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

Abstract

Purpose: Many patients develop severe and persistent pain after hepatectomy delaying postoperative rehabilitation. Studies have suggested that intravenous lidocaine infusion relieved postoperative pain and improved overall postoperative outcomes. However, its efficacy on hepatectomy is still masked, due to the postoperative metabolic change of lidocaine by the liver. We hypothesized that intravenous lidocaine infusion in the perioperative period would lead to postoperative pain reduction and improve the overall patient experience. Study Design and Methods: In this prospective double-blind, randomized controlled design trial, 260 adults scheduled for hepatectomy will be allocated to the lidocaine and the placebo groups. The lidocaine group will be administered lidocaine intravenously during intraoperative period and 72 postoperative hours; the placebo group will be administered normal saline at the same volume, infusion rate, and timing. The primary outcome is the incidence of moderate-severe pain (numeric rating scale ≥4) during movement at 24 hours after surgery. The secondary outcomes include the incidence of moderate-severe pain at 24 hours after surgery at rest, the incidence of moderate-severe pain at 48 and 72 hours after surgery at rest and during movement, the cumulative morphine consumption at 24, 48 and 72 hours postoperatively, bowel function recovery, the incidence of postoperative nausea and vomiting, the incidence of postoperative pulmonary complications, the length of hospital stay, levels of inflammatory factors and patient satisfaction scores. Discussion: This is the first prospective trial to shed light on the efficacy of intraoperative period and 72 postoperative hours intravenous lidocaine on postoperative pain and recovery after hepatectomy. The findings will provide a new strategy of perioperative pain management for hepatectomy.

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

“…Lidocaine promotes postoperative recovery by ameliorating analgesic effect. 31 , 32 It was obvious that higher pain scores in our study significantly lowered postoperative recovery quality, especially POH 12 and POH 24; and this was consistent with the study by Licina et al 33 Pain not only causes short-term or long-term fluctuations in hemodynamics, but also delays brain function returning to normal levels, leading to postoperative cognitive dysfunction or abnormal mental activity; afterwards it slows down the postoperative recovery process. 34 , 35 The former was revealed by lower fluctuations of intraoperative hemodynamic parameters (such as MAP and HR) and lower utilization of vasoactive drugs in our study; and the incidence and extent of agitation reduced significantly during extubation, suggesting that lidocaine played a positive role in postoperative brain function recovery.…”

Effect of systemic lidocaine on postoperative quality of recovery, the gastrointestinal function, inflammatory cytokines of lumbar spinal stenosis surgery: a randomized trial

“…Lidocaine is one of the most widely used local anesthetics in clinics. Previous studies have shown that patients received a bolus of 1.5–2 mg/kg lidocaine completed within 10 min before the induction of anesthesia followed by continuous infusions of 2 mg/kg/hour lidocaine intravenously during anesthesia could improve QoR-40 scores in patients with abdomen surgery 10 – 12 , reduce the need for opioids and the intensity of postoperative pain, and extende the time to first request morphine 13 . Lidocaine affects inflammatory cells in vitro, such as by inhibiting priming of human peripheral poly-morphonuclear cells or neutrophils 14 .…”

Identifying an optimal machine learning model generated circulating biomarker to predict chronic postoperative pain in patients undergoing hepatectomy

“…In this study (NCT04295330), we performed a secondary analysis on the prospective clinical trials (NCT05492669) in Medical Center: West China Hospital (Sichuan, China) (14) and screened 130 patients suffering from primary liver cancer who underwent elective hepatectomy from 2019 to 2021. Study eligibility included those undergoing elective hepatectomy for primary liver cancer, aged 18-80 years, American Society of Anesthesiologists (ASA) physical status I-III; with follow-up assessment for NRS.…”

“…A model to predict CPSP occurrence by integration of postoperative inflammatory biomarkers and clinical variables had not been developed. This is a secondary analysis on follow-up data from a prospective clinical trial, which aim to explore additional options to alleviate MEP after hepatectomy (14). In this study, we hypothesize that novel inflammatory biomarkers play a key role in CPSP development and when combined with clinical variables can predict the onset of CPSP.…”