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).
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.
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.