Effect Of Different Doses Of Lidocaine On Quality Of Early Recovery After Laparoscopic Radical Resection Of Colon Cancer In Elderly Patients

Objective:In this study,a completely randomized controlled trial was conducted to compare the effects of different doses of lidocaine on the quality of early recovery after laparoscopic radical colon cancer surgery in elderly patients,and to explore the reasonable dose of lidocaine.Methods:Sixty patients who underwent laparoscopic radical resection of colon cancer in our hospital from November 2021 to September 2022.All patients were aged 65～85 years old,gender not limited,BMI of 18-28kg/m²,ASA grade I to III,primary school education or above.According to the random number table generated by SPSS,the patients were randomly divided into three groups:normal saline group（group C）,low-dose lidocaine group（group L）,and high-dose lidocaine group（group H）,with 20 cases in each group.Thirty minutes before anesthesia induction,lidocaine was slowly injected intravenously at 1.5mg/kg in both groups L and H,and 1mg?kg^-1?h^-1in group L after the operation began continue pumping until the end of the procedure;Group H at 3mg.kg^-1.h^-1continue pumping until the end of the procedure;Group C was given normal saline instead.Other anesthesia treatments were the same in the three groups.Observation indexes:Anesthesia time,operation time,intraoperative blood loss,intraoperative fluid volume were record.15 quality of recovery（Qo R-15）scores were recorded at 24h before surgery,24h after surgery,and72h after surgery.The scores of the Simple Mental State Scale（MMSE）were recorded 24h before surgery,24h after surgery and 72h after surgery.Interleukin-6（IL-6）and tumor necrosis factor?TNF-α)levels were recorded 24h before and 24h after surgery.Heart rate（HR）and mean arterial pressure（MAP）were recorded at five time points before anesthesia induction（T0）,immediately after placement of the laryngeal mask（T1）,10min after pneumoperitoneum（T2）,at the end of surgery（T3）,and immediately after laryngeal mask removal（T4）.VAS scores were record at2h,6h,24h and 72h after surgery and the number of patient-controlled analgesia（PCA）within 24h after surgery.Propofol dosage,reifentanil dosage,first postoperative exhaust time,length of hospital stay（time from surgery to discharge）,incidence of nausea and vomiting,and lidocaine-related adverse reactions（perioral numbness,severe bradycardia,hypotension,etc.）were recorded.Results:1 General situationThere was no significant difference in age,gender,BMI,ASA grade,TNM,anesthesia time,operation time,blood loss and fluid replenishment stage among the three groups（P>0.05）.2 Qo R-15 score comparisonPreoperative Qo R-15 score among the three groups showed no statistical significance（P>0.05）;Compared with group C,Qo R-15 scores of group L and group H were significantly increased at 24h and 72h after surgery（P<0.05）;Compared with group L,Qo R-15 scores of group H at 24h and 72h after surgery were significantly increased（P<0.05）.Intra-group comparison showed that the Qo R-15 scores of the three groups were significantly lower than those before surgery at 24h and 72h after surgery（P<0.05）;The Qo R-15 score at 72h after surgery was significantly higher than that at 24h after surgery（P<0.05）.3 Comparison of cognitive functionThere was no significant difference in preoperative MMSE scores among the three groups.Compared with group C,MMSE scores of group L and group H were significantly improved at 24h and 72h after surgery,and group H was higher than group L（P<0.05）.In group C,MMSE scores at 24h and 72h after surgery were significantly lower than those at 1d before surgery（P<0.05）,and there was no significant improvement at 72h compared with 24h after surgery（P>0.05）.In group L,MMSE scores at 24h and 72h after surgery were significantly lower than those at 24h after surgery（P<0.05）,but significantly improved at 72h compared with 24h after surgery（P<0.05）.In group H,MMSE score 24h after surgery was significantly lower than 24h before surgery（P<0.05）,and recovered to the preoperative level72h after surgery（P>0.05）.Compared with group C,the incidence of POCD in group H at 72h after operation was significantly reduced（P>0.05）.4 Comparison of inflammatory factorsThere were no significant differences in preoperative IL-6 and TNF-?among the three groups（P>0.05）;Compared with group C,IL-6 and TNF-αin groups L and H were significantly decreased 24h after surgery（P<0.05）.Compared with group L,IL-6 and TNF-αin group H were significantly decreased 24h after surgery（P<0.05）.Compared with pre-operation,IL-6 and TNF-αwere significantly increased 24h after operation in three groups（P<0.05）.5 Comparison of hemodynamicsThere was no significant difference in HR and MAP between the three groups at T0,T1,T2,T3and T4（P>0.05）.Compared with T0,HR of T1～T3was significantly decreased（P<0.05）.There was no significant difference in MAP group at each time point from T0 to T4 among the three groups（P>0.05）.6 Comparison of postoperative painCompared with group C,VAS scores in groups L and H at 2h,6h and24h after surgery were significantly decreased（P<0.05）;there was no significant difference in VAS scores among the three groups 72h after surgery（P>0.05）.In group C,the VAS score at 6h after surgery was significantly higher than that at 2h,24h and 72h after surgery（P<0.05）;the VAS score at 72h after surgery was significantly lower than that at 2h、6h and 24h after surgery（P<0.05）.In group L,the VAS score at 6h after surgery was significantly higher than that at 2h、24h and 72h after surgery（P<0.05）.There was no significant difference in VAS scores in group H at 2h,6h,24h and72h after surgery（P>0.05）.Compared with group C,the number of PCA in group L and group H was significantly reduced,and group H was less than group L（P<0.05）.7 Comparison of other indexesCompared with group C and group L,the dosage of propofol in group H was significantly reduced（P<0.05）.Compared with group C,the dosage of remifentanil in groups L and H was significantly decreased（P<0.05）;Compared with group L,the dosage of remifentanil in group H was significantly reduced（P<0.05）.Compared with C and L groups,the first postoperative exhaust time and length of hospital stay in group H were significantly shortened（P<0.05）.The incidence of nausea and vomiting in group H was significantly decreased（P<0.05）.The anesthesia process of the three groups was smooth,and no lidocaine-related adverse reactions occurred.Conclusions:Continuous injection of lidocaine with 3mg?kg?^-1?h^-1can significantly improve the quality of early recovery after laparoscopic radical colon cancer surgery in elderly patients,and the dose is safe and reliable.