Efficacy of intraoperative systemic lidocaine on quality of recovery after laparoscopic colorectal surgery: a randomized controlled trial

Abstract

Introduction

Many clinical trials have demonstrated the benefits of intraoperative systemic lidocaine administration in major abdominal surgeries. We tested the hypothesis that systemic lidocaine is associated with an enhanced early quality of recovery in patients following laparoscopic colorectal resection.

Patients and Methods

We randomly allocated 126 patients scheduled for laparoscopic colorectal surgery in a 1:1 ratio to receive either lidocaine (1.5 mg kg⁻¹ bolus over 10 min, followed by continuous infusion at 2 mg kg⁻¹ h⁻¹ until the end of surgery) or identical volumes and rates of saline. The primary outcome was the Quality of Recovery-15 score assessed 24 h after surgery. Secondary outcomes were areas under the pain numeric rating scale curve over time, 48-h morphine consumption, and adverse events.

Results

Compared with saline, systemic lidocaine improved the Quality of Recovery-15 score 24 h postoperatively, with a median difference of 4 (95% confidence interval: 1–6; p = 0.015). Similarly, the area under the pain numeric rating scale curve over 48 h at rest and on movement was reduced in the lidocaine group (p = 0.004 and p < 0.001, respectively). However, these differences were not clinically meaningful. Lidocaine infusion reduced the intraoperative remifentanil requirements but not postoperative 48-h morphine consumption (p < 0.001 and p = 0.34, respectively). Additionally, patients receiving lidocaine had a quicker and earlier return of bowel function, as indicated by a shorter time to first flatus (log-rank p < 0.001), yet ambulation time was similar between groups (log-rank test, p = 0.11).

Conclusions

In patients undergoing laparoscopic colorectal surgery, intraoperative systemic lidocaine resulted in statistically but not clinically significant improvements in quality of recovery (see Graphical Abstract).

Trial registration: Chinese Clinical Trial Registry; ChiCTR1900027635.

KEY MESSAGES

• Systemic lidocaine failed to clinically improve the overall quality of recovery following laparoscopic colorectal resection.

• Systemic lidocaine reduced intraoperative remifentanil and time to first flatus but not postoperative 48-h morphine consumption.

• No differences emerged in patient-reported outcomes like opioid side effects, mobility, or satisfaction between groups postoperatively.

Graphical Abstract

Keywords:

• Colorectal surgery
• lidocaine
• pain management
• post-surgical recovery

Acknowledgments

We gratefully acknowledge Dr Fangqin Xue and Dr Liangxiang Huang (Department of Gastrointestinal Surgery, Fujian Provincial Hospital) for their kind support. This study was supported by Natural Science Foundation of Xiamen, China (grant number 3502Z202374068), the Medical Innovation Project of Fujian Province (No. 2022CXA007), and Natural Science Foundation of Fujian Province (No. 2021J01378).

Authors contributions statement

Wenjun Lin: Conceptualization, Methodology, Project administration, Investigation, Writing-review and editing.Ying Yang: Conceptualization, Investigation, Data curation, Visualization, Formal analysis. Yifen Zhou: Methodology, Investigation, Formal analysis, Writing-original draft. Chunlin Qiu: Investigation, Writing-original draft. Yanhua Guo: Conceptualization, Investigation, Validation, Project administration, Writing-review and editing. Yusheng Yao: Conceptualization, Resources, Supervision, Validation, Writing-review and editing. All authors read and gave final approval of the version to be published.

Ethical approval statement

The Ethics Committee of Fujian Provincial Hospital, Fuzhou, China approved the study protocol on October 10, 2019 with the identification number K2019-10-003.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The individual de-identified participant data supporting published results, the study protocol, and the statistical analysis plan are available from the corresponding author upon reasonable request.