Anesthesia and Pain Management (10)
Anesthesia and Sedative Agents (4)
Music Therapy and Health (4)
Cancer, Stress, Anesthesia, and Immune Response (4)
Pain Management and Opioid Use (3)
Journal of anesthesia, analgesia and critical care •
Previous studies have demonstrated that perioperative use of lidocaine effectively reduces opioid requirements in various surgical procedures. Our objective was to evaluate the effect of postoperative intravenous lidocaine infusion on opioid consumption following pelvic bone tumor surgery. This single center randomized controlled trial in a tertiary teaching hospital containing a total of 70 patients, aged 18 to 65 years, with American Society of Anesthesiologists(ASA) physical status classifications of I to III, who were scheduled to undergo pelvic bone tumor surgery. Participants were randomly assigned in a 1:1 ratio to either the lidocaine group(L Group) or the control group(C Group). The L Group received lidocaine for postoperative analgesia, whereas the C Group was administered a placebo saline infusion.The primary outcome was postoperative opioid consumption. Secondary outcomes included the time to first bowel movement, the incidence of postoperative nausea and vomiting(PONV), and pain scores at rest and during movement on postoperative days. A significant difference was observed in the cumulative 72-h morphine equivalent consumption between the L Group (n = 33) and the C Group (n = 33). Patients in the L Group required significantly less morphine equivalent consumption compared to the C Group (13 (0-52) mg vs. 25 (14-85) mg, P = 0.043). Additionally, the proportion of patients experiencing breakthrough pain was significantly lower in the L Group compared to the C Group (33.33% vs. 75.76%, P = 0.001). No significant differences were noted between the groups in secondary outcomes, including the incidence of PONV, numerical pain scores at rest or during movement, time to first bowel evacuation, or time to first oral intake. Postoperative intravenous lidocaine infusion is effective in reducing opioid consumption and the incidence of breakthrough pain following pelvic bone tumor surgery. This single-center, prospective RCT was registered with the Chinese Clinical Trial Registry (ChiCTR2100051207, 15/09/2021). The first research participant was enrolled in September 20, 2021.
International journal of surgery (London, England) •
Lumbar surgery is often associated with significant postoperative pain, high opioid consumption, and delayed bowel function recovery. This study aimed to assess whether intravenous lidocaine infusion could enhance bowel function recovery in patients undergoing lumbar surgery. This multicenter, randomized, controlled, double-blinded study was conducted across three tertiary university hospitals. A total of 96 patients, aged 60-80 years, with an American Society of Anesthesiologists (ASA) classification of I-III, scheduled for lumbar spinal surgery, were randomly assigned to either the lidocaine group (L group) or the control group (C group) in a 1:1 ratio. Patients in the L group received perioperative intravenous lidocaine infusion and, postoperatively, lidocaine as a component of the multimodal patient-controlled analgesia regimen, whereas patients in the C group received normal saline in place of lidocaine under the same regimen. The primary outcome was the time to first evacuation. Secondary outcomes included the time to first defecation, intraoperative opioid consumption, incidence of postoperative nausea and vomiting (PONV), numerical rating scale (NRS) pain scores at rest and during movement, postoperative opioid consumption, and length of hospital stay. Patients in the L group had a significantly shorter evacuation time compared to the C group [(17 hours; 95% CI, 14-20 hours) vs (23 hours; 95% CI, 19-28 hours); P = 0.013)]. Intraoperative opioid consumption was significantly lower in the L group than in the C group, including sufentanil (18 [15, 20] µg vs. 25 [17, 30] µg, P < 0.001) and remifentanil (760 [450, 1040] µg vs. 1000 [760, 1440] µg, P = 0.002). Additionally, propofol usage was significantly lower in the L group compared to the C group (591.57 ± 206.39 mg vs. 692.96 ± 229.50 mg, P = 0.027). No significant differences were observed between the groups for other secondary outcomes. Intravenous lidocaine infusion in patients undergoing lumbar surgery accelerates postoperative bowel function recovery and reduces intraoperative opioid consumption.
This study aimed to compare the efficacy and safety of lidocaine-based patient-controlled intravenous analgesia (PCIA) with sufentanil-based PCIA for managing postoperative pain in patients undergoing laparoscopic colorectal cancer surgery. A total of 126 patients were randomly assigned in a 1:1 ratio to lidocaine group (group L, n = 63) or the sufentanil group (group S, n = 63). The primary endpoint was visual analogue scale (VAS) pain score during movement at 24 h after surgery. Secondary endpoints included VAS pain scores at rest and during movement at 6, 12, 36, and 48 h after surgery, the time of first flatus and defecation after the surgery, postoperative hospitalization time and total hospitalization costs, patient satisfaction scores, and the incidence of adverse events. There was no significant difference between the two groups in VAS pain scores at rest and during movement at 6, 12, 24, 36, and 48 h after surgery (all p > 0.05). The time to first flatus and defecation, as well as postoperative hospitalization time and total hospitalization expenses, were also similar between the two groups (all p > 0.05). However, satisfaction score was significantly higher in group L compared to group S (p < 0.05), and the incidence of postoperative nausea and vomiting (PONV) was significantly lower in group L than in group S (p < 0.05). Lidocaine-based PCIA can effectively relieve postoperative pain, decrease the incidence of PONV, and improve patient satisfaction in patients undergoing laparoscopic colorectal cancer surgery. The study was registered on the Chinese Clinical Trial Registry (ChiCTR) with the registration number ChiCTR2300068854, with the registration date being March 1, 2023.
Febrile infection-related epilepsy syndrome (FIRES) is a catastrophic, drug-resistant epileptic encephalopathy characterized by acute onset following febrile illness and progression to (super-)refractory status epilepticus. We report a case of FIRES in a previously healthy 5-year-and-11-month-old boy who developed super-refractory status epilepticus (SRSE) on day 6 of a nonspecific febrile illness. The seizures were characterized by upward eye deviation, generalized tonic posturing, perioral cyanosis, and persistent impairment of consciousness. Despite comprehensive treatments including multiple immunotherapies (intravenous immunoglobulin administration, methylprednisolone pulse therapy, tocilizumab, and anakinra), ketogenic diet, multiple anti-seizure medications, and management of complications (intracranial pressure control, anti-infective therapy, and respiratory support), seizures remained refractory. Due to refractory seizures, intravenous lidocaine (3 mg/kg/h) was initiated after failed trials of midazolam, propofol and chloral hydrate, and only partial response to ketamine. With a consecutive 35-day infusion (cumulative duration >45 days), this regimen produced substantial reductions in both seizure frequency and severity, with clinically significant improvement in seizure control. Electroencephalogram (EEG) monitoring showed a decrease in the frequency and intensity of epileptic discharges, and improved background activity. The patient's level of consciousness also showed signs of improvement. This case is notable as few reports exist on the use of lidocaine in FIRES patients. It highlights the potential of lidocaine as a valuable anti-seizure option in FIRES management, suggesting the need for further investigation into its safety, efficacy, optimal dosage, and treatment duration in a larger cohort of FIRES patients.
We investigated the efficacy and safety of lidocaine-based patient-controlled intravenous analgesia (PCIA), compared with sufentanil-based PCIA on postoperative pain and recovery quality in patients undergoing thoracoscopic lung surgery. We recruited 160 patients undergoing thoracoscopic lung surgery who were randomized to receive lidocaine-based PCIA (1.5 mg/kg/h) or sufentanil-based PCIA (2 μg/mL) within 48 hours postoperatively. The primary endpoint was visual analogue scores (VAS) pain scores at 6, 12, 24, and 48 hours postoperatively. Postoperative quality of recovery-15 (QoR-15) scores and other prespecified endpoints were also recorded. VAS pain scores at rest and during coughing in the lidocaine group were significantly lower at 6, 12, and 24 hours postoperatively (<0.05), with no difference at 48 hours (0.05). QoR-15 scores in the lidocaine group were higher on postoperative day (POD) 1 (<0.001) and POD2 (<0.001), with significant differences in the two dimensions of postoperative physical comfort and pain (<0.001). The lidocaine group also experienced a shorter time to first flatus, defecation, and ambulation (<0.05), with no difference in the length of postoperative hospitalization and thoracic drainage time (0.05). The serum IL-6, TNF-α, IL-8, cortisol, and epinephrine concentrations were lower in the lidocaine group on POD1 and POD2 (<0.05). The incidence of postoperative nausea and vomiting in the lidocaine group was lower (<0.05), with no differences in other adverse events (>0.05). Compared with sufentanil-based PCIA, lidocaine-based PCIA significantly relieved postoperative pain and improved recovery quality after thoracoscopic lung surgery with fewer postoperative adverse events, which is a considerable choice for postoperative analgesia. This study was retrospectively registered at the Chinese Clinical Trial Registry on March 1st, 2023 (number ChiCTR2300068840).
Journal of anesthesia and translational medicine •
Postoperative sleep disturbance (POSD) caused by postoperative pain can impede the enhanced rapid recovery of elderly patients with colorectal cancer. We propose that perioperative intravenous lidocaine infusion may enhance postoperative sleep quality by alleviating postoperative pain in elderly patients undergoing laparoscopic radical resection for colorectal cancer. Sixty-three elderly patients were divided into two groups: the lidocaine group (group L) and the placebo group (group C). Patients in group L received intravenous injection of lidocaine 1.5 mg/kg during the induction of anesthesia, followed by lidocaine 1.0 mg kg h during surgery and for 24 h after surgery. Patients in group C received the same volume of normal saline. The primary outcome was postoperative sleep function, which was evaluated using the Athens Insomnia Scale (AIS). The secondary outcomes included the pain-at-rest and pain-on-movement of patients at 2, 4, 6, 12, 24, 48, and 72 h after surgery, opioid and propofol consumption, bowel function recovery time, postoperative complications, and lidocaine side effects. Compared to group C, AIS scores in group L were significantly lower on day 1 (12.9 ± 4.0 vs 10.6 ± 3.9, < 0.05), day 3 (8.6 ± 4.2 vs 6.2 ± 3.9, < 0.05), and 1 week (4.3 ± 3.1 vs 2.2 ± 2.5, < 0.05) after surgery. There were no significant differences in VAS scores between the two groups. The intraoperative consumption of propofol and remifentanil was significantly reduced in group L. Lidocaine infusion significantly shortened the recovery time of bowel function. There were no statistical differences between the two groups regarding the incidences of PONV and postoperative pulmonary complications. No cases of local anesthetic toxicity occurred in either group. Perioperative intravenous administration of lidocaine can facilitate the restoration of postoperative sleep function in elderly patients undergoing laparoscopic radical resection of colorectal cancer.
Surgery is one of the most frequent and effective intervention strategies for lumbar spinal stenosis, however, one-third of patients are not satisfied with postoperative outcomes. It is not clear whether perioperative systemic lidocaine could accelerate the early postoperative quality of recovery in patients undergoing lumbar spinal stenosis surgery. 66 patients were enrolled in this trial. Lidocaine or placebo was administered at a loading dose of 1.5 mg/kg for 10 min and then infused at 2.0 mg/kg/hour till the end of surgery. Continued infusion by postoperative patient-controlled intravenous analgesia with a dose of 40 mg/hour. The primary outcome was the quality of recovery. Secondary outcomes included the time of the patient's first flatus, catheter removal time, underground time from the end of the surgery, pain score, levels of inflammatory factors (IL-6, IL-10, TNF-α), postoperative nausea and vomiting (PONV), sufentanil rescues, patients' satisfaction scores, and complications of lidocaine. Eventually, 56 patients were in the final analysis with similar age, Body Mass Index (BMI), duration of surgery and anesthesia, and median QoR-15 score (a development and Psychometric Evaluation of a Postoperative Quality of Recovery Score). The difference in median QoR-15 score in placebo versus lidocaine patients was statistically significant (IQR, 106 (104-108) versus 114 (108.25-119.25), P < 0.001). The Numeric Rating Scale (NRS) score at the 12th hour, median sufentanil rescue consumption, IL-6, tumor necrosis factor-alpha (TNF-α) of patients treatment with lidocaine were lower. Nevertheless, patients given lidocaine had high satisfaction scores. Suggesting that lidocaine enhanced the postoperative quality of recovery, met early postoperative gastrointestinal function recovery, provided superior pain relief, lessened inflammatory cytokines, etc., indicating it may be a useful intervention to aid recovery following lumbar spinal stenosis surgery.