Effects of Systemic Lidocaine on Postoperative Recovery Quality and Immune Function in Patients Undergoing Laparoscopic Radical Gastrectomy

Abstract

Objective

This study aimed to explore the effects of lidocaine on postoperative quality of recovery (QoR) and immune function in patients undergoing laparoscopic radical gastrectomy.

Methods

In total, 135 patients were enrolled and were equally randomized to receive low-dose lidocaine (Group LL: 1.5 mg/kg bolus followed by an infusion at 1.0 mg/kg/hour) or high-dose lidocaine (Group HL: 1.5 mg/kg bolus followed by an infusion at 2.0 mg/kg/hour) or Controls (Group C: received a volume-matched normal saline at the same rate). The primary outcome was a QoR-40 score on postoperative day (POD) 1. Secondary outcomes were a QoR-40 score on POD 3, levels of inflammatory factors (IL-6, IL-10, TNF-α) and CD4⁺T cells, CD8⁺T cells proportions, and CD4⁺/CD8⁺ cell ratios and postoperative recovery of bowel function.

Results

There were no statistically significant differences in patient characteristics at baseline. The total QoR-40 scores on POD 1 in Group HL (171.4±3.89) were higher than those in Group LL (166.20±4.05) and in Group C (163.40±4.38) (adjusted P<0.001). Differences in the dimension scores of QoR-40 for pain, physical comfort, and emotional state were significant across the three groups. Lidocaine administration significantly reduced the release of IL-6, IL-10, TNF-α, and attenuated immune changes induced by trauma. Kaplan–Meier curves showed that the median time to the first exhaust and defecation were shorter in the Group HL than in Groups LL and C (1.55 days vs 2.4 days vs 2.6 days, log rank P<0.0001; and 2.86 days vs 3.22 days vs 3.46 days, log rank P=0.002, respectively). Additionally, patients in lidocaine groups required less remifentanil consumption and experienced lower pain intensity, compared with the control group.

Conclusion

Systemic lidocaine improved postoperative recovery, alleviated inflammation and immunosuppression, and accelerated the return of bowel function, and is thus, worthy of clinical application.

Clinical Trials Registration

ChiCTR2000028934.

Keywords:

• lidocaine
• QoR-40
• postoperative quality of life
• radical gastrectomy

Acknowledgments

The authors thank Dr. Long Wang for his support in inflammatory and immune factors testing. This work was supported by grants from the Qing Lan Project of Jiangsu Province; the Nature Science Foundation of Jiangsu Province (Code: BK20161175); the “Six One” Project of Jiangsu Province (Code: LGY2016039); Jiangsu Provincial Medical Youth Talent (QNRC2016796); Natural Science Research Project of Jiangsu Higher Education Institutions (Code: 17KJA3320006); and the Xuzhou Medical University Innovation Team. The funding was received by Dr. Su Liu. No commercial funding was received.

Data Sharing Statement

The individual participant’s data underlying the results reported in this article may be accessed with approval from the corresponding author 6 months after publication of this study. The study protocol, statistical analysis plan, and clinical study report will also be made available.

Disclosure

The authors report no conflicts of interest in this work.