Zhang Y

Efficacy and safety of perioperative intravenous lidocaine infusion for chronic postoperative pain.

Effect of perioperative lidocaine application on inflammatory factors, immune function, and quality of early postoperative recovery in patients undergoing video-assisted thoracoscopic surgery: a randomized controlled trial.

To assess the effect of low-dose perioperatively continuous infusion of lidocaine on postoperative inflammation, immune function and quality of recovery in patients undergoing video-assisted thoracoscopic surgery (VATS). Patients with lung cancer aged 18-65 years, undergoing elective VATS were randomized into lidocaine intervention (L) and standard care (C) groups. For patients in Group L, 1 mg/kg lidocaine was intravenously injected within approximately 10 min during the induction of anesthesia, followed by a continuous infusion of lidocaine at a rate of 1.5 mg/kg/h until the patient left the operating room. The postoperative analgesia plan included 2% lidocaine at 5 mg/kg. Group C was given an equal volume of normal saline as a control.The primary outcomes were plasma concentrations of tumor necrosis factor-α (TNF-α), interleukin-1(IL-1), and interleukin-6 (IL-6), along with T lymphocyte counts of CD3, CD4, CD8, and the CD4/CD8 ratio before anesthesia induction (T1), and 24 h (T2) and 48 h (T3) postoperatively. Secondary outcomes included the visual analog scale (VAS) for pain at rest and during movement, Time to first post-operative rescue analgesia, Cumulative OME(the oral morphine equivalents) at 24 h, along with the frequency and severity of postoperative nausea and vomiting (PONV) within the initial 48-h after surgery. In Group C and Group L, compared with preoperative levels, the levels of CD3 + , CD4 + and the ratio of CD4 + /CD8 + were significantly decreased at 24 and 48 h postoperatively, while the levels of TNF-α, IL-1 and IL-6 were significantly increased (P < 0.05). Compared with Group C, in Group L, the levels of CD3 + , CD4 + and the ratio of CD4 + /CD8 + were significantly increased at 24 and 48 h postoperatively, while the levels of TNF-α, IL-1 and IL-6 were significantly decreased (P < 0.05).Additionally, the L group experienced less pain on the movement VAS, the decreased OME dosage and a lower rate of PONV within 48 h postoperatively than the C group (P < 0.05). Intravenous infusion of lidocaine during the perioperative period was effective in reducing postoperative inflammatory response and the postoperative suppression of cellular immune function in the body, as well as significantly reducing the level of postoperative pain and the incidence of PONV in patients undergoing VATS.

Intravenous lidocaine for the treatment of sepsis-associated encephalopathy: a retrospective cohort study.

This study aimed to evaluate the efficacy of intraoperative intravenous lidocaine administration in the management of sepsis-associated encephalopathy (SAE). This retrospective cohort analysis included 165 patients diagnosed with SAE, who were categorized into two groups: the lidocaine group ( = 55) and the control group ( = 110). The lidocaine group received an intravenous injection of lidocaine at 1.5 mg/kg following anesthesia induction, and then received a continuous infusion at 1.5 mg/kg/h until the completion of surgery. The control group did not receive lidocaine during surgery. Data collected included patient demographics, medical history, infection site, Acute Physiology and Chronic Health Evaluation (APACHE) II score, Sequential Organ Failure Assessment (SOFA) score, Glasgow Coma Scale (GCS) score, laboratory results, anesthetic agents used, surgery duration, and length of stay in the intensive care unit (ICU). The primary outcome was the in-hospital prognosis of SAE. Patients in the lidocaine group had a significantly shorter ICU stay and a significantly higher rate of favorable prognosis compared with the control group ( < 0.05). Multivariate logistic regression analysis identified age and surgery duration as risk factors for SAE prognosis, whereas intraoperative intravenous lidocaine, GCS score, and intravenous dexmedetomidine emerged as protective factors. Intraoperative intravenous administration of lidocaine significantly enhanced the prognosis of SAE patients.

Comment on "Intravenous lidocaine infusion accelerates postoperative bowel function recovery in patients undergoing lumbar surgery: a multi-center, randomized controlled trial".

Impact of transversus abdominis plane block plus intravenous lidocaine on rapid recovery after bariatric surgery.

The study aimed to explore the impact of transversus abdominis plane block (TAPB) combined with intravenous lidocaine on rapid recovery after bariatric surgery. A total of 80 patients who underwent elective bariatric surgery from October 2022 to October 2023 were selected as study participants and divided into a control group (CG) and a study group (SG). The CG received ultrasound-guided TAPB with ropivacaine, while the SG received ultrasound-guided TAPB with ropivacaine plus intravenous lidocaine. The two groups were compared in terms of total doses of propofol, remifentanil, and sufentanil used; pain intensity; intraoperative conditions; levels of inflammatory factors; additional use of postoperative analgesics; incidence of adverse reactions; and postoperative recovery time. Compared to the CG, the SG showed significant reductions in the total intraoperative doses of propofol, remifentanil, and sufentanil ( < 0.05). In addition, the SG had lower visual analog scale (VAS) scores at rest and during coughing at 12, 24, and 48 h postoperatively ( < 0.05), as well as lower heart rate (HR) and mean arterial pressure (MAP) values at time points T1-T3 ( < 0.05). On the first day after surgery, the levels of tumor necrosis factor-α (TNF-α) and interleukin 6 (IL-6) in the SG were significantly lower than those in the CG ( < 0.05), and the SG also required less additional use of postoperative analgesics ( < 0.05). Furthermore, the SG exhibited a shorter time to first flatus, first defecation, and first ambulation, as well as a shorter length of hospital stay compared to the CG (all  < 0.05). TAPB combined with intravenous lidocaine may provide effective postoperative analgesia for patients after bariatric surgery and may accelerate their rapid recovery.

Effect of Intravenous Lidocaine on Postoperative Cognitive Dysfunction in Patients Undergoing Laparoscopic Colorectal Surgery: A Two-Center, Randomized, Double-Blind Controlled Trial.

In patients undergoing gastrointestinal surgery, enhancing perioperative cognitive function and facilitating expedited postoperative recovery are critical components for achieving swift rehabilitation. Intravenous administration of lidocaine has been shown to mitigate the perioperative inflammatory response in surgical patients; however, its influence on postoperative cognitive performance remains unassessed. Consequently, this study was conducted to investigate the impact of intravenous lidocaine on postoperative cognitive function in participants undergoing laparoscopic surgery for colorectal cancer. We performed a prospective, randomized controlled trial at The First People's Hospital of Changde City and Zhongshan People's Hospital to assess the impact of intravenous lidocaine on postoperative cognitive dysfunction (POCD) in patients undergoing laparoscopic radical resection for colorectal carcinoma. The primary endpoints of our investigation included Mini-Mental State Examination (MMSE) scores measured preoperatively and 7 days postoperatively, as well as the incidence of POCD at the 7-day mark following surgery. Secondary outcomes comprised an evaluation of recovery parameters in the postanesthesia care unit, overall length of hospitalization, and the prevalence of postoperative complications in both study cohorts. The occurrence of POCD at day 7 postsurgery was significantly lower in the lidocaine group compared to the placebo group ( < 0.05). When stratified by age, both elderly patients (≥65 years) and nonelderly patients in the lidocaine group exhibited a significantly reduced incidence of POCD on the seventh day postoperatively compared to the placebo group ( < 0.05). Preoperative MMSE scores were comparable between the two groups; however, on the seventh day after surgery, the lidocaine group had significantly higher MMSE scores than the placebo group ( < 0.05). In the nonelderly cohort, MMSE scores were also significantly elevated in the lidocaine group compared to the placebo group at day 7 postsurgery ( < 0.05). Mediation analysis indicated that lidocaine's influence on the incidence of POCD on the seventh postoperative day was partially mediated by propofol. Furthermore, there were no significant differences observed in intraoperative medication, postoperative recovery, or perioperative adverse events between the groups ( > 0.05). Perioperative administration of intravenous lidocaine has been shown to significantly enhance cognitive function on the seventh postoperative day following laparoscopic colorectal surgery. The mediating influence of propofol on the association between lidocaine and the occurrence of POCD at this time point was determined to be 10%.

Optimizing Lidocaine Dosing in Hepatectomy Patients: A Population Pharmacokinetic Study of Active Metabolites.

Lidocaine and its active metabolites are metabolized mainly by the liver, and liver-compromised may slow the metabolism of lidocaine and its active metabolites. In addition to excessive lidocaine, accumulated active metabolites may also lead to lidocaine-related toxicity in liver-compromised patients. This study aimed to describe the population pharmacokinetics of lidocaine and its active metabolites in partial hepatectomy patients and propose a novel drug regimen involving lidocaine-weighted active metabolites. The concentrations of lidocaine and its active metabolites from thirty-five patients underwent partial hepatectomy were analysed by non-linear mixed-effects models. The mean loading dose was 86.07 mg, and the median continuous infusion dose was 57.97 mg/h. A population pharmacokinetic model fitting the plasma concentrations of lidocaine and its active metabolites was built to explore the factors affecting the concentrations of lidocaine and its active metabolites. A two-compartment model with first-order elimination was used to determine the concentrations of lidocaine and its active metabolites. The different dosing simulations revealed that the selected appropriate loading dose did not exceed 1.5 mg/kg, and the continuous infusion dose of lidocaine should preferably not surpass 1.5 mg/kg/h in Chinese hepatectomy patients. The simulation results of long-term infusion of lidocaine during the postoperative stage after liver resection that showed there was a significant accumulation of MEGX after more than 24 hours of lidocaine infusion, and when the infusion rate reached 1 mg/kg/h, the MEGX concentration exceeded 5 µg/mL. This study proposes for the first time the integration of lidocaine concentration with active metabolites and simulation-based dosing recommendations. During the 24-hour medication period for Chinese hepatectomy patients, the recommended safe dosage includes a loading dose not exceeding 1.5 mg/kg and an infusion dose not exceeding 1.5 mg/kg/h. Monitoring of active metabolites, in addition to lidocaine is also necessary for continuous infusion of lidocaine. The trial is registered at chictr.org.cn (ChiCTR2100042730).

The effect of intravenous lidocaine on postoperative cognitive dysfunction: a systematic review and meta-analysis.

Postoperative cognitive dysfunction (POCD) has been reported as a significant complication in elderly patients. Various methods have been proposed for reducing the incidence and severity of POCD. Intravenous lidocaine administration has been reported in the literature to reduce POCD, but the effect of lidocaine remains controversial. We screened Medline, Embase, Cochrane Library, and China National Knowledge Infrastructure (up to April 2022) databases following a search strategy for intravenous lidocaine on POCD. We also screened related bibliographies on lidocaine for POCD. Ten articles comprising 1517 patients were selected and analyzed. We divided the postoperative follow-up period as follows: short term (<30 days), medium term (30-90 days), and long term (>90 days). We found that lidocaine could attenuate the overall incidence of POCD, especially in the short term. There were no differences between lidocaine and placebo on the overall severity of POCD. Lidocaine administered intravenously could attenuate the overall incidence of POCD and its severity in the short term.