Effects of an intravenous lidocaine bolus before tracheal extubation on recovery after breast surgery – Lidocaine at the End (LATE) study: a randomized controlled clinical trial

AIM: To investigate whether IV lidocaine improves emergence, early recovery, and late recovery after general anesthesia in women who undergo breast surgery. METHODS: Sixty-seven women with American Society of Anesthesiologists physical status I-II, scheduled for breast surgery were randomized to receive an IV lidocaine 1.5 mg/kg bolus (n = 34) or saline placebo (n = 33) before tracheal extubation. Anesthesia was induced with thiopental, vecuronium, and fentanyl, and maintained with sevoflurane ~ 1 MAC and 50% nitrous-oxide in oxygen. No postoperative nausea and vomiting (PONV) prophylaxis was given. Time to extubation, bucking before extubation, and quality of emergence, as well as early and late recovery (coughing post-extubation, sore throat, PONV, and pain scores) within 24 hours postoperatively were evaluated. Diclofenac and meperidine were used for the treatment of pain and metoclopramide for PONV. RESULTS: The groups did not significantly differ in demographics, intraoperative data, or PONV risk scores. Extubation was ~ 8 minutes in both groups. Patients who received IV lidocaine had significantly smoother recovery, both statistically and clinically; they had better extubation quality scores (1.5 [1-3] vs 3 [1-5], P < 0.001), less bucking before extubation (38% vs 91%, P < 0.001), less coughing after extubation (at 1 min 18% vs 42%, P = 0.026; and at 24 hours 9% vs 27%, P = 0.049), and less sore throat (6% vs 48%, P < 0.001). Late PONV decreased (3% vs 24%, P = 0.013). There were no differences in pain scores and treatment. CONCLUSION: In women who underwent breast surgery, IV lidocaine bolus administered just before extubation attenuated bucking, cough and sore throat, and PONV for 24 hours after general anesthesia, without prolonging the emergence. ISRCTN: 71855856.