Efficacy of Intravenous Infusion of Lignocaine on Bowel Function Recovery and Postoperative Pain After Major Abdominal Surgery

Background: Postoperative ileus and pain remain significant challenges following major abdominal surgeries, prolonging hospital stays and increasing morbidity. Intravenous lidocaine has emerged as a potential adjunct to enhance recovery and reduce opioid requirements. This study evaluated the efficacy of intravenous lidocaine infusion on bowel function recovery and postoperative pain management in patients undergoing major abdominal surgery. Methods: A prospective, randomized, double-blind, placebo-controlled trial was conducted at six KAHER institutes in Hubballi, North Karnataka. Five hundred sixty patients aged 18-60 years undergoing major abdominal surgeries were randomized to receive either intravenous lidocaine (1.5 mg/kg bolus followed by 1.5 mg/kg/h infusion) or an equal volume of normal saline from induction of anesthesia until 24 hours postoperatively. Primary outcomes included time to first flatus, first bowel movement, and tolerance of oral diet. Secondary outcomes included postoperative pain scores, analgesic consumption, length of hospital stay, and complications. Results: Patients receiving lidocaine experienced significantly faster return of bowel function compared to controls, with shorter time to first flatus (mean 52.8±14.6 vs. 74.3±18.2 hours, p<0.001), earlier first bowel movement (mean 72.4±16.8 vs. 96.5±22.4 hours, p<0.001), and earlier tolerance of solid food (mean 64.2±15.6 vs. 86.7±19.8 hours, p<0.001). Lidocaine-treated patients reported lower pain scores at rest and during movement at all time points up to 72 hours postoperatively (p<0.001). Total opioid consumption was reduced by 35% in the lidocaine group (p<0.001). Mean hospital stay was significantly shorter in the lidocaine group (5.2±1.7 vs. 7.4±2.3 days, p<0.001). No serious lidocaine-related adverse events were observed. Conclusion: Intravenous lidocaine infusion significantly improved postoperative bowel function recovery, reduced pain intensity, decreased analgesic requirements, and shortened hospital stay following major abdominal surgery. These findings support the incorporation of intravenous lidocaine into enhanced recovery protocols for major abdominal surgeries