Li H

Corrigendum to 'Efficacy of prolonged intravenous lidocaine infusion for postoperative movement-evoked pain following hepatectomy' (Br J Anaesth 2023; 131: 113-21).

Intravenous Lidocaine and Cognitive Recovery After Endoscopic Submucosal Dissection: A Randomized Controlled Trial.

While intravenous lidocaine reduces propofol requirements during procedures, its effects on postoperative cognitive function remain uncertain. This study evaluated whether lidocaine enhances cognitive recovery in patients undergoing endoscopic submucosal dissection (ESD) with propofol sedation. In this randomized, double-blind, placebo-controlled trial, 234 patients undergoing colorectal ESD received either intravenous lidocaine (1.5 mg/kg bolus followed by 2 mg/kg/h infusion) or a saline placebo. The standard sedation protocol included sufentanil 0.1 μg/kg and propofol for induction, with additional propofol as needed to maintain adequate sedation depth. The primary outcome was cognitive recovery on postoperative day 3 assessed by the PostopQRS cognitive domain. Secondary outcomes included recovery patterns at four timepoints (30 minutes, 1, 3, and 7 days), propofol consumption, injection pain, satisfaction scores, and adverse events. The lidocaine group demonstrated significantly better cognitive recovery than the placebo group [relative risk 1.15, 95% confidence interval (CI) 1.04-1.28, p=0.008], with benefits lasting through day 7 (p=0.035). Lidocaine administration resulted in a 25% reduction in propofol consumption [230 (208-258) mg compared to 305 (261-354) mg, with a median difference of -71 mg, 95% CI -85 to -57, p<0.001]. Additionally, injection pain scores were significantly lower in the lidocaine group [median score of 0 (0-1) versus 1 (0-3), p<0.001]. The incidence of hypotensive episodes was also reduced with lidocaine administration (12.8% compared to 24.8%, p=0.019). Importantly, no lidocaine toxicity was observed. Intravenous lidocaine was associated with enhanced cognitive recovery on postoperative day 3, as well as decreased propofol requirements, injection pain, and hypotensive episodes during ESD. These results indicate that lidocaine may serve as an effective adjuvant in endoscopic sedation protocols. ClinicalTrials.gov, NCT05750056.

A Systematic Review and Meta-analysis of the Analgesic Effects of Lidocaine Administered Intravenously or Intraperitoneally Post-Abdominal Surgery.

Reducing postoperative pain is still a tremendous challenge for perioperative clinicians. Lidocaine is a local anesthetic that belongs to the amide class and has anti-inflammatory, anti-hyperalgesic, and analgesic effects. Extensive research has been conducted to determine the optimal route for its administration. To compare the efficacy of perioperative intravenous lidocaine with that of intraperitoneal lidocaine on postoperative analgesia in patients undergoing abdominal surgery. EMBASE, PubMed, and The Cochrane Library were searched for randomized controlled trials published through December 2022 that compared patients receiving perioperative intravenous lidocaine with those receiving intraperitoneal lidocaine. The primary outcome measures included the pain score, as evaluated by the Visual Analog Scale, and opioid analgesia requirements. The secondary outcome measures were hospitalization length, gastrointestinal function recovery, etc. The data were acquired and recorded in electronic spreadsheets that had been designed for this purpose. This systematic review's design was based on the Cochrane Handbook for Systematic Reviews of Interventions and was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method was used to examine the certainty of the evidence. Furthermore, we examined the dependability of the calculated (favorable) treatment effects through considerations of information size and modified significance thresholds (trial sequential analysis). Seven trials including 478 patients were included. Our meta-analysis demonstrates that compared with intravenous lidocaine, patients who received intraperitoneal lidocaine had lower pain scores at 4 hours (mean difference [MD] 1.40; 95% CI, 0.22 to 2.59); 12 hours (MD 0.18; 95% CI, 0.06 to 0.30); and 24 hours (MD -0.12; 95% CI -0.40 to 0.17) postsurgery. However, no obvious difference in opioid consumption (P > 0.05) was found. In addition, the intraperitoneal lidocaine group had a longer postsurgery hospital stay than the intravenous lidocaine group (95%CI, -0.17 to -0.00; I2 = 0%). Intravenous lidocaine was more beneficial for achieving gastrointestinal return than intraperitoneal lidocaine (95% CI, -0.26 to -0.10; I2 = 2%). The sample size of enrolled RCTs was small, which could potentially result in an overestimation or underestimation of the treatment effect in the collected data. There was high heterogeneity among the studies. This meta-analysis suggests that post-abdominal surgery intraperitoneal lidocaine administration has a better analgesic effect than intravenous lidocaine, with a lower pain score. However, intravenous lidocaine is more beneficial for gastrointestinal recovery after abdominal surgery.

Postoperative analgesic effect of intravenous coinjection of lidocaine and dexmedetomidine in gynaecological surgery: a systematic review and meta-analysis.

Hysterectomy or myomectomy is a common gynaecological procedure that results in moderate to severe acute postoperative pain, which can cause many adverse effects. This study aimed to compare the postoperative analgesic efficacy, opioid consumption, quality of postoperative recovery (QOR) and adverse reactions of intravenous coinjection of lidocaine and dexmedetomidine versus lidocaine or dexmedetomidine alone in gynaecological surgery. Systematic review and meta-analysis was performed. The PubMed, Embase, Cochrane Library and Web of Science databases were used to access the articles. Electronic databases were searched for eligible studies published before 1 May 2024. All randomised controlled trials (RCTs) were included in the final analysis in which the intraoperative intervention group received intravenous coinjection of lidocaine and dexmedetomidine, and the control group received intravenous injection of lidocaine or dexmedetomidine alone in gynaecologic procedures. Study retrieval, literature screening, data extraction and risk of bias assessment were performed independently by two reviewers. The quality of included studies was assessed by the Cochrane Collaboration Risk of Bias (ROB V.2.0). Data were expressed as standardised mean difference, weighted mean difference or relative risk with 95% CI. Review Manager V.5.4 was used for data analysis. A total of five RCTs were included, involving 672 patients, of which 224 patients received coinjection of lidocaine and dexmedetomidine. The results revealed that coinjection of lidocaine and dexmedetomidine was superior to individual lidocaine in the visual analogue scale (VAS) scores at 1 hour (MD=-0.90, 95% CI (-1.11 to -0.69), p<0.001), 2 hours (MD=-0.99, 95% CI (-1.19 to -0.80), p<0.001), 4 hours (MD=-1.20, 95% CI (-1.75 to -0.66), p<0.001), 6 hours (MD=-1.09, 95% CI (-1.48 to -0.70), p<0.001), 8 hours (MD=-1.22, 95% CI (-1.61 to -0.83), p<0.001) and 12 hours (MD=-0.76, 95% CI (-1.35 to -0.17), p=0.o1) after surgery. Compared with the dexmedetomidine group, the lidocaine+dexmedetomidine group had low VAS scores at 1 hour (MD=-0.60, 95% CI (-0.83 to -0.37), p<0.001), 2 hours (MD=-0.70, 95% CI (-0.87 to -0.53), p<0.001), 6 hours (MD=-0.79, 95% CI (-0.98 to -0.59), p<0.001), 8 hours (MD=-0.77, 95% CI (-1.25 to -0.28), p=0.002) and 12 hours (MD=-0.56, 95% CI (-1.00 to -0.11), p=0.01) after surgery. Coinjection of lidocaine and dexmedetomidine resulted in significantly lower postoperative opioid consumption, postoperative nausea and vomiting and bradycardia than lidocaine alone (all p<0.05). Compared with the dexmedetomidine group, the lidocaine+dexmedetomidine group shortened the time to intestinal transit resumption (p=0.003). Coinjection of lidocaine and dexmedetomidine reduced intraoperative opioid consumption and increased QOR scores compared with lidocaine and dexmedetomidine alone (all p<0.05). Lidocaine combined with dexmedetomidine had superior analgesic efficacy and safety. However, due to the limitation in the number of available studies, more large-scale, prospective RCTs are needed for further investigation.PROSPERO registration numberCRD42023384018.

Author Correction: Effect of systemic lidocaine on postoperative quality of recovery, the gastrointestinal function, inflammatory cytokines of lumbar spinal stenosis surgery: a randomized trial.

Effect of systemic lidocaine on postoperative quality of recovery, the gastrointestinal function, inflammatory cytokines of lumbar spinal stenosis surgery: a randomized trial.

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.