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Opioids are commonly used for postoperative analgesia, but concerns about their potential link to cancer progression and metastasis have led to interest in opioid-free regimens. Intravenous lignocaine, with its analgesic and potential anticancer properties, is emerging as an alternative. We aimed to compare the incidence of inadequate postoperative analgesia and the need for rescue medications between intravenous lignocaine and morphine following major head and neck surgeries.

This retrospective observational study included 40 adult patients who had undergone major head and neck surgeries with reconstruction, divided into two groups. Group M received morphine 0.02 mg/kg/h infusion, and Group L received lignocaine 0.5 mg/kg/h infusion for postoperative analgesia. Data on hemodynamic responses, rescue analgesic use, and ventilation duration were extracted from electronic medical records and intensive care unit nurses' charts. Inadequate analgesia was defined as a >20% increase in heart rate or mean arterial pressure (MAP) from baseline.

Group L showed a significantly lower incidence of inadequate analgesia (20%) compared to Group M (20% vs. 80%, P = 0.0002). Patients in Group L required significantly less rescue clonidine (P < 0.001) and had significantly lower total dexmedetomidine consumption and duration of infusion. Mean heart rate and MAP were significantly higher in Group M at various postoperative time points. Postoperative ventilation duration was comparable between the groups.

Intravenous lignocaine significantly reduced inadequate analgesia and need for rescue medications with optimal hemodynamics in the immediate postoperative period following major head and neck surgeries. Further large-scale, prospective, randomized controlled trials are warranted.