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De la Gala F, Piñeiro P, Reyes A, Simón C, Vara E, Rancan L, Huerta LJ, Gonzalez G, Benito C, Muñoz M, Grande P, Paredes SD, Aznar PT, Perez A, Martinez D, Higuero F, Sanz D, De Miguel JP, Cruz P, Olmedilla L, Lopez Gil E, Duque P, Sanchez-Pedrosa G, Valle M, Garutti I. Effect of intraoperative paravertebral or intravenous lidocaine versus control during lung resection surgery on postoperative complications: A randomized controlled trial. Trials 2019; 20:622. [PMID: 31694684 PMCID: PMC6836654 DOI: 10.1186/s13063-019-3677-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 08/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Use of minimally invasive surgical techniques for lung resection surgery (LRS), such as video-assisted thoracoscopy (VATS), has increased in recent years. However, there is little information about the best anesthetic technique in this context. This surgical approach is associated with a lower intensity of postoperative pain, and its use has been proposed in programs for enhanced recovery after surgery (ERAS). This study compares the severity of postoperative complications in patients undergoing LRS who have received lidocaine intraoperatively either intravenously or via paravertebral administration versus saline. METHODS/DESIGN We will conduct a single-center randomized controlled trial involving 153 patients undergoing LRS through a thoracoscopic approach. The patients will be randomly assigned to one of the following study groups: intravenous lidocaine with more paravertebral thoracic (PVT) saline, PVT lidocaine with more intravenous saline, or intravenous remifentanil with more PVT saline. The primary outcome will be the comparison of the postoperative course through Clavien-Dindo classification. Furthermore, we will compare the perioperative pulmonary and systemic inflammatory response by monitoring biomarkers in the bronchoalveolar lavage fluid and blood, as well as postoperative analgesic consumption between the three groups of patients. We will use an ANOVA to compare quantitative variables and a chi-squared test to compare qualitative variables. DISCUSSION The development of less invasive surgical techniques means that anesthesiologists must adapt their perioperative management protocols and look for anesthetic techniques that provide good analgesic quality and allow rapid rehabilitation of the patient, as proposed in the ERAS protocols. The administration of a continuous infusion of intravenous lidocaine has proven to be useful and safe for the management of other types of surgery, as demonstrated in colorectal cancer. We want to know whether the continuous administration of lidocaine by a paravertebral route can be substituted with the intravenous administration of this local anesthetic in a safe and effective way while avoiding the risks inherent in the use of regional anesthetic techniques. In this way, this technique could be used in a safe and effective way in ERAS programs for pulmonary resection. TRIAL REGISTRATION EudraCT, 2016-004271-52; ClinicalTrials.gov, NCT03905837 . Protocol number IGGFGG-2016 version 4.0, 27th April 2017.
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Affiliation(s)
- Francisco De la Gala
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Patricia Piñeiro
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Almudena Reyes
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Carlos Simón
- Department Thoracic Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Elena Vara
- Biochemical Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Lisa Rancan
- Biochemical Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Luis Javier Huerta
- Department Thoracic Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Guillermo Gonzalez
- Department Thoracic Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Carmen Benito
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Marta Muñoz
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pilar Grande
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Sergio D Paredes
- Biochemical Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Pablo Tomas Aznar
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Alvaro Perez
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - David Martinez
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Fernando Higuero
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - David Sanz
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Juan Pedro De Miguel
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Patricia Cruz
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Luis Olmedilla
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Elena Lopez Gil
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Patricia Duque
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Mayte Valle
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ignacio Garutti
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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