The effect of lignocaine on pain outcomes for women undergoing gynaecological surgery for chronic pelvic pain

We propose a double-blinded prospective randomised placebo-controlled clinical trial. We aim to investigate the effect of perioperative intravenous lignocaine in women with chronic pelvic pain (CPP) undergoing operative gynaecological laparoscopy at the Monash Endosurgery unit at Moorabbin Hospital in Melbourne Victoria. CPP is a common cause of physical, emotional and socio-economical dysfunction in women which is often complex and challenging to manage. Operative laparoscopy is frequently a component of multidisciplinary management, however the benefits of surgery are often reduced or counteracted by central sensitization pathognomonic to CPP. Pre-existing pain and inadequate pain management in the perioperative period are strong predictors of persisting pain and dissatisfaction with surgery postoperatively. Intravenous lignocaine (IVL) has anti-inflammatory, analgesic and anti-hyperalgesic properties impacting the peripheral and central nervous system. IVL infusions improve pain scores in patients with non-gynaecological chronic pain conditions. Perioperative IVL improves postoperative pain, analgesia requirements, nausea and vomiting and recovery of bowel function in a variety of surgical fields with minimal adverse effects and a good safety profile. Whilst previous studies of perioperative IVL have largely excluded patients with chronic pain, this patient group is likely to benefit most from the use of IVL in the perioperative period. We hypothesis that IVL compared to placebo will significantly improve visual analogue scale (VAS) pain scores in the perioperative period for women with CPP undergoing operative gynaecological laparoscopy.