Intravenous lidocaine to prevent endothelial dysfunction after major abdominal surgery: a randomized 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, randomized, 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 haemodynamic 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. Since in comparisons to other types of clinical situations, syndecan-1 was only slightly upregulated, endothelial dysfunction after major abdominal surgery might be overestimated.

Effect of volatile and total intravenous anesthesia on syndecan-1 shedding after minimally invasive gastrectomy: a randomized trial

“…There was approximately a 20% increase in serum syndecan-1 at POD 1 compared to preoperative values in our patients. This increase is lower than previously reported increases of syndecan-1 of 40–70% at 24 h following major abdominal surgery 5 , 7 . The discrepancy may arise from the difference in the extent of surgical trauma and the duration of the operation because (1) we studied only minimally invasive surgery, whereas previous studies included open surgery mostly, and (2) we included only gastrectomy, whereas previous studies included various types of abdominal surgery 5 , 7 .…”

“…This increase is lower than previously reported increases of syndecan-1 of 40–70% at 24 h following major abdominal surgery 5 , 7 . The discrepancy may arise from the difference in the extent of surgical trauma and the duration of the operation because (1) we studied only minimally invasive surgery, whereas previous studies included open surgery mostly, and (2) we included only gastrectomy, whereas previous studies included various types of abdominal surgery 5 , 7 . In fact, different types of surgery have been associated with perioperative variations in serum syndecan-1 levels; increases of 30–40% have been reported after lung resection surgery 9 , 11 , whereas up to 65-fold increases have been reported after major vascular surgery with CPB 4 .…”

“…However, the number of patients in our study is larger than that of previous clinical studies comparing syndecan-1 between two treatment groups 7 , 9 , 10 , 12 , 21 . Second, we evaluated syndecan-1 only until POD 1 based on previous studies 7 , 12 . However, we evaluated WBC count, NLR, and CRP levels until POD 5 and no differences were found between the groups.…”

“…Acute degradation of the EG has been demonstrated in patients after cardiac surgery, sepsis, and major trauma, and elevation of EG markers in blood is associated with poor outcomes in these patients 3 , 6 , 8 . Although previous studies have shown EG shedding in patients after major abdominal surgery 5 , 7 , literature on EG degradation after minimally invasive abdominal surgery was scarce. Minimally invasive abdominal surgery implies less inflammatory response compared to open surgical techniques 17 , 18 , from which it could be inferred that minimally invasive abdominal surgery would cause less EG damage.…”

The use of a vascular occlusion test combined with near-infrared spectroscopy in perioperative care: a systematic review

“…No effects on the VOT-derived NIRS values were found in a study trying to determine the protective effect of lidocaine on the endothelial barrier 24 h after surgery in patients undergoing major abdominal surgery [18].…”