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).
This study aimed to compare the efficacy and safety of lidocaine-based patient-controlled intravenous analgesia (PCIA) with sufentanil-based PCIA for managing postoperative pain in patients undergoing laparoscopic colorectal cancer surgery. A total of 126 patients were randomly assigned in a 1:1 ratio to lidocaine group (group L, n = 63) or the sufentanil group (group S, n = 63). The primary endpoint was visual analogue scale (VAS) pain score during movement at 24 h after surgery. Secondary endpoints included VAS pain scores at rest and during movement at 6, 12, 36, and 48 h after surgery, the time of first flatus and defecation after the surgery, postoperative hospitalization time and total hospitalization costs, patient satisfaction scores, and the incidence of adverse events. There was no significant difference between the two groups in VAS pain scores at rest and during movement at 6, 12, 24, 36, and 48 h after surgery (all p > 0.05). The time to first flatus and defecation, as well as postoperative hospitalization time and total hospitalization expenses, were also similar between the two groups (all p > 0.05). However, satisfaction score was significantly higher in group L compared to group S (p < 0.05), and the incidence of postoperative nausea and vomiting (PONV) was significantly lower in group L than in group S (p < 0.05). Lidocaine-based PCIA can effectively relieve postoperative pain, decrease the incidence of PONV, and improve patient satisfaction in patients undergoing laparoscopic colorectal cancer surgery. The study was registered on the Chinese Clinical Trial Registry (ChiCTR) with the registration number ChiCTR2300068854, with the registration date being March 1, 2023.
Zhang YX, Ma L, Yiliaikebaier M, Zhang W, Li RX , et al.
Neurological research •
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.
We investigated the efficacy and safety of lidocaine-based patient-controlled intravenous analgesia (PCIA), compared with sufentanil-based PCIA on postoperative pain and recovery quality in patients undergoing thoracoscopic lung surgery. We recruited 160 patients undergoing thoracoscopic lung surgery who were randomized to receive lidocaine-based PCIA (1.5 mg/kg/h) or sufentanil-based PCIA (2 μg/mL) within 48 hours postoperatively. The primary endpoint was visual analogue scores (VAS) pain scores at 6, 12, 24, and 48 hours postoperatively. Postoperative quality of recovery-15 (QoR-15) scores and other prespecified endpoints were also recorded. VAS pain scores at rest and during coughing in the lidocaine group were significantly lower at 6, 12, and 24 hours postoperatively (<0.05), with no difference at 48 hours (0.05). QoR-15 scores in the lidocaine group were higher on postoperative day (POD) 1 (<0.001) and POD2 (<0.001), with significant differences in the two dimensions of postoperative physical comfort and pain (<0.001). The lidocaine group also experienced a shorter time to first flatus, defecation, and ambulation (<0.05), with no difference in the length of postoperative hospitalization and thoracic drainage time (0.05). The serum IL-6, TNF-α, IL-8, cortisol, and epinephrine concentrations were lower in the lidocaine group on POD1 and POD2 (<0.05). The incidence of postoperative nausea and vomiting in the lidocaine group was lower (<0.05), with no differences in other adverse events (>0.05). Compared with sufentanil-based PCIA, lidocaine-based PCIA significantly relieved postoperative pain and improved recovery quality after thoracoscopic lung surgery with fewer postoperative adverse events, which is a considerable choice for postoperative analgesia. This study was retrospectively registered at the Chinese Clinical Trial Registry on March 1st, 2023 (number ChiCTR2300068840).
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.