ORIGINAL ARTICLE Effects of Intravenous Versus Epidural Lidocaine Infusion on Pain Intensity and Bowel Function After Major Large Bowel Surgery: a Double-Blind Randomized Controlled Trial Chryssoula Staikou & Alexandra Avramidou & Georgios D. Ayiomamitis & Spyros Vrakas & Eriphili Argyra Received: 28 May 2014 /Accepted: 3 September 2014 /Published online: 23 September 2014 # 2014 The Society for Surgery of the Alimentary Tract Abstract Background We compared the effects of intravenous lidocaine (IVL) with lumbar epidural lidocaine analgesia (LEA) on pain and ileus after open colonic surgery. Methods Between December 2011 and February 2013, 60 patients were randomly allocated to IVL, LEA, or control group. The IVL group received intraoperatively lidocaine 2 % intravenously (1.5 mg/kg bolus, 2 mg/kg/h infusion) and normal saline (NS) epidurally. The LEA group received lidocaine epidurally (1.5 mg/kg bolus, 2 mg/kg/h infusion) and NS intravenously. The control group received NS both intravenously and epidurally, as bolus and infusion. All NS volumes were calculated as if containing lidocaine 2 % at the aforementioned doses. We assessed pain intensity at rest/cough at 1, 2, 4, 12, 24, and 48 h postoperatively (numerical rating scale 0–10), 48-h analgesic consumption, and time to first flatus passage. Results Data from 60 patients (20 per group) were analyzed. The IVL group had significantly lower pain scores at rest and cough compared to LEA or control group only at 1, 2, and 4 h postoperatively (P <0.005 for all comparisons). The 48-h analgesic requirements and time to first flatus passage did not differ significantly between IVL group and LEA or control group (P >0.05). Conclusions Compared with LEA-lidocaine or placebo, intravenous lidocaine offered no clinically significant benefit in terms of analgesia and bowel function. Keywords Intravenous lidocaine . Epidural lidocaine . Open large bowel surgery . Postoperative ileus Introduction The pathophysiology of postoperative pain is multifactorial; surgical trauma and inflammatory mediators, sympathetic stimulation, and catecholamine release are all involved in the process. These factors, along with the opioid consumption are also implicated in the postoperative reduced bowel motility. 1 The duration of ileus, which is mainly encountered after intraperitoneal surgical procedures, may be shortened with minimization of opioids, enhancement of bowel contrac- tility via sympathetic blockade, 2,3 and systemic administration of local anesthetics. 4,5 Since both pain and delayed bowel function result in pa- tient discomfort and prolongation of hospitalization with ad- verse outcomes and increased costs, non-opioid-based anal- gesic techniques have attracted the interest of many Authors’ Contributions Study conception and design: A. Avramidou, G. Ayiomamitis, E. Argyra Acquisition of data: A. Avramidou, G. Ayiomamitis, S. Vrakas Analysis and interpretation of data: S. Vrakas, C. Staikou Drafting of manuscript: A. Avramidou, C. Staikou Critical revision of manuscript: C. Staikou, E. Argyra C. Staikou (*) : E. Argyra First Department of Anesthesiology, Aretaieion Hospital, University of Athens School of Medicine, 76 Vass. Sophias Av., 11528 Athens, Greece e-mail: c_staikou@yahoo.gr A. Avramidou Department of Anesthesiology, Tzaneion General Hospital, Zanni & 1 Afentouli Strs, 18536 Piraeus, Greece G. D. Ayiomamitis Second Department of Surgery, Tzaneion General Hospital, Zanni & 1 Afentouli Strs, 18536 Piraeus, Greece S. Vrakas Tzaneion General Hospital, Zanni & 1 Afentouli Strs, 18536 Piraeus, Greece J Gastrointest Surg (2014) 18:2155–2162 DOI 10.1007/s11605-014-2659-1