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Intravenous infusion of lidocaine as an anesthesia adjuvant can improve patient outcomes, but its impact on intrapulmonary shunt during one-lung ventilation (OLV) has not been clarified. To determine the effect of intravenous lidocaine infusion on intrapulmonary shunt during OLV and postoperative cognitive function in video-assisted thoracoscopic surgery (VATS). Sixty patients who underwent OLV for thoracic surgery were randomized to receive intravenous infusion of lidocaine (lidocaine group, n = 30) or normal saline (control group, n = 30) for anesthesia induction. Arterial and venous blood gases were measured during two-lung ventilation and at 15 and 30 min after OLV (OLV + 15 and OLV + 30). The Mini-Mental State Examination was administered before the surgery and at postoperative 12 months to assess patient cognitive function. No significant difference was found in intrapulmonary shunt fraction (Qs/Qt) between the lidocaine group and the control group at OLV + 15 (p = 0.493) and OLV + 30 (p = 0.754). The lidocaine group used significantly lower doses of propofol and remifentanil compared to the control group (both p < 0.001). Furthermore, no significant difference was observed in the incidence of postoperative cognitive dysfunction between the lidocaine group and the control group at 1 year post-operation (3.3% vs 6.7%, p = 0.554). Intravenous lidocaine administered in VATS had no significant impact on intrapulmonary shunt during OLV or postoperative cognitive function. However, it significantly reduced the doses of anesthetics used during the surgery.
To compare the effects of transversalis fascia plane (TFP) block versus intravenous lidocaine infusion on early recovery after gynecologic laparoscopic surgery. In this randomized trial, 59 patients were assigned to: Group L (n = 30): Intravenous lidocaine (bolus 1.5 mg/kg followed by 25 μg/kg/min infusion); Group T (n = 29): Bilateral ultrasound-guided TFP block with 40 mL of 0.33% ropivacaine. Both groups underwent standardized general anesthesia and patient-controlled intravenous analgesia (PCIA). The primary outcome was quality of recovery-15 (QoR-15) scores on postoperative day 1 (POD1). Secondary outcomes included numerical rating scale (NRS), PCIA demand, inflammatory markers (IL-6, TNF-α), time to first flatus, and adverse events. No significant differences were observed in QoR-15 scores, intraoperative drug consumption, pain scores, PCIA demand, inflammatory markers, or adverse events (P > 0.05). However, Group L exhibited a shorter time to first flatus (P < 0.05). TFP block and lidocaine infusion provided comparable recovery quality, though lidocaine may accelerate gastrointestinal recovery.
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.
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.