الفهرس 
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Abstract
Appendectomy is one of the most common surgical procedures. Conventional (open) appendectomy is one of open abdominal surgery which associated with post-operative pain, nausea, ileus, and prolonged hospital stay. So, a multimodal analgesia regimen is recommended in the perioperative setting as it provides superior analgesia and reduces opioid requirement.
IV lidocaine injection is one of multimodal analgesics. It has analgesic, antihyperalgesic, and anti-inflammatory effects through several potential mechanisms. Intravenous lidocaine increases acetylcholine concentration at the spinal level through an activation of both muscarinic and nicotinic receptors, and thereby prolongs the pain threshold. Also, by activating central glycine (an inhibitory neurotransmitter) receptor, systemic lidocaine inhibits glutamate-induced excitatory response on the wide dynamic response in the spinal neurons. The anti-hyperalgesic effect of IV lidocaine is due to blockade of NMDA receptor signaling and it is mediated indirectly by inhibition of the protein kinase C pathway. In addition to this, the anti-infammatory effect caused by the reduction of cytokines such as IL-6, IL-1β and TNFα.
In addition, lidocaine infusion include a reduction in the incidence of postoperative nausea and vomiting, early return of bowel motility and improved quality of recovery.
The current prospective randomized double-blinded study was conducted at the surgery department, Faculty of Medicine, Ain Shams university and it included 40 patients who were undergone urgent open appendectomy and met the selection criteria.
They were classified into 2 groups: group L: patient who received IV bolus injection of lidocaine (1.5mg/kg slowly over 10 min) before the skin incisions followed by a continuous IV infusion at the rate of 2mg/kg/h via infusion pump(B-BRAUN), group S (control): patient who received 0.9% normal saline in equal volume and in the same manner.
• Demographic data: showed no significant difference.
• Hemodynamics: there was no significant difference between group L and groups regarding baseline hemodynamics while during incision at 15, 30, 45, 60 minutes and on extubation there was significant difference between group L and group S regarding hemodynamics except diastolic blood pressure showed no significant difference during intubation.
• Postoperative pain: There was statistically difference between the studied groups regarding postoperative VAS at 4, 20 or 24 hours due to patient mobilization and the effect of pethidine starts to decrease in controlling pain. There is statistically non-significant difference between the studied groups regarding VAS at 8, 12, and 16 hours because patient is under the effect of analgesia with pethidine (However, VAS is lower within lidocaine group at any point of time).
• Opioid requirement: There was statistically significant difference between the studied groups regarding pethidine dose needed. Patients within lidocaine group need significantly lower pethidine doses than those with control group.
• Postoperative gastrointestinal recovery: There was statistically significant difference between the studied groups regarding time to pass flatus. Patients within lidocaine group pass flatus significantly earlier than those with control group.
• Postoperative complications (nausea, vomiting,and illeus): There is statistically non-significant difference between the studied groups regarding postoperative complications.
• No patient showed lidocaine toxicity.