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 Table of Contents    
LETTER TO THE EDITOR
Year : 2013  |  Volume : 17  |  Issue : 4  |  Page : 264

Intravenous lignocaine for treatment of refractory ileus following spinal cord injury


1 Department of Neuroanesthesiology, Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India
2 Department of Neuroanesthesiology, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication19-Sep-2013

Correspondence Address:
Tumul Chowdhury
Department of Neuroanesthesiology, Neurosciences Center, 7th Floor, All India Institute of Medical Sciences, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-5229.118418

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How to cite this article:
Dube SK, Kumar S, Chowdhury T. Intravenous lignocaine for treatment of refractory ileus following spinal cord injury. Indian J Crit Care Med 2013;17:264

How to cite this URL:
Dube SK, Kumar S, Chowdhury T. Intravenous lignocaine for treatment of refractory ileus following spinal cord injury. Indian J Crit Care Med [serial online] 2013 [cited 2018 May 27];17:264. Available from: http://www.ijccm.org/text.asp?2013/17/4/264/118418


Sir,

Gastrointestinal (GI) motility disturbances can be one of the major causes of patient discomfort in the intensive care unit (ICU) and are also associated with increased rate of ventilator associated pneumonia, infections, the risk of bacterial translocation, and the inability to be fed. [1] Here we have highlighted the management of refractory ileus after spinal cord injury.

A 30-year-old male (54 kg) presented with traumatic spinal cord injury at T7-T8 level. After a corrective spine surgery the patient was shifted to the ICU for further management. During ICU stay, the patient had ileus which precluded starting of early enteral nutrition. All the laboratory investigations and ultrasononography of whole abdomen were normal. All the possible causes of ileus included fluid and electrolyte imbalance, drugs promoting ileus and mechanical gut obstruction were excluded. On day three, we decided to start treatment with IV lignocaine infusion in our patient. Intravenous lignocaine (1 mg/kg) followed by 1-4 mg/min was administered to the patient. After 26 h of infusion, signs of bowel motility (passage of stool and flatulence) were apparent and the lignocaine infusion was stopped and enteral nutrition was started. The patient had an uneventful stay in the ICU thereafter and was discharged from the ICU.

Ileus following acute spinal cord injury is a known entity. Partial disruption of afferent and efferent spinal cord innervations and stress response to trauma or surgical management are the important causes of ileus following spinal cord injury. Lidocaine may improve smooth muscle contractility and basic cell function by cellular repair mechanisms which are still unknown. [2] Neostigmine has been suggested as one of the therapeutic modality for refractory ileus in spinal cord injured patient. [3] However, we did not use neostigmine for the treatment of ileus in our patient as there was chance of deleterious effects of neostigmine in spinal cord injured patients who may be prone to autonomic disturbance and bradycardia. [4]

In conclusion, lignocaine can be an important therapeutic option in case of refractory ileus following spinal cord injury and should be started to reduce the overall morbidity.

 
  References Top

1.Fruhwald S, Holzer P, Metzler H. Intestinal motility disturbances in intensive care patients pathogenesis and clinical impact. Intensive Care Med 2007;33:36-44.  Back to cited text no. 1
[PUBMED]    
2.Baumann A, Audibert G, Klein O, Mertes PM. Continuous intravenous lidocaine in the treatment of paralytic ileus due to severe spinal cord injury. Acta Anaesthesiol Scand 2009;53:128-30.  Back to cited text no. 2
[PUBMED]    
3.Althausen PL, Gupta MC, Benson DR, Jones DA. The use of neostigmine to treat postoperative ileus in orthopedic spinal patients. J Spinal Disord 2001;14:541-5.  Back to cited text no. 3
[PUBMED]    
4.Kuo CP, Jao SW, Chen KM, Wong CS, Yeh CC, Sheen MJ, et al. Comparison of the effects of thoracic epidural analgesia and i.v. infusion with lidocaine on cytokine response, postoperative pain and bowel function in patients undergoing colonic surgery. Br J Anaesth 2006;97:640-6.  Back to cited text no. 4
    




 

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