Intravenous Infusion of Lidocaine Can Accelerate Postoperative Early Recovery in Patients Undergoing Surgery for Obstructive Sleep Apnea

Abstract

Obstructive sleep apnea (OSA) is defined by intermittent and recurrent episodes of partial or complete obstruction of the upper airway during sleep. Intermittent and recurrent hypoxia/reoxygenation is the main pathophysiological mechanism of OSA. Its consequences include systemic inflammation, activation of the sympathetic nervous system, and release of oxygen free radicals. Infusion of intravenous (IV) lidocaine has anti-inflammatory, antihyperalgesic, and analgesic properties, supporting its use as an anesthetic adjuvant. Lidocaine can reduce nociception and/or cardiovascular responses to surgical stress, as well as postoperative pain and/or analgesic requirements. Because of the high prevalence of OSA in obese patients, the use of opioids to manage postoperative pain in that population is often accompanied by the development of adverse respiratory events, such as hypoventilation and hypoxemia. IV infusion of lidocaine has been shown to enhance the quality of early recovery after laparoscopic bariatric and upper airway surgery. However, limited evidence exists regarding its use in patients undergoing surgery for OSA. In addition, whether IV infusion of lidocaine can improve postoperative early recovery in patients undergoing surgery for OSA remains unknown. Therefore, we hypothesized that IV infusion of lidocaine can improve postoperative early recovery in patients undergoing surgery for OSA. Perioperative infusion also may be a promising analgesic adjunct to enhanced recovery after surgery (ERAS) protocols.

Effects of Perioperative Lidocaine Infusion on Pain Management and Quality of Recovery Following Thyroid Surgery: A Systematic Review and Meta-analysis

“…The year of publication ranged from 2014 to 2022; the main ASA status was I-II, and only one study involved patients ranked as ASA III [17]. Among the trials included in our meta-analysis, surgery could be divided into two types: open surgery in nine studies [17,18,[29][30][31][32][33][34][35] and endoscopic surgery in two studies [19,36]. Moreover, the loading and maintaining doses of medication were unrestricted, so various combinations of loading doses and maintaining doses appeared.…”

“…Considering that most Chinese articles did not receive rigorous peer review, we deliberately ranked all ve Chinese studies as "unclear risk of bias" in the "other bias" domain. In total, four trials [17,18,30,31] were ranked as "low risk of bias", and six [19,29,[33][34][35][36] were evaluated as "unclear risk of bias". One trial was deemed as "high risk of bias", because we could hardly nd any evidence of blinding patients, care providers and outcome assessors [32].…”

“…Forest plot shows that extubation time was lowered in Con group than Lido group with no heterogeneity (MD = 0.53, 95% CI [0.19, 0.87], P = 0.90, I 2 = 0%) after pooled analysis of ve trials (30)(31)(32)(33)35). ( Fig.…”

“…A sum of 11 RCTs [17][18][19][29][30][31][32][33][34][35][36] with 761 patients involved in the meta-analysis (381 in Lido group and 380 in Con group). Out of these RCTs, six studies were published in English [17][18][19][29][30][31] and ve in Chinese [32][33][34][35][36].…”

“…A sum of 11 RCTs [17][18][19][29][30][31][32][33][34][35][36] with 761 patients involved in the meta-analysis (381 in Lido group and 380 in Con group). Out of these RCTs, six studies were published in English [17][18][19][29][30][31] and ve in Chinese [32][33][34][35][36]. The year of publication ranged from 2014 to 2022; the main ASA status was I-II, and only one study involved patients ranked as ASA III [17].…”