Monoclonal and Polyclonal Antibodies Research (6)
Immune cells in cancer (5)
Inflammatory Biomarkers in Disease Prognosis (5)
Glycosylation and Glycoproteins Research (4)
Atrial Fibrillation Management and Outcomes (3)
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.
Esophageal cancer is the eighth most prevalent malignant tumor in the world and has the sixth highest mortality rate. Postoperative pulmonary complications (PPCs) are one of the most common complications of minimally invasive esophagectomy (MIE). The non-local anesthetic effects of lidocaine have been widely reported, but only a few studies have focused on its effects on lung protection in MIE. This study is designed to test the hypothesis that intraoperative intravenous lidocaine infusion can reduce the incidence of PPCs in patients undergoing MIE. In this double-center, randomized, double-blind, placebo-controlled superiority trial, 770 participants from three centers will be randomly assigned to two groups, namely the lidocaine group and the placebo group in a 1:1 ratio. The primary outcome is the incidence of PPCs within 7 days following surgery. The secondary outcomes include the incidence of (1) respiratory infection; (2) respiratory failure; (3) pneumothorax; (4) atelectasis; (5) pleural effusion; (6) bronchospasm; (7) aspiration pneumonitis; (8) anastomotic fistula; (9) moderate to severe pain within 24 and 48 h at rest and when coughing; (10) additional rescue analgesics use. This study aims to address a significant gap in the prevention of PPCs in patients undergoing MIE for esophageal cancer. PPCs are common and can negatively impact recovery and survival outcomes, making effective prevention strategies crucial. While lidocaine's non-local anesthetic properties, including anti-inflammatory and analgesic effects, have been well-documented, few studies have focused on its role in lung protection during MIE. By assessing the incidence of PPCs and other secondary outcomes, this trial seeks to determine whether intraoperative lidocaine infusion can offer a novel, non-invasive approach to reducing PPC risk and improving overall postoperative recovery. If lidocaine proves effective, this study will provide a new way to improve patient outcomes, particularly for those with high PPCs risk. Furthermore, the results could expand the scope of lidocaine use in surgical settings, suggesting a potentially low-cost and accessible intervention for broader perioperative lung protection. NCT06138041 (ClinicalTrials.gov, registration date: 2024-10-22). This study will provide a reliable conclusion investigating the effect of intraoperative intravenous lidocaine infusion on postoperative pulmonary complications in patients undergoing minimally invasive esophagectomy. The study includes an appropriate sample size and a double-center, randomized, and double-blind placebo-controlled design, which reduces potential bias. The full analysis set consists of all participants according to the intention-to-treat principle and the per-protocol set will be both performed. Per-protocol analysis will be used for sensitivity analyses. Intravenous lidocaine infusion is only continued until patients are transferred out of the post-anesthesia care unit, while the benefit of prolonged infusion in the ward will not be investigated.
Liu M, Harris S, Andreou AP, Al-Kaisy A, Pang D , et al.
PloS one •
Fibromyalgia is a chronic pain condition characterised by widespread pain. The current treatment primarily focuses on self-management and symptomatic relief. IV lidocaine infusion is the most performed procedure in the UK that is offered after conventional therapy has failed. We aim to identify the predictors of response to systemic lidocaine to enable targeted treatment for individuals who are more likely to benefit. This study adheres to the RECORD guidelines for reporting studies using routinely collected observational data. It was conducted retrospectively and employed data derived from clinical records of patients who received standard care. Adult patients who had completed questionnaires and quantitative sensory testing (QST) before IV lidocaine infusion were included. We collected data consecutively from 132 patients, including 24 men and 108 women. Responders were defined as patients who experienced a pain reduction of 50% or greater lasting for at least three weeks following an IV lidocaine infusion at a dose of 5 mg/kg. We identified 22% of patients as responders. Our findings indicate a notable gender disparity in the number of responders, with a response rate of 25.9% observed in female patients compared to 4.2% in male patients (p = 0.02). Functional impairment in the revised fibromyalgia impact questionnaire was higher in female patients than male patients (22.6 ± 5.8 vs 19.8 ± 7.7, p = 0.043). Responders were younger (42.7 ± 11.2 vs 49.4 ± 11.4, p = 0.003), had shorter pain duration in years (10.0 ± 6.1 vs 14.1 ± 9.3, p = 0.015), and lower weekly pain scores (7.8 ± 1.7 vs 8.5 ± 1.4, p = 0.014). No significant difference in QST parameters or loss/gain phenotypes was observed between responders and non-responders. A normal QST was identified in 25% of responders and 16% of non-responders. Consequently, QST alone could not predict the response to systemic lidocaine infusion. IV lidocaine infusion proves effective, especially for younger female patients, which should be added to conventional therapies for these patients.