Objective This study aimed to explore the effects of lidocaine on postoperative quality of recovery (QoR) and immune function in patients undergoing laparoscopic radical gastrectomy. Methods In total, 135 patients were enrolled and were equally randomized to receive low-dose lidocaine (Group LL: 1.5 mg/kg bolus followed by an infusion at 1.0 mg/kg/hour) or high-dose lidocaine (Group HL: 1.5 mg/kg bolus followed by an infusion at 2.0 mg/kg/hour) or Controls (Group C: received a volume-matched normal saline at the same rate). The primary outcome was a QoR-40 score on postoperative day (POD) 1. Secondary outcomes were a QoR-40 score on POD 3, levels of inflammatory factors (IL-6, IL-10, TNF-α) and CD4 + T cells, CD8 + T cells proportions, and CD4 + /CD8 + cell ratios and postoperative recovery of bowel function. Results There were no statistically significant differences in patient characteristics at baseline. The total QoR-40 scores on POD 1 in Group HL (171.4±3.89) were higher than those in Group LL (166.20±4.05) and in Group C (163.40±4.38) (adjusted P <0.001). Differences in the dimension scores of QoR-40 for pain, physical comfort, and emotional state were significant across the three groups. Lidocaine administration significantly reduced the release of IL-6, IL-10, TNF-α, and attenuated immune changes induced by trauma. Kaplan–Meier curves showed that the median time to the first exhaust and defecation were shorter in the Group HL than in Groups LL and C (1.55 days vs 2.4 days vs 2.6 days, log rank P <0.0001; and 2.86 days vs 3.22 days vs 3.46 days, log rank P =0.002, respectively). Additionally, patients in lidocaine groups required less remifentanil consumption and experienced lower pain intensity, compared with the control group. Conclusion Systemic lidocaine improved postoperative recovery, alleviated inflammation and immunosuppression, and accelerated the return of bowel function, and is thus, worthy of clinical application. Clinical Trials Registration ChiCTR2000028934.

Purpose The non-local anesthetic effects of lidocaine have been widely reported, but there are still few studies on lung protection. We aimed to test the hypothesis that intravenous infusion of lidocaine exerts lung-protective effects in patients at intermediate/high risk of postoperative pulmonary complications (PPCs) on major abdominal surgery. Patients and Methods Patients ≥18 years, ASA II or III, with intermediate/high risk for PPCs, were included. Patients were randomly assigned into group lidocaine (received a bolus of lidocaine 1.5 mg kg −1 before the induction of anesthesia, then followed by a continuous infusion of 2.0 mg kg −1 h −1 intraoperatively until the end of surgery) or group control (received 0.9% saline in place of lidocaine at the same time points). The incidence of PPCs within 7 postoperative days was measured, defined as a collapsed composite outcome of atelectasis, respiratory infection, pleural effusion, pneumonia, respiratory failure or acute respiratory distress syndrome (ARDS) developed within 7 postoperative days, or hospital discharge, whichever came sooner. Results Of 200 subjects screened, 195 patients were finally analyzed. Overall, 35.9% (70/195) patients sustained PPCs, which occurred fewer in group lidocaine 25.8% (25/97), compared with group control 45.9% (45/98) (relative risk: 0.56, 95% CI: 0.38 to 0.84; absolute risk reduction: −20.1%; P = 0.003). Considering single PPCs episode, the most common PPC in both groups was atelectasis. The atelectasis incidence was 11.3% (11/97) in group lidocaine, much lower than that in group control 29.6% (29/98) (relative risk: 0.38, 95% CI: 0.20 to 0.72; absolute risk reduction: −18.3%, P = 0.002). However, the incidences of any other PPCs episodes were similar between the two groups. Conclusion Intraoperative intravenous infusion lidocaine could decrease the incidence of PPCs in patients at intermediate/high risk of postoperative pulmonary complications undergoing major abdominal surgery.

Objective To explore the effect of nutritional prehabilitation on the clinical prognosis of elderly patients undergoing abdominal tumor surgery. Methods A prospective cohort study was conducted. Participants were divided into two groups according to whether they received oral nutritional supplementation at the first outpatient visit. The nutritional prehabilitation group (n = 41) adopted nutritional prehabilitation mode, while the control group (n = 55) was treated with routine care-mode. All patients underwent laparoscopic surgery according to National Comprehensive Cancer Network (NCCN) guidelines. The changes of nutritional status, complications, psychological status, hospitalization days and expenditures were compared between the two groups. Results Both of the weight of patients in two groups were decreased. The decline of body weight in prehabilitation group was less than control group (-1.87 vs. -2.55 kg, P < 0.01). The improvement of hospital anxiety scale score in the nutritional prehabilitation group was significant. (4.78 vs. 5.31, P = 0.01). The infection rate of nutritional prehabilitation group was lower than that of control group (17.07% vs. 36.36%, P = 0.04). At discharge, patients in the nutritional prehabilitation group had significantly fewer hospitalization days (14.29 vs. 17.11 d, P = 0.03). Conclusion In elderly patients undergoing abdominal tumor surgery, nutritional prehabilitation model may help maintain better physical and mental status,reducing infection rate and shorten hospitalization days.

No abstract