Intravenous lidocaine and cancer outcomes after radical cystectomy

Abstract

In conclusion, we recommend strongly that the medical community take L€ onnqvist's appeal ('time for a solution') 2 seriously, and urge medical companies and manufacturers to provide improved infusion solutions that are physiologically composed and balanced (Table 1), and which include clear and detailed guidance for their safe and effective use. We believe that these relatively simple steps, which can be achieved without increasing costs, will have a substantial clinical benefit in reducing morbidity and potentially saving lives.

Trial watch: local anesthetics in cancer therapy

“… 1–3 , 134−145 For instance, intravenous lidocaine administered during cystectomy, ovariectomy or pancreatectomy increased OS and disease-free survival (DFS), emerging as an independent factor for better prognosis. 136 , 146 , 147 Local injection of lidocaine during hepatectomy decreased the incidence of recurrence and the rate of death. 137 Levobupivacaine, administered through paravertebral block to optimally control pain after mastectomy, was associated with increased recurrence-free survival (RFS) in breast cancer patients.…”

“…Independent good prognosis factor (HR = 0.36, 95%CI[0.15–0.90]; p = .029). 146 Bladder LA (epidural) One thousand six hundred and twenty-eight patients included (887 epidural) No benefit in improved short-term outcomes, cancer-specific survival (p = .804) or OS (p = .136) 158 Breast Levobupivacaine (paravertebral) One hundred and twenty-nine patients included (50 with paravertebral block) Association between paravertebral block and RFS ( p = .012) 2 Breast LA (paravertebral) Seven hundred ninety-two women involved (188 paravertebral) No benefit in RFS ( p = .172) 159 Cervix LA (neuraxial) One hundred and thirty-two patients treated with brachytherapy under neuraxial (n = 63) or GA (n = 69). No benefit in recurrence ( p = .863), in long-term mortality from recurrence ( p = .265), or in all-cause mortality ( p = .209) 160 Colon LA (peridural) Eight hundred and seventy-six patients involved (208 peridural) Do not improve OS ( p = .175), cancer-specific survival ( p = .111) or DFS ( p = .43) 161 Colon Bupivacaine (epidural) Two thousand seven hundred and forty-eight patients included (449 epidural) No association between epidural and recurrence or death 162 Colon LA (epidural) Forty-two thousand one hundred and fifty-one patients included (9,670 epidural) Association between epidural and improved survival (HR = 0.91, 95%CI[0.87–0.94]; p < .001) ...…”

Anesthesia and cancer recurrence: a narrative review

“…In a retrospective study of approximately 2,000 patients (pancreatic cancer), intravenous lidocaine infusion was associated with a modest increase in 1- and 3-year overall survival (68% vs. 63% for 1-year overall survival and 34% vs. 27% for 3-year overall survival), with no difference in disease-free survival [ 172 ]. Another retrospective study on radical cystectomy for bladder cancer (n = 144) found that intraoperative lidocaine administration was associated with a reduction in overall mortality (adjusted HR, 0.36; 95% CI, 0.12–0.83) and cancer recurrence (30% vs. 47%) within 2 years compared to patients who did not receive lidocaine [ 175 ].…”

“…To avoid overdose toxicity, IV lidocaine infusions have dose-limitation [ 159 , 160 ]. Most clinical studies have used a bolus of 1.5 mg/kg IV at induction, followed by 2 mg/kg/h IV infusion [ 172 ], or a bolus of 1 mg/kg IV, followed by 1.5 mg/kg/h IV infusion [ 175 ].…”

Combinatorial Therapy of Cancer: Possible Advantages of Involving Modulators of Ionic Mechanisms

“…A retrospective review of patients undergoing primary debulking surgery for ovarian cancer concluded, albeit with some limitations, that intraoperative intravenous lidocaine infusion was associated with improved disease-free survival and overall survival [ 18 ]. Similarly, intraoperative intravenous lidocaine infusion during radical cystectomy for bladder cancer appeared to be associated with prolonged overall and disease-free survival [ 19 ]. These promising results should be interpreted cautiously and need to be confirmed by subsequent randomized clinical trials.…”