The Influence of Intravenous Lidocaine Infusion on Postoperative Outcome and Neutrophil-to-Lymphocyte Ratio in Colorectal Cancer Patients. A Pilot Study

Abstract

Background and Aims: In the last years increasing scientific evidence drew attention on the potential effects of anesthetic drugs on postoperative outcome in cancer patients. Local anesthetics, especially lidocaine, have been intensively studied in relation with postoperative outcome in colorectal cancer patients. Our study objectives were to investigate the effects of perioperative intravenous lidocaine infusion on neutrophil-to-lymphocyte ratio and short-term postoperative outcome. Additionally, we also looked at 1 year outcome after intended radical colorectal cancer surgery.
 Methods: 150 patients scheduled for colorectal cancer surgery were randomized to receive sevoflurane anaesthesia with or without 48 hours lidocaine infusion.
 Results: 73 patients were included in the group A (sevoflurane) and 77 in the group B (sevoflurane with lidocaine). Lidocaine infusion did not modify neutrophil-to-lymphocyte ratio at 24 hours after surgery (p=0.58). Patients receiving intravenous lidocaine had significantly lower morphine consumption (p=0.04), faster mobilization time (p=0.001) and fewer days spent in the hospital (p=0.04). Moreover, at 1 year follow- up, patients in group B had a significant decreased rate of recurrences (p=0.03). There was no significant difference in 1 year survival (p=0.22).
 Conclusions: In our study, intravenous lidocaine infusion hastened the postoperative recovery of patients in terms of mobilization, hospital discharge and opioid consumption and reduced 1 year recurrence rate. Further studies on larger groups of patients are needed.

Anesthesia-related intervention for long-term survival and cancer recurrence following breast cancer surgery: A systematic review of prospective studies

“…Alexa et al . observed that intravenous lidocaine infusion decreases the risk of cancer recurrence in colorectal cancer patients [ 37 ]. Notwithstanding, a similar intervention did not improve overall survival rates in patients with pancreatic cancer [ 38 ].…”

“…A large number of studies have corroborated the anti-tumorigenic effect of lidocaine [34][35][36]. Alexa et al observed that intravenous lidocaine infusion decreases the risk of cancer recurrence in colorectal cancer patients [37]. Notwithstanding, a similar intervention did not…”

Trial watch: local anesthetics in cancer therapy

“… 197 Colo-rectal Lidocaine (intravenous) One hundred and fifty patients randomized to receive lidocaine (n = 77) or not (n = 73). Decreased rate of recurrence ( p = .03) but no impact on 1-year survival ( p = .22) 200 ENT Ropivacaine (epidural) Thirty patients randomized to receive epidural or not. Reduction in blood glucose ( p = .0153) and cortisol ( p = .0074) 118 Gastric Ropivacaine (epidural) Fifty patients randomized to receive epidural or not.…”

“… 199 In the study by Alexa et al ., a significant reduction in recurrences was observed after the intravenous injection of lidocaine during colectomy. 200 After hepatectomy, the analgesic infusion of ropivacaine (bolus plus continuous injection through a local catheter) improved postoperative survival compared to the use of tramadol and fentanyl to control surgical pain. 201 The perfusion of ropivacaine through an intraperitoneal catheter minimized the time to initiate adjuvant chemotherapy after ovariectomy compared to the control group.…”

Neutrophils and Anesthetic Drugs: Implications in Onco-Anesthesia

“…lidocaine postoperatively decreased the NLR after breast cancer surgery [136], while Alexa et al did not find an influence of i.v. lidocaine at 24 h after colorectal surgery [137]. An erector spinae plane block (ESPB) significantly decreased the NLR after spine surgery [138].…”