1
Significance
Evaluation of the outcomes of patients receiving intravenous lidocaine and its effect on
reducing postoperative pain and opioid requirements compared to patients who do not receive
intravenous lidocaine is an important clinical issue to implement a practice change in hospitals
that do not currently utilize IV lidocaine. Opioids are extensively used as analgesics for moderate
to severe acute and chronic pain during surgical procedures (Paul et al., 2021; Steele et al.,
2022). Nonetheless, these analgesic medication groups have several potential drawbacks since
they create various adverse effects. Paul et al. (2021) claim that analgesic tolerance, physical
dependence, constipation, respiratory depression, and nausea and vomiting (N/V) are among
them. Respiratory depression occurs less commonly than other adverse effects, yet it can be fatal
in some cases (Paul et al., 2021). Bateman et al. (2021) acknowledge that opioid-induced
respiratory depression is characterized by slow, shallow, and irregular breathing, which can
progress to respiratory arrest in severe instances, such as sustained apnoea. Additionally, opioids
cause muscle stiffness and impede chemoreflex and upper airway patency.
Intravenous lidocaine (IVL) can be an alternative because it can be advantageous in a
perioperative environment due to its properties. Beaussier et al. (2018) inform that lidocaine is a
Class 1b antiarrhythmic agent and a local amide anesthetic. A meta-analysis of abdominal
surgery showed that lidocaine improved pain management, opiate use, postoperative ileus, the
incidence of PONV, and duration of hospital stay (Beaussier et al., 2018). Aside from its well-
known analgesic and anti-inflammatory qualities, IVL may also improve bronchial reactivity, the
incidence of venous thrombosis, and recovery from postsurgical ileus (Beaussier et al., 2018).
Moreover, with the generally prescribed doses, lidocaine's therapeutic efficacy remains very
high, and plasma concentrations continue to stay well below the cardiotoxic and neurotoxic
, 2
permissible levels, which clinicians may use to conclude the benefit-risk profile of IVL in
comparison to other analgesic methods.
Theoretical Framework: Middle Range Theory of Acute Pain
A middle-range theory of acute pain management has been used to train nurses about
pain management. According to the original hypothesis, in individuals with moderate to severe
acute pain, the healthcare professional should administer effective pain medicine and
pharmacologic and nonpharmacologic adjuvants to strike a balance between analgesia and side
effects (Good, 1998). Moreover, the nurse should routinely check pain and side effects and
educate patients on how to engage. The middle-range theory asserts that "multimodal
intervention, attentive pain management, and patient participation" contribute to the balance of
analgesia and side effects (Good, 1998, p. 120). The balance of analgesia and side effects is
critical because when opioids are taken, the risk of adverse impacts develops and should be
mitigated.
Hence, both studies selected are solely based on attentive pain management using
lidocaine. Good (1998) emphasizes the need for nurse researchers to test a fundamental middle-
range theory of pain that applies to practice. For instance, Li et al. (2018) acknowledge that
lidocaine is utilized to impede neural conductions and has anti-inflammatory qualities during the
perioperative phase. The findings of the meta-analysis revealed that intravenous lidocaine was
related to lower pain ratings (Li et al., 2018). Furthermore, lidocaine was linked to a decrease in
the occurrence of nausea and vomiting, ileus, and pruritus. Following a laparoscopic
cholecystectomy (LC), intravenous lidocaine minimizes initial postoperative pain, overall opioid
needs, and opioid-related side effects.
Effective pain management after surgery is critical for functional recovery and preventing
Significance
Evaluation of the outcomes of patients receiving intravenous lidocaine and its effect on
reducing postoperative pain and opioid requirements compared to patients who do not receive
intravenous lidocaine is an important clinical issue to implement a practice change in hospitals
that do not currently utilize IV lidocaine. Opioids are extensively used as analgesics for moderate
to severe acute and chronic pain during surgical procedures (Paul et al., 2021; Steele et al.,
2022). Nonetheless, these analgesic medication groups have several potential drawbacks since
they create various adverse effects. Paul et al. (2021) claim that analgesic tolerance, physical
dependence, constipation, respiratory depression, and nausea and vomiting (N/V) are among
them. Respiratory depression occurs less commonly than other adverse effects, yet it can be fatal
in some cases (Paul et al., 2021). Bateman et al. (2021) acknowledge that opioid-induced
respiratory depression is characterized by slow, shallow, and irregular breathing, which can
progress to respiratory arrest in severe instances, such as sustained apnoea. Additionally, opioids
cause muscle stiffness and impede chemoreflex and upper airway patency.
Intravenous lidocaine (IVL) can be an alternative because it can be advantageous in a
perioperative environment due to its properties. Beaussier et al. (2018) inform that lidocaine is a
Class 1b antiarrhythmic agent and a local amide anesthetic. A meta-analysis of abdominal
surgery showed that lidocaine improved pain management, opiate use, postoperative ileus, the
incidence of PONV, and duration of hospital stay (Beaussier et al., 2018). Aside from its well-
known analgesic and anti-inflammatory qualities, IVL may also improve bronchial reactivity, the
incidence of venous thrombosis, and recovery from postsurgical ileus (Beaussier et al., 2018).
Moreover, with the generally prescribed doses, lidocaine's therapeutic efficacy remains very
high, and plasma concentrations continue to stay well below the cardiotoxic and neurotoxic
, 2
permissible levels, which clinicians may use to conclude the benefit-risk profile of IVL in
comparison to other analgesic methods.
Theoretical Framework: Middle Range Theory of Acute Pain
A middle-range theory of acute pain management has been used to train nurses about
pain management. According to the original hypothesis, in individuals with moderate to severe
acute pain, the healthcare professional should administer effective pain medicine and
pharmacologic and nonpharmacologic adjuvants to strike a balance between analgesia and side
effects (Good, 1998). Moreover, the nurse should routinely check pain and side effects and
educate patients on how to engage. The middle-range theory asserts that "multimodal
intervention, attentive pain management, and patient participation" contribute to the balance of
analgesia and side effects (Good, 1998, p. 120). The balance of analgesia and side effects is
critical because when opioids are taken, the risk of adverse impacts develops and should be
mitigated.
Hence, both studies selected are solely based on attentive pain management using
lidocaine. Good (1998) emphasizes the need for nurse researchers to test a fundamental middle-
range theory of pain that applies to practice. For instance, Li et al. (2018) acknowledge that
lidocaine is utilized to impede neural conductions and has anti-inflammatory qualities during the
perioperative phase. The findings of the meta-analysis revealed that intravenous lidocaine was
related to lower pain ratings (Li et al., 2018). Furthermore, lidocaine was linked to a decrease in
the occurrence of nausea and vomiting, ileus, and pruritus. Following a laparoscopic
cholecystectomy (LC), intravenous lidocaine minimizes initial postoperative pain, overall opioid
needs, and opioid-related side effects.
Effective pain management after surgery is critical for functional recovery and preventing
