morphinics in the perioperative period. Side effects can be paralytic ileus or nausea and vomiting and delay the enhanced recovery after surgery. Intravenous lidocaine and TEA share several properties like anti hyperalgesia, anti inflammatory effect, intestinal process, anti tumoral effect… which suggests an additive effect of their combination that was not studied yet.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Abdominal Surgery by Laparotomy Thoracic Epidural Analgesia Analgesia Lidocaine Adverse Reaction

Interventions

Blood sampleOTHER

Lidocaine blood sample 30 min before the end of the surgery Lidocaine blood sample at the end of the infusion lidocaine and ropivacaine blood sample 2 h after the ropivacaine infusion of the TEA Ropivacaine blood sample 24h after the infusion of the TEA

LidocainDRUG

Lidocaine will be injected during the anaesthetic induction and infused until the surgical closure (30 minutes before the end) The occurrence of adverse events will be monitor by a physical examination and blood samples of lidocainemia and ropivacainemia in the perioperative period.

ropivacaineDRUG

Lidocaine will be injected during the anaesthetic induction and infused until the surgical closure (30 minutes before the end), then ropivacaine will be injected in the TEA at the same time and infused during 24h. The occurrence of adverse events will be monitor by a physical examination and blood samples of lidocainemia and ropivacainemia in the perioperative period.

Outcomes

Primary Outcomes

Blood lidocaine concentration (micrograms/ml)

Lidocaine blood sample will be performed 30 min before the end of the surgery

Time frame: 30 minutes before the end of surgery

blood lidocaine concentration (micrograms/ml)

lidocaine blood sample will be performed at the end of the infusion,

Time frame: at the end of the surgery (assessed up to 2 hours)

blood lidocaine and ropivacaine concentration (micrograms/ml)

lidocaine and ropivacaine blood sample 2 h after the ropivacaine infusion of the TEA,

Time frame: at 2 hours

blood ropivacaine concentration (micrograms/ml)

ropivacaine blood sample 24h after the infusion of the TEA

Time frame: at 24 hours