Wang Z

Shanxi Medical University

Publications

h-index

(0 citations, 3 total works)

Research Topics

Anesthesia and Pain Management (2) Anesthesia and Sedative Agents (2) Intensive Care Unit Cognitive Disorders (2) Pain Management and Opioid Use (1) Cancer, Stress, Anesthesia, and Immune Response (1)

Lidocaine Infusion Publications

Effect of Intraoperative Intravenous Lidocaine on Postoperative Delirium in Elderly Patients Undergoing Posterior Lumbar Interbody Fusion.

Feng X, Jia J, Sang Y, Zhao Y, Wang Z , et al.

Drug design, development and therapy • 2026-01-01

This study aimed to evaluate the effect of intraoperative intravenous (IV) lidocaine on the incidence of postoperative delirium (POD) in elderly patients undergoing major spinal surgery. In this prospective, single-center randomized clinical trial, elderly patients scheduled for elective posterior lumbar interbody fusion (PLIF) with instrumentation spanning two or more vertebral segments were enrolled. A total of 270 patients were randomized to receive either intravenous lidocaine (Group L) or saline (Group C). Group L received lidocaine at a bolus dose of 1.5 mg/kg before induction, followed by continuous infusion at 1.5 mg/kg/h until the end of surgery, while Group C received an equivalent volume of saline. All patients underwent standardized general anesthesia. The primary outcome was the incidence of postoperative delirium (POD) within 5 days after surgery. Secondary outcomes included delirium severity, onset, duration, and subtype (hypoactive, hyperactive, or mixed), postoperative visual analog scale (VAS; 0-100 mm) pain scores, intraoperative anesthetic consumption, 24-hour sufentanil consumption and patient-controlled intravenous analgesia (PCIA) attempts, and perioperative adverse events. The lidocaine group had a lower incidence of postoperative delirium (8.9% vs 20.7%; RR, 0.43; 95% CI, 0.23-0.81; < 0.05). Among patients who developed delirium, the duration was comparable between groups, while severity scores were higher and time to onset was shorter in the control group. Within the first 24 hours postoperatively, the lidocaine group had lower VAS scores, fewer PCIA attempts, and a reduced cumulative sufentanil dose. Opioid-related adverse events, including nausea and vomiting, were less frequent, with no cases of local anesthetic toxicity, and the overall hospital stay was comparable. In elderly patients undergoing PLIF, intraoperative intravenous lidocaine (1.5 mg/kg administered before induction, followed by continuous infusion at 1.5 mg/kg/h until the end of surgery) lowered the occurrence of postoperative delirium (POD) within the first 5 days after surgery.

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

He C, Qi X, Liu Y, Jin Y, Zhang M , et al.

Drug design, development and therapy • 2025-01-01

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).

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