Effect of lidocaine infusion compared to dexmedetomidine infusion on proinflammatory cytokines and stress response in pelvi–abdominal cancer surgeries: a randomized clinical trial

Abstract

Background & Objectives: Stress response to extensive surgeries in cancer patients results in an imbalance between the pro-inflammatory and anti-inflammatory cytokines, besides activating an inflammatory cascade. We investigated the comparative effects of intravenous infusion of dexmedetomidine and lidocaine on proinflammatory cytokines and the stress reaction.
 Methodology: A prospective randomized double blind trial was performed in National Cancer Institute. 54 patients scheduled for pelvi–abdominal cancer surgery under general anesthesia were randomly allocated to three equal groups. Lidocaine group: patients received 1.5 mg/kg loading dose of lidocaine followed by 1.5 mg/kg/h infusion; Dexmedetomidine group: received a loading dose of dexmedetomidine 1 µg/kg followed by infusion of 0.5 µg/kg/h; or Saline group: received 50 ml of normal saline followed by infusion at a rate of 10 ml/h till the end of the surgery. The primary outcome was a postoperative target level of IL–6 after 24 h.
 Results: Immediate and 24 h postoperative IL–6 and TNFα were significantly lower in both dexmedetomidine and lidocaine groups compared to the control group (P < 0.001). Dexmedetomidine group had a significantly lower IL–6 and TNFα levels compared to lidocaine group at immediate postoperative and 24 h postoperative period (P < 0.001). Dexmedetomidine and lidocaine groups had a significantly lower lactate and insulin levels compared to the control group immediately postoperatively as well as 24 h postoperatively (P < 0.001). The dexmedetomidine group had a significantly lower lactate levels compared to the lidocaine group immediately postoperatively only. The lidocaine group had lower insulin level than the control group regarding immediate postoperative period only.
 Conclusion: Intraoperative infusion of dexmedetomidine or lidocaine, both attenuate the postoperative levels of proinflammatory cytokines and stress response in patients undergoing pelvi–abdominal cancer surgeries.
 Clinical trial registration: The study was registered at clinicaltrials.gov (NCT 04148599).
 Key words: Lidocaine; Dexmedetomidine; Interleukins; Tumor necrosis factor-α; Stress response; Pelvi–abdominal cancer; Surgery
 Abbreviations: TNF - Tumor necrosis factor; IL – Interleukins;
 Citation: Hassan MM, Saleh RG, Abdalla NO, Radwan NH, Abdelghfar EM. Effect of lidocaine infusion compared to dexmedetomidine infusion on proinflammatory cytokines and stress response in pelvi–abdominal cancer surgeries: a randomized clinical trial. Anaesth. pain intensive care 2021;26 (1):44-52.
 DOI: 10.35975/apic.v26i1.1765
 Received: February 15, 2021, Reviewed: December 02, 2021, Accepted: December 05, 2021

Comparative study between the effect of dexmedetomidine and lidocaine infusion on intraoperative analgesic requirement and hemodynamics during craniotomy

“…In patients undergoing pelvi-abdominal cancer surgeries, intraoperative infusion of dexmedetomidine or lidocaine, both have led to attenuation of proinflammatory cytokines and stress response in the post-operative period. 27 The analgesic, antihyperalgesic, and anti-inflammatory effects of IV lidocaine can occur due to sodium channel blockade and inhibition of N-methyl-D-aspartate receptors. 28 Dexmedetomidine has anti-nociceptive and sedative properties owing to specific α 2-adrenergic receptor agonistic activity.…”

Systemic Anti-Inflammatory Effects of Intravenous Lidocaine in Surgical Patients: A Systematic Review and Meta-Analysis

“…In nine studies, open abdominal surgery was performed: abdominal hysterectomy [37,39,41], cholecystectomy [45], colorectal surgery [46][47][48], mixed major open abdominal procedures [35] and pelvi-abdominal cancer surgery [49]. In eight studies, video-assisted minimally invasive procedures were conducted: laparoscopic cholecystectomy [50,51], laparoscopic renal surgery [52], laparoscopic hysterectomy [40], laparoscopic gastroplasty [53], laparoscopic colorectal surgery [43], laparoscopic radical gastrectomy [54] and videoassisted thoracic surgery [38].…”

“…We noted geographical variability among the studies. Seven studies were conducted in China [38][39][40]42,44,50,54], three in each of the countries Brazil [37,51,53] and Egypt [43,48,49] and one in each of the following countries: Pakistan [45], the Netherlands [34], India [35], Switzerland [52], Israel [41], Germany [47], Taiwan [46] and South Korea [36].…”

“…Table 1 presents a summary of the details of lidocaine administration for each study. In 19 studies, intravenous lidocaine administration was initiated with a bolus dose of 1 mg/kg to 2.5 mg/kg of body weight, with 1.5 mg/kg being the most common dose, used in 15 of the included studies [34][35][36]39,40,42,44,[47][48][49][50][51][52][53][54]. In two studies, lidocaine administration was started as a continuous infusion without a bolus dose [37,43].…”

“…The dose of lidocaine infusion varied among studies from 1 mg/kg/h to 3 mg/kg/h. In 8 studies, the continuous infusion of lidocaine was delivered with a rate of <2 mg/kg/h [34,36,37,44,46,50,51,53], whereas an infusion rate of ≥2 mg/kg/h was applied in 12 other studies [35,[38][39][40][41][42][43]45,[47][48][49]54]. In 1 study, a higher infusion dose (≥2 mg/kg/h) was employed during the first study period, followed by continuous infusion (<2 mg/kg/h) during the second study period [52].…”