Further Experience in the Prevention of Deep-Vein Thrombosis (DVT) After Elective HIP Surgery Using Lignocaine

We have shown that the administration of intravenous (IV) lignocaine 2mg/min commenced prior to surgery is associated with a marked reduction in the total incidence of deepvein thrombosis (DVT), In particular, thigh vein thrombus was absent, after elective hip surgery. (Lancet 2, 797 - 799, 1977). The present investigation was to determine the effect of a lesser dose of IV and of Intramuscular (IM) lignocaine. In 25 patients IV lignocaine 1mg/min was administered by central venous line, starting 4 hours before, and during the first week following, surgery. Thereafter in 11 of these patients lignocaine was administered intramuscularly; 200mg 4 hourly in 7 patients and 300mg 4 hourly in 4 patients. Monitoring for DVT was by thermography, performed pre-operatively and daily postoperatively until discharge. Phlebography was performed in all cases either when thermography became positive or on the 14th postoperative day. During the administration of IV lignocaine the total incidence of DVT was 32 per cent (expected incidence 70 - 80%) wIth an incidence of thigh vein thrombosis of 25 per cent (expected incidence 50%). The incidence of DVT during IM lignocaine using either dosage regime was similar to the expected incidence of DVT in patients receiving no prophylaxis. We conclude that the effect of lignocaine in the prophylaxis of DVT following hip surgery is both route and dosage dependent.