Anesthesia and Pain Management (3)
Anesthesia and Sedative Agents (3)
Discourse Analysis and Cultural Communication (2)
Asthma and respiratory diseases (1)
Mast cells and histamine (1)
Pain following hepatectomy may delay recovery and increase opioid use. We tested the primary hypothesis that combining lidocaine and low-dose esketamine would reduce movement-evoked pain 24 h after hepatic resection. We also evaluated whether this approach reduced opioid consumption and improved quality of recovery. Patients having elective hepatic resections were allocated randomly to receive lidocaine-esketamine or placebo from induction of anaesthesia until the end of surgery. After surgery, patients allocated to lidocaine-esketamine were given a continuous infusion of lidocaine with esketamine for 72 h. All patients received transversus abdominis plane blocks with ropivacaine 2 mg.kg after induction of anaesthesia. Postoperative analgesia was provided by patient-controlled intravenous analgesia with sufentanil. In total, 304 patients were included, of whom 145 (48%) had open surgery. Lidocaine-esketamine infusion reduced median (IQR [range]) pain scores with movement at 24 h (3 (2-4 [1-6]) vs. 4 (3-5 [1-9]), p < 0.001); 48 h (3 (2-4 [0-7]) vs. 4 (3-5 [0-8]), p < 0.001); and 72 h (2 (1-3 [0-6]) vs. 3 (2-4 [0-7]), p < 0.001), respectively. Moderate-to-severe movement-evoked pain at 24 h was evident in 52/152 (34%) patients who received lidocaine-esketamine vs. 85/152 (56%) who received placebo (p < 0.001). Cumulative sufentanil equivalents were significantly reduced at each measurement time and quality of recovery scores were significantly higher through the first 72 h for lidocaine-esketamine compared with placebo, but these changes were clinically modest. The combination of lidocaine with esketamine reduced movement-evoked pain and opioid consumption whilst improving quality of recovery during the initial 72 h after hepatic resection. However, treatment effects were modest and of limited clinical importance.
Elevated high-sensitivity troponin T levels shortly after noncardiac surgery are closely linked to myocardial injury, a key factor in 30-day postoperative mortality. Intravenous lidocaine, known for its potent anti-inflammatory and membrane-stabilizing properties, has shown cardioprotective potential in other surgical settings, but its efficacy in noncardiac thoracic surgery remains unclear. This study was a double-blind, placebo-controlled randomized trial. Participants were randomly allocated to the lidocaine or placebo group with a 1:1 ratio. Single-centre, double-blind, randomized controlled trial. Academic tertiary care medical centre. Patients scheduled for noncardiac thoracic surgery, predominantly via video-assisted thoracoscopic surgery (VATS), under general anesthesia from June 12, 2021 to June 12, 2022. Patients received intravenous lidocaine (1.5 mg kg bolus pre-induction followed by 1.5 mg kg h infusion until surgery end) or volume-matched saline. Dosing was adjusted to ideal body weight for BMI ≥ 25 kg m². Study drugs were prepared by blinded staff and administered via standardized pumps. The primary outcome was high-sensitivity troponin T concentration at 24 h postoperatively. Secondary outcomes encompassed: (1) the absolute change from baseline to 24 h post-surgery for high-sensitivity troponin T (2) the occurrence of MINS, identified by high-sensitivity troponin T levels of 14 ng l or higher within 48 h after surgery; (3) levels of NT-proBNP, CK-MB, myoglobin, hs-CRP, and inflammatory markers on the first and second postoperative days; (4) overall opioid use during surgery; and (5) hemodynamic parameters during the operation. Between June 12, 2021, and June 12, 2022, we enrolled 119 patients who underwent thoracic surgery for lung cancer (mean age 59.41 years [SD 11.085], 58 [48.7%] male). The median [IQR] 24-hour high-sensitivity troponin T level did not differ between the lidocaine and control groups (8.00 [6.00–15.00] ng l vs. 8.00 [5.00–10.00] ng l, = 0.34). Additionally, the absolute change in hs-TnT from baseline showed no significant difference (3.21 ± 5.93 ng l⁻¹ vs. 3.00 ± 8.56 ng l⁻¹, = 0.88).The incidence of MINS was similar between the groups (23.3% vs. 23.7%, = 0.96). Lidocaine exhibited significant anti-inflammatory properties, resulting in an 84.8% reduction in 48-hour IL-6 levels (46.5 ± 33.6 pg ml vs. 307.0 ± 312.2 pg ml, = 0.04). In a post-hoc analysis, age was identified as a significant independent predictor of myocardial injury (OR 0.259 for age < 65 vs. ≥ 65 years; 95% CI 0.107 to 0.627; = 0.003), but no evidence of an interaction with the treatment allocation was found. Perioperative lidocaine infusion significantly suppressed systemic inflammation, but did not reduce early myocardial biomarker release in the overall cohort. The finding that younger age was associated with a lower risk of myocardial injury, irrespective of treatment group, suggests that age is a key prognostic factor. Further studies are warranted to explore age-specific cardioprotective strategies and the underlying mechanisms of inflammatory-myocardial coupling. ChiCTR2100047336. Registered on June 12, 2021. The online version contains supplementary material available at 10.1186/s12871-026-03733-y.
Hung KC, Chang LC, Wang WT, Liao SW, Hsu CW , et al.
Systematic reviews •
Dexmedetomidine and lidocaine are commonly used adjuvants in postoperative pain management; however, their comparative efficacy is unclear. This meta-analysis compared the effects of intravenous dexmedetomidine and lidocaine on postoperative analgesia and recovery. Cochrane Library, Medline, Embase, and Google Scholar were searched from their inception to July 1, 2024, to identify relevant randomized controlled trials (RCTs) comparing intravenous dexmedetomidine and lidocaine in adult patients undergoing non-cardiac surgery under general anesthesia. The primary outcomes were the postoperative pain score at 24 h and postoperative opioid consumption. The secondary outcomes included early postoperative pain scores, intraoperative opioid/anesthetic requirements, hemodynamic parameters, recovery characteristics, and inflammatory markers. Twenty-four studies (1,697 patients) were included. There was no significant difference between dexmedetomidine and lidocaine in terms of pain scores at 24 h (mean difference [MD]: 0.01, p = 0.88) or overall postoperative opioid consumption (standardized MD[SMD]: -0.51, p = 0.06). However, dexmedetomidine was associated with lower pain scores at 2-4 h postoperatively (MD:-0.41, p = 0.02), reduced intraoperative anesthetic agent requirements (SMD:-1.1, p = 0.004), a longer time to rescue analgesic (MD: -29.93 min, p < 0.00001), and improved quality of recovery scores (SMD: 1.72, p = 0.01). Dexmedetomidine resulted in lower heart rate and blood pressure compared to lidocaine, without differences in other recovery characteristics and inflammation. Both dexmedetomidine and lidocaine are effective adjuvants for improving postoperative outcomes. Nevertheless, dexmedetomidine has shown advantages in terms of early pain control, reduced anesthetic requirements, and improved quality of recovery. The choice of these agents should be based on individual patient factors and specific surgical procedures.
The concurrent use of a ropivacaine transversus abdominis plane (TAP) block with intravenous lidocaine infusion, though effective for pain relief, raises safety concerns regarding local anesthetic systemic toxicity (LAST). This study aimed to assess the dose-risk relationship of LAST in this combination by escalating the ropivacaine dose while fixing the lidocaine dose. In this dose-escalation study, adult patients undergoing colorectal cancer surgery received a 0.2% ropivacaine TAP block (1.5, 2.0 or 2.5 mg kg) and intravenous lidocaine infusion (2 mg kg bolus, followed by 2 mg kg h), both dosed according to ideal body weight (IBW). The primary outcome was the occurrence of LAST, identified by clinical symptoms, new-onset ECG irregularities, etc. Secondary outcomes included plasma concentrations of ropivacaine and lidocaine. Nine patients were included in the per-protocol analysis, and 26 were included in the intention-to-treat analysis. No signs of LAST were observed. Plasma ropivacaine concentrations remained consistently below 2.2 µg mL, however, eight patients in the intention-to-treat population and three patients in the per-protocol population had plasma lidocaine concentrations exceeding 5.0 µg mL at 10 min post-bolus. In the per-protocol population, peak plasma ropivacaine concentrations occurred at 30 min (range, 20-60) post-TAP block, with median values of 1.14 (range, 0.85-1.18), 1.42 (range, 1.29-1.80), and 1.96 (range, 1.47-2.06) µg mL across dose groups. The peak plasma lidocaine concentrations in patients occurred at 10 min post-bolus infusion, with median values of 4.59 µg mL (range, 3.24-6.67) and gradually decreased after 2 h. The intention-to-treat analysis found similar results. Although no signs of LAST were observed with the combination of a 1.5 to 2.5 mg kg ropivacaine TAP block and intravenous lidocaine infusion under general anaesthesia, extreme caution is still warranted regarding the potential risk of LAST. This trial was registered at ClinicalTrials.gov (NCT06006026) on 23 August 2023.