Fospropofol disodium (fospropofol), a water-soluble prodrug of propofol, reduces injection pain and anesthetic requirements but frequently causes paresthesia. Intravenous lidocaine has been shown to alleviate dexamethasone-induced paresthesia, yet its effect on fospropofol-related symptoms remains uncertain. We combined preclinical and clinical studies, first evaluating the safety and pharmacological changes of fospropofol premixed with lidocaine through in vitro and in vivo experiments and then conducting a randomized controlled trial in adult surgical patients to evaluate whether the lidocaine premixing strategy affects the occurrence of fospropofol-induced paresthesia. In the preclinical study, the findings indicated that mixture of fospropofol and lidocaine remained physicochemically stable, with faster onset and longer sedation duration compared with fospropofol alone, without additional adverse effects. In the clinical trial, 74 patients received fospropofol dissolved in either 20 mL of normal saline or 0.75% lidocaine and 72 were included in the primary outcome analysis of paresthesia. This adverse reaction occurred in 83.3% of patients in both groups, mainly within 40-60 s after administration. No group differences were observed in plasma inflammatory markers and phosphate; however, phosphate levels increased postadministration in both groups. This study provides important guidance for clinical practice, showing that premixing lidocaine does not effectively alleviate paresthesia induced by fospropofol.
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.