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IAJPS 2016, 3 (8), 836-840

V.Ravi Sankar et al

CODEN (USA): IAJPBB

ISSN 2349-7750
ISSN: 2349-7750
INDO AMERICAN JOURNAL OF
PHARMACEUTICAL SCIENCES
Available online at: http://www.iajps.com
Research Article
LOW DOSE INTRAVENOUS INFUSION OF LIGNOCAINE

IN POST OPERATIVE PAIN
Dr. Venuturumilli Ravi Sankar*1, Dr. V. Lakshmi Kameswari2, Dr. T.V. Subba Rao3
1
Consultant cardiac Anesthesiologist, Apollo Hospitals, Secunderabad, Telangana State
Associate Professor, Pharmacology, Osmania Medical College, Hyderabad, Telangana State
Former Professor & H.O.D., Anesthesiology, Guntur Government Hospital, Guntur, Andhra Pradesh
Abstract:
In spite of spectacular advances in pain relief during surgery, relief of pain in post operative period still
remains a problem. The most important is that the deficiencies of current routine methods of pain relief are
being increasingly exposed. The present study has been taken up with the intention of evaluating the
postoperative analgesic effect of continuous lignocaine infusion in low doses as used for cardiac arrhythmias.
Lignocaine is extensively studied regarding its pharmacology and pharmacokinetics in comparison with
narcotic analgesics viz., free from respiratory depression and addiction liability. The primary action of the local
anesthetic is on the cell membrane of the axon on which it produces electrical stabilization. The large transient
increase in permeability to sodium ions necessary for propagation of the impulse is prevented thus the resting
potential is maintained and depolarization in response to stimulation is inhibited. Patients were randomly
grouped in to two groups of 50 in each. Group A given Lignocaine intravenously and Group B given saline
intravenously post operatively for a period of 24 hrs. Patients were monitored by measurement of pulse rate,
systolic blood pressure, continuous ECG monitoring. Post operative instructions included a note to give
narcotic or sedative, if in severe pain after informing the author. Pain during 24hrs after surgery was assessed
by linear analogue scale ranging from 0 to 100 as per Bond and Pilowsky. The study was prospective
controlled and randomized. Data were expressed as meanS.E.M. Single tailed studentt test was used to
express the difference of the means of two samples. The results showed that continuous intravenous lignocaine
decreased the postoperative pain persistently and reduced the narcotic analgesic dose significantly and did not
cause any significant adverse effects.
Divine is the task to relieve pain-Hippocrates
For all the happiness mankind can gain, is not in pleasure, but in rest from pain-John Dryden (1631-1701)
Key Words: Lignocaine, Pethidine, Linear analogue scale, Infusion, Narcotic
Corresponding author:
Dr. Ravi Sankar Venuturumilli, M.D.,
Consultant Cardiac Anesthesiologist,
Apollo Heart institute, Apollo Hospitals,
Jubilee Hills, Hyderabad-500096
Email: [email protected]
QR code
Please cite this article in press as V.Ravi Sankar et al, Low dose intravenous infusion of lignocaine
In post operative pain, Indo Am. J. P. Sci, 2016; 3(8).
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IAJPS 2016, 3 (8), 836-840
V.Ravi Sankar et al
INTRODUCTION:
Postoperative pain has got particular importance
not only because of frequency but also because of
its psychological influence on the patient. Its
complex nature forms a firm bond between
anesthesiologist, surgeon and the patient. Incidence
of post operative pain differs like thoracic and
upper abdominal surgeries leading followed by
those on the lower abdomen (Table 1) [1].
Table: 1. Incidence of Post Operative Pain in
abdominal, non abdominal and Thoracic
regions.
Abdominal
Non abdominal Thoracic
Upper 63.2%
Limbs26.9%
Cardiac 72.5%
Lower 51.3%
Perineal 24.3%
Noncardiac
74.6%
Inguinal
22.7%
Body wall
20.0%
Neck 11.7%
Personality variations contribute to pain perception,

like elderly and the very young require less
analgesic requirement, Stable patients with low
neuroticism may be expected to suffer less than
neurotic patients [2]. The fact that placebos may
relieve pain in 35% of patients and that this action
will vary with the presence of anxiety further
emphasizes that emotion may alter the severity of
pain experienced [3]. Pain is conducted by two
types of pain fibres in the periphery A, delta and C
fibres. Peripheral sensory nerves have their cell
bodies in the dorsal root ganglion and central
projection of A delta and C fibre neurons enter the
dorsal horn in the lateral division of the dorsal root.
Thalamus is involved in the experience of Pain,
Post central gyrus is necessary for its accurate
localization and prefrontal cortex for the unpleasant
affective reaction to it.
The gate control theory proposed by Melzack and
Wall in 1965, stressed the role of dorsal horn of the
spinal cord, which is influenced by impulses from
brain. Prostaglandins of E and I series sensitize
pain receptors and PGE are believed to be involved
in the amplification of pain, followed by
bradykinin,
histamine,
acetylcholine,
5hydroxytryptamine and inorganic ions like H and K
may also be involved in mediation of pain.
Stimulationof A and C fibres release substance P
which excites 100% HT neurons and 14% of LT
neurons. Opiate group of drugs when administered
systemically shown to depress release of Substance
P in substantia gelatinosa, which can be reversed
by Naloxone, an opiate antagonist. , opiod
receptors are responsible for supraspinal analgesia,
euphoria, dependence, dysphoria, spinal analgesia
respectively.
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ISSN 2349-7750
Classical local anesthetics [4] block sodium

conductance probably by a dual action on the cell
membrane action on the receptor within the sodium
channels and membrane expansion. Action on the
receptor accounts for 90% nerve blocking effect of
Lignocaine and appears to be shared by both
quaternary analogues of Lignocaine and by amide
[5,6] local anesthetics acting in the cationic form.
Membrane expansion is a nonspecific reaction,
analogues to electrical stabilization produced by
non polar lipid soluble barbiturates, benzocaine and
general anesthetics. A thick fibre is less readily
blocked by local anesthetic than a thin one. In other
words the thicker the nerve fibre greater the
concentration of local anesthetic required to block
the conduction. Amide local anesthetics,
bupivacaine, etidocaine have more protein binding,
so are 2, 3 times longer acting than their
homologues mepivacaine, lignocaine amide
anesthetics [7,8 and 9]. The Paraben preservative
has a tendency for hypersensitivity reactions.
MATERIALS AND METHODS:
The study was under taken in one hundred patients
of either sex scheduled for abdominal or chest
surgeries at Government General Hospital Guntur
from (December 1985 to December 1986) for a
period of 1 year. Age of the patients ranged from
22 to 62 years. Informed consent from each patient
was taken for inclusion to the study and the
protocol was approved by the Head of the
department of Anesthesiology and Superintendent,
Government General Hospital, Guntur. The
patients were classified according to American
Society of Anesthesiologists Classification of
physical status, ASA Grade 1(normal healthy
patient) and Grade- 2 (patient with mild systemic
disease) were selected for the study.
Preanaesthetic medication with 0.65 mg atropine
sulphate intramuscularly and 5mg diazepam
intravenously 30 minutes before induction.
Anaesthesia was induced with 4 mg/kg thiopentone
sodium. After administration of 0.1mg/kg
Pancuronium intravenously and ventilating the
patient with oxygen and nitrous oxide mixture
50:50 for 2 minutes endotracheal intubation was
performed with suitable cuffed endotracheal tube.
Anaesthesia was maintained with oxygen, Nitrous
oxide and 0.5% Halothane. Relaxation was
maintained with additional doses of 1 mg
Pancuronium as indicated in surgery. 1.2 mg
Atropine followed by 2.5mg of Neostigmine was
administered to reverse the neuromuscular
blockade.
Patients were divided randomly into two groups,
Group A received Lignocaine 2mg/min and Group
B Saline intravenously. Half an hour before skin
Page 837
IAJPS 2016, 3 (8), 836-840
V.Ravi Sankar et al
incision group A also received bolus dose of

lignocaine8 in 0.6% saline ( 100mg :
20mg/ml),followed by 2mg/min(2.5gm lignocaine
in 540ml physiologic saline i.e., continued 24th
post operative hour. Group B received infusion of
normal saline. Patients were monitored by
measurement of pulse rate, systolic blood pressure
as well as continuous monitoring of ECG where
ever possible throughout the period of
lignocaine/saline infusion [10]. Postoperative
instructions included a note to give narcotic or
sedative only when patient is in severe pain after
informing the observer.
RESULTS AND DISCUSSION:
Pain Assessment: Pain during the initial 24 hours
after surgery was assessed using a linear analogue
scale ranging from 0(no pain) to 100(pain as bad as
it could be). Each patient scored his pain at 2 hr
intervals starting 1hour after the return from
operating theatre (when patients were fully
conscious). Each patients requirement of
Injections of 50mg Pethidine was recorded for 72
hours post operatory (Figure 1). Sleep pattern on 1st
post operatory day was recorded. The observers
impression based on duration of analgesia,
consistency of analgesia, side effects profile and
supplementation of narcotic analgesics were
ISSN 2349-7750
recorded. Questions concerning postoperative

vomiting, adverse reactions to lignocaine, like
lightheadedness, tinnitus, peri-oral numbness,
drowsiness, slurred speech, were put to the patient
on the morning of the first postoperative day and
responses were recorded by the observer.
The study was prospective, controlled, and
randomized. Mean Pain scores were calculated for
each patient by summing up the pain scores during
first 24 hours after surgery (Table 2 and Figure 2).
The mean requirements of pethidine for 72 hours
after surgery were calculated. Data was expressed
as Mean S.E.M. Single tailed studentt test
which is accurate measure of deciding whether the
difference between two means of samples is
significant or not, was used for comparison of
quantitative variables i.e. significant difference
between means. t is the ratio of observed
difference between two samples and standard error
of difference between two sample values (Figure 3
and Figure 4).
T= X1-X2/ S.E (X1-X2)
In this analysis of comparing two means of a
chosen chance of being wrong is considered as
5% i.e., 95% confidence.
Table 2: Accumulated Pain Scores at the first pain assessment 1hr i.e., before giving pethidine
Groups
Mean accumulated pain Scores S.E.M
A (Lignocaine)
9.50.5
B (Saline)
29.050.4
200
180
160
140
120
Pethidine
100
MeanS.E.M
80
60
40
20
0
24hrs
48hrs
72hrs
Fig 1: Pethidine requirements during the first, second and third postoperative days
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IAJPS 2016, 3 (8), 836-840
V.Ravi Sankar et al
ISSN 2349-7750
70
60
50
40
GroupB
30
GroupA
20
10
0
1
12
15
18
Time in Hours
21
24
Fig 2: Pain Scores during initial 24 hours after Surgery
30
Mean
S.E.M
20
10
S.E.M
0
Lignocaine
Saline
Mean
Fig 3:Comparison of Systolic B.P s between Groups A and B during initial 24 hrs after Surgery
value was<0.001
132
130
128
126
124
122
120
118
116
114
Group A
(Lignocaine)
Group B (normal
saline)
8 10 12 14 16 18 20 22 24
TIme Interval in Hours
Fig 4: Systolic B.P s between Groups A and B during initial 24 hrs after Surgery P value was<0.001
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IAJPS 2016, 3 (8), 836-840
V.Ravi Sankar et al
CONCLUSION:
The efficacy of continuous low dose (2mg/min)
intravenous infusion of Lignocaine on post
operative pain in a controlled, randomized trial in
one hundred patients after elective abdominal and
thoracic surgeries was studied. Lignocaine infusion
was started 30 minutes before operation after
giving a bolus dose of 100mg Lignocaine and
continued for 24 hours after surgery in 50 patients.
Saline was infused in other group of 50 patients
and if pain reported Pethidine injections were given
to this group. Lignocaine treated patients had
lower pain scores [11] (P<0.001) as compared to
the control group.
Lignocaine treated group
required less pethidine [12] during first (P<0.001),
second (P<0.001) and third (P<0.02) post operative
days. Control group had higher pain scores
(29.050.4) and required more pethidine injections.
Lignocaine treated patients did not show any
significant side effects. Lignocaine maintained
heart rate and blood pressure in a steady state,
provided good sleep, free from respiratory
depression. Finally this new technique though
needs continuous monitoring of the heart rate and
blood pressure, has a good margin of safety with
the doses used. It also reduced the usage of narcotic
analgesics which produce considerable side effects
like respiratory depression. With its proven
antiarrhythmic effect this new technique can be
used to the anesthesiologists in all surgical cases
postoperatively particularly associated with cardiac
rhythm irregularities.
REFERENCES:
1.Loan, W.B. and J.W. Dundee, The clinical
assessment of pain. Practitioner, 1967; 198(188): p.
759-68.
2.Dalrymple, D. G., Parbrook, G. D., and Steel, D.
F. Factors predisposing to postoperative pain and
pulmonary complications. A study of female
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ISSN 2349-7750
patients undergoing elective cholecystectomy. Br.

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3.Beecher, H. K.: Appraisal of Drugs Intended to
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11.Tania cursino de Menezes Couceiro,
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IAJPS 2016, 3 (8), 836-840

CODEN (USA): IAJPBB

INDO AMERICAN JOURNAL OF

LOW DOSE INTRAVENOUS INFUSION OF LIGNOCAINE

Consultant cardiac Anesthesiologist, Apollo Hospitals, Secunderabad, Telangana State

Associate Professor, Pharmacology, Osmania Medical College, Hyderabad, Telangana State

IAJPS 2016, 3 (8), 836-840

Personality variations contribute to pain perception,

Classical local anesthetics [4] block sodium

IAJPS 2016, 3 (8), 836-840

incision group A also received bolus dose of

recorded. Questions concerning postoperative

Mean accumulated pain Scores S.E.M

IAJPS 2016, 3 (8), 836-840

Fig 2: Pain Scores during initial 24 hours after Surgery

IAJPS 2016, 3 (8), 836-840

patients undergoing elective cholecystectomy. Br.

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