Anesthesia and Pain Management (1)
Anesthesia and Sedative Agents (1)
Neurogenesis and neuroplasticity mechanisms (1)
Extracellular vesicles in disease (1)
Neuroinflammation and Neurodegeneration Mechanisms (1)
Elevated high-sensitivity troponin T levels shortly after noncardiac surgery are closely linked to myocardial injury, a key factor in 30-day postoperative mortality. Intravenous lidocaine, known for its potent anti-inflammatory and membrane-stabilizing properties, has shown cardioprotective potential in other surgical settings, but its efficacy in noncardiac thoracic surgery remains unclear. This study was a double-blind, placebo-controlled randomized trial. Participants were randomly allocated to the lidocaine or placebo group with a 1:1 ratio. Single-centre, double-blind, randomized controlled trial. Academic tertiary care medical centre. Patients scheduled for noncardiac thoracic surgery, predominantly via video-assisted thoracoscopic surgery (VATS), under general anesthesia from June 12, 2021 to June 12, 2022. Patients received intravenous lidocaine (1.5 mg kg bolus pre-induction followed by 1.5 mg kg h infusion until surgery end) or volume-matched saline. Dosing was adjusted to ideal body weight for BMI ≥ 25 kg m². Study drugs were prepared by blinded staff and administered via standardized pumps. The primary outcome was high-sensitivity troponin T concentration at 24 h postoperatively. Secondary outcomes encompassed: (1) the absolute change from baseline to 24 h post-surgery for high-sensitivity troponin T (2) the occurrence of MINS, identified by high-sensitivity troponin T levels of 14 ng l or higher within 48 h after surgery; (3) levels of NT-proBNP, CK-MB, myoglobin, hs-CRP, and inflammatory markers on the first and second postoperative days; (4) overall opioid use during surgery; and (5) hemodynamic parameters during the operation. Between June 12, 2021, and June 12, 2022, we enrolled 119 patients who underwent thoracic surgery for lung cancer (mean age 59.41 years [SD 11.085], 58 [48.7%] male). The median [IQR] 24-hour high-sensitivity troponin T level did not differ between the lidocaine and control groups (8.00 [6.00–15.00] ng l vs. 8.00 [5.00–10.00] ng l, = 0.34). Additionally, the absolute change in hs-TnT from baseline showed no significant difference (3.21 ± 5.93 ng l⁻¹ vs. 3.00 ± 8.56 ng l⁻¹, = 0.88).The incidence of MINS was similar between the groups (23.3% vs. 23.7%, = 0.96). Lidocaine exhibited significant anti-inflammatory properties, resulting in an 84.8% reduction in 48-hour IL-6 levels (46.5 ± 33.6 pg ml vs. 307.0 ± 312.2 pg ml, = 0.04). In a post-hoc analysis, age was identified as a significant independent predictor of myocardial injury (OR 0.259 for age < 65 vs. ≥ 65 years; 95% CI 0.107 to 0.627; = 0.003), but no evidence of an interaction with the treatment allocation was found. Perioperative lidocaine infusion significantly suppressed systemic inflammation, but did not reduce early myocardial biomarker release in the overall cohort. The finding that younger age was associated with a lower risk of myocardial injury, irrespective of treatment group, suggests that age is a key prognostic factor. Further studies are warranted to explore age-specific cardioprotective strategies and the underlying mechanisms of inflammatory-myocardial coupling. ChiCTR2100047336. Registered on June 12, 2021. The online version contains supplementary material available at 10.1186/s12871-026-03733-y.
Fospropofol disodium (fospropofol), a water-soluble prodrug of propofol, reduces injection pain and anesthetic requirements but frequently causes paresthesia. Intravenous lidocaine has been shown to alleviate dexamethasone-induced paresthesia, yet its effect on fospropofol-related symptoms remains uncertain. We combined preclinical and clinical studies, first evaluating the safety and pharmacological changes of fospropofol premixed with lidocaine through in vitro and in vivo experiments and then conducting a randomized controlled trial in adult surgical patients to evaluate whether the lidocaine premixing strategy affects the occurrence of fospropofol-induced paresthesia. In the preclinical study, the findings indicated that mixture of fospropofol and lidocaine remained physicochemically stable, with faster onset and longer sedation duration compared with fospropofol alone, without additional adverse effects. In the clinical trial, 74 patients received fospropofol dissolved in either 20 mL of normal saline or 0.75% lidocaine and 72 were included in the primary outcome analysis of paresthesia. This adverse reaction occurred in 83.3% of patients in both groups, mainly within 40-60 s after administration. No group differences were observed in plasma inflammatory markers and phosphate; however, phosphate levels increased postadministration in both groups. This study provides important guidance for clinical practice, showing that premixing lidocaine does not effectively alleviate paresthesia induced by fospropofol.
Postoperative pain is a common concern for patients undergoing modified radical mastectomy (MRM) for breast cancer. Intravenous lidocaine may alleviate acute postsurgical pain. This study aimed to evaluate the analgesic effect of lidocaine in patients receiving sevoflurane or propofol maintenance anesthesia. This study is a secondary analysis of a randomized controlled trial evaluating the effect of lidocaine on postoperative outcomes. One hundred patients scheduled for MRM were randomized into four groups ( = 25 per group): sevoflurane (S), sevoflurane plus lidocaine (SL), propofol (P), or propofol plus lidocaine (PL). The primary outcome was the area under the curve (AUC) of the numerical rating scale (NRS) score at rest and during movement within 24 h postoperatively, while secondary outcomes included resting and active NRS within 24 h postoperatively, changes in early inflammatory markers (IL-6, IL-1 β, TNF-α, NF-κ B), consumption of anesthetics and analgesics, adverse events, and patient satisfaction. Compared with their respective control groups, lidocaine infusion in Groups SL and PL significantly reduced the resting and active AUC for NRS score at 24 h postoperatively (S vs. SL, < 0.001; P vs. PL, < 0.001) and yielded lower resting and active NRS scores at 3, 6, and 12 h after surgery (all < 0.001). No significant intergroup differences were observed in perioperative immune cell counts. However, postoperative serum levels of IL-6, IL-1 <, TNF-α, and NF-κB activity were significantly lower in the lidocaine groups (SL and PL) than in the controls (S and P). The consumption of anesthetics and analgesics, incidence of adverse events, and patient satisfaction within 24 h were comparable among the four groups. Intraoperative intravenous lidocaine infusion reduced acute postoperative pain, attenuated the early systemic inflammatory response in MRM patients. These benefits were independent of the maintenance anesthetic used (sevoflurane vs. propofol). However, given the multiple confounding factors that may affect the results of this study due to its design, further randomized controlled trials are required to confirm causality and assess long-term clinical and mechanistic outcomes. ChiCTR2300068563 (registered February 23, 2023).
The full extent of intravenous lidocaine's effectiveness in alleviating postoperative pain and enhancing gastrointestinal function recovery remains uncertain. We conducted an exhaustive search of databases to identify randomized controlled trials that compared intravenous lidocaine infusion's efficacy to that of a placebo or routine care in patients undergoing gastrointestinal surgery. The primary outcome measure was resting pain scores 24 h postoperatively. We utilized a random-effects model based on the intention-to-treat principle for the overall results. This study included twenty-four trials with 1533 patients. Intravenous lidocaine significantly reduced resting pain scores 24 h after gastrointestinal surgery (twenty trials, SMD -0.67, 95% CI -1.09 to -0.24, P=0.002, I = 90%). This finding was consistent in subgroup analyses and sensitivity analyses. The benefit was also observed at other resting and moving time points (1, 2, 4, and 12 h) postoperatively. Intravenous lidocaine significantly decreased opioid consumption within 24 h after surgery (eleven trials, SMD: -1.19; 95% CI: -1.99 to -0.39; P=0.003). Intravenous lidocaine also shortened the time to bowel sound (MD: -8.51; 95% CI: -14.59 to -2.44; P=0.006), time to first flatus (MD: -6.00; 95% CI: -9.87 to -2.13; P=0.002), and time to first defecation (MD: -9.77; 95% CI: -17.19 to -2.36; P=0.01). Perioperative intravenous lidocaine can alleviate acute pain and expedite gastrointestinal function recovery in patients undergoing gastrointestinal surgery. However, the results should be interpreted with caution due to substantial heterogeneity. Further large-scale studies are necessary to validate these findings.
Anesthesia techniques and drug selection may influence tumor recurrence and metastasis. Neutrophil extracellular trapping (NETosis), an immunological process, has been linked to an increased susceptibility to metastasis in individuals with tumors. Furthermore, recurrence may be associated with vascular endothelial growth factor A (VEGF-A), a mediator of angiogenesis. This study investigates the impact of lidocaine (combined with sevoflurane or propofol anesthesia ) during breast cancer surgery inhibits the expression of biomarkers associated with metastasis and recurrence (specifically H3Cit, NE, MPO, MMP-9 and VEGF-A). We randomly assigned 120 women undergoing primary or invasive breast tumor resection to receive one of four anesthetics: sevoflurane (S), sevoflurane plus i.v. lidocaine (SL), propofol (P), and propofol plus i.v. lidocaine (PL). Blood samples were collected before induction and 3 h after the operation. Biomarkers associated with NETosis (citrullinated histone H3 [H3Cit], myeloperoxidase [MPO], and neutrophil elastase [NE]) and angiogenesis were quantified using enzyme-linked immunosorbent assays. Patient and breast tumor characteristics, along with perioperative management, did not differ between study groups. In intra-group comparisons, S and P groups demonstrated a statistically significant increase in post-operative MPO (S group: 10.39[6.89-17.22] vs. 14.31[8.55-20.87] ng ml-1, P = 0.032; P group: 9.45[6.73-17.37] vs. 14.34[9.87-19.75] ng ml-1, P = 0.035)and NE(S group: 182.70[85.66-285.85] vs. 226.20[91.85-391.65] ng ml-1, P = 0.045; P group: 154.22[97.31-325.30] vs. 308.66[132.36-483.57] ng ml-1, P = 0.037) concentrations compared to pre-operative measurements, whereas SL and PL groups did not display a similar increase. H3Cit, MMP-9, and VEGF-A concentrations were not significantly influenced by the anesthesia techniques and drugs. Regardless of the specific technique employed for general anesthesia, there was no increase in the postoperative serum concentrations of MPO and NE after perioperative lidocaine infusion compared to preoperative serum concentrations. This supports the hypothesis that intravenous lidocaine during cancer surgery aimed at achieving a cure may potentially decrease the likelihood of recurrence. Further interpretation and discussion of clinical implications are warranted, emphasizing the significance of these findings in the context of cancer surgery and recurrence prevention. ChiCTR2300068563.
This study aims to explore the analgesic effect of lidocaine administered through the hepatic artery during hepatic artery infusion chemotherapy (HAIC) for hepatocellular carcinoma (HCC). A total of 45 HCC patients were randomly divided into a study group and a control group. Both groups received oxaliplatin (OXA) based FOLFOX protocol via electronic infusion pump. The study group was continuously infused with 100 mg of lidocaine during HAIC, while 5% glucose solution was infused in the same way as described above. Changes in vital signs, visual analogue score (VAS) and general comfort score (GCQ scale) were recorded before surgery (Time point 0), at the end of infusion (Time point 01), 1 h after HAIC (Time point 02), 3 h after HAIC (Time point 03) and 6 h after HAIC (Time point 04). At each point of time from Time point 0 through Time point 04, the differences in MAP, RR and SPO between the two groups were not statistically significant ( > 0.05). At each point of time from Time point 01 through Time point 04, the mean VAS scores in the study group were smaller and GCQ scores were higher than those in the control group, and the differences were both statistically significant ( < 0.05). Lidocaine infusion through the hepatic artery during HAIC effectively reduces intraoperative and postoperative pain and improves patient satisfaction with pain management, making it a valuable technique for clinical practice.