Intravenous lidocaine to prevent endothelial dysfunction after major abdominal surgery: A randomised controlled pilot trial

Abstract

Background Major abdominal surgery is associated with endothelial glycocalyx disruption. The anti-inflammatory effects of lidocaine were recently associated with endothelial barrier protection.Methods This was a single-centre, parallel group, randomised, controlled, double blind, pilot trial. Forty adult patients scheduled for major abdominal surgery were included between December 2016 and March 2017 in the setting of a University Hospital in Brussels (Belgium); reasons for non-inclusion were planned liver resection and conditions associated to increased risk of local anesthetics systemic toxicity. Patients were randomized to receive either lidocaine by continuous intravenous administration or an equivalent volume of 0.9% saline. The primary endpoint was the postoperative syndecan-1 concentration (difference between groups). Near-infrared spectroscopy of the thenar eminence in association with the vascular occlusion test, and contemporary analysis of flow-mediated dilation of the brachial artery were the secondary outcomes, along with hemodynamic data. Blood samples and data were collected before surgery (T0), and at 1–3 h (T1) and 24 h (T2) post-surgery. Results Syndecan-1 concentration increased significantly post-surgery ( P <0.001), but without any difference between groups. The near-infrared spectroscopy-derived and flow-mediated dilation-derived variables showed minor changes unrelated to group assignment. Compared with the placebo group, the intervention group had a significantly lower peri-operative mean arterial pressure and cardiac index, despite equally conducted goal-directed haemodynamic management. Postoperative lactate concentrations were similar between groups. Conclusions Lidocaine failed to have any effect on endothelial function. Endothelial dysfunction in major abdominal surgery may be overestimated.