Lignocaine as an intravenous analgesic

This narrative article describes a case of a 56-year-old man with a background of chronic obstructive pulmonary disease, atrial fibrillation and long-term opiate use for chronic pain, undergoing emergency laparotomy for bowel perforation. The emergent nature of the procedure meant that regular anticoagulants (used due to atrial fibrillation) could not be stopped in time, which, in turn, precluded the use of neuraxial anaesthetic techniques. In view of this and within the context of the background of chronic use of opiates and the extent of planned surgery, challenges in postoperative pain management were anticipated. This case illustrates the value of multimodal analgesia, with a particular focus on intravenous lignocaine as a valuable analgesic adjunct. The concept of chronic post-surgical pain is examined with particular attention to risk factors and preventative measures. The mechanism of action and general pharmacology of lignocaine are described. Possible modes of administering a lignocaine bolus and infusion in the perioperative context are delineated. The importance of following local protocols for intravenous lignocaine administration is highlighted. Finally, risk factors and features of local anaesthetic toxicity, as well as its main features are described. The management of local anaesthetic toxicity is outlined, with the most current guidelines taken into consideration.