Overview
Postoperative pain management is crucial for elderly patients undergoing laparoscopic colorectal surgery. This article summarizes current evidence on the use of continuous intravenous lidocaine infusion as a component of multimodal analgesia, highlighting potential benefits for postoperative analgesia, recovery times, and safety in older adults.
What is continuous intravenous lidocaine, and why consider it?
Lidocaine is a local anesthetic that, when given systemically via continuous IV infusion, can provide analgesic and anti-hyperalgesic effects. In the perioperative setting, continuous lidocaine infusion is used as part of multimodal analgesia strategies designed to reduce opioid requirements, minimize adverse effects, and improve overall recovery. For elderly patients, who often have comorbidities and altered pharmacokinetics, optimizing analgesia is particularly important to maintain respiratory function, mobilization, and functional outcomes.
Study context and population
Recent investigations have focused on elderly cohorts undergoing laparoscopic colorectal surgery, a procedure associated with meaningful postoperative pain but favorable recovery trajectories when pain is well controlled. In these studies, researchers have examined whether a continuous lidocaine infusion intra- and postoperatively can enhance analgesia without introducing unacceptable safety risks in older adults. Ethical oversight and informed consent were emphasized, with attention to individualized dosing and monitoring in line with geriatric anesthesia considerations.
Key findings on analgesia and recovery
Across multiple studies, continuous lidocaine infusions have shown potential benefits in postoperative analgesia for elderly patients. Most consistently reported outcomes include:
- Reduced opioid consumption in the first 24–48 hours after surgery, minimizing opioid-related side effects such as delirium, nausea, and constipation.
- Lower reported pain scores at rest and during mobilization, contributing to earlier ambulation and improved patient comfort.
- Shorter time to first flatus and bowel movements in some cohorts, supporting faster gastrointestinal recovery after colorectal procedures.
- No significant increase in lidocaine-related adverse events when dosing is carefully tailored to age, weight, renal function, and liver function.
While results are encouraging, effect sizes vary by study design, lidocaine dosing regimens, and perioperative protocols. Importantly, the elderly population may experience greater sensitivity to systemic lidocaine, underscoring the need for vigilant monitoring and individualized plans.
Safety considerations and practical dosing
Safety is paramount in older patients. Clinicians typically use lower infusion rates and shorter durations, with continuous assessment for signs of lidocaine toxicity, including neurologic changes (dizziness, tinnitus, altered mental status) and cardiovascular symptoms (bradycardia, arrhythmias). Renal and hepatic function are considered when determining maintenance doses and maximum infusion limits. Standard practice emphasizes careful electrolyte management, avoidance of drug interactions, and seamless coordination with multimodal analgesia regimens that may include acetaminophen, NSAIDs where appropriate, regional anesthesia, and non-pharmacologic strategies.
Implications for clinical practice
The potential benefits of continuous intravenous lidocaine infusion align with modern enhanced recovery after surgery (ERAS) pathways, particularly for elderly patients who stand to gain from reduced opioid exposure and quicker return of function. Implementing lidocaine protocols requires multidisciplinary collaboration, hospital-specific dosing guidelines, and robust monitoring. When integrated thoughtfully, lidocaine infusions can be a valuable tool to improve analgesia, support earlier mobilization, and promote smoother postoperative courses for elderly individuals undergoing laparoscopic colorectal surgery.
Conclusion
Continuous intravenous lidocaine infusion represents a promising component of multimodal analgesia for elderly patients after laparoscopic colorectal surgery. While evidence points toward improved postoperative analgesia and recovery with careful patient selection and monitoring, larger randomized trials and standardized protocols will help refine dosing, safety, and long-term outcomes. Clinicians should weigh benefits against potential risks and tailor strategies to each patient’s health status and surgical context.
