Clinical Observation Of Intravenous Lidocaine-assisted Analgesia In Thoracoscopic Surgery

Objective To observe the effect of intravenous lidocaine infusion on intraoperative general anesthesia drug dosage,and postoperative pain in thoracoscopic surgery under general anesthesia with surgical pleth index(SPI)as the target index.Methods This experiment was a prospective,double-blind,randomized controlled study.Seventy patients undergoing elective general anesthesia thoracoscopic surgery in the First Affiliated Hospital of Soochow University from September 2018 to April 2019 were randomly divided into lidocaine group(Group L)and control group(Group C).Group L was injected with 1.5 mg/kg of lidocaine slowly before induction of anesthesia in 10 minutes.Lidocaine injection was continuously infused with 2.0 mg/kg/h until the end of operation immediately after induction.Group C was injected with normal saline of equal volume before induction of anesthesia,and continuous infusion of normal saline of equal volume immediately after induction.Propofol combined with remifentanil was used for total intravenous anesthesia in both groups.BIS was maintained between 40-60 and SPI was maintained between 20-50.Fentanyl 0.05 mg was injected immediately when the SPI value was greater than 50 or the SPI increased by 10(△SPI>10)for more than 2 minutes.The SPI,HR,MAP and BIS of the two groups were observed after admission(T0),after loading(T1),before intubation(T2),immediately intubation(T3),2 minutes before skin incision(T4),immediately skin incision(T5),after operation(T6),and immediately extubation(T7).The total amount of propofol and fentanyl used during operation,the numerical rating scale(NRS)of pain immediately after extubation,1h,6h,12h and 24h after extubation,the use of analgesic remedies after operation,the incidence of nausea and vomiting after operation,the overall satisfaction after operation and the occurrence of adverse reactions of lidocaine were recorded.Results There were 64 patients in our study.In the two groups,MAP,HR,SPI and BIS were significantly higher at T3 than at T2 and T7 than at T6(P<0.05),and MAP,HR and SPI were significantly higher at T5 than at T4(P<0.05).MAP,HR,SPI and BIS were significantly higher at T7than at T4(P<0.05).Inter-group comparison:Compared with group C,SPI in Group L at T5,T6 and T7 time points decreased significantly(P<0.05).Compared with Group C,the intraoperative dosage of fentanyl in Group L was significantly lower(P<0.05).There was significant difference in the NRS scores of group L at 1 h and 6 h after operation(P<0.05).The use of analgesic remedies in Group L was significantly reduced within 24 h after operation(P<0.05).The overall satisfaction of group L was higher than that of group C(P<0.05).Conclusion In thoracoscopic surgery under general anesthesia intravenous lidocaine infusion can make intraoperative hemodynamics more stable,significantly reduce the amount of analgesic drugs used during and after surgery,reduce early postoperative NRS scores,and improve satisfaction of patients.