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The Effects of Intravenous Lidocaine and Intravenous Magnesium on the Duration of Neuraxial Anesthesia 

Janessa Terry, RN, DNP, CRNA

DNP Nurse Anesthesia

The Effects of Intravenous Lidocaine and Intravenous Magnesium on the Duration of Neuraxial Anesthesia 

Project Category:  

Project Team: Janessa Terry, DNP, CRNA Jessika Tynes, DNP, CRNA Jennifer Greenwood, CRNA, PhD (Advisor)


Background: Neuraxial anesthesia is a common route of anesthetic delivery for patients undergoing total joint replacement. Enhanced recovery after surgery (ERAS) protocols in orthopedic surgery use multimodal pain management, often including neuraxial anesthesia, with the goal of improving postoperative outcomes. The aim of this study was to compare the effects of intravenous magnesium and intravenous lidocaine on the clinical outcomes of neuraxial anesthesia with tetracaine or bupivacaine.

Methods: A retrospective cohort study was conducted for patients at a community hospital who underwent total joint replacement for whom neuraxial anesthesia was used. Consecutive sampling was used and yielded 78 patients who met inclusion criteria between April 2018 and March 2021. Postoperative outcomes were collected in the electronic medical record (EMR) and analyzed by linear and multiple regression analysis. Sensory and motor recovery, postoperative ambulation, consumption of opioids, reported pain, and length of stay were analyzed.

Results: Patients who received the ERAS protocol had shorter LOS (1.5+0.6, 1.6+0.6 days p=0.019), less opioid requirements (22.3 vs 33.3 total morphine equivalents, p=0.014), and increased ambulation distance on POD1 with physical therapy (121+65, 111.6+64 feet, p=0.037), compared to patients who did not receive the ERAS protocol. Sensory and motor recovery were unable to be assessed due to insufficient data in the EMR.

Conclusion: Implementation of the ERAS protocol for total joint replacement patients was associated with decreased opioid consumption and length of stay, as well as increased distance for postoperative ambulation, leading to a more prompt recovery.

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