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

Figures & data

Figure 1. Consolidated Standards of Reporting Trials (CONSORT) flow diagram of the study.

Table 1. Characteristics of participants receiving systemic lidocaine or saline.

	Lidocaine (n = 58)	Saline (n = 59)	p value
Age, yr	60.8 (10.8)	60 (11.4)	0.682
Height, cm	164.5 (6.9)	166.1 (7.9)	0.252
Weight, kg	65 (8.7)	66.6 (7.7)	0.300
BMI, kg/m^2	23.8 (2.3)	24.1 (2.2)	0.446
Sex; male	31 (53%)	33 (56%)	0.787
ASA physical status, n (%)			0.809
I	7 (12%)	8 (14%)
II	51 (88%)	51 (86%)
Duration of operation, min	203 (45)	197 (44)	0.464
Duration of anaesthesia, min	229 (47)	226 (48)	0.757
Preoperative QoR-15 score	132 (125–137)	133 (126–138)	0.633
Type of procedure, n (%)			0.327
Left hemicolectomy	11 (19%)	15 (25%)
Right hemicolectomy	16 (28%)	11 (19%)
Sigmoid resection	24 (41%)	19 (32%)
Rectal resection	2 (3%)	6 (10%)
Transverse colectomy	5 (9%)	8 (14%)
Stoma, n (%)			> 0.99
None	56 (96.6%)	55 (93.2%)
Ileostomy	1 (1.7%)	2 (3.4%)
Colostomy	1 (1.7%)	2 (3.4%)

Note: Data are mean (SD), median (IQR), or number (proportion). ASA, American Society of Anesthesiologists; BMI, body mass index; QoR-15, 15-item Quality of Recovery scale.

Figure 2. Beeswarm–Violin plots depict the distribution of the global QoR-15 score preoperatively and 24 h and 48 h postoperatively in patients receiving saline or lidocaine.

Note: Compared with saline, systemic lidocaine improved the quality of recovery-15 scores at 24 hours postoperatively, with a median difference (95% CI) of 4 points (1 to 6), p = 0.015. The violin plot visualizes the distribution shape of the numerical data using kernel density estimation. Circles represent individuals, the solid lines within the boxes of 25th and 75th percentile values depict the median values, and the whiskers symbolize the data within 1.5 times the interquartile range. POD 1, postoperative day 1; POD 2, postoperative day 2.

Figure 3. Boxplot for numerical rating scale pain score in patients who received either saline or lidocaine at different time points during rest (A) and movement (B).

Note: In a boxplot, the box represents the interquartile range (IQR), the horizontal line inside the box indicates the median, and the whisker represents the maximum and minimum values within 1.5 times the IQR. Intragroup differences were assessed using the Mann–Whiney U-test. Asterisks indicate statistically significant differences between groups (p < 0.05).

Table 2. Secondary and exploratory outcomes for participants receiving systemic lidocaine or saline.

	Lidocaine (n = 58)	Saline (n = 59)	Relative risk, hazard ratio, or median difference (all 95%CI)	p value
AUCrest of pain NRS to 48 h	80.8 (67.3 to 109.2)	102 (81.8 to 123.3)	−15.5 (−25.5 to −5.0)	0.004
AUCmovement of pain NRS to 48 h	150.7 (138.5 to 182.7)	164.5 (147.0 to 183.8)	−11.5 (−21.0 to −1.7)	0.023
Morphine to 48 h, mg	50 (32 to 64)	52 (38 to 70)	−4 (−12 to 4)	0.344
0–8 h	14 (8 to 20)	18 (10 to 24)	−4 (−6 to 0)	0.043
8–24 h	20 (14 to 24)	20 (14 to 26)	0 (−4 to 2)	0.935
24–48 h	16 (12 to 20)	16 (12 to 20)	0 (–2 to 2)	0.772
Remifentanil consumption, μg	1080 (800 to 1325)	1960 (1500 to 2380)	−840 (−1020 to −660)	< 0.001
Emergence time, min	15 (13 to 18)	14 (12 to 16)	1 (0 to 2)	0.194
Nausea or vomiting to 48 h, n (%)	13 (22%)	16 (27%)	0.89 (0.60 to 1.31)	0.669
Pruritus to 48 h, n (%)	5 (9%)	7 (12%)	0.85 (0.51 to 1.42)	0.563
Dizziness to 48 h, n (%)	3 (5%)	5 (8%)	0.79 (0.45 to 1.40)	0.717
Time to flatus, h	30 (22 to 37)	37 (28 to 49)	2.01 (1.37 to 2.95)	< 0.001
Time to ambulation, h	36 (24 to 46)	41 (31 to 49)	1.34 (0.92 to 1.94)	0.11
Patient satisfaction scores at 48 h	9 (8 to 10)	8 (8 to 10)	0 (0 to 1)	0.097
Type of complication, n (%)
Anastomotic leakage, n (%)	4 (6.9%)	1 (1.7%)	2.60 (0.37 to 0.97)	0.207
Ileus, n (%)	2 (3.4%)	1 (1.7%)	1.53 (0.31 to 7.64)	0.619
Bleeding, n (%)	1 (1.7%)	0	N/A	> 0.99
Pulmonary, n (%)	0	1 (1.7%)	0.50 (0.42 to 0.60)	> 0.99
Intra-abdominal abscess, n (%)	4 (6.9%)	3 (5.1%)	1.19 (0.50 to 2.85)	0.717

Note: Data are median (IQR) or number (proportion). AUC, area under the curve; N/A, not applicable; NRS, numeric rating scale.

Figure 4. Kaplan–Meier cumulative incidence curves of first flatus (A) and ambulation (B) up to 72 h of follow-up in patients who received either saline or lidocaine.

Note: Tick marks on the curve indicate censored observations.

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.