Although ambulatory gynecological laparoscopy is considered to be a minimally invasive
surgical procedure, only 60% of patients undergoing this procedure are satisfied with
postoperative pain control. Postoperative pain can lead to physiological, immunological and
psychological derangements in patients.It also has been shown to be the most common cause of
hospital admission after outpatient surgery.
Opioids constitute the most commonly used pain management strategy after surgery, however
they have many undesirable side effects including nausea, vomiting and respiratory
depression. Different strategies have been developed to decrease the amount of opioid
required after surgery. Opioid sparing drugs as well as regional anesthesia have been shown
to be effective. Systemic administration of lidocaine has been shown to decrease opioid
consumption, improve recovery of bowel function and promote a better recovery after inpatient
procedures. Lidocaine has been shown to have analgesic, antihyperalgesic and
anti-inflammatory properties. It also has an excellent safety profile when give by a low-dose
infusion.
The improvement of surgical technique and anesthesia care has made major adverse outcomes
infrequent, especially in the ambulatory setting. Assessing patient's quality of recovery has
become an important outcome in several studies. The patient's capacity to return to his
normal activities is one of the most important sign of a successful outpatient procedure and
it has significant economic implications.
Quality of recovery -40(QoR-40) is a validated 40 item instrument to assess the quality of
post-operative recovery. Myels et al. have concluded that the QoR-40 would be a useful
outcome measure to assess the impact on changes in health care delivery, but anesthesia
studies underutilize this instrument.
The research question for the study is; does the use of systemic perioperative lidocaine
improve quality of recovery after outpatient laparoscopy?