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Seok Han B, Ko S, Seok Park M, Ji Lee Y, Eun Kim S, Lee P, Jin Cho Y, Gyeol Go H, Kwak S, Park E, Lim A, Lee S, Yoo S, Kim H, Hee Jung K, Hong SS. Lidocaine combined with general anesthetics impedes metastasis of breast cancer cells via inhibition of TGF-β/Smad-mediated EMT signaling by reprogramming tumor-associated macrophages. Int Immunopharmacol 2024; 142:113207. [PMID: 39312860 DOI: 10.1016/j.intimp.2024.113207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 08/30/2024] [Accepted: 09/17/2024] [Indexed: 09/25/2024]
Abstract
Surgical resection is the best-known approach for breast cancer treatment. However, post-operative metastases increase the rate of death. The potential effect of anesthetic drugs on long-term tumor growth, risk of metastasis, and recurrence after surgery has been investigated in cancer patients. However, the underlying mechanisms remain unclear. Therefore, we aimed to elucidate the anti-metastatic effect of lidocaine combined with common anesthetics and its mechanisms of action on lung metastasis in breast cancer models. The combination of lidocaine with propofol or sevoflurane inhibited the growth of TNBC cells compared to treatment alone. In addition, the combination effectively inhibited cancer cell migration and invasion. It suppressed tumor growth and increased the survival rate in breast 4 T1 orthotopic models. More importantly, it inhibited lung metastasis and recurrence compared with groups treated with a single anesthetic. In co-culture with TAMs and TNBC cells, lidocaine not only reduced M2-tumor-associated macrophages (TAM) that were increased by sevoflurane or propofol but also increased M1 macrophage polarization, impeding tumor growth in TNBC. Also, we found that the transforming growth factor-β (TGF-β) derived from TAMs increased EMT signaling in TNBC cells, and that lidocaine affected cancer cells as well as M2-TAMs, inducing M2 to M1 reprogramming and decreasing TGF-β/Smads-mediated EMT signaling in TNBC cells, leading to inhibition of cancer metastasis and recurrence. These findings suggest lidocaine combined with general anesthetics as a potential therapeutic approach for the inhibition of recurrence and metastasis of breast cancer patients undergoing curative resection.
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Affiliation(s)
- Beom Seok Han
- Department of Biomedical Sciences, College of Medicine, and Program in Biomedical Science & Engineering, Inha University, 366, Seohae-daero, Jung-gu, Incheon 22332, Republic of Korea
| | - Soyeon Ko
- Department of Biomedical Sciences, College of Medicine, and Program in Biomedical Science & Engineering, Inha University, 366, Seohae-daero, Jung-gu, Incheon 22332, Republic of Korea
| | - Min Seok Park
- Department of Biomedical Sciences, College of Medicine, and Program in Biomedical Science & Engineering, Inha University, 366, Seohae-daero, Jung-gu, Incheon 22332, Republic of Korea
| | - Yun Ji Lee
- Department of Biomedical Sciences, College of Medicine, and Program in Biomedical Science & Engineering, Inha University, 366, Seohae-daero, Jung-gu, Incheon 22332, Republic of Korea
| | - Sang Eun Kim
- Department of Biomedical Sciences, College of Medicine, and Program in Biomedical Science & Engineering, Inha University, 366, Seohae-daero, Jung-gu, Incheon 22332, Republic of Korea
| | - Pureunchowon Lee
- Department of Biomedical Sciences, College of Medicine, and Program in Biomedical Science & Engineering, Inha University, 366, Seohae-daero, Jung-gu, Incheon 22332, Republic of Korea
| | - Ye Jin Cho
- Department of Biomedical Sciences, College of Medicine, and Program in Biomedical Science & Engineering, Inha University, 366, Seohae-daero, Jung-gu, Incheon 22332, Republic of Korea
| | - Han Gyeol Go
- Department of Biomedical Sciences, College of Medicine, and Program in Biomedical Science & Engineering, Inha University, 366, Seohae-daero, Jung-gu, Incheon 22332, Republic of Korea
| | - Sehan Kwak
- Department of Biomedical Sciences, College of Medicine, and Program in Biomedical Science & Engineering, Inha University, 366, Seohae-daero, Jung-gu, Incheon 22332, Republic of Korea
| | - Eunji Park
- Department of Biomedical Sciences, College of Medicine, and Program in Biomedical Science & Engineering, Inha University, 366, Seohae-daero, Jung-gu, Incheon 22332, Republic of Korea
| | - Ayoung Lim
- Department of Biomedical Sciences, College of Medicine, and Program in Biomedical Science & Engineering, Inha University, 366, Seohae-daero, Jung-gu, Incheon 22332, Republic of Korea
| | - Suji Lee
- Department of Biomedical Sciences, College of Medicine, and Program in Biomedical Science & Engineering, Inha University, 366, Seohae-daero, Jung-gu, Incheon 22332, Republic of Korea
| | - Seungjong Yoo
- Department of Anesthesiology and Pain Medicine, Inha University, 366, Seohae-daero, Jung-gu, Incheon 22332, Republic of Korea
| | - Hyunzu Kim
- Department of Anesthesiology and Pain Medicine, Inha University, 366, Seohae-daero, Jung-gu, Incheon 22332, Republic of Korea.
| | - Kyung Hee Jung
- Department of Biomedical Sciences, College of Medicine, and Program in Biomedical Science & Engineering, Inha University, 366, Seohae-daero, Jung-gu, Incheon 22332, Republic of Korea.
| | - Soon-Sun Hong
- Department of Biomedical Sciences, College of Medicine, and Program in Biomedical Science & Engineering, Inha University, 366, Seohae-daero, Jung-gu, Incheon 22332, Republic of Korea.
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Lin W, Yang Y, Zhuo Y, Qiu C, Guo Y, Yao Y. Efficacy of intraoperative systemic lidocaine on quality of recovery after laparoscopic colorectal surgery: a randomized controlled trial. Ann Med 2024; 56:2315229. [PMID: 38346397 PMCID: PMC10863528 DOI: 10.1080/07853890.2024.2315229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 02/01/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION Many clinical trials have demonstrated the benefits of intraoperative systemic lidocaine administration in major abdominal surgeries. We tested the hypothesis that systemic lidocaine is associated with an enhanced early quality of recovery in patients following laparoscopic colorectal resection. PATIENTS AND METHODS We randomly allocated 126 patients scheduled for laparoscopic colorectal surgery in a 1:1 ratio to receive either lidocaine (1.5 mg kg-1 bolus over 10 min, followed by continuous infusion at 2 mg kg-1 h-1 until the end of surgery) or identical volumes and rates of saline. The primary outcome was the Quality of Recovery-15 score assessed 24 h after surgery. Secondary outcomes were areas under the pain numeric rating scale curve over time, 48-h morphine consumption, and adverse events. RESULTS Compared with saline, systemic lidocaine improved the Quality of Recovery-15 score 24 h postoperatively, with a median difference of 4 (95% confidence interval: 1-6; p = 0.015). Similarly, the area under the pain numeric rating scale curve over 48 h at rest and on movement was reduced in the lidocaine group (p = 0.004 and p < 0.001, respectively). However, these differences were not clinically meaningful. Lidocaine infusion reduced the intraoperative remifentanil requirements but not postoperative 48-h morphine consumption (p < 0.001 and p = 0.34, respectively). Additionally, patients receiving lidocaine had a quicker and earlier return of bowel function, as indicated by a shorter time to first flatus (log-rank p < 0.001), yet ambulation time was similar between groups (log-rank test, p = 0.11). CONCLUSIONS In patients undergoing laparoscopic colorectal surgery, intraoperative systemic lidocaine resulted in statistically but not clinically significant improvements in quality of recovery (see Graphical Abstract).Trial registration: Chinese Clinical Trial Registry; ChiCTR1900027635.
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Affiliation(s)
- Wenjun Lin
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Ying Yang
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Yifen Zhuo
- Department of Anesthesiology, Xiamen Haicang Hospital, Xiamen, China
| | - Chunlin Qiu
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Yanhua Guo
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Yusheng Yao
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
- Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, China
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Lin Z, Chen C, Xie S, Chen L, Yao Y, Qian B. Systemic lidocaine versus erector spinae plane block for improving quality of recovery after laparoscopic cholecystectomy: A randomized controlled trial. J Clin Anesth 2024; 97:111528. [PMID: 38905964 DOI: 10.1016/j.jclinane.2024.111528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/26/2024] [Accepted: 06/11/2024] [Indexed: 06/23/2024]
Abstract
STUDY OBJECTIVE To compare intravenous lidocaine, ultrasound-guided erector spinae plane block (ESPB), and placebo on the quality of recovery and analgesia after laparoscopic cholecystectomy. DESIGN A prospective, triple-arm, double-blind, randomized, placebo-controlled non-inferiority trial. SETTING A single tertiary academic medical center. PATIENTS 126 adults aged 18-65 years undergoing elective laparoscopic cholecystectomy. INTERVENTIONS Patients were randomly allocated to one of three groups: intravenous lidocaine infusion (1.5 mg/kg bolus followed by 2 mg/kg/h) plus bilateral ESPB with saline (25 mL per side); bilateral ESPB with 0.25% ropivacaine (25 ml per side) plus placebo infusion; or bilateral ESPB with saline (25 ml per side) plus placebo infusion. MEASUREMENTS The primary outcome was the 24-h postoperative Quality of Recovery-15 (QoR-15) score. The non-inferiority of lidocaine versus ESPB was assessed with a margin of -6 points and 97.5% confidence interval (CI). Secondary outcomes included 24-h area under the curve (AUC) for pain scores, morphine consumption, and adverse events. MAIN RESULTS 124 patients completed the study. Median (IQR) 24-h QoR-15 scores were 123 (117-127) for lidocaine, 124 (119-126) for ESPB, and 112 (108-117) for placebo. Lidocaine was non-inferior to ESPB (median difference -1, 97.5% CI: -4 to ∞). Both lidocaine (median difference 9, 95% CI: 6-12, P < 0.001) and ESPB (median difference 10, 95% CI: 7-13, P < 0.001) were superior to placebo. AUC for pain scores and morphine use were lower with lidocaine and ESPB versus placebo (P < 0.001 for all), with no significant differences between lidocaine and ESPB. One ESPB patient reported a transient metallic taste; no other block-related complications occurred. CONCLUSIONS For patients undergoing laparoscopic cholecystectomy, intravenous lidocaine provides a non-inferior quality of recovery compared to ESPB without requiring specialized regional anesthesia procedures. Lidocaine may offer a practical and accessible alternative within multimodal analgesia pathways.
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Affiliation(s)
- Zhiwei Lin
- Department of Anesthesiology, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Chanjuan Chen
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Shengyuan Xie
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Lei Chen
- Department of Anesthesiology, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yusheng Yao
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.
| | - Bin Qian
- Department of Anesthesiology, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China.
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Tognolini AR, Roberts JA, Pandey S, Wallis SC, Eley VA. Propofol does not alter the protein binding and unbound concentration of lidocaine at clinically targeted plasma concentrations in vitro - A short communication. Anaesth Crit Care Pain Med 2024; 43:101419. [PMID: 39089457 DOI: 10.1016/j.accpm.2024.101419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/11/2024] [Accepted: 05/25/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Intravenous lidocaine is increasingly used as an analgesic adjunct during general anaesthesia. Lidocaine is highly protein-bound and changes to binding can alter drug efficacy or toxicity. We aimed to measure the effect of various propofol and lidocaine plasma concentration combinations on the protein binding and concentration of lidocaine in vitro. METHODS Known targeted concentrations of propofol and lidocaine were added to drug-free human plasma in vitro. Samples were prepared and analysed in various clinically relevant concentration combinations; propofol at 0, 2, 4 and 6 µg/mL, and lidocaine at 1, 3 and 5 µg/mL. The total and unbound concentrations of lidocaine were measured by ultra-high performance liquid chromatography-mass spectrometry and percentage protein binding was determined. Data were presented as mean and standard deviation (SD) and differences between groups analysed. RESULTS The overall mean protein binding of lidocaine was 68.8% (SD 5.5, range 57.5-80.9%). Beta regression analysis revealed no statistically significant difference in lidocaine percentage binding across a range of propofol and lidocaine concentration combinations. CONCLUSION Propofol did not alter the unbound and free pharmacologically active proportion of lidocaine at different clinically targeted concentrations of propofol and lidocaine in plasma in vitro. The percentage of plasma protein binding of lidocaine in this study was consistent with previously published results.
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Affiliation(s)
- Angela R Tognolini
- Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Butterfield St, Herston 4006, Queensland, Australia; Faculty of Medicine, The University of Queensland, St Lucia 4067, Queensland, Australia.
| | - Jason A Roberts
- The University of Queensland Centre for Clinical Research, The University of Queensland, Herston 4006, Queensland, Australia; Departments of Pharmacy and Intensive Care Medicine, The Royal Brisbane and Women's Hospital, Butterfield St, Herston 4006, Queensland, Australia; Herston Infectious Diseases Institute (HeIDI), Metro North Health, Herston 4006, Queensland, Australia; Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Saurabh Pandey
- The University of Queensland Centre for Clinical Research, The University of Queensland, Herston 4006, Queensland, Australia
| | - Steven C Wallis
- The University of Queensland Centre for Clinical Research, The University of Queensland, Herston 4006, Queensland, Australia
| | - Victoria A Eley
- Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Butterfield St, Herston 4006, Queensland, Australia; Faculty of Medicine, The University of Queensland, St Lucia 4067, Queensland, Australia
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Xiao G, Sun H, Jiang G, Liu Y, Song G, Kong D. Binary Catalytic Hydrogen/Deuterium Exchange of Free α-Amino Acids and Derivatives. Chemistry 2024; 30:e202402045. [PMID: 39042826 DOI: 10.1002/chem.202402045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 07/21/2024] [Accepted: 07/22/2024] [Indexed: 07/25/2024]
Abstract
The increasing demand for deuterium-labeled amino acids and derivatives has heightened interest in direct hydrogen/deuterium exchange reactions of free amino acids. Existing methods, including biocatalysis and metal catalysis, typically require expensive deuterium sources or excessive use of deuterium reagents and often struggle with site selectivity. In contrast, this binary catalysis system, employing benzaldehyde and Cs2CO3 in the presence of inexpensive D2O with minimal stoichiometric quantities, facilitates efficient hydrogen/deuterium exchange at the α-position of amino acids without the need for protecting groups in the polar aprotic solvent DMSO. The process is highly compatible with most natural and non-natural α-amino acids and derivatives, even those with potentially reactive functionalities. This advancement not only addresses the cost and efficiency concerns of existing methods but also significantly broadens the applicability and precision of deuterium labeling in biochemical research.
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Affiliation(s)
- Guorong Xiao
- State Key Laboratory of Chemical Resource Engineering, Beijing University of Chemical Technology, Beijing, 100029, China
| | - Hong Sun
- State Key Laboratory of Chemical Resource Engineering, Beijing University of Chemical Technology, Beijing, 100029, China
| | - Gege Jiang
- State Key Laboratory of Chemical Resource Engineering, Beijing University of Chemical Technology, Beijing, 100029, China
| | - Ying Liu
- State Key Laboratory of Chemical Resource Engineering, Beijing University of Chemical Technology, Beijing, 100029, China
| | - Gaohan Song
- State Key Laboratory of Chemical Resource Engineering, Beijing University of Chemical Technology, Beijing, 100029, China
| | - Duanyang Kong
- State Key Laboratory of Chemical Resource Engineering, Beijing University of Chemical Technology, Beijing, 100029, China
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Mihretu F, Azale T, Mohammed F, Agumas A, Timerga S, Befikadu A. Lidocaine pre-treatment for Succinylcholine induced postoperative myalgia and associated factors: Longitudinal study. Surg Open Sci 2024; 21:45-51. [PMID: 39391286 PMCID: PMC11465034 DOI: 10.1016/j.sopen.2024.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 07/19/2024] [Accepted: 09/16/2024] [Indexed: 10/12/2024] Open
Abstract
Introduction Postoperative myalgia in surgical patients is mainly caused by the routinely administered depolarizing muscle relaxant, Succinylcholine. There are many proposed strategies but no one were indicated as ideal preventive mechanisms for Succinylcholine induced post-operative myalgia. Even if data were sparse, Lidocaine pretreatment can reduce postoperative myalgia which requires further supportive evidences urging the initiation of this study. Methods Prospective longitudinal cohort study was conducted from March to May 2021 at Dessie Comprehensive Specialized Hospital on 208 adult surgical patients. Patients pretreated with Lidocaine preoperatively were grouped as exposed and others as unexposed. Patients meeting the inclusion criteria during the study period were selected sequentially from the daily operation schedule list. Postoperative myalgia level was measured using post-operative myalgia survey repeatedly. The result was analyzed by Cochran's Q test and generalized estimating equation (GEE). Adjusted odds ratio with 95 % confidence interval and p value < 0.05 was used to show the difference, direction and strength of association. Result Exposure specific incidence rate showed that 22 %, 22 % and 29.8 % of patients exposed to Lidocaine and 40.6 %, 42.7 % and 34 % not exposed to Lidocaine developed myalgia at 12, 24, and 48 h respectively. There is no significant difference in the incidence of myalgia over time between the repeated measurements in Lidocaine exposed patients (p = 0.513) but in non-exposed patients (p = 0.003). Also, there is no difference in the distribution of other predictors between Lidocaine exposed and non-exposed groups (p > 0.05). Exposure to Lidocaine reduces postoperative myalgia significantly [AOR = 0.33, 95 % CI = (0.17,0.66)]. Multimodal analgesia [AOR = 0.32, 95 % CI = (0.18,0.55)], non-steroidal anti-inflammatory drugs alone [AOR = 0.47, 95 % CI = (0.29,0.76)], postoperative immobility [AOR = 0.61, 95 % CI = (0.47,0.8)], and being male [AOR = 0.48, 95 % CI = (0.26,0.87)] were other determinants in reducing Succinylcholine induced postoperative myalgia. Conclusion Lidocaine pretreatment can significantly reduce the occurrence of Succinylcholine induced postoperative myalgia. Additionally, usage of multimodal analgesia with non-steroidal anti-inflammatory drugs or even only non-steroidal anti-inflammatory drugs in the intraoperative and postoperative period can reduce Succinylcholine induced postoperative myalgia.
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Affiliation(s)
- Fassil Mihretu
- Wollo University, College of Medicine and Health Sciences, Department of Anesthesia, Dessie, Ethiopia
- Dessie Comprehensive Specialized Hospital, Dessie, Ethiopia
| | - Telake Azale
- University of Gondar, College of Medicine and Health Sciences, School of Public Health, Gondar, Ethiopia
| | - Foziya Mohammed
- Wollo University College of Medicine and Health Sciences, School of Public Health, Dessie, Ethiopia
| | - Amare Agumas
- Wollo University, College of Medicine and Health Sciences, Department of Anesthesia, Dessie, Ethiopia
- Dessie Comprehensive Specialized Hospital, Dessie, Ethiopia
| | - Sara Timerga
- Wollo University, College of Medicine and Health Sciences, Department of Anesthesia, Dessie, Ethiopia
- Dessie Comprehensive Specialized Hospital, Dessie, Ethiopia
| | - Aynalem Befikadu
- Wollo University, College of Medicine and Health Sciences, Department of Anesthesia, Dessie, Ethiopia
- Dessie Comprehensive Specialized Hospital, Dessie, Ethiopia
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Polomeni MM, Huguet T, Mariotti M, Larcher C, Delort F, Minville V, Kern D. Avoiding pain during propofol injection in pediatric anesthesia: Hypnoanalgesia of the hand versus intravenous lidocaine. Paediatr Anaesth 2024; 34:742-749. [PMID: 38693886 DOI: 10.1111/pan.14909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 05/03/2024]
Abstract
INTRODUCTION Pain related to injection of propofol during induction of anesthesia decreases from 66.8% without prevention, to 22-31% of cases when lidocaine is associated. Hypnoanalgesia of the hand is currently used for painful procedures in children but has never been evaluated in this indication. The primary aim of this prospective randomized single-blind study was to evaluate the efficacy of hypnoanalgesia of the hand for the prevention of moderate to severe pain during intravenous injection of propofol alone in comparison to lidocaine admixture. The secondary aim was to compare the global satisfaction of children in both methods. PATIENTS AND METHODS One hundred patients aged 7-14 years, ASA 1-2, admitted for scheduled surgery under general anesthesia were randomized into two groups. Group L received a mixture of 1% propofol (3 mg/kg) and 1% Lidocaine (0.3 mg/kg). Group H received 1% propofol (3 mg/kg) after hypnoanalgesia of the hand realized by a single experimented operator. A video was made in order to evaluate the pain related to propofol injection by a blinded observer using the 4-point score of Cameron (painful ≥ 2). The global satisfaction of children was evaluated in postanesthesia care unit and documented if visual analog score was <7/10. RESULTS Ninety-six patients were analyzed. The rate of painful patients did not differ significantly between groups (8.5% in group H [n = 47] vs 6.1% in group L [n = 49], OR= 0.70; 95% CI [0.13-3.35], p = 0.65), nor did the rate of nonsatisfied patients (10.6 in group H vs. 12.2% in group L, OR = 0.85; 95% CI [0.19-3.65], p = 1). CONCLUSIONS Our results suggest that hypnoanalgesia of the hand alone is effective to prevent the pain related to propofol injection in children. No significant difference was found in comparison with lidocaine admixture nor for pain or satisfaction.
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Affiliation(s)
- Marie-Madeleine Polomeni
- Department of Anesthesia and Intensive Care, University Hospital of Toulouse, Toulouse, France
- Department of Anesthesia and Intensive Care, Children Hospital, University Hospital of Toulouse, Toulouse, France
| | - Thomas Huguet
- Department of Anesthesia and Intensive Care, University Hospital of Toulouse, Toulouse, France
| | - Maryline Mariotti
- Department of Pediatric Analgesia and Palliative Care, Children Hospital of Toulouse, Toulouse, France
| | - Claire Larcher
- Department of Anesthesia and Intensive Care, University Hospital of Toulouse, Toulouse, France
- Department of Anesthesia and Intensive Care, Children Hospital, University Hospital of Toulouse, Toulouse, France
| | - François Delort
- Department of Anesthesia and Intensive Care, University Hospital of Toulouse, Toulouse, France
- Department of Anesthesia and Intensive Care, Children Hospital, University Hospital of Toulouse, Toulouse, France
| | - Vincent Minville
- Department of Anesthesia and Intensive Care, University Hospital of Toulouse, Toulouse, France
| | - Delphine Kern
- Department of Anesthesia and Intensive Care, University Hospital of Toulouse, Toulouse, France
- Department of Anesthesia and Intensive Care, Children Hospital, University Hospital of Toulouse, Toulouse, France
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Heidari M, Shetebi H, Golshiri P, Hoghughi S. Lidocaine and Dexamethasone, Ketamine and Dexamethasone, and Dexamethasone Alone in Tonsillectomy Complications. Adv Biomed Res 2024; 13:40. [PMID: 39224399 PMCID: PMC11368224 DOI: 10.4103/abr.abr_234_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 11/07/2022] [Accepted: 11/12/2022] [Indexed: 09/04/2024] Open
Abstract
Background Common complications including stridor, laryngospasm, and bronchospasm are important in patients undergoing general anesthesia. Dexamethasone, lidocaine, and ketamine could have significant roles in reducing these complications. Here we aimed to compare the use of these drugs during tonsillectomy. Materials and Methods This study was performed on 100 children that were candidates of tonsillectomy. Patients were divided into 4 groups receiving dexamethasone 0.1 mg/kg and lidocaine 1 mg/kg, ketamine 0.5 mg/kg and dexamethasone 0.1 mg/kg, dexamethasone 0.1 mg/kg, and normal saline after surgical procedures. We evaluated and compared data regarding the duration of anesthesia, oxygenation saturation, blood pressure (systolic and diastolic (SBP and DBP)), re-intubation, laryngospasm, bronchospasm, requiring analgesics after surgeries, recovery stay duration, and nausea and vomiting. Results Administration of ketamine and dexamethasone was associated with the lowest pain and lowest need for postoperative analgesic administrations in patients (P = 0.02). Patients that received lidocaine and dexamethasone had the lowest frequencies of airway stimulations (P < 0.001). Evaluations of complications in patients revealed that stridor was significantly lower in patients that received ketamine and dexamethasone (P = 0.01). Conclusion Usage of ketamine and dexamethasone was associated with the lowest pain severities and lowest complications. On the other hand, patients that received lidocaine and dexamethasone had the least airway stimulations.
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Affiliation(s)
- Morteza Heidari
- Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Shetebi
- Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parastoo Golshiri
- Department of Community and Family Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Somayeh Hoghughi
- Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran
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Larsson M, Sartipy U, Franco-Cereceda A, Öwall A, Jakobsson J. The effect of continuous bilateral parasternal block with lidocaine on patient-controlled analgesia opioid requirement and recovery after open heart surgery: a double-blind randomised controlled trial. BJA OPEN 2024; 10:100279. [PMID: 38680128 PMCID: PMC11046074 DOI: 10.1016/j.bjao.2024.100279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/15/2024] [Indexed: 05/01/2024]
Abstract
Background We hypothesised that a continuous 72-h bilateral parasternal infusion of lidocaine at 2×35 mg h-1 would decrease pain and the inflammatory response after sternotomy for open heart surgery, subsequently improving quality of recovery. Methods We randomly allocated 45 participants to a 72-h bilateral parasternal infusion of lidocaine or saline commencing after wound closure. The primary outcome was the cumulative patient-controlled analgesia (PCA) morphine consumption at 72 h. Secondary outcomes included total morphine requirement, pain, peak expiratory flow, and serum interleukin-6 concentration. In addition, we used an eHealth platform for a 3-month follow-up of pain, analgesic use, and Quality of Recovery-15 scores. Results The 72-h PCA morphine requirement was significantly lower in the lidocaine than the saline group (10 mg [inter-quartile range: 5-19 mg] and 28.2 mg [inter-quartile range: 16-42.5 mg], respectively; P=0.014). The total morphine requirement (including morphine administered before the start of PCA) was significantly lower at 24, 48, and 72 h. Pain was well controlled with no difference in pain scores between treatment groups. The peak expiratory flow was lower in the lidocaine group at 72 h. Interleukin-6 concentrations showed no difference at 24, 48, or 72 h. Quality of Recovery-15 scores did not differ between treatment groups at any time during the 3-month follow-up. Conclusions After sternotomy for open heart surgery, a 72-h bilateral parasternal lidocaine infusion significantly decreased PCA and total morphine requirement. However, neither signs of decreased inflammatory response nor an improvement in recovery was seen. Clinical trial registration EudraCT number 2018-004672-35.
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Affiliation(s)
- Mark Larsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Function Perioperative Medicine and Intensive Care, Section for Cardiothoracic Anaesthesia and Intensive Care, Sweden
| | - Ulrik Sartipy
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Franco-Cereceda
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Öwall
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Function Perioperative Medicine and Intensive Care, Section for Cardiothoracic Anaesthesia and Intensive Care, Sweden
| | - Jan Jakobsson
- Institution for Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
- Department of Anaesthesia and Intensive Care, Danderyd Hospital, Stockholm, Sweden
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10
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Qian J, Zhang Q, Cao Y, Chu X, Gao Y, Xu H, Cai H, Wu J. Perfusion drugs for non‑muscle invasive bladder cancer (Review). Oncol Lett 2024; 27:267. [PMID: 38659423 PMCID: PMC11040539 DOI: 10.3892/ol.2024.14400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024] Open
Abstract
The high recurrence rate and poor prognosis of non-muscle invasive bladder cancer (BC) are challenges that need to be urgently addressed. Transurethral cystectomy for bladder tumors is often combined with bladder perfusion therapy, which can effectively reduce the recurrence and progression rates of BC. The present review integrated and analyzed currently available bladder perfusion drugs, mainly including chemotherapeutic agents, immunotherapeutic agents and other adjuvant perfusion drugs. Bacillus Calmette-Guerin (BCG) perfusion was the pioneering immunotherapy for early BC and still ranks high in the selection of perfusion drugs. However, BCG infusion has a high toxicity profile and has been shown to be ineffective in some patients. Due to the limitations of BCG, new bladder perfusion drugs are constantly being developed. Immunotherapeutic agents have opened a whole new chapter in the selection of therapeutic agents for bladder perfusion. The present review explored the mechanism of action, clinical dosage and adverse effects of a variety of bladder perfusion drugs currently in common use, described combined perfusion and compared the effects of certain drugs on BC.
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Affiliation(s)
- Jingyuan Qian
- Department of Nursing, Jiangsu Cancer Hospital and The Affiliated Cancer Hospital of Nanjing Medical University and Jiangsu Institute of Cancer Research, Nanjing, Jiangsu 210009, P.R. China
| | - Qiuchen Zhang
- Department of Urology, Jiangsu Cancer Hospital and The Affiliated Cancer Hospital of Nanjing Medical University and Jiangsu Institute of Cancer Research, Nanjing, Jiangsu 210009, P.R. China
| | - Yang Cao
- Department of Urology, Jiangsu Cancer Hospital and The Affiliated Cancer Hospital of Nanjing Medical University and Jiangsu Institute of Cancer Research, Nanjing, Jiangsu 210009, P.R. China
| | - Xi Chu
- Department of Urology, Jiangsu Cancer Hospital and The Affiliated Cancer Hospital of Nanjing Medical University and Jiangsu Institute of Cancer Research, Nanjing, Jiangsu 210009, P.R. China
| | - Yiyang Gao
- Department of Urology, Jiangsu Cancer Hospital and The Affiliated Cancer Hospital of Nanjing Medical University and Jiangsu Institute of Cancer Research, Nanjing, Jiangsu 210009, P.R. China
| | - Haifei Xu
- Department of Urology, Nantong Tumor Hospital, Nantong, Jiangsu 226006, P.R. China
| | - Hongzhou Cai
- Department of Urology, Jiangsu Cancer Hospital and The Affiliated Cancer Hospital of Nanjing Medical University and Jiangsu Institute of Cancer Research, Nanjing, Jiangsu 210009, P.R. China
| | - Jiajia Wu
- Department of Nursing, Jiangsu Cancer Hospital and The Affiliated Cancer Hospital of Nanjing Medical University and Jiangsu Institute of Cancer Research, Nanjing, Jiangsu 210009, P.R. China
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11
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Albazee E, Alsubaie HM, AlKandery M, Abdulrahman S, Alsaleh S. Efficacy of perioperative lidocaine infusion on surgical field quality during functional endoscopic sinus surgery: a systematic review and meta-analysis with trial sequential analysis. Eur Arch Otorhinolaryngol 2024; 281:2819-2831. [PMID: 38231242 DOI: 10.1007/s00405-024-08455-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 01/18/2024]
Abstract
PURPOSE To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) that assessed the efficacy of perioperative intravenous lidocaine versus placebo in improving the quality of surgical field during functional endoscopic sinus surgery (FESS). METHODS PubMed, Scopus, Web of Science, and CENTRAL were thoroughly searched from inception until June 2023. The included RCTs were evaluated via RoB-2 tool. Our primary endpoint included intraoperative surgical field quality, and secondary endpoints involved operative duration, estimated blood loss, time for post-anesthesia care unit (PACU) discharge, postoperative pain, mean difference in heart rate (HR), and mean difference in mean arterial pressure (MAP). Continuous data were pooled as mean difference (MD) or standardized mean difference (SMD) via RevMan software. Also, the certainty of evidence for each outcome were assessed according to the GRADE system. RESULTS Four RCTs with total of 267 patients were included. Regarding the intraoperative quality of surgical field, the results indicated a significant difference in favor of the lidocaine group compared to the placebo group (n = 3 RCTs, MD - 0.80, 95% CI [- 0.98, - 0.61], p < 0.001, moderate certainty of evidence). The trial sequential analysis showed there is a substantial and conclusive evidence. Regarding time for PACU discharge, there was a significant difference that favor lidocaine group (p < 0.05). On the contrary, there was no significant difference between lidocaine and placebo groups in terms of operative duration, estimated blood loss, postoperative pain, mean change in MAP and HR, (p > 0.05). CONCLUSION Our review revealed that lidocaine infusion, compared with a placebo, significantly improved the surgical field and shortened the time required for PACU discharge. However, lidocaine did not reduce surgery time, estimated blood loss, postoperative pain, MAP, or HR.
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Affiliation(s)
- Ebraheem Albazee
- Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait.
| | - Hemail M Alsubaie
- Otorhinolaryngology-Head and Neck Surgery and Communication Sciences Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mashael AlKandery
- Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait
| | - Shawkat Abdulrahman
- Department of Otolaryngology-Head and Neck Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Saad Alsaleh
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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12
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Hu Y, Zhang QY, Qin GC, Zhu GH, Long X, Xu JF, Gong Y. Balanced opioid-free anesthesia with lidocaine and esketamine versus balanced anesthesia with sufentanil for gynecological endoscopic surgery: a randomized controlled trial. Sci Rep 2024; 14:11759. [PMID: 38782997 PMCID: PMC11116438 DOI: 10.1038/s41598-024-62824-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 05/21/2024] [Indexed: 05/25/2024] Open
Abstract
In this randomized controlled trial, 74 patients scheduled for gynecological laparoscopic surgery (American Society of Anesthesiologists grade I/II) were enrolled and randomly divided into two study groups: (i) Group C (control), received sufentanil (0.3 μg/kg) and saline, followed by sufentanil (0.1 μg/kg∙h) and saline; and (ii) Group F (OFA), received esketamine (0.15 mg/kg) and lidocaine (2 mg/kg), followed by esketamine (0.1 mg/kg∙h) and lidocaine (1.5 mg/kg∙h). The primary outcome was the 48-h time-weighted average (TWA) of postoperative pain scores. Secondary outcomes included time to extubation, adverse effects, and postoperative sedation score, pain scores at different time points, analgesic consumption at 48 h, and gastrointestinal functional recovery. The 48-h TWAs of pain scores were 1.32 (0.78) (95% CI 1.06-1.58) and 1.09 (0.70) (95% CI 0.87-1.33) for Groups F and C, respectively. The estimated difference between Groups F and C was - 0.23 (95% CI - 0.58 - 0.12; P = 0.195). No differences were found in any of the secondary outcomes and no severe adverse effects were observed in either group. Balanced OFA with lidocaine and esketamine achieved similar effects to balanced anesthesia with sufentanil in patients undergoing elective gynecological laparoscopic surgery, without severe adverse effects.Clinical Trial Registration: ChiCTR2300067951, www.chictr.org.cn 01 February, 2023.
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Affiliation(s)
- Yang Hu
- Institute of Anesthesiology and Critical Care Medicine, China Three Gorges University and Yichang Central People's Hospital, Yichang, 443000, Hubei, China
| | - Qing-Yun Zhang
- Institute of Anesthesiology and Critical Care Medicine, China Three Gorges University and Yichang Central People's Hospital, Yichang, 443000, Hubei, China
| | - Guan-Chao Qin
- Institute of Anesthesiology and Critical Care Medicine, China Three Gorges University and Yichang Central People's Hospital, Yichang, 443000, Hubei, China
| | - Guo-Hong Zhu
- Institute of Anesthesiology and Critical Care Medicine, China Three Gorges University and Yichang Central People's Hospital, Yichang, 443000, Hubei, China
| | - Xiang Long
- Institute of Anesthesiology and Critical Care Medicine, China Three Gorges University and Yichang Central People's Hospital, Yichang, 443000, Hubei, China
| | - Jin-Fei Xu
- Institute of Anesthesiology and Critical Care Medicine, China Three Gorges University and Yichang Central People's Hospital, Yichang, 443000, Hubei, China
| | - Yuan Gong
- Institute of Anesthesiology and Critical Care Medicine, China Three Gorges University and Yichang Central People's Hospital, Yichang, 443000, Hubei, China.
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13
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Gajniak D, Mendrala K, König-Widuch G, Parzonka S, Gierek D, Krzych ŁJ. Effect of lidocaine on intraoperative blood pressure variability in patients undergoing major vascular surgery. BMC Anesthesiol 2024; 24:170. [PMID: 38714924 PMCID: PMC11075205 DOI: 10.1186/s12871-024-02550-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/26/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Dynamic fluctuations of arterial blood pressure known as blood pressure variability (BPV) may have short and long-term undesirable consequences. During surgical procedures blood pressure is usually measured in equal intervals allowing to assess its intraoperative variability, which significance for peri and post-operative period is still under debate. Lidocaine has positive cardiovascular effects, which may go beyond its antiarrhythmic activity. The aim of the study was to verify whether the use of intravenous lidocaine may affect intraoperative BPV in patients undergoing major vascular procedures. METHODS We performed a post-hoc analysis of the data collected during the previous randomized clinical trial by Gajniak et al. In the original study patients undergoing elective abdominal aorta and/or iliac arteries open surgery were randomized into two groups to receive intravenous infusion of 1% lidocaine or placebo at the same infusion rate based on ideal body weight, in concomitance with general anesthesia. We analyzed systolic (SBP), diastolic (DBP) and mean arterial blood (MAP) pressure recorded in 5-minute intervals (from the first measurement before induction of general anaesthesia until the last after emergence from anaesthesia). Blood pressure variability was then calculated for SBP and MAP, and expressed as: standard deviation (SD), coefficient of variation (CV), average real variability (ARV) and coefficient of hemodynamic stability (C10%), and compared between both groups. RESULTS All calculated indexes were comparable between groups. In the lidocaine and placebo groups systolic blood pressure SD, CV, AVR and C10% were 20.17 vs. 19.28, 16.40 vs. 15.64, 14.74 vs. 14.08 and 0.45 vs. 0.45 respectively. No differences were observed regarding type of surgery, operating and anaesthetic time, administration of vasoactive agents and intravenous fluids, including blood products. CONCLUSION In high-risk vascular surgery performed under general anesthesia, lidocaine infusion had no effect on arterial blood pressure variability. TRIAL REGISTRATION ClinicalTrials.gov; NCT04691726 post-hoc analysis; date of registration 31/12/2020.
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Affiliation(s)
- Dariusz Gajniak
- Department of Anaesthesiology and Intensive Care, Upper-Silesian Medical Centre of the Medical University of Silesia in Katowice, Ziolowa 45 street, Katowice, 40-635, Poland.
| | - Konrad Mendrala
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Gabriela König-Widuch
- Department of Anaesthesiology and Intensive Care, Upper-Silesian Medical Centre of the Medical University of Silesia in Katowice, Ziolowa 45 street, Katowice, 40-635, Poland
| | - Szymon Parzonka
- Department of Anaesthesiology and Intensive Care, Upper-Silesian Medical Centre of the Medical University of Silesia in Katowice, Ziolowa 45 street, Katowice, 40-635, Poland
| | - Danuta Gierek
- Department of Anaesthesiology and Intensive Care, Upper-Silesian Medical Centre of the Medical University of Silesia in Katowice, Ziolowa 45 street, Katowice, 40-635, Poland
| | - Łukasz J Krzych
- Department of Acute Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
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14
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Foong KW, Chaw SH, Lo YL, Loh PS. Population Pharmacokinetics of Intravenous Lidocaine in Adults: A Systematic Review. Clin Pharmacokinet 2024; 63:623-643. [PMID: 38703307 DOI: 10.1007/s40262-024-01373-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND The establishment of optimal dosing regimens for intravenous (IV) lidocaine in the perioperative setting, aiming to balance effective pain relief with minimisation of potential side effects, is a topic of ongoing debate. This discussion stems from the significant variability in lidocaine's pharmacokinetic (PK) parameters and its relatively narrow safety margin. Population pharmacokinetic (popPK) modelling has emerged as a valuable tool for understanding the factors contributing to this observed variability in drug kinetics. OBJECTIVES This systematic review compiles the existing knowledge on lidocaine's PK properties and published popPK models, with a focus on significant covariates. METHODS A systematic search on Cochrane CENTRAL, Medline, and EMBASE was performed from inception to June 2023. Original clinical studies that administered IV lidocaine to adults and performed PK analyses using a nonlinear mixed effects modelling approach were included. The quality of the included studies was assessed by compliance with the Clinical Pharmacokinetics (ClinPK) statement checklist. RESULTS Seven studies were included, which involved a diverse adult population, including both volunteers and patients with various comorbidities. Lidocaine PK was primarily characterised by a two- or three-compartment model. The volume of distribution at steady state ranged from 66 to 194 L, and the total clearance ranged from 22 to 49 L/h. Despite adjusting for significant covariates like heart failure status, alpha-1-acid glycoprotein, duration of lidocaine infusion, and body weight, each study revealed substantial variability in PK parameters. The potential impact of hepatic or renal function biomarkers on these PK parameters calls for further investigation. Incomplete reporting of key aspects of developed models may hinder the models' reliability and clinical application. CONCLUSION The findings emphasise the importance of tailoring drug dosage to ensure the safe and effective use of intravenous lidocaine. Optimal design methodologies may be incorporated for a more efficient identification of important covariates. Utilising contemporary model evaluation methods like visual predictive checks and bootstrapping would enhance the robustness of popPK models and the reliability of their predictions. This comprehensive review advances our understanding of lidocaine's pharmacokinetics and lays the groundwork for further research in this critical area of perioperative pain management. Review protocol registered on 25 August 2023 in PROSPERO (CRD42023441113). This work was supported by the Fundamental Research Grant Scheme, the Ministry of Higher Education, Malaysia (FRGS/1/2020/SKK01/UM/02/2).
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Affiliation(s)
- Keng Wah Foong
- Department of Anaesthesiology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Sook Hui Chaw
- Department of Anaesthesiology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Yoke Lin Lo
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, No. 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia
| | - Pui San Loh
- Department of Anaesthesiology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
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15
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Chen MS, Chong ZY, Huang C, Huang HC, Su PH, Chen JC. Lidocaine attenuates TMZ resistance and inhibits cell migration by modulating the MET pathway in glioblastoma cells. Oncol Rep 2024; 51:72. [PMID: 38606513 PMCID: PMC11024889 DOI: 10.3892/or.2024.8731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 03/05/2024] [Indexed: 04/13/2024] Open
Abstract
Glioblastoma multiforme (GBM) is the most aggressive type of malignant brain tumor. Currently, the predominant clinical treatment is the combination of surgical resection with concurrent radiotherapy and chemotherapy, using temozolomide (TMZ) as the primary chemotherapy drug. Lidocaine, a widely used amide‑based local anesthetic, has been found to have a significant anticancer effect. It has been reported that aberrant hepatocyte growth factor (HGF)/mesenchymal‑epithelial transition factor (MET) signaling plays a role in the progression of brain tumors. However, it remains unclear whether lidocaine can regulate the MET pathway in GBM. In the present study, the clinical importance of the HGF/MET pathway was analyzed using bioinformatics. By establishing TMZ‑resistant cell lines, the impact of combined treatment with lidocaine and TMZ was investigated. Additionally, the effects of lidocaine on cellular function were also examined and confirmed using knockdown techniques. The current findings revealed that the HGF/MET pathway played a key role in brain cancer, and its activation in GBM was associated with increased malignancy and poorer patient outcomes. Elevated HGF levels and activation of its receptor were found to be associated with TMZ resistance in GBM cells. Lidocaine effectively suppressed the HGF/MET pathway, thereby restoring TMZ sensitivity in TMZ‑resistant cells. Furthermore, lidocaine also inhibited cell migration. Overall, these results indicated that inhibiting the HGF/MET pathway using lidocaine can enhance the sensitivity of GBM cells to TMZ and reduce cell migration, providing a potential basis for developing novel therapeutic strategies for GBM.
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Affiliation(s)
- Ming-Shan Chen
- Department of Anesthesiology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 60002, Taiwan, R.O.C
- Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung 41354, Taiwan, R.O.C
| | - Zhi-Yong Chong
- Department of Biochemical Science and Technology, National Chiayi University, Chiayi 600355, Taiwan, R.O.C
| | - Cheng Huang
- Department of Biotechnology and Laboratory Science in Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan, R.O.C
| | - Hsiu-Chen Huang
- Department of Applied Science, National Tsing Hua University South Campus, Hsinchu 30014, Taiwan, R.O.C
- Center for Teacher Education, National Tsing Hua University, Hsinchu 300044, Taiwan, R.O.C
| | - Pin-Hsuan Su
- Department of Biochemical Science and Technology, National Chiayi University, Chiayi 600355, Taiwan, R.O.C
| | - Jui-Chieh Chen
- Department of Biochemical Science and Technology, National Chiayi University, Chiayi 600355, Taiwan, R.O.C
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16
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Belfiore J, Castellani Niccolini N, Fleissner Z, Chadha R, Biancofiore G. Pain management in liver transplant recipients: a focus on current and future strategies. Minerva Anestesiol 2024; 90:452-461. [PMID: 38571405 DOI: 10.23736/s0375-9393.24.17805-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Liver transplantation is the only curative treatment option for patients with end-stage liver disease. Anesthesiologists and intensivists are fully involved in this procedure due to the perioperative care focus on hemodynamic, respiratory and metabolic support. However, quite surprisingly, postoperative pain management does not have clinical primary consideration in this class of patients due to a combination of factors including the thought that liver transplantation recipients have less pain and require lower doses of analgesics than patients who undergo other types of major abdominal surgery. Other factors contribute to make the management of postoperative pain somewhat complex in this class of patients: 1) drug pharmacokinetics and metabolism by the new liver is not predictable; 2) the multifactorial nature of liver graft recovery; and 3) the alterations of homeostasis, including circulatory, respiratory and metabolic vulnerability, in the days postoperative period. As a result, post-liver transplantation analgesia is underestimated not only from the clinical point of view but also in the literature and only a few papers deal with the management of postoperative pain in this particular class of patients. Thus, in the experts' opinion paper we aimed to report the possible strategies for managing post-LT pain with a focus on opioids alternatives and possible future developments in this particular clinical setting also in the view that improvements in perioperative care have made it possible to adopt fast track and Enhanced Recovery After Surgery-oriented protocols also in this class of patients.
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Affiliation(s)
- Jacopo Belfiore
- Unit of Transplant Anesthesia and Critical Care, AOU Pisana, University of Pisa, Pisa, Italy
| | | | - Zachary Fleissner
- Unit of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Ryan Chadha
- Unit of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Gianni Biancofiore
- Unit of Transplant Anesthesia and Critical Care, AOU Pisana, University of Pisa, Pisa, Italy -
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17
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Che Y, Wang M, Wu X, Wang X. The efficacy of articaine in pain management during endodontic procedures in pediatric patients. Perioper Med (Lond) 2024; 13:33. [PMID: 38689354 PMCID: PMC11062012 DOI: 10.1186/s13741-024-00389-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 04/15/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVE This trial aimed to study the efficacy of articaine in pain management during endodontic procedures in pediatric patients. METHODS Ninety-eight children who received endodontic painless treatment were collected and randomly divided into the control group and observation group, with 49 cases in each group. The control group received infiltration anesthesia with lidocaine, and the observation group received infiltration anesthesia with articaine. Anesthesia effect, anesthesia onset time, sensory recovery time, duration of anesthesia, pain intensity, blood pressure, heart rate, and adverse reactions were compared. RESULTS The effective rate of anesthesia in the observation group was higher than that in the control group. The anesthesia onset time and sensory recovery time were shorter, the duration of anesthesia was longer, and the VAS score and facial expression score were lower in the observation group than in the control group. The heart rate of the observation group was lower, and diastolic blood pressure was higher than those of the control group. The total incidence of adverse reactions in the observation group was lower than that in the control group. CONCLUSION In the treatment of dental pulp diseases in children, the use of articaine can achieve better anesthesia effect and rapid onset of anesthesia and has less impact on the patient's blood pressure and heart rate, but it also can relieve pain and has good safety after the use of medication. It is worthy of clinical application.
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Affiliation(s)
- Yilei Che
- Department of Stomatology, Aerospace Center Hospital (ASCH), No.15, YuQuan Road, Haidian District, Beijing, 100049, China
| | - Minhua Wang
- Department of Stomatology, Eye Hospital China Academy of Chinese Medical Sciences, Beijing, 100040, China
| | - Xiaozhen Wu
- Department of Stomatology, Aerospace Center Hospital (ASCH), No.15, YuQuan Road, Haidian District, Beijing, 100049, China
| | - Xueling Wang
- Department of Stomatology, Aerospace Center Hospital (ASCH), No.15, YuQuan Road, Haidian District, Beijing, 100049, China.
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18
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Zhang W, Liu J, Li X, Bai Z, Sun Y, Chen X. Lidocaine effects on neutrophil extracellular trapping and angiogenesis biomarkers in postoperative breast cancer patients with different anesthesia methods: a prospective, randomized trial. BMC Anesthesiol 2024; 24:162. [PMID: 38678209 PMCID: PMC11055234 DOI: 10.1186/s12871-024-02540-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 04/11/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Anesthesia techniques and drug selection may influence tumor recurrence and metastasis. Neutrophil extracellular trapping (NETosis), an immunological process, has been linked to an increased susceptibility to metastasis in individuals with tumors. Furthermore, recurrence may be associated with vascular endothelial growth factor A (VEGF-A), a mediator of angiogenesis. This study investigates the impact of lidocaine (combined with sevoflurane or propofol anesthesia ) during breast cancer surgery inhibits the expression of biomarkers associated with metastasis and recurrence (specifically H3Cit, NE, MPO, MMP-9 and VEGF-A). METHODS We randomly assigned 120 women undergoing primary or invasive breast tumor resection to receive one of four anesthetics: sevoflurane (S), sevoflurane plus i.v. lidocaine (SL), propofol (P), and propofol plus i.v. lidocaine (PL). Blood samples were collected before induction and 3 h after the operation. Biomarkers associated with NETosis (citrullinated histone H3 [H3Cit], myeloperoxidase [MPO], and neutrophil elastase [NE]) and angiogenesis were quantified using enzyme-linked immunosorbent assays. RESULTS Patient and breast tumor characteristics, along with perioperative management, did not differ between study groups. In intra-group comparisons, S and P groups demonstrated a statistically significant increase in post-operative MPO (S group: 10.39[6.89-17.22] vs. 14.31[8.55-20.87] ng ml-1, P = 0.032; P group: 9.45[6.73-17.37] vs. 14.34[9.87-19.75] ng ml-1, P = 0.035)and NE(S group: 182.70[85.66-285.85] vs. 226.20[91.85-391.65] ng ml-1, P = 0.045; P group: 154.22[97.31-325.30] vs. 308.66[132.36-483.57] ng ml-1, P = 0.037) concentrations compared to pre-operative measurements, whereas SL and PL groups did not display a similar increase. H3Cit, MMP-9, and VEGF-A concentrations were not significantly influenced by the anesthesia techniques and drugs. CONCLUSIONS Regardless of the specific technique employed for general anesthesia, there was no increase in the postoperative serum concentrations of MPO and NE after perioperative lidocaine infusion compared to preoperative serum concentrations. This supports the hypothesis that intravenous lidocaine during cancer surgery aimed at achieving a cure may potentially decrease the likelihood of recurrence. Further interpretation and discussion of clinical implications are warranted, emphasizing the significance of these findings in the context of cancer surgery and recurrence prevention. CLINICAL TRIAL REGISTRATION ChiCTR2300068563.
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Affiliation(s)
- Wenjuan Zhang
- School of Clinical Medicine, Ningxia Medical University, No.692 Shengli South Street Xingqing District, Yinchuan, 750004, Ningxia, China
| | - Jiao Liu
- School of Clinical Medicine, Ningxia Medical University, No.692 Shengli South Street Xingqing District, Yinchuan, 750004, Ningxia, China
| | - Xiaohui Li
- Department of Anaesthesia and Perioperative Medicine, Cancer Hospital, General Hospital of Ningxia Medical University, No.804 Shengli South Street Xingqing District, Yinchuan, 750004, Ningxia, China
| | - Zhixia Bai
- Department of Anaesthesia and Perioperative Medicine, Cancer Hospital, General Hospital of Ningxia Medical University, No.804 Shengli South Street Xingqing District, Yinchuan, 750004, Ningxia, China
| | - Yan Sun
- Department of Anaesthesia and Perioperative Medicine, Cancer Hospital, General Hospital of Ningxia Medical University, No.804 Shengli South Street Xingqing District, Yinchuan, 750004, Ningxia, China
| | - Xuexin Chen
- Department of Anaesthesia and Perioperative Medicine, Cancer Hospital, General Hospital of Ningxia Medical University, No.804 Shengli South Street Xingqing District, Yinchuan, 750004, Ningxia, China.
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Grassin P, Descamps R, Bourgine J, Lubrano J, Fiant AL, Lelong-Boulouard V, Hanouz JL. Safety of perioperative intravenous lidocaine in liver surgery - A pilot study. J Anaesthesiol Clin Pharmacol 2024; 40:242-247. [PMID: 38919445 PMCID: PMC11196064 DOI: 10.4103/joacp.joacp_391_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 06/27/2024] Open
Abstract
Background and Aims Perioperative lidocaine infusion has many interesting properties such as analgesic effects in the context of enhanced recovery after surgery. However, its use is limited in liver surgery due to its hepatic metabolism. Material and Methods This prospective, monocentric study was conducted from 2020 to 2021. Patients undergoing liver surgery were included. They received a lidocaine infusion protocol until the beginning of hepatic transection (bolus dose of 1.5 mg kg-1, then a continuous infusion of 2 mg kg-1 h-1). Plasma concentrations of lidocaine were measured four times during and after lidocaine infusion. Results Twenty subjects who underwent liver resection were analyzed. There was 35% of preexisting liver disease before tumor diagnosis, and 75% of liver resection was defined as "major hepatectomy." Plasmatic levels of lidocaine were in the therapeutic range. No blood sample showed a concentration above the toxicity threshold: 1.6 (1.3-2.1) μg ml-1 one hour after the start of infusion, 2.5 (1.7-2.8) μg ml-1 at the end of hepatic transection, 1.7 (1.3-2.0) μg ml-1 one hour after the end of infusion, and 1.2 (0.8-1.4) μg ml-1 at the end of surgery. Comparative analysis between the presence of a preexisting liver disease or not and the association of intraoperative vascular clamping or not did not show significant difference concerning lidocaine blood levels. Conclusion Perioperative lidocaine infusion seems safe in the field of liver surgery. Nevertheless, additional prospective studies need to assess the clinical usefulness in terms of analgesia and antitumoral effects.
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Affiliation(s)
- Pierre Grassin
- Department of Anesthesiology and Critical Care, Caen University Hospital, Caen, France
| | - Richard Descamps
- Department of Anesthesiology and Critical Care, Caen University Hospital, Caen, France
| | - Joanna Bourgine
- Department of Pharmacology, Caen University Hospital, Caen, France
| | - Jean Lubrano
- Department of Digestive Surgery, Caen University Hospital, Caen, France
| | - Anne-Lise Fiant
- Department of Anesthesiology and Critical Care, Caen University Hospital, Caen, France
| | | | - Jean-Luc Hanouz
- Department of Anesthesiology and Critical Care, Caen University Hospital, Caen, France
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20
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Qin GC, Hu Y, Cha NH, Zhang QY, Gong Y. Intravenous lidocaine on postoperative pain and opioid consumption during gynecological surgery: a meta-analysis of randomized controlled trials. Minerva Obstet Gynecol 2024; 76:181-187. [PMID: 36255169 DOI: 10.23736/s2724-606x.22.05209-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION This study aimed to evaluate the role of intravenous lidocaine as a adjuvant anesthetics in patients undergoing gynecological surgery. EVIDENCE ACQUISITION We conducted a meta-analysis of randomized controlled trials (RCTs) from PubMed/Medline, Embase and clinic trails.gov involving the use of intravenous lidocaine in gynecological surgery. We used a more comprehensive search strategy to adequately screen for randomized controlled trials involving intravenous lidocaine infusion in gynecological surgery. First outcomes were postoperative pain scores. And secondary outcomes included 24 h postoperative opioids consumption, time to first flatus, and incidence of postoperative nausea and vomiting. EVIDENCE SYNTHESIS A total of 6 RCTs comprising 375 patients were included in the meta-analysis. There were statistically significant between postoperative pain scores. The consumption of opioids and anesthetics during surgery and 24 hours after surgery was statistically significant when compared with the control group. Postoperative pain scores were similar at 2, 4, 6, 8, 10, 12, 24, 48 hours between groups. No statistical differences were found in postoperative complications including nausea, vomiting and restoration of the intestinal function. CONCLUSIONS Our results indicated that the current literature supports the perioperative use of intravenous lidocaine as part of multimodal analgesia and beneficial to patients in early postoperative analgesia, reduced opioid consumption.
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Affiliation(s)
- Guan-Chao Qin
- Institute of Anesthesiology and Critical Care Medicine, Three Gorges University & Yichang Central People's Hospital, Yichang, China
| | - Yang Hu
- Institute of Anesthesiology and Critical Care Medicine, Three Gorges University & Yichang Central People's Hospital, Yichang, China
| | - Ning-Hui Cha
- Institute of Anesthesiology and Critical Care Medicine, Three Gorges University & Yichang Central People's Hospital, Yichang, China
| | - Qing-Yun Zhang
- Institute of Anesthesiology and Critical Care Medicine, Three Gorges University & Yichang Central People's Hospital, Yichang, China
| | - Yuan Gong
- Institute of Anesthesiology and Critical Care Medicine, Three Gorges University & Yichang Central People's Hospital, Yichang, China -
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21
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Althans AR, Kumpati B, Lavage DR, Esper SA, Subramaniam K, Boisen ML, Holder-Murray J. Use of Perioperative Intravenous Lidocaine as Part of an Abdominal Surgery Enhanced Recovery Pathway Does Not Significantly Impact Postoperative Pain. Am Surg 2024; 90:624-630. [PMID: 37786239 DOI: 10.1177/00031348231204916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
BACKGROUND The utility of perioperative intravenous lidocaine in improving postoperative pain control remains unclear. We aimed to compare postoperative pain outcomes in ERP abdominal surgery patients who did vs did not receive intravenous lidocaine. We hypothesized that patients receiving lidocaine would have lower postoperative pain scores and consume fewer opioids. METHODS We performed a retrospective cohort study of patients undergoing elective abdominal surgery at a single institution via an ERP from 2017 to 2018. Patients who received lidocaine in the 6 months prior to a lidocaine shortage were compared to those who did not receive lidocaine for 6 months following the shortage. The primary outcome measures were pain scores as measured on the visual analogue scale and opioid consumption as measured by oral morphine equivalents (OME). RESULTS We identified 1227 consecutive ERP abdominal surgery patients for inclusion (519 patients receiving lidocaine and 708 patients not receiving lidocaine). Demographics between the two cohorts were similar, with the following exceptions: more females, and more patients with a history of psychiatric diagnoses in the group that did not receive lidocaine. Adjusted, mixed linear models for both OME (P = .23) and pain scores (P = .51) found no difference between the lidocaine and no lidocaine groups. DISCUSSION In our study of ERP abdominal surgery patients, perioperative intravenous lidocaine did not offer improvement in postoperative pain scores or OME consumed. We therefore do not recommend the use of intravenous lidocaine as part of an ERP multimodal pain management strategy in abdominal surgery patients.
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Affiliation(s)
- Alison R Althans
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Danielle R Lavage
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Stephen A Esper
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kathirvel Subramaniam
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michael L Boisen
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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22
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Lönnqvist PA. Fascial plane blocks in children-Scientifically supported or not? Paediatr Anaesth 2024; 34:13-18. [PMID: 37650686 DOI: 10.1111/pan.14752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/14/2023] [Accepted: 08/23/2023] [Indexed: 09/01/2023]
Abstract
Since the introduction of Fascial Plane Blocks in 2007 there has been an enormous interest and application of Fascial Plane Blocks, evidenced by substantially more than 1000 PubMed items. Despite this gigantic number of publications, also including randomized controlled trials and meta-analyses in children, there is still no clear-cut insight into how much of the purported effect is in fact due to the blockade of nerve structures and how much is merely adding the well-known analgesic and anti-inflammatory effects of the plasma levels of local anesthetics that are achieved with these techniques. Furthermore, Fascial Plane Blocks appear useful only if compared to conventional multi-modal analgesia (no block or placebo) and Fascial Plane Blocks lack the potency to provide surgical anesthesia on their own and appear only to be of value when used for minor-moderate surgery. Despite the huge literature, there has so far not emerged any clinical situations where Fascial Plane Blocks have definitively been shown to be the block of choice, being decisively more effective than other established regional blocks. Lastly, Fascial Plane Blocks may appear as virtually free of complications, but case reports are emerging that point to a real risk for causing local anesthetic systemic toxicity when using Fascial Plane Blocks. This text aims to synthesize the current knowledge base regarding the Fascial Plane Blocks that are relevant to use in the pediatric context. In summary, there does currently not exist any convincing scientific evidence for the continued support for the use of Fascial Plane Blocks in children, except for the rectus sheath block and possibly also the transmuscular quadratus lumborum block.
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Affiliation(s)
- Per-Arne Lönnqvist
- Section of Anaesthesiology and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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23
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Silva A, Mourão J, Vale N. A Review of the Lidocaine in the Perioperative Period. J Pers Med 2023; 13:1699. [PMID: 38138926 PMCID: PMC10744742 DOI: 10.3390/jpm13121699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
This review analyzes the controversies surrounding lidocaine (LIDO), a widely recognized local anesthetic, by exploring its multifaceted effects on pain control in the perioperative setting. The article critically analyzes debates about lidocaine's efficacy, safety, and optimal administration methods. While acknowledging its well-documented analgesic attributes, the text highlights the ongoing controversies in its application. The goal is to provide clinicians with a comprehensive understanding of the current discourse, enabling informed decisions about incorporating lidocaine into perioperative protocols. On the other hand, emphasizes the common uses of lidocaine and its potential role in personalized medicine. It discusses the medication's versatility, including its application in anesthesia, chronic pain, and cardiovascular diseases. The text recognizes lidocaine's widespread use in medical practice and its ability to be combined with other drugs, showcasing its adaptability for individualized treatments. Additionally, it explores the incorporation of lidocaine into hyaluronic acid injections and its impact on pharmacokinetics, signaling innovative approaches. The discussion centers on how lidocaine, within the realm of personalized medicine, can offer safer and more comfortable experiences for patients through tailored treatments.
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Affiliation(s)
- Abigail Silva
- PerMed Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal;
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal;
| | - Joana Mourão
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal;
- Department of Anesthesiology, Centro Hospitalar Universitário de São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Surgery and Physiology Department, Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
| | - Nuno Vale
- PerMed Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal;
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal;
- Department of Community Medicine, Health Information and Decision (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
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He L, Hu J, Han Y, Xiong W. Predictive modeling of postoperative gastrointestinal dysfunction: the role of serum bilirubin, sodium levels, and surgical duration in gynecological cancer care. BMC Womens Health 2023; 23:598. [PMID: 37957730 PMCID: PMC10644577 DOI: 10.1186/s12905-023-02779-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 11/10/2023] [Indexed: 11/15/2023] Open
Abstract
OBJECTIVE To elucidate the role of preoperative serum bilirubin and sodium levels, along with the duration of surgery, in predicting postoperative gastrointestinal dysfunction (POGD) following gynecological cancer surgery, informing tailored perioperative strategies. METHODS We conducted a retrospective analysis of 281 patients undergoing gynecological cancer surgery between 2018 and 2023. This analysis focused on preoperative serum bilirubin and sodium levels and intraoperative factors (surgical duration) as potential predictors of POGD. Logistic regression models were utilized for analysis, controlling for relevant confounders. RESULTS Elevated preoperative serum bilirubin was associated with a reduced risk of POGD (mean level in non-POGD cases: 14.172 ± 4.0701, vs. POGD cases: 9.6429 ± 3.5351; p < 0.001), suggesting a protective role. Lower preoperative sodium levels were identified in the POGD group (136.26 mEq/L [IQR: 135.2-137.63]) compared to the non-POGD group (139.32 mEq/L [IQR: 137.7-140.75]; p < 0.001), highlighting its predictive value. Additionally, longer surgical duration was associated with increased POGD incidence, with POGD cases experiencing surgeries lasting 6.1547 ± 1.9426 hours compared to 4.5959 ± 1.5475 hours in non-POGD cases (p < 0.001). CONCLUSION Our findings underscore the importance of serum bilirubin, sodium levels, and surgical duration as significant predictors of POGD in patients undergoing gynecological cancer surgery. These indicators should be integrated into a predictive model, aiding clinicians in identifying high-risk patients, allowing for personalized perioperative care adjustments, potentially mitigating POGD risks.
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Affiliation(s)
- Lijuan He
- Health Management Center, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, People's Republic of China
| | - Jun Hu
- The Department of Gynecology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, People's Republic of China
| | - Yun Han
- Department of Urology, Yibin Fifth People's Hospital, Yibin, Sichuan, 644100, People's Republic of China
| | - Wenli Xiong
- Health Management Center, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, People's Republic of China.
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25
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Smith WR, Valrie CR, Jaja C, Kenney MO. Precision, integrative medicine for pain management in sickle cell disease. FRONTIERS IN PAIN RESEARCH 2023; 4:1279361. [PMID: 38028431 PMCID: PMC10666191 DOI: 10.3389/fpain.2023.1279361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Sickle cell disease (SCD) is a prevalent and complex inherited pain disorder that can manifest as acute vaso-occlusive crises (VOC) and/or chronic pain. Despite their known risks, opioids are often prescribed routinely and indiscriminately in managing SCD pain, because it is so often severe and debilitating. Integrative medicine strategies, particularly non-opioid therapies, hold promise in safe and effective management of SCD pain. However, the lack of evidence-based methods for managing SCD pain hinders the widespread implementation of non-opioid therapies. In this review, we acknowledge that implementing personalized pain treatment strategies in SCD, which is a guideline-recommended strategy, is currently fraught with limitations. The full implementation of pharmacological and biobehavioral pain approaches targeting mechanistic pain pathways faces challenges due to limited knowledge and limited financial and personnel support. We recommend personalized medicine, pharmacogenomics, and integrative medicine as aspirational strategies for improving pain care in SCD. As an organizing model that is a comprehensive framework for classifying pain subphenotypes and mechanisms in SCD, and for guiding selection of specific strategies, we present evidence updating pain research pioneer Richard Melzack's neuromatrix theory of pain. We advocate for using the updated neuromatrix model to subphenotype individuals with SCD, to better select personalized multimodal treatment strategies, and to identify research gaps fruitful for exploration. We present a fairly complete list of currently used pharmacologic and non-pharmacologic SCD pain therapies, classified by their mechanism of action and by their hypothesized targets in the updated neuromatrix model.
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Affiliation(s)
- Wally R. Smith
- Division of General Internal Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Cecelia R. Valrie
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States
| | - Cheedy Jaja
- College of Nursing, University of South Florida School of Nursing, Tampa, FL, United States
| | - Martha O. Kenney
- Department of Anesthesiology, Duke University, Durham, NC, United States
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26
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Li Y. Letter to the Editor: Response to: Comment on: Application of a new serratus anterior plane block in modified radical mastectomy under ultrasound guidance: A prospective, randomized controlled trial. J Clin Anesth 2023; 89:111179. [PMID: 37348283 DOI: 10.1016/j.jclinane.2023.111179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Yuanhai Li
- The First Affiliated Hospital of Anhui Medical University, China.
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27
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Costa GL, Spadola F, Di Pietro S, Nava V, Licata P, Giudice E, Leonardi F, Bruno F, Messina L, Macrì F, Macrì D, Ferrantelli V, Tabbì M, Interlandi C. Tramadol vs. Lidocaine Administered Intraperitoneally and in Incisional Lines for the Intraoperative and Postoperative Pain Management of Romifidine-Telazol-Anesthetized Swine Undergoing Umbilical Hernia Repair. Animals (Basel) 2023; 13:2905. [PMID: 37760305 PMCID: PMC10525986 DOI: 10.3390/ani13182905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
The aim of the study was to compare the analgesic efficacy of tramadol and lidocaine for local anesthesia during umbilical hernia repair in swine. The study was performed on 66 large white crossbred swine. The swine received a mixture of tiletamine/zolazepam at 5 mg/kg and romifidine at 80 µg/kg, administered intramuscularly. Then, they were divided into three groups (n = 22) that received different treatments with lidocaine at 4 mg/kg and tramadol at 4 mg/kg. The LL group received lidocaine both by infiltration of the surgical planes and intraperitoneally. The LT group received lidocaine by infiltration of the surgical planes and tramadol intraperitoneally. The TT group received tramadol both by infiltration of the surgical planes and intraperitoneally. In all groups, the infiltration of the surgical planes into the umbilical region involved both the skin and muscle planes. Heart rate, noninvasive arterial blood pressure, and respiratory frequency were recorded during surgery. The response to the surgical stimulus was evaluated using a cumulative pain scale (the cut-off point for rescue analgesia was set to 10). Postoperative pain was assessed using the UNESP-Botucatu pig composite acute pain scale (the cut-off point was set to 4). The trend of physiological variables was adequate for patients under anesthesia. No subject required intraoperative and postoperative rescue analgesia. Tramadol could therefore be used for pain management in livestock.
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Affiliation(s)
- Giovanna Lucrezia Costa
- Department of Veterinary Sciences, University of Messina, Via Palatucci Annunziata, 98168 Messina, Italy; (F.S.); (S.D.P.); (V.N.); (P.L.); (E.G.); (F.B.); (L.M.); (F.M.); (M.T.); (C.I.)
| | - Filippo Spadola
- Department of Veterinary Sciences, University of Messina, Via Palatucci Annunziata, 98168 Messina, Italy; (F.S.); (S.D.P.); (V.N.); (P.L.); (E.G.); (F.B.); (L.M.); (F.M.); (M.T.); (C.I.)
| | - Simona Di Pietro
- Department of Veterinary Sciences, University of Messina, Via Palatucci Annunziata, 98168 Messina, Italy; (F.S.); (S.D.P.); (V.N.); (P.L.); (E.G.); (F.B.); (L.M.); (F.M.); (M.T.); (C.I.)
| | - Vincenzo Nava
- Department of Veterinary Sciences, University of Messina, Via Palatucci Annunziata, 98168 Messina, Italy; (F.S.); (S.D.P.); (V.N.); (P.L.); (E.G.); (F.B.); (L.M.); (F.M.); (M.T.); (C.I.)
| | - Patrizia Licata
- Department of Veterinary Sciences, University of Messina, Via Palatucci Annunziata, 98168 Messina, Italy; (F.S.); (S.D.P.); (V.N.); (P.L.); (E.G.); (F.B.); (L.M.); (F.M.); (M.T.); (C.I.)
| | - Elisabetta Giudice
- Department of Veterinary Sciences, University of Messina, Via Palatucci Annunziata, 98168 Messina, Italy; (F.S.); (S.D.P.); (V.N.); (P.L.); (E.G.); (F.B.); (L.M.); (F.M.); (M.T.); (C.I.)
| | - Fabio Leonardi
- Department of Veterinary Science, University of Parma, Via del Taglio 10, 43126 Parma, Italy;
| | - Fabio Bruno
- Department of Veterinary Sciences, University of Messina, Via Palatucci Annunziata, 98168 Messina, Italy; (F.S.); (S.D.P.); (V.N.); (P.L.); (E.G.); (F.B.); (L.M.); (F.M.); (M.T.); (C.I.)
| | - Laura Messina
- Department of Veterinary Sciences, University of Messina, Via Palatucci Annunziata, 98168 Messina, Italy; (F.S.); (S.D.P.); (V.N.); (P.L.); (E.G.); (F.B.); (L.M.); (F.M.); (M.T.); (C.I.)
| | - Francesco Macrì
- Department of Veterinary Sciences, University of Messina, Via Palatucci Annunziata, 98168 Messina, Italy; (F.S.); (S.D.P.); (V.N.); (P.L.); (E.G.); (F.B.); (L.M.); (F.M.); (M.T.); (C.I.)
| | - Daniele Macrì
- Zooprophylactic Institute, Via Gino Marinuzzi 4, 90100 Palermo, Italy; (D.M.); (V.F.)
| | - Vincenzo Ferrantelli
- Zooprophylactic Institute, Via Gino Marinuzzi 4, 90100 Palermo, Italy; (D.M.); (V.F.)
| | - Marco Tabbì
- Department of Veterinary Sciences, University of Messina, Via Palatucci Annunziata, 98168 Messina, Italy; (F.S.); (S.D.P.); (V.N.); (P.L.); (E.G.); (F.B.); (L.M.); (F.M.); (M.T.); (C.I.)
| | - Claudia Interlandi
- Department of Veterinary Sciences, University of Messina, Via Palatucci Annunziata, 98168 Messina, Italy; (F.S.); (S.D.P.); (V.N.); (P.L.); (E.G.); (F.B.); (L.M.); (F.M.); (M.T.); (C.I.)
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28
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Geng C, Hu B, Jiang J, Zhang Y, Tang W, Pan M, Sun L, Chen P, Wang H. The effect of intravenous lidocaine on postoperative cognitive dysfunction: a systematic review and meta-analysis. BMC Anesthesiol 2023; 23:299. [PMID: 37670239 PMCID: PMC10478315 DOI: 10.1186/s12871-023-02202-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/07/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Postoperative cognitive dysfunction (POCD) has been reported as a significant complication in elderly patients. Various methods have been proposed for reducing the incidence and severity of POCD. Intravenous lidocaine administration has been reported in the literature to reduce POCD, but the effect of lidocaine remains controversial. METHODS We screened Medline, Embase, Cochrane Library, and China National Knowledge Infrastructure (up to April 2022) databases following a search strategy for intravenous lidocaine on POCD. We also screened related bibliographies on lidocaine for POCD. Ten articles comprising 1517 patients were selected and analyzed. We divided the postoperative follow-up period as follows: short term (<30 days), medium term (30-90 days), and long term (>90 days). OUTCOMES We found that lidocaine could attenuate the overall incidence of POCD, especially in the short term. There were no differences between lidocaine and placebo on the overall severity of POCD. CONCLUSION Lidocaine administered intravenously could attenuate the overall incidence of POCD and its severity in the short term.
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Affiliation(s)
- Chuan Geng
- Department of Anesthesiology, Fengxian People's Hospital, Fengxian County, Xuzhou City, 221700, Jiangsu Province, China
| | - Baoji Hu
- Department of Anesthesiology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Jihong Jiang
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Yunhe Zhang
- Department of Centre ICU, Shanghai East Hospital, School of medicine, Tongji University, Shanghai, 200085, China
| | - Weiqing Tang
- Department of Anesthesiology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Mengzhi Pan
- Department of Anesthesiology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Leilei Sun
- Department of Anesthesiology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Peifen Chen
- Department of Respiratory Diseases, The Third People's Hospital of Shenzhen, the Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, 518112, Guangdong, China.
| | - Hengyue Wang
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, 200433, China.
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29
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Rissel R, Moellmann C, Albertsmeier V, Renz M, Ruemmler R, Kamuf J, Hartmann EK, Ziebart A. Clinical dosage of lidocaine does not impact the biomedical outcome of sepsis-induced acute respiratory distress syndrome in a porcine model. PeerJ 2023; 11:e15875. [PMID: 37637154 PMCID: PMC10448879 DOI: 10.7717/peerj.15875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/18/2023] [Indexed: 08/29/2023] Open
Abstract
Background Sepsis is a common disease in intensive care units worldwide, which is associated with high morbidity and mortality. This process is often associated with multiple organ failure including acute lung injury. Although massive research efforts have been made for decades, there is no specific therapy for sepsis to date. Early and best treatment is crucial. Lidocaine is a common local anesthetic and used worldwide. It blocks the fast voltage-gated sodium (Na+) channels in the neuronal cell membrane responsible for signal propagation. Recent studies show that lidocaine administered intravenously improves pulmonary function and protects pulmonary tissue in pigs under hemorrhagic shock, sepsis and under pulmonary surgery. The aim of this study is to show that lidocaine inhalative induces equivalent effects as lidocaine intravenously in pigs in a lipopolysaccharide (LPS)-induced sepsis with acute lung injury. Methods After approval of the local State and Institutional Animal Care Committee, to induce the septic inflammatory response a continuous infusion of lipopolysaccharide (LPS) was administered to the pigs in deep anesthesia. Following induction and stabilisation of sepsis, the study medication was randomly assigned to one of three groups: (1) lidocaine intravenously, (2) lidocaine per inhalation and (3) sham group. All animals were monitored for 8 h using advanced and extended cardiorespiratory monitoring. Postmortem assessment included pulmonary mRNA expression of mediators of early inflammatory response (IL-6 & TNF-alpha), wet-to-dry ratio and lung histology. Results Acute respiratory distress syndrome (ARDS) was successfully induced after sepsis-induction with LPS in all three groups measured by a significant decrease in the PaO2/FiO2 ratio. Further, septic hemodynamic alterations were seen in all three groups. Leucocytes and platelets dropped statistically over time due to septic alterations in all groups. The wet-to-dry ratio and the lung histology showed no differences between the groups. Additionally, the pulmonary mRNA expression of the inflammatory mediators IL-6 and TNF-alpha showed no significant changes between the groups. The proposed anti-inflammatory and lung protective effects of lidocaine in sepsis-induced acute lung injury could not be proven in this study.
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Affiliation(s)
- René Rissel
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Christian Moellmann
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Victoria Albertsmeier
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Miriam Renz
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Robert Ruemmler
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Jens Kamuf
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Erik K. Hartmann
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Alexander Ziebart
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
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Zheng K, Han M, Kang F, Yang C, Li J. A comparative study on the effect of dopamine vs phenylephrine in improving the cutaneous analgesic effect of mexiletine in rats. Perioper Med (Lond) 2023; 12:26. [PMID: 37312135 PMCID: PMC10262512 DOI: 10.1186/s13741-023-00314-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 05/22/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND The present study aimed to compare the effects of the combined administration of two adjuvants, dopamine and phenylephrine, on the cutaneous analgesic effect and duration of mexiletine in rats. METHODS Nociceptive blockage was evaluated by the inhibition of response to skin pinpricks in rats via the cutaneous trunci muscle reflex (CTMR). After subcutaneous injection, the analgesic activities of mexiletine in the absence and presence of either dopamine or phenylephrine were assessed. Each injection was standardized into 0.6 ml with a mixture of drugs and saline. RESULTS Subcutaneous injections of mexiletine successfully induced dose-dependent cutaneous analgesia in rats. The results revealed that rats injected with 1.8 μmol mexiletine exhibited 43.75% blockage (%MPE), while rats injected with 6.0 μmol mexiletine showed 100% blockage. Co-application of mexiletine (1.8 or 6.0 μmol) with dopamine (0.06, 0.60, or 6.00 μmol) elicited full sensory block (%MPE). Sensory blockage ranged from 81.25% to 95.83% in rats injected with mexiletine (1.8 μmol) and phenylephrine (0.0059 or 0.0295 μmol), and complete subcutaneous analgesia was observed in rats injected with mexiletine (1.8 μmol) and a higher concentration of phenylephrine (0.1473 μmol). Furthermore, mexiletine at 6.0 μmol completely blocked nociception when combined with any concentration of phenylephrine, while 0.1473 μmol phenylephrine alone exhibited 35.417% subcutaneous analgesia. The combined application of dopamine (0.06/0.6/6 μmol) and mexiletine (1.8/6 μmol) resulted in increased %MPE, complete block time, full recovery time, and AUCs compared to the combined application of phenylephrine (0.0059 and 0.1473 μmol) and mexiletine (1.8/6 μmol) (p < 0.001). CONCLUSION Dopamine is superior to phenylephrine in improving sensory blockage and enhancing the duration of nociceptive blockage by mexiletine.
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Affiliation(s)
- Kesong Zheng
- Department of Anesthesiology, Division of Life Sciences and Medicine, the First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230036, Anhui, China
| | - Mingming Han
- Department of Anesthesiology, Division of Life Sciences and Medicine, the First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230036, Anhui, China
| | - Fang Kang
- Department of Anesthesiology, Division of Life Sciences and Medicine, the First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230036, Anhui, China
| | - Chengwei Yang
- Department of Anesthesiology, Division of Life Sciences and Medicine, the First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230036, Anhui, China
| | - Juan Li
- Department of Anesthesiology, Division of Life Sciences and Medicine, the First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230036, Anhui, China.
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Cha NH, Hu Y, Zhu GH, Long X, Jiang JJ, Gong Y. Opioid-free anesthesia with lidocaine for improved postoperative recovery in hysteroscopy: a randomized controlled trial. BMC Anesthesiol 2023; 23:192. [PMID: 37270472 DOI: 10.1186/s12871-023-02152-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/25/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Anesthesia with opioids negatively affects patients' quality of recovery. Opioid-free anesthesia attempts to avoid these effects. This study aimed to evaluate the effect of opioid-free anesthesia on the quality of recovery, using lidocaine on patients undergoing hysteroscopy. METHODS A parallel-group, randomized, double-blind, controlled trial was conducted in Yichang Central Peoples' Hospital, Hubei Province, China, from January to April, 2022. We included 90 female patients (age: 18-65 years, American Society of Anesthesiologists Physical Status Class I-II) scheduled for elective hysteroscopy, 45 of whom received lidocaine (Group L), and 45 received sufentanil (Group S). Patients were randomly allocated to receive either lidocaine or sufentanil perioperatively. The primary outcome was the quality of postoperative recovery, which was assessed using the QoR-40 questionnaire (a patient-reported outcome questionnaire measuring the quality of recovery after surgery). RESULTS The two groups were similar in age, American Society of Anesthesiology physical status, height, weight, body mass index, and surgical duration. The QoR scores were significantly higher in Group L than Group S. The incidence of postoperative nausea and vomiting, as well as the time to extubation were significantly lower in Group L than Group S. CONCLUSION Opioid-free anesthesia with lidocaine achieves a better quality of recovery, faster recovery, and a shorter time to extubation than general anesthesia with sufentanil. TRIAL REGISTRATION The trial was registered on January 15, 2022 in the Chinese Clinical Trial Registry ( http://www.chictr.org.cn/showprojen.aspx?proj=149386 ), registration number ChiCTR2200055623.(15/01/2022).
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Affiliation(s)
- N H Cha
- Institute of Anesthesiology and Critical Care Medicine, Three Gorges University & Yichang Central People's Hospital, No. 183 Yiling Avenue, Wujiagang District, 443000, Yichang City, Hubei, China
| | - Y Hu
- Institute of Anesthesiology and Critical Care Medicine, Three Gorges University & Yichang Central People's Hospital, No. 183 Yiling Avenue, Wujiagang District, 443000, Yichang City, Hubei, China
| | - G H Zhu
- Institute of Anesthesiology and Critical Care Medicine, Three Gorges University & Yichang Central People's Hospital, No. 183 Yiling Avenue, Wujiagang District, 443000, Yichang City, Hubei, China
| | - X Long
- Institute of Anesthesiology and Critical Care Medicine, Three Gorges University & Yichang Central People's Hospital, No. 183 Yiling Avenue, Wujiagang District, 443000, Yichang City, Hubei, China
| | - J J Jiang
- Institute of Anesthesiology and Critical Care Medicine, Three Gorges University & Yichang Central People's Hospital, No. 183 Yiling Avenue, Wujiagang District, 443000, Yichang City, Hubei, China
| | - Yuan Gong
- Institute of Anesthesiology and Critical Care Medicine, Three Gorges University & Yichang Central People's Hospital, No. 183 Yiling Avenue, Wujiagang District, 443000, Yichang City, Hubei, China.
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Ostović H, Šimac B, Pražetina M, Bradić N, Peršec J. The Effect of Intravenous Lidocaine, Ketamine, and Lidocaine-Ketamine Combination in Colorectal Cancer Surgery: A Randomized Controlled Trial. Anesth Analg 2023; Publish Ahead of Print:00000539-990000000-00586. [PMID: 37224065 DOI: 10.1213/ane.0000000000006555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Colorectal resections are associated with a pronounced inflammatory response, severe postoperative pain, and postoperative ileus. The aim of this study was to evaluate the main effects of lidocaine and ketamine, and their interaction in colorectal cancer (CRC) patients after open surgery. The interaction could be additive if the effect of 2 drugs given in combination equals the sum of their individual effects, or multiplicative if their combined effect exceeds the sum of their individual effects. We hypothesized that the combination of lidocaine and ketamine might reduce the inflammatory response additively or synergistically. METHODS Eighty-two patients undergoing elective open colorectal resection were randomized to receive either lidocaine or placebo and either ketamine or placebo in a 2 × 2 factorial design. After induction of general anesthesia, all subjects received an intravenous bolus (lidocaine 1.5 mg/kg and/or ketamine 0.5 mg/kg and/or a matched saline volume) followed by a continuous infusion (lidocaine 2 mg·kg-1·h-1 and/or ketamine 0.2 mg·kg-1·h-1 and/or a matched saline volume) until the end of surgery. Primary outcomes were serum levels of white blood cell (WBC) count, interleukins (IL-6, IL-8), and C-reactive protein (CRP) measured at 2 time points: 12 and 36 hours after surgery. Secondary outcomes included intraoperative opioid consumption; visual analog scale (VAS) pain scores at 2, 4, 12, 24, 36, and 48 hours postoperatively; cumulative analgesic consumption within 48 hours after surgery; and time to first bowel movement. We assessed the main effects of each of lidocaine and ketamine and their interaction on the primary outcomes using linear regression analyses. A Bonferroni-adjusted significance level was set at .05/8 = .00625 for primary analyses. RESULTS No statistically significant differences were observed with either lidocaine or ketamine intervention in any of the measured inflammatory markers. No multiplicative interaction between the 2 treatments was confirmed at 12 or 36 hours after surgery: WBC count, P = .870 and P = .393, respectively; IL-6, P = .892 and P = .343, respectively; IL-8, P = .999 and P = .996, respectively; and CRP, P = .014 and P = .445, respectively. With regard to inflammatory parameters, no evidence of additive interactions was found. Lidocaine and ketamine, either together or alone, significantly reduced intraoperative opioid consumption versus placebo, and, except for lidocaine alone, improved pain scores. Neither intervention significantly influenced gut motility. CONCLUSIONS Our study results do not support the use of an intraoperative combination of lidocaine and ketamine in patients undergoing open surgery for CRC.
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Affiliation(s)
- Helena Ostović
- From the Clinical Department of Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Dubrava, Zagreb, Croatia
- Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Brankica Šimac
- Clinical Department of Laboratory Diagnostics, University Hospital Dubrava, Zagreb, Croatia
| | - Marko Pražetina
- From the Clinical Department of Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Dubrava, Zagreb, Croatia
| | - Nikola Bradić
- From the Clinical Department of Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Dubrava, Zagreb, Croatia
- Department of Biomedical Sciences, University North, Varaždin, Croatia
| | - Jasminka Peršec
- From the Clinical Department of Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Dubrava, Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, Zagreb, Croatia
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Sarakatsianou C, Perivoliotis K, Baloyiannis I, Georgopoulou S, Tsiaka A, Tzovaras G. Efficacy of intraoperative intravenous lidocaine infusion on postoperative opioid consumption after laparoscopic cholecystectomy: a randomized controlled trial. Langenbecks Arch Surg 2023; 408:197. [PMID: 37198418 PMCID: PMC10191684 DOI: 10.1007/s00423-023-02937-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 05/12/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE We designed this study to evaluate the impact of intraoperative intravenous lidocaine infusion on postoperative opioid consumption after laparoscopic cholecystectomy. METHODS In total, 98 patients scheduled for elective laparoscopic cholecystectomy were included and randomized. In the experimental group, intravenous lidocaine (bolus 1.5 mg/kg and continuous infusion 2 mg/kg/h) was administered intraoperatively additionally to the standard analgesia, whereas the control group received a matching placebo. Blinding existed at the level of both the patient and the investigator. RESULTS Our study failed to confirm any benefit in opioid consumption, during the postoperative period. Lidocaine resulted to reduced intraoperative systolic, diastolic, and mean arterial pressure. Lidocaine administration did not change postoperative pain scores or the incidence of shoulder pain, at any time endpoint. Moreover, we did not identify any difference in terms of postoperative sedation levels and nausea rates. CONCLUSION Overall, lidocaine did not have any effect on postoperative analgesia after laparoscopic cholecystectomy.
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Affiliation(s)
- Chamaidi Sarakatsianou
- Department of Anaesthesiology, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece.
| | | | - Ioannis Baloyiannis
- Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
| | - Stavroula Georgopoulou
- Department of Anaesthesiology, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
| | - Aikaterini Tsiaka
- Department of Anaesthesiology, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
| | - George Tzovaras
- Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
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Skoczek AC, Ruane PW, Rasarmos AP, Fernandez DL. Effects of Novel Multimodal Transversus Abdominis Plane Block on Postoperative Opioid Usage and Hospital Length of Stay Following Elective Ventral Hernia Repair. Cureus 2023; 15:e38603. [PMID: 37284363 PMCID: PMC10239664 DOI: 10.7759/cureus.38603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/05/2023] [Indexed: 06/08/2023] Open
Abstract
Background and objective Traditional transversus abdominis plane (TAP) blocks consisting of a local anesthetic, typically bupivacaine, have previously been shown to reduce postoperative pain following gastrointestinal surgery, including hernia repair. However, elective abdominal wall reconstructions for the repair of large ventral hernias continue to cause patients significant postoperative pain, resulting in prolonged hospital stays and need for opioid pain medication. This study aimed to analyze the postoperative opioid pain medication usage and hospital length of stay (LOS) in patients who received a nontraditional multimodal TAP block of ropivacaine (local anesthetic), ketorolac (non-steroidal anti-inflammatory), and epinephrine following elective ventral hernia repair. Methods A retrospective review of medical records for patients who underwent elective robotic ventral hernia repair by a single surgeon was conducted. Postoperative hospital LOS and opioid usage for patients with the multimodal TAP block were compared to those without. Results A total of 334 patients met the inclusion criteria for LOS analysis: 235 received the TAP block and 109 did not. Patients who received the TAP block had a statistically significant shorter LOS compared to patients who had no TAP block (1.09 ± 1.22 days vs. 2.53 ± 1.57 days; P<0.001). Medical records for 281 patients, 214 with the TAP block and 67 without the TAP block, contained information and were analyzed for postoperative opioid usage. A statistically significantly fewer number of patients who had the TAP block required hydromorphone patient-controlled analgesia pump (3.3% vs. 36%; P<0.001) and oral opioids (29% vs. 78%; P<0.001) postoperatively. Those with TAP block required intravenous opioids more frequently (50% vs 10%; P<0.001) although at much less dosages than those without TAP block (4.86 ± 2.62 mg vs. 10.29 ±3.90 mg; P<0.001). Conclusion In conclusion, this multimodal TAP block of ropivacaine, ketorolac, and epinephrine may represents an effective method to improve hospital LOS and postoperative opioid usage in patients undergoing robotic abdominal wall reconstruction for ventral hernia repair.
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Affiliation(s)
| | - Patrick W Ruane
- Medicine, Edward Via College of Osteopathic Medicine, Spartanburg, USA
| | - Alex P Rasarmos
- Medicine, Edward Via College of Osteopathic Medicine - Auburn, Auburn, USA
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Gajniak D, Mendrala K, Cyzowski T, Polak M, Gierek D, Krzych ŁJ. Efficacy of Lidocaine Infusion in High-Risk Vascular Surgery—A Randomized, Double-Blind, Placebo-Controlled Single-Center Clinical Trial. J Clin Med 2023; 12:jcm12062312. [PMID: 36983312 PMCID: PMC10053864 DOI: 10.3390/jcm12062312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/03/2023] [Accepted: 03/15/2023] [Indexed: 03/18/2023] Open
Abstract
Background: In perioperative pain control, adjuvants such as lidocaine can reduce opioid consumption in a specific type of surgery. The aim of this single-center prospective double-blinded randomized controlled trial was to determine opioid consumption in the perioperative period in patients receiving continuous lidocaine infusion. Methods: Patients undergoing elective abdominal aorta and/or iliac arteries open surgery were randomized into two groups to receive 1% lidocaine or placebo at the same infusion rate based on ideal body weight (bolus of 0.15 mL/kg during the induction of anesthesia followed by continuous infusion of 0.2 mL/kg/h during surgery; postoperatively 0.1 mL/kg/h for 24 h) additionally to standard opioid analgesia. Results: Total opioid consumption within 24 h after surgery was 89.2 mg (95%CI 80.9–97.4) in the lidocaine and 113.1 mg (95%CI 102.5–123.6) in the placebo group (p = 0.0007). Similar findings were observed in opioid consumption intraoperatively (26.7 mg (95%CI 22.2–31.3) vs. 35.1 mg (95%CI 29.1–41.2), respectively, p = 0.029) and six hours postoperatively (47.5 mg (IQR 37.5–59.5) vs. 60 mg (IQR 44–83), respectively, p = 0.01). Conclusions: In high-risk vascular surgery, lidocaine infusion as an adjunct to standard perioperative analgesia is effective. It may decrease opioid consumption by more than 20% during the first 24 h after surgery, with no serious adverse effects noted during the study period.
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Affiliation(s)
- Dariusz Gajniak
- Department of Anaesthesiology and Intensive Care, Upper Silesian Medical Centre, Medical University of Silesia, 40-752 Katowice, Poland
| | - Konrad Mendrala
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
- Correspondence:
| | - Tomasz Cyzowski
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | - Michał Polak
- Department of Anaesthesiology and Intensive Care, Upper Silesian Medical Centre, Medical University of Silesia, 40-752 Katowice, Poland
| | - Danuta Gierek
- Department of Anaesthesiology and Intensive Care, Upper Silesian Medical Centre, Medical University of Silesia, 40-752 Katowice, Poland
| | - Łukasz J. Krzych
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
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Tejedor A, Bijelic L, Polanco M, Pujol E. Intravenous lidocaine infusion compared to thoracic epidural analgesia in cytoreductive surgery with or without heated intraperitoneal chemotherapy. A retrospective case-cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:597-603. [PMID: 36437212 DOI: 10.1016/j.ejso.2022.11.096] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 10/12/2022] [Accepted: 11/17/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Intravenous (IV) lidocaine is a proven analgesic therapy but has not been evaluated in extensive procedures such as cytoreductive surgery (CRS). Our aim was to assess the effectiveness and safety of IV lidocaine in this setting. METHODS This is a retrospective hybrid case-cohort study investigating analgesic effectiveness and complications of perioperative IV lidocaine at 1.5 mg/kg/h for 48 h compared to thoracic epidural anaesthesia (TEA) among patients undergoing CRS in a high-volume centre. RESULTS Sixty patients were included, 20 received IV lidocaine and 40 underwent TEA. Pain scores were low (median ≤2) and similar in both groups (p = 0.88). At 72 h, the lidocaine group had a lower median pain score (p = 0.03). Overall opioid consumption in the first 48 h was lower in the lidocaine compared to the TEA group (median 0 (IQR 0-9.5) mg vs. 45.4 (0-62.4) MME respectively, p = 0.001). Opioid consumption was also lower in the lidocaine compared to the TEA group during the whole 5-day period (median 1 (IQR 1-13.5) mg vs. 112 (36.6-137.85) MME respectively, p = 0.000). The incidence of PONV was significantly lower in the lidocaine group (27.5% vs 5%, p = 0.047) with no difference in other complications or length of in-hospital stay. CONCLUSION Intravenous lidocaine infusion may be a safe and effective analgesic approach in CRS and is associated with a significant reduction of opioid use and PONV compared to opioid-containing TEA.
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Affiliation(s)
- Ana Tejedor
- Department of Anaesthesiology, Hospital Sant Joan Despí Moisès Broggi, Barcelona, 08970, Spain.
| | - Lana Bijelic
- Peritoneal Surface Malignancies Unit, Department of Surgery, Hospital Sant Joan Despí Moisès Broggi, Barcelona, 08970, Spain.
| | - Mauricio Polanco
- Department of Anaesthesiology, Hospital Sant Joan Despí Moisès Broggi, Barcelona, 08970, Spain.
| | - Elisenda Pujol
- Department of Anaesthesiology, Hospital Sant Joan Despí Moisès Broggi, Barcelona, 08970, Spain.
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Delgado MA, Ferreira LA, Gomes BJDS, Leite IKO, Gomez MV, Castro-Junior C. Preclinical study in a postoperative pain model to investigate the action of ketamine, lidocaine, and ascorbic acid in reversing fentanyl-induced, non-glutamate-dependent hyperalgesia. Pain Rep 2023; 8:e1062. [PMID: 37731750 PMCID: PMC10508464 DOI: 10.1097/pr9.0000000000001062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/18/2022] [Accepted: 11/30/2022] [Indexed: 04/03/2023] Open
Abstract
Introduction Opioid-induced hyperalgesia (OIH) is a paradoxical phenomenon in which exposure to opioids can increase sensitivity to painful stimuli. Currently, several drugs have been used in an attempt to prevent OIH. We design this study to address the effect of preemptive treatment with ketamine, lidocaine, and ascorbic acid in a rat preclinical model of perioperative opioid-induced hyperalgesia. Methods To reproduce OIH in a model of postoperative pain, rats received successive doses of fentanyl subcutaneously and underwent an incision in the paw. In an attempt to prevent OIH, ketamine, lidocaine, and ascorbic acid were administered before treatment with fentanyl. The von Frey test and the hot-plate test were used to evaluate mechanical allodynia and thermal hyperalgesia, respectively, with a follow-up period from 1 hour up to 7 days after surgery. Spinal cord nerve terminals (synaptosomes) were used to assess glutamate release under our experimental conditions. Results Consecutive fentanyl injections increased the postoperative pain as indicated by increased thermal hyperalgesia and allodynia 48 hours after incision. Ketamine, lidocaine, and the combination of ketamine + lidocaine were able to prevent thermal hyperalgesia but not mechanical allodynia. Ascorbic acid did not prevent the hyperalgesia induced by fentanyl. We found no correlation between spinal glutamate release and the pharmacological treatments. Conclusion Fentanyl induced a hyperalgesic effect that last few days in a postoperative model of pain. Hyperalgesic effect was not totally inhibited by ketamine and lidocaine in rats. Increased glutamate release was not the main molecular mechanism of fentanyl-induced hyperalgesia.
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Affiliation(s)
- Marina Ayres Delgado
- Programa de pós graduação em ciências da saúde, Santa Casa de Belo Horizonte Ensino e Pesquisa, Belo Horizonte, Minas Gerais, Brazil
| | - Luana Assis Ferreira
- Programa de pós graduação em ciências da saúde, Santa Casa de Belo Horizonte Ensino e Pesquisa, Belo Horizonte, Minas Gerais, Brazil
| | - Bianka Jaciara dos Santos Gomes
- Programa de pós graduação em ciências da saúde, Santa Casa de Belo Horizonte Ensino e Pesquisa, Belo Horizonte, Minas Gerais, Brazil
| | - Isis Katarine Orlandi Leite
- Programa de pós graduação em ciências da saúde, Santa Casa de Belo Horizonte Ensino e Pesquisa, Belo Horizonte, Minas Gerais, Brazil
| | - Marcus Vinícius Gomez
- Programa de pós graduação em ciências da saúde, Santa Casa de Belo Horizonte Ensino e Pesquisa, Belo Horizonte, Minas Gerais, Brazil
| | - Célio Castro-Junior
- Programa de pós graduação em ciências da saúde, Santa Casa de Belo Horizonte Ensino e Pesquisa, Belo Horizonte, Minas Gerais, Brazil
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Liu X, Zheng F, Tian L, Li T, Zhang Z, Ren Z, Chen X, Chen W, Li K, Sheng J. Lidocaine inhibits influenza a virus replication by up-regulating IFNα4 via TBK1-IRF7 and JNK-AP1 signaling pathways. Int Immunopharmacol 2023; 115:109706. [PMID: 36638664 DOI: 10.1016/j.intimp.2023.109706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/02/2023] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Abstract
Influenza A viruses (IAV), significant respiratory pathogenic agents, cause seasonal epidemics and global pandemics in intra- and interannual cycles. Despite effective therapies targeting viral proteins, the continuous generation of drug-resistant IAV strains is challenging. Therefore, exploring novel host-specific antiviral treatment strategies is urgently needed. Here, we found that lidocaine, widely used for local anesthesia and sedation, significantly inhibited H1N1(PR8) replication in macrophages. Interestingly, its antiviral effect did not depend on the inhibition of voltage-gated sodium channels (VGSC), the main target of lidocaine for anesthesia. Lidocaine significantly upregulated early IFN-I, interferon α4 (IFNα4) mRNA, and protein levels, but not those of early IFNβ in mouse RAW 264.7 cell line and human THP-1 derived macrophages. Knocking out IFNα4 by CRISPR-Cas9 partly reversed lidocaine's inhibition of PR8 replication in macrophages. Mechanistically, lidocaine upregulated IFNα4 by activating TANK-binding kinase 1 (TBK1)-IRF7 and JNK-AP1 signaling pathways. These findings indicate that lidocaine has an incredible antiviral potential by enhancing IFN-I signaling in macrophages. In conclusion, our results indicate the potential auxiliary role of lidocaine for anti-influenza A virus therapy and even for anti-SARS-CoV-2 virus therapy, especially in the absence of a specific medicine.
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Affiliation(s)
- Xueer Liu
- Department of Microbiology and Immunology, Guangdong Provincial Key Laboratory of Infectious Disease and Molecular Immunopathology, Shantou University Medical College, 22 Xinling Road, Shantou 515041, Guangdong, China
| | - Fengqing Zheng
- Department of Microbiology and Immunology, Guangdong Provincial Key Laboratory of Infectious Disease and Molecular Immunopathology, Shantou University Medical College, 22 Xinling Road, Shantou 515041, Guangdong, China
| | - Lu Tian
- Department of Microbiology and Immunology, Guangdong Provincial Key Laboratory of Infectious Disease and Molecular Immunopathology, Shantou University Medical College, 22 Xinling Road, Shantou 515041, Guangdong, China
| | - Tian Li
- Department of Microbiology and Immunology, Guangdong Provincial Key Laboratory of Infectious Disease and Molecular Immunopathology, Shantou University Medical College, 22 Xinling Road, Shantou 515041, Guangdong, China
| | - Zelin Zhang
- Department of Microbiology and Immunology, Guangdong Provincial Key Laboratory of Infectious Disease and Molecular Immunopathology, Shantou University Medical College, 22 Xinling Road, Shantou 515041, Guangdong, China
| | - Zhihui Ren
- Department of Microbiology and Immunology, Guangdong Provincial Key Laboratory of Infectious Disease and Molecular Immunopathology, Shantou University Medical College, 22 Xinling Road, Shantou 515041, Guangdong, China
| | - Xiaoxuan Chen
- Department of Microbiology and Immunology, Guangdong Provincial Key Laboratory of Infectious Disease and Molecular Immunopathology, Shantou University Medical College, 22 Xinling Road, Shantou 515041, Guangdong, China
| | - Weiqiang Chen
- Department of Neurosurgery, First Affiliated Hospital of Shantou University Medical College, 57 Changping Road, Shantou 515041, Guangdong, China.
| | - Kangsheng Li
- Department of Microbiology and Immunology, Guangdong Provincial Key Laboratory of Infectious Disease and Molecular Immunopathology, Shantou University Medical College, 22 Xinling Road, Shantou 515041, Guangdong, China.
| | - Jiangtao Sheng
- Department of Microbiology and Immunology, Guangdong Provincial Key Laboratory of Infectious Disease and Molecular Immunopathology, Shantou University Medical College, 22 Xinling Road, Shantou 515041, Guangdong, China.
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Tumor Necrosis Factor Alpha: Implications of Anesthesia on Cancers. Cancers (Basel) 2023; 15:cancers15030739. [PMID: 36765695 PMCID: PMC9913216 DOI: 10.3390/cancers15030739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 01/27/2023] Open
Abstract
Cancer remains a major public health issue and a leading cause of death worldwide. Despite advancements in chemotherapy, radiation therapy, and immunotherapy, surgery is the mainstay of cancer treatment for solid tumors. However, tumor cells are known to disseminate into the vascular and lymphatic systems during surgical manipulation. Additionally, surgery-induced stress responses can produce an immunosuppressive environment that is favorable for cancer relapse. Up to 90% of cancer-related deaths are the result of metastatic disease after surgical resection. Emerging evidence shows that the interactions between tumor cells and the tumor microenvironment (TME) not only play decisive roles in tumor initiation, progression, and metastasis but also have profound effects on therapeutic efficacy. Tumor necrosis factor alpha (TNF-α), a pleiotropic cytokine contributing to both physiological and pathological processes, is one of the main mediators of inflammation-associated carcinogenesis in the TME. Because TNF-α signaling may modulate the course of cancer, it can be therapeutically targeted to ameliorate clinical outcomes. As the incidence of cancer continues to grow, approximately 80% of cancer patients require anesthesia during cancer care for diagnostic, therapeutic, or palliative procedures, and over 60% of cancer patients receive anesthesia for primary surgical resection. Numerous studies have demonstrated that perioperative management, including surgical manipulation, anesthetics/analgesics, and other supportive care, may alter the TME and cancer progression by affecting inflammatory or immune responses during cancer surgery, but the literature about the impact of anesthesia on the TNF-α production and cancer progression is limited. Therefore, this review summarizes the current knowledge of the implications of anesthesia on cancers from the insights of TNF-α release and provides future anesthetic strategies for improving oncological survival.
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Intravenous lidocaine simultaneously infused with sufentanil to accelerate gastrointestinal function recovery in patients after thoracolumbar surgery: a prospective, randomized, double-blind controlled study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:313-320. [PMID: 36394651 DOI: 10.1007/s00586-022-07456-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/05/2022] [Accepted: 11/06/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE Postoperative gastrointestinal dysfunction is one of the common complications of surgery, especially after surgery for a thoracolumbar spinal fracture. Intravenous lidocaine is a potential method to improve postoperative gastrointestinal function in surgical patients, reduce opioid use and shorten hospital stays. The purpose of this study is to explore the effect of intravenous lidocaine on the recovery of gastrointestinal function in patients after thoracolumbar surgery. METHODS In this study, 48 eligible patients undergoing elective thoracolumbar spine fractures resection and internal fixation surgery were enrolled to receive intravenous injections of lidocaine in different concentrations during the perioperative period. Patients were randomly divided into three groups: control group (group A), low concentration of lidocaine group (group B) and high concentration of lidocaine group (group C), 16 patients in each group. First postoperative exhaust time, numbers of bowel sound at preoperative and postoperative 3, 6, 12, 24 h, pain scores at postoperative 0, 3, 6, 12, 24, 48 h, total sufentanil use in PACU and perioperative periods, postoperative hospital stay and analgesic remedy within postoperative 48 h were recorded and compared. The primary endpoints include: the time of first flatus passage after the operation, the number of bowel sounds per minute counted with stethoscope at 30 min before anesthesia induction and at 3, 6, 12 and 24 h postoperative. The secondary endpoints included: the pain scores at PACU (after entering into PACU), 3, 6, 12, 24 and 48 h postoperative, the amount of sufentanil administrated by intravenous push during operation and the numbers of patients needed rescuing sufentanil in PACU, and the numbers of patients needed administration of gastric motility drugs or non-steroidal analgesics at ward within 48 h postoperation, length of hospital stay (from the first day after surgery to discharge from hospital) and the incidence of adverse reactions. RESULTS Compared with group A, the first postoperative exhaust time in group B and C occurred much earlier (23.3 ± 11.0 h vs. 16.0 ± 6.6 h, 16.6 ± 5.1 h, P < 0.05). Compared with preoperation, the numbers of bowel sound significantly increased at 24 h postoperatively in group B, while group B at 6 h and group C at 6 and 24 h postoperatively had significantly more active bowel sounds compared to group A (P < 0.05). There were no remarkable differences in VAS scores within 12 h postoperatively among three groups, and however, significantly lower VAS scores were found at 12, 24 and 48 h postoperatively in group C when comparing to Group A (p < 0.05). There was no statistical significance in the incidence of postoperative flatulence and nausea and vomiting, the number of patients needed rescuing sufentanil in PACU, the length of postoperative hospital stay and the number of patients requiring non-steroidal analgesics at ward within 48 h postoperation. CONCLUSIONS Intravenous lidocaine infusion together with patient-controlled analgesia of sufentanil expedited the early recovery of gastrointestinal function and improved analgesic quality of sefentanyl in patients undergoing thoracolumbar surgeries.
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Heath C, Hii J, Thalayasingam P, von Ungern-Sternberg BS, Sommerfield D. Perioperative intravenous lidocaine use in children. Paediatr Anaesth 2022; 33:336-346. [PMID: 36424875 DOI: 10.1111/pan.14608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 11/08/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
Perioperative pain management impacts patient morbidity, quality of life, and hospitalization cost. In children, it impacts not only the child, but the whole family. Adjuncts for improved perioperative analgesia continue to be sought to minimize adverse side effects associated with opioids and for those in whom regional or neuraxial anesthesia is not suitable. The use of ketamine and alpha agonists may be useful in these settings but have noted adverse effects including hallucinations, hemodynamic instability, and excessive sedation. One alternative is intravenous lidocaine. Despite its off-label use, intravenous lidocaine has demonstrated anti-neuropathic, anti-hyperalgesic, and anti-inflammatory actions and is an emerging technique. Multiple studies in adults have demonstrated beneficial effects of perioperative intravenous lidocaine including improved perioperative analgesia with reduced postoperative opioid use, improved gastrointestinal function, earlier mobilization, and reduction in hospital length of stay. Despite the limited pediatric literature, some of these findings have been replicated. Large-scale trials providing evidence for the pediatric pharmacokinetics and high-quality safety data with respect to intravenous lidocaine are still however lacking. To date, dose ranges studied in the pediatric population have not been associated with serious side effects and current data suggests perioperative intravenous lidocaine in a subgroup of pediatric surgical patients seems well-tolerated and beneficial.
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Affiliation(s)
- Chloe Heath
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Western Australia, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Justin Hii
- Perioperative Medicine Team, Telethon Kids Institute, Perth, Western Australia, Australia.,Department of Anaesthesia, Joondalup Health Campus, Joondalup, WA, Australia
| | - Priya Thalayasingam
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Western Australia, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Perth, Western Australia, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - David Sommerfield
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Western Australia, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Perth, Western Australia, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, Western Australia, Australia
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Qi XR, Sun JY, An LX, Zhang K. Effect of intravenous lidocaine on the ED 50 of propofol for inserting gastroscope without body movement in adult patients: a randomized, controlled study. BMC Anesthesiol 2022; 22:319. [PMID: 36253717 PMCID: PMC9575225 DOI: 10.1186/s12871-022-01861-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background Circulatory and respiratory depression are common problems that occur in propofol alone sedation during gastroscopy. As a widely used analgesic adjuvant, intravenous lidocaine can reduce the consumption of propofol during Endoscopic retrograde cholangiopancreatography (ERCP) or colonoscopy. However, it is still unknown the median effective dose (ED50) of propofol when combined with lidocaine intravenously. This study aimed to compare the ED50 of propofol with or without intravenous lidocaine for inserting gastrointestinal endoscope successfully. Methods Fifty nine patients undergoing gastroscopy or gastrointestinal (GI) endoscopy were randomly divided into control group (Group C, normal saline + propofol) or lidocaine group (Group L, lidocaine + propofol). Patients were initially injected a bolus of 1.5 mg/kg lidocaine in Group L, whereas equivalent volume of 0.9% saline in Group C. Anaesthesia was then induced with a single bolus of propofol in all subjects. The induction dose of propofol was determined by the modified Dixon’s up-and-down method, and the initial dose was 1.5 mg/kg in both groups. The primary outcome was the ED50 of propofol induction dose with or without intravenous lidocaine. The secondary outcomes were the induction time, the first propofol bolus time (FPBT: from MOAA/S score ≤ 1 to first rescue bolus propofol), and adverse events (AEs: hypoxemia, bradycardia, hypotension, and body movements). Results Totally, 59 patients were enrolled and completed this study. The ED50 of propofol combined with lidocaine was 1.68 ± 0.11 mg/kg, significantly reduced compared with the normal saline group, 1.88 ± 0.13 mg/kg (P = 0.002). There was no statistical difference in induction time (P = 0.115) and the FPBT (P = 0.655) between the two groups. There was no significantly difference about the AEs between the two groups. Conclusion The ED50 of propofol combined with intravenous lidocaine for successful endoscope insertion in adult patients, was 1.68 ± 0.11 mg/kg significantly reduced compared with the control group. Trial registration Chinese Clinical Trial Registry, No: ChiCTR2200059450. Registered on 29 April 2022. Prospective registration. http://www.chictr.org.cn.
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Affiliation(s)
- Xiu-Ru Qi
- Department of Anesthesia, Beijing Friendship Hospital, Capital Medical University, No.95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - Jing-Yi Sun
- Department of Anesthesia, Beijing Friendship Hospital, Capital Medical University, No.95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - Li-Xin An
- Department of Anesthesia, Beijing Friendship Hospital, Capital Medical University, No.95 Yongan Road, Xicheng District, Beijing, 100050, China.
| | - Ke Zhang
- Department of Anesthesia, Beijing Friendship Hospital, Capital Medical University, No.95 Yongan Road, Xicheng District, Beijing, 100050, China
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Effects of Systemic Lidocaine Versus Dexmedetomidine on the Recovery Quality and Analgesia After Thyroid Cancer Surgery: A Randomized Controlled Trial. Pain Ther 2022; 11:1403-1414. [PMID: 36203077 PMCID: PMC9633913 DOI: 10.1007/s40122-022-00442-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/20/2022] [Indexed: 10/10/2022] Open
Abstract
INTRODUCTION Surgical management is commonly used for thyroid cancer. We evaluated the effects of systemic lidocaine versus dexmedetomidine on the recovery quality and analgesia after thyroid cancer surgery. METHODS A total of 120 patients with thyroid cancer were randomly allocated to group L (received lidocaine 1.5 mg/kg loading, continuously infused 1.5 mg/kg per hour), group D (received dexmedetomidine 0.5 µg/kg loading, continuously infused 0.5 µg/kg per hour) and group C (received normal saline), with 40 cases in each group. Anaesthesia induction and maintenance were performed using target-controlled infusions (TCIs) of propofol and remifentanil. The primary outcome of the quality of recovery-15 (QoR-15) score was recorded on the day before surgery and postoperative day 1 (POD1). Secondary outcomes included the consumption of remifentanil during surgery, time to first required rescue analgesia, number of patients requiring rescue analgesia, postoperative cumulative consumption of tramadol, visual analogue scale (VAS) pain score, incidence of postoperative nausea or vomiting (PONV) and side effects. RESULTS The total score of the QoR-15 at POD1 (median, IQR) was higher in group L (128.0, 122.0-132.8) and group D (127.5, 122.5-132.5) compared to group C (118.5, 113.0-123.5) (P = 0.000). Compared to group C, systemic lidocaine and dexmedetomidine reduced cumulative consumption of remifentanil and VAS pain score (P = 0.000). The time to first required rescue analgesia (mean, SD) was longer in group L (8.1 h, 1.2 h) and group D (8.5 h, 1.9 h) than group C (5.9 h, 0.9 h) (P = 0.000). The number of patients requiring rescue analgesia was lower in group L (8/40, 20%) and group D (6/40, 15%) than group C (16/40, 40%) (P = 0.029), and cumulative consumption of tramadol (mean, SD) was lower in group L (44.0 mg, 17.1 mg) and group D (51.7 mg, 14.1 mg) than group C (73.9 mg, 18.4 mg) (P = 0.000). The incidence of PONV in group L (7/40, 17.5%) and group D (9/40, 22.5%) was lower than group C (18/40, 45.0%) (P = 0.016). Bradycardia (heart rate less than 50 beats/min or lower) was noted in 25 patients (25/40, 62.5%), which was reversed by intravenous administration of atropine 0.5 mg. CONCLUSION Systemic lidocaine and dexmedetomidine had similar effects on enhancing the quality of recovery, alleviating the intensity of pain and reducing the incidence of PONV after thyroid cancer surgery. However, dexmedetomidine may result in bradycardia. Therefore, lidocaine was superior to dexmedetomidine. TRIAL REGISTRATION ChiCTR.org.cn (ChiCTR2000038442). Registered on September 22, 2020.
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Qi XR, Sun JY, An LX, Zhang K, Xue FS. Effects of intravenous lidocaine on hypoxemia induced by propofol-based sedation for gastrointestinal endoscopy procedures: study protocol for a prospective, randomized, controlled trial. Trials 2022; 23:800. [PMID: 36153625 PMCID: PMC9509543 DOI: 10.1186/s13063-022-06719-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 09/06/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Oxygen-desaturation episodes, blood pressure drops, and involuntary body movement are common problems that occur in propofol-based sedation in the procedure of painless gastrointestinal (GI) endoscopy. As a widely used analgesic adjuvant, intravenous lidocaine can reduce the consumption of propofol during ERCP or colonoscopy. However, it is still unknown how lidocaine affects the incidence of oxygen-desaturation episodes and cardiovascular events, and involuntary movement during painless GI endoscopy. Therefore, we aimed to assess the effectiveness and safety of intravenous lidocaine in propofol-based sedation for GI endoscopy.
Methods
We will conduct a single-center, prospective, randomized, double-blind, saline-controlled trial. A total number of 300 patients undergoing painless GI procedures will be enrolled and randomly divided into the lidocaine group (Group L) and the control group (Group C). After midazolam and sufentanil intravenous injection, a bolus of 1.5 mg/kg lidocaine was immediately injected and followed by a continuous infusion of 4 mg/kg/h in the lidocaine group, whereas the same volumes of saline solution in the control group. Then, propofol was titrated to produce unconsciousness during the procedure. The primary outcome will be the incidence of oxygen-desaturation episodes. Secondary outcomes will be the incidence of involuntary body movement, discomfort symptoms, propofol consumption, endoscopist, and patient satisfaction.
Discussion
Propofol-based deep sedation without intubation is widely used in painless GI endoscopy. However, adverse events such as hypoxemia often occur clinically. We expect to assess the effect of lidocaine on reducing the incidence of oxygen-desaturation episodes, cardiovascular events, and involuntary body movement. We believe that the results of this trial will provide an effective and safe method for painless GI endoscopy.
Trial registration
Chinese Clinical Trial Registry ChiCTR2100053818. Registered on 30 November 2021.
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Chandra S, Pryambodho P, Omega A. Evaluation of continuous intravenous lidocaine on brain relaxation, intraoperative opioid consumption, and surgeon's satisfaction in adult patients undergoing craniotomy tumor surgery: A randomized controlled trial. Medicine (Baltimore) 2022; 101:e30216. [PMID: 36086723 PMCID: PMC10980468 DOI: 10.1097/md.0000000000030227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 07/12/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In craniotomy tumor removal, brain relaxation after dura opening is essential. Lidocaine is known to have analgesic and antiinflammatory effects. It is excellent in decreasing cerebral metabolic rate of oxygen, cerebral blood flow, and cerebral blood volume; and can potentially reduce intracranial pressure, resulting in exceptional brain relaxation after dura opening. However, no study has examined continuous intravenous lidocaine infusion on brain relaxation, intraoperative opioid consumption and surgeon's satisfaction in adult patients undergoing craniotomy tumor removal. METHODS A total of 60 subjects scheduled for craniotomy tumor removal were enrolled in a double-blind, randomized controlled trial with consecutive sampling. Patients received either an intravenous bolus of lidocaine (2%) 1.5 mg/kg before induction followed by 2 mg/kg/h continuous infusion up to skin closure (lidocaine group) or placebo with similar volume (NaCl 0.9%). Neurosurgeons evaluated brain relaxation and surgeon's satisfaction with a 4-point scale, total intraoperative opioid consumption was recorded in μg and μg/kg/min. RESULTS All sixty subjects were included in the study. Lidocaine group showed better brain relaxation after dura opening (96.7% vs 70%; lidocaine vs placebo, P < .006), less intraoperative fentanyl consumption (369.2 μg vs 773.0 μg; P < .001, .0107 vs .0241 μg/kg/min; lidocaine vs placebo, P < .001). Higher surgeon's satisfaction was found in lidocaine group (96.7% vs 70%, P = .006). No side effects were observed during this study. CONCLUSIONS Continuous lidocaine intravenous infusion improves brain relaxation after dura opening, and decreases intraoperative opioid consumption, with good surgeon satisfaction in adult patients undergoing craniotomy tumor removal.
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Affiliation(s)
- Susilo Chandra
- Department of Anesthesiology and Intensive Care, Cipto Mangunkusumo General Hospital, Universitas Indonesia, DKI Jakarta, Indonesia
| | - Pry Pryambodho
- Department of Anesthesiology and Intensive Care, Cipto Mangunkusumo General Hospital, Universitas Indonesia, DKI Jakarta, Indonesia
| | - Andy Omega
- Department of Anesthesiology and Intensive Care, Cipto Mangunkusumo General Hospital, Universitas Indonesia, DKI Jakarta, Indonesia
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Zhang J, Kong L, Ni J. ED50 and ED95 of Propofol Combined with Different Doses of Intravenous Lidocaine for First-Trimester Uterine Aspiration: A Prospective Dose-Finding Study Using Up-and-Down Sequential Allocation Method. Drug Des Devel Ther 2022; 16:3343-3352. [PMID: 36199630 PMCID: PMC9527702 DOI: 10.2147/dddt.s382412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/15/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose This study aimed to test the effect of different doses of intravenous lidocaine on the median effective dose (ED50) and 95% effective dose (ED95) of propofol-induction dose and identify the optimal dose. Patients and Methods Patients undergoing first-trimester uterine aspiration were screened and randomly enrolled into the following groups: saline (L0), 0.5 mg/kg lidocaine (L0.5), 1.0 mg/kg lidocaine (L1.0), and 1.5 mg/kg lidocaine (L1.5). Anesthesia was induced with 1.0 µg/kg fentanyl. Prepared lidocaine or saline solution was injected later according to allocation, followed by propofol. The dose of propofol for each patient was determined using the up-and-down sequential study design. The primary end point was the ED50 and ED95 of the propofol-induction dose. The total propofol doses, awakening time, and adverse events were recorded. Results The ED50 (95% confidence interval) of propofol was significantly lower in groups L1.0 and L1.5 than group L0 (1.6 [1.5–1.7] mg/kg and 1.8 [1.6–1.9] mg/kg, versus 2.4 [2.3–2.5] mg/kg, respectively; p<0.001). There was no significant difference in ED50 between groups L1.0 and L1.5 (p>0.05). However, surprisingly, the ED50 was significantly higher in group L0.5 than L0 (2.8 [2.6–3.0] mg/kg vs 2.4 [2.3–2.5] mg/kg; p<0.05). The total doses of propofol in groups L1.0 and L1.5 were lower than those in groups L0 and L0.5 (p<0.05). The systolic blood pressure (SBP) decline after anesthesia induction in group L0.5 was greater than that in group L0 (p<0.01). The incidence of respiratory depression in group L0.5 was greater than that in groups L0 and L1.0 (p<0.05). Conclusion In patients who underwent first-trimester uterine aspiration, intravenous lidocaine 1.0 mg/kg prior to propofol injection significantly reduced the ED50 of propofol induction dose without severe side effects, equivalent to the effect of 1.5 mg/kg dose. We recommend 1.0 mg/kg as the optimal dose.
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Affiliation(s)
- Jingwen Zhang
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People’s Republic of China
| | - Linglingli Kong
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People’s Republic of China
| | - Juan Ni
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People’s Republic of China
- Correspondence: Juan Ni, Department of Anesthesiology, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, No. 20, Section 3, South of Renmin Road, Chengdu, Sichuan, 610041, People’s Republic of China, Tel +86 18180609890, Fax +86 2885503752, Email
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Impact of lidocaine on hemodynamic and respiratory parameters during laparoscopic appendectomy in children. Sci Rep 2022; 12:14038. [PMID: 35982198 PMCID: PMC9388633 DOI: 10.1038/s41598-022-18243-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 08/08/2022] [Indexed: 11/08/2022] Open
Abstract
We assessed the influence of systemic lidocaine administration on ventilatory and circulatory parameters, and the pneumoperitoneum impact on the cardiopulmonary system during a laparoscopic appendectomy in children. A single-center parallel single-masked randomized controlled study was carried out with 58 patients (3-17 years). Intravenous lidocaine bolus of 1.5 mg/kg over 5 min before induction of anesthesia followed by lidocaine infusion at 1.5 mg/kg/h intraoperatively. Respiratory system compliance (C, C/kg), Ppeak-PEEP and Pulse rate (Pulse), systolic, diastolic and mean blood pressure (NBPs, NBPd, NBPm), assessed in the Lidocaine and Control group, at the: beginning (P1), minimum lung compliance (P2) and at the end of surgery (P3) were compared. The respiratory/hemodynamic parameters did not differ between the groups at any stage of operation. Blood Pressure and Ppeak-PEEP were significantly higher at the P2 compared to P1 and P3 stages (P < 0.001, 1 - β ≥ 0.895) that correlated with lung compliance changes: C/kg vs. NBPs and Ppeak-PEEP (- 0.42, - 0.84; P < 0.001); C vs. Pulse and Ppeak-PEEP (- 0.48, - 0.46; P < 0.001). Although an increase in intraabdominal pressure up to 12(15) mmHg causes significant changes in hemodynamic/respiratory parameters, there appears to be no risk of fatal reactions in 1E, 2E ASA patients. Systemic lidocaine administration doesn't alleviate circulatory/respiratory alterations during pneumoperitoneum. No lidocaine related episode of anaphylaxis, systemic toxicity, circulatory disturbances or neurological impairment occurred.ClinicalTrials.gov: 22/03/2019.Trial registration number: NCT03886896.
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Hu S, Wang M, Li S, Zhou W, Zhang Y, Shi H, Ye P, Sun J, Liu F, Zhang W, Zheng L, Hou Q, Wang Y, Sun W, Chen Y, Lu Z, Ji Z, Liao L, Lv X, Wang Y, Wang X, Yang H. Intravenous Lidocaine Significantly Reduces the Propofol Dose in Elderly Patients Undergoing Gastroscopy: A Randomized Controlled Trial. Drug Des Devel Ther 2022; 16:2695-2705. [PMID: 35983429 PMCID: PMC9381011 DOI: 10.2147/dddt.s377237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/04/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Propofol-based sedation has been widely used for gastroscopy, but the risk of respiratory suppression in elderly patients should not be overlooked. Intravenous (IV) lidocaine during surgery can reduce the demand for propofol and the incidence of cardiopulmonary complications. We examined whether IV lidocaine reduces the dose of propofol and the occurrence of adverse events during gastroscopy in elderly patients. Methods We conducted a prospective, single-center, double-blind randomized controlled trial in elderly patients aged ≥65 years with ASA I-II. Subjects were randomly assigned to the lidocaine group (Group L, n=70), who received IV 1.5 mg kg−1 lidocaine followed by a continuous infusion of 4 mg kg−1 h−1 lidocaine, or the normal saline group (Group N, n=70), who received an equal volume of saline in the same way. Results IV lidocaine reduced the total and maintenance propofol dose in Group L (p<0.001), with no significant effect on the induction dose. The incidence of intraoperative hypoxia (p=0.035), emergency airway management events (p=0.005), duration of gastroscopy (p<0.05), consciousness recovery time (p<0.001), and postoperative pain (p=0.009) were all reduced in Group L. Patient (p=0.025) and gastroscopist (p=0.031) satisfaction was higher in Group L. Intraoperative hemodynamic parameters, the respiratory rate, the incidence of sedation-related events and anesthesiologist satisfaction were similar between the two groups. Conclusion IV lidocaine can significantly reduce the amount of propofol, the incidence of hypoxia and postoperative pain during gastroscopy in elderly patients, with a higher patient and gastroscopist satisfaction.
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Affiliation(s)
- Song Hu
- Graduate School, Wannan Medical College, Wuhu, 241002, People’s Republic of China
- Department of Anesthesiology and Pain Management, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People’s Republic of China
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, People’s Republic of China
| | - Mingxia Wang
- Department of Anesthesiology and Pain Management, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People’s Republic of China
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, People’s Republic of China
| | - Siyu Li
- Department of Anesthesiology and Pain Management, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People’s Republic of China
| | - Wenyu Zhou
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, People’s Republic of China
| | - Yi Zhang
- Department of Anesthesiology and Pain Management, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People’s Republic of China
| | - Haobing Shi
- Department of Anesthesiology and Pain Management, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People’s Republic of China
| | - Pengcheng Ye
- Department of Anesthesiology and Pain Management, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People’s Republic of China
| | - Jixiong Sun
- Department of Anesthesiology and Pain Management, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People’s Republic of China
| | - Feng Liu
- Department of Anesthesiology and Pain Management, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People’s Republic of China
| | - Wei Zhang
- Department of Anesthesiology and Pain Management, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People’s Republic of China
| | - Li Zheng
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, People’s Republic of China
| | - Qianhao Hou
- Department of Anesthesiology and Pain Management, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People’s Republic of China
| | - Yue Wang
- Department of Anesthesiology and Pain Management, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People’s Republic of China
| | - Weixin Sun
- Department of Anesthesiology and Pain Management, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People’s Republic of China
| | - Yuanli Chen
- Department of Anesthesiology and Pain Management, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People’s Republic of China
| | - Zhenzhen Lu
- Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China
| | - Zhonghua Ji
- Department of Anesthesiology and Pain Management, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People’s Republic of China
| | - Lijun Liao
- Department of Anesthesiology and Pain Management, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People’s Republic of China
| | - Xin Lv
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, People’s Republic of China
| | - Yinglin Wang
- Department of Anesthesiology and Pain Management, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People’s Republic of China
| | - Xiangrui Wang
- Department of Anesthesiology and Pain Management, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People’s Republic of China
| | - Hao Yang
- Department of Anesthesiology and Pain Management, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People’s Republic of China
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, People’s Republic of China
- Correspondence: Hao Yang; Xiangrui Wang, Department of Anesthesiology and Pain Management, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, People’s Republic of China, Email ;
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Liu J, Liu K, Wang H, Hu H, Sun G, Ye X, Lou Z, Bian J, Bo L. Effect of Perioperative Intravenous Lidocaine on Postoperative Recovery in Patients Undergoing Ileostomy Closure: Study Protocol for a Randomized Controlled Trial. J Pain Res 2022; 15:1863-1872. [PMID: 35813030 PMCID: PMC9259056 DOI: 10.2147/jpr.s362911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/17/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Jia Liu
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Kun Liu
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Huixian Wang
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Hongli Hu
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Guolin Sun
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Xiaofei Ye
- Department of Health Statistics, Naval Medical University, Shanghai, People’s Republic of China
| | - Zheng Lou
- Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Jinjun Bian
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Lulong Bo
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China
- Correspondence: Lulong Bo; Jinjun Bian, Faculty of Anaesthesiology, Changhai Hospital, Naval Medical University, Shanghai, 200433, People’s Republic of China, Tel +86-2131161839, Email ;
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50
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Lee IWS, Schraag S. The Use of Intravenous Lidocaine in Perioperative Medicine: Anaesthetic, Analgesic and Immune-Modulatory Aspects. J Clin Med 2022; 11:3543. [PMID: 35743617 PMCID: PMC9224677 DOI: 10.3390/jcm11123543] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/12/2022] [Accepted: 06/16/2022] [Indexed: 12/14/2022] Open
Abstract
This narrative review provides an update on the applied pharmacology of lidocaine, its clinical scope in anaesthesia, novel concepts of analgesic and immune-modulatory effects as well as the current controversy around its use in perioperative opioid-sparing multi-modal strategies. Potential benefits of intravenous lidocaine in the context of cancer, inflammation and chronic pain are discussed against concerns of safety, toxicity and medico-legal constraints.
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Affiliation(s)
- Ingrid Wing-Sum Lee
- School of Medicine, University of Glasgow, Wolfson Medical School Building, University Avenue, Glasgow G12 8QQ, UK;
| | - Stefan Schraag
- Department of Perioperative Medicine, Golden Jubilee National Hospital, Agamemnon Street, Clydebank G81 4DY, UK
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