Journal of anesthesia, analgesia and critical care •
Previous studies have demonstrated that perioperative use of lidocaine effectively reduces opioid requirements in various surgical procedures. Our objective was to evaluate the effect of postoperative intravenous lidocaine infusion on opioid consumption following pelvic bone tumor surgery. This single center randomized controlled trial in a tertiary teaching hospital containing a total of 70 patients, aged 18 to 65 years, with American Society of Anesthesiologists(ASA) physical status classifications of I to III, who were scheduled to undergo pelvic bone tumor surgery. Participants were randomly assigned in a 1:1 ratio to either the lidocaine group(L Group) or the control group(C Group). The L Group received lidocaine for postoperative analgesia, whereas the C Group was administered a placebo saline infusion.The primary outcome was postoperative opioid consumption. Secondary outcomes included the time to first bowel movement, the incidence of postoperative nausea and vomiting(PONV), and pain scores at rest and during movement on postoperative days. A significant difference was observed in the cumulative 72-h morphine equivalent consumption between the L Group (n = 33) and the C Group (n = 33). Patients in the L Group required significantly less morphine equivalent consumption compared to the C Group (13 (0-52) mg vs. 25 (14-85) mg, P = 0.043). Additionally, the proportion of patients experiencing breakthrough pain was significantly lower in the L Group compared to the C Group (33.33% vs. 75.76%, P = 0.001). No significant differences were noted between the groups in secondary outcomes, including the incidence of PONV, numerical pain scores at rest or during movement, time to first bowel evacuation, or time to first oral intake. Postoperative intravenous lidocaine infusion is effective in reducing opioid consumption and the incidence of breakthrough pain following pelvic bone tumor surgery. This single-center, prospective RCT was registered with the Chinese Clinical Trial Registry (ChiCTR2100051207, 15/09/2021). The first research participant was enrolled in September 20, 2021.
International journal of surgery (London, England) •
Lumbar surgery is often associated with significant postoperative pain, high opioid consumption, and delayed bowel function recovery. This study aimed to assess whether intravenous lidocaine infusion could enhance bowel function recovery in patients undergoing lumbar surgery. This multicenter, randomized, controlled, double-blinded study was conducted across three tertiary university hospitals. A total of 96 patients, aged 60-80 years, with an American Society of Anesthesiologists (ASA) classification of I-III, scheduled for lumbar spinal surgery, were randomly assigned to either the lidocaine group (L group) or the control group (C group) in a 1:1 ratio. Patients in the L group received perioperative intravenous lidocaine infusion and, postoperatively, lidocaine as a component of the multimodal patient-controlled analgesia regimen, whereas patients in the C group received normal saline in place of lidocaine under the same regimen. The primary outcome was the time to first evacuation. Secondary outcomes included the time to first defecation, intraoperative opioid consumption, incidence of postoperative nausea and vomiting (PONV), numerical rating scale (NRS) pain scores at rest and during movement, postoperative opioid consumption, and length of hospital stay. Patients in the L group had a significantly shorter evacuation time compared to the C group [(17 hours; 95% CI, 14-20 hours) vs (23 hours; 95% CI, 19-28 hours); P = 0.013)]. Intraoperative opioid consumption was significantly lower in the L group than in the C group, including sufentanil (18 [15, 20] µg vs. 25 [17, 30] µg, P < 0.001) and remifentanil (760 [450, 1040] µg vs. 1000 [760, 1440] µg, P = 0.002). Additionally, propofol usage was significantly lower in the L group compared to the C group (591.57 ± 206.39 mg vs. 692.96 ± 229.50 mg, P = 0.027). No significant differences were observed between the groups for other secondary outcomes. Intravenous lidocaine infusion in patients undergoing lumbar surgery accelerates postoperative bowel function recovery and reduces intraoperative opioid consumption.
Perioperative inflammatory responses are a series of endogenous immune responses produced by the body following surgical trauma. Excessive inflammatory response weakens the body's ability to repair surgical trauma and reduces the body's defense against the invasion of harmful factors, leading to a series of complications, such as infections, pain, and organ damage, which prolong the length of hospitalization and increase the risk of death. Lidocaine is a classical local anesthetic widely used in clinical practice because of its local anesthetic and antiarrhythmic effects. Several recent studies have shown that lidocaine modulates the body's inflammatory response, and that its anti-inflammatory properties can lead to analgesia, organ protection, and improved postoperative recovery. In this paper, we introduce the mechanism of the modulating effect of lidocaine on the perioperative inflammatory response and its clinical application, to provide a reference for the clinical prevention and treatment of the perioperative inflammatory response.