Efficacy Of Intravenous Lidocaine On Postoperative Pain And Early Recovery Quality After Video-assisted Thoracic Surgery

Aims:Primary aim:To investigate the effects of intravenous lidocaine during video-assisted thoracic surgery on the postoperative pain.Secondary aims:To examine the effects of intravenous lidocaine during video-assisted thoracic surgery on early recovery quality by measuring the serum inflammatory factors and quality of recovery-40 survey.Methods:Sixty patients undergoing video-assisted thoracic surgery under general anesthesia in the operating room of the Second Hospital of Jilin University from September 2022to January 2023 were randomly selected according to the inclusion and exclusion criteria.In this trial,total intravenous anesthesia was induced with intravenous midazolam 0.03-0.05 mg/kg,sufentanil 0.4 g/kg,cis-atracurium 0.2 mg/kg and etomidate 0.2-0.4 mg/kg and followed by infusing of propofol and remifentanil for maintenance of anesthesia.According to random number table method,60 patients were randomly divided into the experimental lidocaine group（Group L）and the saline control group（Group C）,with 30 patients in each group.Patients in the experimental lidocaine group（Group L）received a bolus of 1.5 mg/kg lidocaine intravenously 10min before induction of anesthesia（the time of injection more than 10 min）,followed by continuous infusion of 1.5 mg/kg/h until the end of the surgery.Patients in the saline control group（Group C）were given an identical volume and rates of 0.9%saline using the same application protocol.The primary endpoint was the postoperative 0.5（t₆）,1（t₇）,4（t₈）,8（t₉）,24(t₁₀),48(t₁₁)-hour numeric rating scale（NRS）scores.The secondary endpoints were opioid consumption,hemodynamic changes before anesthesia induction（t₀）,before intubation（t₁）,after intubation（t₂）,before extubation（t₄）and after extubation（t₅）,the serum inflammatory factors level before anesthesia induction（t₀）,after anesthesia end（t₃）and 24 h after surgery(t₁₀)including Interleukin-6（IL-6）,C-reactive protein（CRP）,monocyte chemotactic protein-1（MCP-1）and matrix metalloproteinase 9（MMP-9）,quality of recovery-40（QoR-40）survey administered on the preoperative day（t’）and postoperative day 1(t₁₀);after anesthesia end（t₃）the symptoms of lidocaine toxicity.Results:1.There were no statistically significant differences between the two groups in terms of general conditions such as gender,age,height,weight,ASA classification and smoking history（P>0.05）.2.There were no statistically significant differences between the two groups in terms of lesion site,type of surgery,surgery time,anesthesia time,awakening time and extubation time（P>0.05）.3.Patients in the lidocaine group had significantly lower NRS scores than the control group at 0.5（t₆）,1（t₇）,4（t₈）,8（t₉）,24(t₁₀),48(t₁₁)hour postoperatively（P<0.05）.4.The differences in the consumption of sufentanil and remifentanil between the two groups were not statistically significant（P>0.05）.5.The mean arterial pressure and heart rate of patients in the lidocaine group were statistically significantly lower than those in the control group after intubation（t₂）and after extubation（t₅）（P<0.05）.In contrast,the differences in mean arterial pressure and heart rate before induction（t₀）,before intubation（t₁）and before extubation（t₄）were not statistically significant（P>0.05）.The differences in SpO₂ between the two groups at diverse time points were not statistically significant（P>0.05）.6.The IL-6 levels in the lidocaine group were obviously lower than those in the control group at the end of anesthesia（t₃）and postoperative 24 h(t₁₀),and the differences were statistically significant（P<0.05）.There were no statistically significant differences in the levels of CRP,MCP-1 and MMP-9 in serum between the two groups at all time points（P>0.05）.7.There were no statistically significant differences between the two groups in the overall QoR-40 score on the day before（t’）and after surgery(t₁₀)（P>0.05）.8.Only one patient had slight tingle around his mouth after anesthesia（t₃）.Conclusions:During anesthesia of video-assisted thoracic surgery,intravenous lidocaine can attenuate postoperative pain manifestly,reduce the serum IL-6 level.Thus,lidocaine is considered as a part of multimodal analgesia for thoracic surgery and patient’s recovery after VATS could benefit from it.