Can systemic lidocaine be used in controlled hypotension? A double-blinded randomized controlled study in patients undergoing functional endoscopic sinus surgery

IntroductionFunctional endoscopic sinus surgery (FESS) is one of the operations that need controlled hypotension. Many drugs were successfully used in this purpose, e.g., magnesium sulfate, esmolol, and volatile anesthetics. Hypotension was observed to occur after submucosal injection of lidocaine. Based on this observation, it was hypothesized in this double-blinded randomized controlled study that lidocaine may be effective in producing controlled hypotension.MethodsForty-eight ASA I–II adults planned to undergo FESS were given a standard general anesthetic after which they were divided into 2 equal groups to receive either lidocaine infusion in a dose of 1.5 mg/kg/h (group L, n = 24) or equal volumes of normal saline (group C, n = 24). Primary outcome was the surgical field rating score (0–5 points). Secondary outcomes included hemodynamic parameters, extubation time, end-tidal sevoflurane concentrations, fentanyl consumption, and postoperative visual analog pain scores (VASs).ResultsBoth groups were similar regarding hemodynamic parameters. Surgical field scores were significantly lower in group L than in group C at all intraoperative time points (P < 0.05). Extubation time was significantly longer in group C than in group L [group C: 12.4(2.3) min and group L: 9.1(3) min, P = 0.03]. Intraoperative fentanyl dose was significantly higher in group C than in group L [group C: 172(37) mcg and group L: 149(34) mcg, P = 0.03]. End-tidal sevoflurane concentrations were significantly lower in group L than in group C at most intraoperative time points (P < 0.05). Postoperative VAS pain scores in the PACU were higher in group C than in group L (P < 0.05).ConclusionThis study showed the ability of intravenous lidocaine infusion of 1.5 mg/kg/h to produce controlled hypotension in patients undergoing FESS and the superiority of this technique over placebo to achieve favorable surgical field scoring.