Effects of Systemic Lidocaine on Postoperative Recovery Quality and Immune Function in Patients Undergoing Laparoscopic Radical Gastrectomy

Abstract

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.

Efficacy of perioperative intravenous lidocaine infusion on postoperative pulmonary complications in patients undergoing video-assisted thoracoscopic lung resection surgery: protocol for a randomised controlled trial

“…17 18 Perioperative lidocaine infusion can attenuate some proinflammatory effects by acting on the molecular targets of the inflammatory signalling pathway. 6 7 A previous study by Lv et al 19 demonstrated that lidocaine administration could significantly reduce the release of interleukin (IL)-6, IL-10 and tumour necrosis factor-α, consistent with the results of studies by Song et al and Yardeni et al . 20 21 …”

Efficacy of Perioperative Continuous Intravenous Lidocaine Infusion for 72 Hours on Postoperative Pain and Recovery in Patients Undergoing Hepatectomy: Study Protocol for a Prospective Randomized Controlled Trial

“…Their results showed that the concentrations of IL-6, TNF-α in plasma of lidocaine group were significantly lower than those in placebo group after surgery. 28 However, de Oliveira et al draws the opposite conclusion that intravenous lidocaine failed to interfere with the production of IL-6 after hysterectomy. 29 The differences in surgery types may be responsible for the conflicted results above.…”

Effect of Systemic Lidocaine on Postoperative Early Recovery Quality in Patients Undergoing Supratentorial Tumor Resection

“… 9 During general anesthesia, systemic lidocaine (1.5 mg/kg or 1.5–2 mg/kg/h, intravenously) contributed to lowering intraoperative opioids consumption and postoperative pain intensity; it also had additional advantages of inhibiting inflammatory response by reducing pro-inflammatory factors, such as IL-6 and TNF-α, and maintaining immune function. 10–12 Lidocaine can reduce cerebral infarction scopes within 24 h after focal cerebral ischemia, confirming its brain-protection effect. 13 Niiyama et al demonstrated that lidocaine maintained adenosine triphosphate content of hippocampal CA1 pyramidal neurons during and after ischemia by protecting mitochondria, thus playing a neuroprotective role.…”

“…Several possible interpretations involved were as follows: (1) Anesthetic mechanisms of lidocaine and propofol were not completely overlapping; (2) lidocaine had a protective effect on endothelial cells, but excessive infusion of propofol may destroy endothelial cells, which consequently weakened the anti-inflammatory effect of propofol by damaging the immune system; (3) lidocaine itself had an effect of inhibiting inflammatory response. 10 , 25 , 29 , 30 …”