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      The Effect of Lidocaine on Postoperative Quality of Recovery and Lung Protection of Patients Undergoing Thoracoscopic Radical Resection of Lung Cancer

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          Abstract

          Purpose

          To evaluate the effectiveness and safety of lidocaine on postoperative quality of recovery and lung protection of patients undergoing thoracoscopic radical resection of lung cancer.

          Patients and Methods

          Seventy ASA II–III patients undergoing thoracoscopic radical resection of lung cancer were randomly assigned into either the lidocaine group (Group L) or control group (Group C). Patients in Group L received lidocaine with a 1.5 mg/kg bolus before induction of anesthesia, followed by 2.0 mg/kg/h until the end of the operation while the patients in Group C received volume-matched normal saline at the same rate. The main outcome was the quality of recovery-40 score (QoR-40 score) at 24 h postoperatively. The peak airway pressure (Ppeak) and plateau airway pressure (Pplat), the partial pressure of oxygen in arterial blood (PaO 2), partial pressure of carbon dioxide in arterial blood (PaCO 2), alveolar-arterial oxygen gradient (A-aDO2), oxygenation index (OI), time to first flatus and defecation, intraoperative hemodynamics and opioid consumption were also recorded.

          Results

          There were no statistically difference at patients’ baseline characteristics. The QoR-40 score of Group L was significantly higher than that of Group C at 24 h after surgery ( P=0.014). Ppeak, Pplat, and A-aDO 2 of Group L were significantly lower than those of Group C ( P<0.001, P<0.001, P=0.025, respectively) after the ventilation recovery of both lungs, and the PaO 2 and OI of the Group L were significantly higher than those of Group C ( P=0.027, P=0.027, respectively). Time to first flatus and defecation in Group L was significantly lower compared with Group C ( P=0.037, P=0.025, respectively).

          Conclusion

          Intravenous lidocaine can improve the quality of recovery of patients undergoing thoracoscopic radical resection of lung cancer, while also providing lung protection, favorable postoperative analgesia, a reduction in the time to first flatus and defecation after surgery.

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          Most cited references 17

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          Perioperative Use of Intravenous Lidocaine.

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            Systemic lidocaine to improve postoperative quality of recovery after ambulatory laparoscopic surgery.

            Perioperative systemic lidocaine has been shown to have beneficial postoperative analgesic effects. The only previous study examining the use of lidocaine in the outpatient setting did not detect an opioid-sparing effect after hospital discharge. More importantly, it is unknown whether systemic lidocaine provides a better postoperative quality of recovery to patients undergoing ambulatory surgery. Our objective in the current study was to examine the effect of systemic lidocaine on postoperative quality of recovery in patients undergoing outpatient laparoscopic surgery. The study was a prospective, randomized, double-blind, placebo-controlled clinical trial. Healthy female subjects were randomized to receive lidocaine (1.5 mg/kg bolus followed by a 2 mg/kg/h infusion until the end of the surgical procedure) or the same volume of saline. The primary outcome was the Quality of Recovery-40 questionnaire at 24 hours after surgery. A 10-point difference represents a clinically relevant improvement in quality of recovery based on previously reported values on the mean and range of the Quality of Recovery-40 score in patients after anesthesia and surgery. Other data collected included opioid consumption, pain scores, and time to meet hospital discharge. Data were compared using group t tests and the Wilcoxon exact test. The association between opioid consumption and quality of recovery was evaluated using Spearman ρ. P < 0.01 was used to reject the null hypothesis for the primary outcome. Seventy subjects were recruited and 63 completed the study. There were no baseline differences regarding subject and surgical characteristics between the study groups. Patients in the lidocaine group had better global quality of recovery scores compared with the saline group, median difference of 16 (99% confidence interval [CI], 2-28), P = 0.002. Patients in the lidocaine group met hospital discharge criteria faster than the saline group, mean difference of -26 minutes (95% CI, -6 to -46 minutes) (P = 0.03). After hospital discharge, subjects in the lidocaine group required less oral opioids, median difference of -10 (95% CI, 0 to -30) (oral milligrams morphine equivalents), than the saline group (P = 0.01). There was an inverse association between postoperative opioid consumption and quality of recovery (ρ = 0.64, P < 0.001). Systemic lidocaine improves postoperative quality of recovery in patients undergoing outpatient laparoscopy. Patients who received lidocaine had less opioid consumption, which translated to a better quality of recovery. Lidocaine is a safe, inexpensive, effective strategy to improve quality of recovery after ambulatory surgery.
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              Essential Elements of Multimodal Analgesia in Enhanced Recovery After Surgery (ERAS) Guidelines.

              Perioperative multimodal analgesia uses combinations of analgesic medications that act on different sites and pathways in an additive or synergistic manner to achieve pain relief with minimal or no opiate consumption. Although all medications have side effects, opiates have particularly concerning, multisystemic, long-term, and short-term side effects, which increase morbidity and prolong admissions. Enhanced recovery is a systematic process addressing each aspect affecting recovery. This article outlines the evidence base forming the current multimodal analgesia recommendations made by the Enhanced Recovery After Surgery Society (ERAS). We describe current evidence and important future directions for effective perioperative multimodal analgesia in enhanced recovery pathways.
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                Author and article information

                Journal
                Drug Des Devel Ther
                Drug Des Devel Ther
                dddt
                dddt
                Drug Design, Development and Therapy
                Dove
                1177-8881
                07 April 2021
                2021
                : 15
                : 1485-1493
                Affiliations
                [1 ]Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University , Xuzhou, People’s Republic of China
                [2 ]Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University , Xuzhou, 221000, Jiangsu, People’s Republic of China
                [3 ]Department of Pain, The Affiliated Hospital of Xuzhou Medical University , Xuzhou, 221000, Jiangsu, People’s Republic of China
                Author notes
                Correspondence: Guanglei Wang Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University , 99 Huaihai West Road, Xuzhou, 221000, Jiangsu, People’s Republic of ChinaTel +8613852087156 Email wguanglei2000@163.com
                Article
                297642
                10.2147/DDDT.S297642
                8039043
                © 2021 Wang et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 2, Tables: 12, References: 17, Pages: 9
                Categories
                Clinical Trial Report

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