Efficacy of intravenous lidocaine in improving post-operative nausea, vomiting and early recovery after laparoscopic gynaecological surgery

Effect of intravenous lidocaine on postoperative fatigue syndrome in patients undergoing laparoscopic radical colorectal cancer surgery: a randomized clinical trial

To investigate the effect of intravenous lidocaine on postoperative fatigue syndrome (POFS) in laparoscopic radical colorectal cancer surgery patients, a randomized controlled trial enrolled 86 patients aged over 18 with preoperative Christensen score ≤ 4 at Xuzhou Central Hospital from September 2023 to June 2024. The lidocaine group (group L) received an intravenous infusion of 1.5 mg·kg-1 of lidocaine for 15 min, 30 min prior to anesthetic induction, followed by sustained infusion at 1.5 mg·kg- 1·h- 1 until surgical closure. The control group (group C) received an equal volume of normal saline in the same manner. Compared with the group C, the time-weighted average (TWA) of Christensen score in the group L decreased by 0.42 (95% CI, 0.12 ~ 0.73, P < 0.05). Compared with the group C, the VAS at 1,3 and 5 days after surgery in the group L were lower (P < 0.05), the levels of IL-6 and TNF-α immediately after surgery and 24 h after surgery were lower (P < 0.05), and the time to first flatus and defecation was shorter (P < 0.05). No significant differences between the two groups in extubation time, PACU stay duration, incidence of postoperative nausea and vomiting (PONV), or length of postoperative hospital stay (P > 0.05). Results indicate that intravenous lidocaine effectively improved POFS in patients undergoing laparoscopic radical resection of colorectal cancer, which might be achieved by inhibiting the postoperative inflammatory response and reducing postoperative pain.

The role of intravenous lidocaine infusion in enhanced recovery after laparoscopic renal surgeries: A randomized control trial

Background and Aims

Enhanced recovery after surgery (ERAS) has been applied in various laparoscopic procedures. Intravenous lidocaine (IVL) infusion is used for laparoscopic procedures as a part of ERAS protocols. The study aimed to evaluate the role of IVL infusion in enhanced bowel recovery after laparoscopic renal surgeries.

Material and Methods

A randomized, double-blind, placebo-control trial was conducted on 80 patients (with American Society of Anesthesiologists physical status I-II) who presented for laparoscopic renal surgeries under general anesthesia. The study period was from Oct 2018 to Sept 2019. By computer-generated codes, patients were randomly divided into two groups: L (lidocaine) and C (control). Group L received an intravenous (IV) bolus (1.5 mg/kg) of 2% lidocaine over 2 min, followed by an IV lidocaine infusion at the rate of 1.5 mg/kg/h until skin closure. Group C received the same volume of bolus followed by normal saline infusion. Patients were monitored for bowel functions, total hospital stay, and total analgesic consumption. Student's t-test and Chi-square test were used for quantitative data and occurrence of events, respectively. P <0.05 was considered to be statistically significant.

Results

First bowel sound, flatus, and defecation occurred in 16.4 ± 2.50, 26.7 ± 9.02, and 39.1 ± 6.31 h, respectively, in group L and 18.2 ± 2.90, 32.3 ± 3.11, and 43.3 ± 4.22 h, respectively, in group C (P = 0.006, 0.001, and 0.01, respectively). Total hospital stay was 4.0 ± 0.74 and 5.3±0.0.91 days in groups L and C, respectively (P < 0.001).

Conclusion

The present study concluded that IVL could enhance the bowel recovery and reduce total hospital stay after laparoscopic renal surgeries.

Effect of co-administration of intravenous lidocaine and dexmedetomidine on the recovery from laparoscopic hysterectomy: a randomized controlled trial

BACKGROUND

Some evidences have reported that intravenous lidocaine and dexmedetomidine alone can improve the quality of recovery after surgery. The main purpose of our study to explore whether co-administration of lidocaine and dexmedetomidine infusion could further improve the quality of recovery after laparoscopic hysterectomy compared to either lidocaine or dexmedetomidine administration.

METHODS

A total of 160 subjects were randomly allocated to four groups: the control group (group C) received an equal volume of normal saline, the lidocaine group (group L) received lidocaine (1.5 mg/kg for bolus over 10 min before induction of anesthesia, 1.5 mg/kg/h for continuous infusion), the dexmedetomidine group (group D) received dexmedetomidine (0.5 µg/kg for bolus over 10 min before induction of anesthesia, 0.4 µg/kg/h for continuous infusion), the lidocaine plus dexmedetomidine group (group LD) received lidocaine (1.5 mg/kg for bolus over 10 min before induction of anesthesia, 1.5 mg/kg/h for continuous infusion) and dexmedetomidine combined infusion (0.5 µg/kg for bolus over 10 minutes before induction of anesthesia, 0.4 µg/kg/h for continuous infusion). The primary endpoint was the quality of recovery-40 (QoR-40) scores on postoperative day 1 (POD1). The quality of sleep on POD1, remifentanil total dose, visual analog scale (VAS) pain scores, the number of patients with self-press the pump, time to open eye and extubation, length of postanesthesia care unit (PACU) stay, the incidence of intraoperative bradycardia, hypotension, arrhythmias, hypoxemia in the PACU, and nausea or vomiting within 24 h after surgery were regarded as the secondary outcomes.

RESULTS

The total QoR-40 scores were significantly increased in groups L, D, and LD on POD1 compared with group C (all P<0.05). The total QoR-40 scores were the highest in group LD on POD1 compared to other three groups (all P<0.001). Sleep quality was significantly improved in group LD compared to other three groups on POD1 (all P<0.05). The VAS pain scores were obviously reduced at 8 h in group L and at 4, 8 h in group D after surgery compared to group C and were the lowest in group LD (all P<0.05). The number of patients with self-press the pump was significantly reduced in groups D and LD compared to group C (8(20.0%) and 27(67.5%), P<0.001; 2(5.0%) and 27(67.5%), P<0.001, respectively). Length of PACU stay significantly prolonged in groups D (21.7±3.0) and LD (25.5±4.0) compared to group C (19.6±3.3) (P=0.028, P<0.001). The incidence of intraoperative bradycardia was significantly higher in groups D and LD than in groups C and L (all P<0.001). The rate of hypoxemia was higher in groups D (55.0%) and LD (70.0%) than in groups C (15.0%) and L (20.0%) (all P<0.05). The incidence of nausea was lower in group LD (10.0%) than in group C (37.5%) (P<0.05).

CONCLUSIONS

Co-administration of lidocaine plus dexmedetomidine infusion improved to some extent the quality of recovery on POD1 compared to lidocaine and dexmedetomidine alone, but it significantly increased the incidence of intraoperative bradycardia and hypoxemia in the PACU, and prolonged the length of PACU stay.

Bacillus coagulans TBC169 probiotics for the recovery of intestinal function after gynecological laparoscopic surgery: a randomized, placebo-controlled trial

BACKGROUND

Evidence suggests that Bacillus coagulans TBC169 can improve intestinal motility.

AIM

To investigate the effectiveness and safety of Bacillus coagulans TBC169 probiotics in promoting the recovery of intestinal function after gynecological laparoscopic surgery.

METHOD

Patients who underwent laparoscopic surgeries due to gynecological diseases were randomly assigned to the high-dose, conventional-dose, and the placebo-control groups (1:1:1 ratio). The primary outcome was the time to the first passage of flatus time (FFT). Secondary outcomes were the time to the first defecation (FDT), the time to the first bowel sounds (TFBS), the duration of hospital stay (DHS), and the incidence of postoperative adverse events (AEs).

RESULTS

Compared to the placebo-control group, shorter FFT values were observed in the conventional-dose (23.15 h vs. 29.10 h, P < 0.05) and high-dose (19.15 h vs. 29.10 h, P < 0.001) groups. Similar trends were observed regarding TFBS in the conventional-dose (18.50 h vs. 21.10 h, P < 0.05) and high-dose (15.20 h vs. 21.10 h, P < 0.001) groups. There were no significant differences in FFT and TFBS between the intervention groups. Compared to the placebo-control group, lower incidences of postoperative adverse events were observed in the conventional-dose (12.50% vs. 40.00%, P < 0.05) and the high-dose (5.00% vs. 40.00%, P < 0.001) groups. However, there were no significant differences between these intervention groups.

CONCLUSION

Bacillus coagulans TBC169 probiotics can accelerate intestinal function recovery, and reduce postoperative adverse events in patients after gynecological laparoscopic surgery. The study protocol was registered at the Chinese Clinical Trial Registry (ChiCTR2200059518).

Genetic Susceptibility Toward Nausea and Vomiting in Surgical Patients

Postoperative nausea and vomiting (PONV) are frequently occurring adverse effects following surgical procedures. Despite predictive risk scores and a pallet of prophylactic antiemetic treatments, it is still estimated to affect around 30% of the patients, reducing their well-being and increasing the burden of post-operative care. The aim of the current study was to characterize selected genetic risk factors of PONV to improve the identification of at risk patients. We genotyped 601 patients followed during the first 24 h after surgery for PONV symptoms in the absence of any antiemetic prophylaxis. These patients were recruited in the frame of a randomized, placebo controlled clinical study aiming to test the efficacy of dexamethasone as a treatment of established PONV. We examined the impact of selected single nucleotide polymorphisms (SNPs) located around 13 different genes and the predicted activity of 6 liver drug metabolizing enzymes from the cytochromes P450 family (CYP) on the occurrence and recurrence of PONV. Our genetic study confirms the importance of genetic variations in the type 3B serotonin receptor in the occurrence of PONV. Our modelling shows that integration of rs3782025 genotype in preoperative risk assessments may help improve the targeting of antiemetic prophylaxis towards patients at risk of PONV.

Effects of Lidocaine on Motor-Evoked Potentials and Somatosensory-Evoked Potentials in Patients Undergoing Intraspinal Tumour Resection: Study Protocol for a Prospective Randomized Controlled Trial

Purpose

Study Design and Methods

Discussion

Effects of lidocaine, dexmedetomidine, and their combination infusion on postoperative nausea and vomiting following laparoscopic hysterectomy: a randomized controlled trial

Background

A few studies have reported that administration of lidocaine and dexmedetomidine relieves the incidence of postoperative nausea and vomiting (PONV). We explored whether combined infusion of lidocaine plus dexmedetomidine had lower occurrence of PONV undergoing laparoscopic hysterectomy with general anesthesia.

Methods

A total of 248 women undergoing elective laparoscopic hysterectomy were allocated into the following four groups: the control group (group C, n = 62) received an equal volume of saline, the lidocaine group (group L, n = 62) received intravenous lidocaine (bolus infusion of 1.5 mg/kg over 10 min, 1.5 mg/kg/h continuous infusion), the dexmedetomidine group (group D, n = 62) received dexmedetomidine administration (bolus infusion of 0.5 µg/kg over 10 min, 0.4 µg/kg/h continuous infusion), and the lidocaine plus dexmedetomidine group (group LD, n = 62) received combination of lidocaine (bolus infusion of 1.5 mg/kg over 10 min, 1.5 mg/kg/h continuous infusion) and dexmedetomidine administration (bolus infusion of 0.5 µg/kg over 10 min, 0.4 µg/kg/h continuous infusion). The primary outcome was the incidence of nausea, vomiting, and PONV during the first 48 h after surgery. The secondary outcomes included the incidence of total 24 h PONV after surgery, intraoperative remifentanil requirement, postoperative pain visual analogue scale (VAS) scores and fentanyl consumption, the incidence of bradycardia, agitation, shivering, and mouth dry during post-anesthesia care unit (PACU) stay period.

Results

The occurrence of nausea and PONV in group LD (5.0 and 8.3%) at 0–2 h after operation was lower than group C (21.7 and 28.3%) (P < 0.05). There was no statistically significant difference with respect to occurrence of nausea and PONV in groups L (13.3 and 20.0%) and D (8.3 and 13.3%) at 0–2 h after operation compared to group C (21.7 and 28.3%). The incidence of nausea, vomiting, and PONV at 2–24 and 24–48 h after surgery in all four groups was not statistically significant. The incidence of total 24 h PONV in group LD (33.3%) was significantly decreased compared to group C (60.0%) (P < 0.05). The cumulative consumption of fentanyl at 6 and 12 h after surgery was significantly reduced in group LD compared to other three groups (P < 0.05). The pain VAS scores were significantly decreased at 2, 6, and 12 h after operation in group LD compared to other three groups (P < 0.05). Remifentanil dose in the intraoperative period was significantly lower in groups LD and D compared with groups C and L (P < 0.05). The number of mouth dry, bradycardia, and over sedation during the PACU stay period was markedly increased in group LD (28.3, 30.0, and 35.0%, respectively) compared with groups C (1.7, 1.7, and 3.3%, respectively) and L (3.3, 5.0, and 6.7%, respectively) (P < 0.05).

Conclusions

Lidocaine combined with dexmedetomidine infusion markedly decreased the occurrence of nausea and PONV at 0–2 h as well as the total 24 h PONV. However, it significantly increased the incidence of mouth dry, bradycardia, and over sedation during the PACU stay period after laparoscopic hysterectomy with general anesthesia.

Trial registration

ClinicalTrials.gov (NCT03809923), registered on January 18, 2019.

Effects of different thermal insulation methods on the nasopharyngeal temperature in patients undergoing laparoscopic hysterectomy: a prospective randomized controlled trial

Background

This study explored the comparison of the thermal insulation effect of incubator to infusion thermometer in laparoscopic hysterectomy.

Methods

We assigned 75 patients enrolled in the study randomly to three groups: Group A: Used warming blanket; group B: Used warming blanket and infusion thermometer; group C: Used warming blanket and incubator. The nasopharyngeal temperature at different time points during the operation served as the primary outcome.

Results

The nasopharyngeal temperature of the infusion heating group was significantly higher than that of the incubator group 60 min from the beginning of surgery (T3): 36.10 ± 0.20 vs 35.81 ± 0.20 (P<0.001)90 min from the beginning of surgery (T4): 36.35 ± 0.20 vs 35.85 ± 0.17 (P<0.001). Besides, the nasopharyngeal temperature of the incubator group was significantly higher compared to that of the control group 60 min from the beginning of surgery (T3): 35.81 ± 0.20 vs 35.62 ± 0.18 (P<0.001); 90 min from the beginning of surgery (T4): 35.85 ± 0.17 vs 35.60 ± 0.17 (P<0.001). Regarding the wake-up time, that of the control group was significantly higher compared to the infusion heating group: 24 ± 4 vs 21 ± 4 (P = 0.004) and the incubator group: 24 ± 4 vs 22 ± 4 (P = 0.035).

Conclusion

Warming blanket (38 °C) combined infusion thermometer (37 °C) provides better perioperative thermal insulation. Hospitals without an infusion thermometer can opt for an incubator as a substitute.

Trial registration

This trial was registered with ChiCTR2000039162, 20 October 2020.

Intravenous Infusion of Lidocaine Can Accelerate Postoperative Early Recovery in Patients Undergoing Surgery for Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is defined by intermittent and recurrent episodes of partial or complete obstruction of the upper airway during sleep. Intermittent and recurrent hypoxia/reoxygenation is the main pathophysiological mechanism of OSA. Its consequences include systemic inflammation, activation of the sympathetic nervous system, and release of oxygen free radicals. Infusion of intravenous (IV) lidocaine has anti-inflammatory, antihyperalgesic, and analgesic properties, supporting its use as an anesthetic adjuvant. Lidocaine can reduce nociception and/or cardiovascular responses to surgical stress, as well as postoperative pain and/or analgesic requirements. Because of the high prevalence of OSA in obese patients, the use of opioids to manage postoperative pain in that population is often accompanied by the development of adverse respiratory events, such as hypoventilation and hypoxemia. IV infusion of lidocaine has been shown to enhance the quality of early recovery after laparoscopic bariatric and upper airway surgery. However, limited evidence exists regarding its use in patients undergoing surgery for OSA. In addition, whether IV infusion of lidocaine can improve postoperative early recovery in patients undergoing surgery for OSA remains unknown. Therefore, we hypothesized that IV infusion of lidocaine can improve postoperative early recovery in patients undergoing surgery for OSA. Perioperative infusion also may be a promising analgesic adjunct to enhanced recovery after surgery (ERAS) protocols.

Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review

Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) remain common and distressing complications following surgery. The routine use of opioid analgesics for perioperative pain management is a major contributing factor to both PONV and PDNV after surgery. PONV and PDNV can delay discharge from the hospital or surgicenter, delay the return to normal activities of daily living after discharge home, and increase medical costs. The high incidence of PONV and PDNV has persisted despite the introduction of many new antiemetic drugs (and more aggressive use of antiemetic prophylaxis) over the last two decades as a result of growth in minimally invasive ambulatory surgery and the increased emphasis on earlier mobilization and discharge after both minor and major surgical procedures (e.g. enhanced recovery protocols). Pharmacologic management of PONV should be tailored to the patient’s risk level using the validated PONV and PDNV risk-scoring systems to encourage cost-effective practices and minimize the potential for adverse side effects due to drug interactions in the perioperative period. A combination of prophylactic antiemetic drugs with different mechanisms of action should be administered to patients with moderate to high risk of developing PONV. In addition to utilizing prophylactic antiemetic drugs, the management of perioperative pain using opioid-sparing multimodal analgesic techniques is critically important for achieving an enhanced recovery after surgery. In conclusion, the utilization of strategies to reduce the baseline risk of PONV (e.g. adequate hydration and the use of nonpharmacologic antiemetic and opioid-sparing analgesic techniques) and implementing multimodal antiemetic and analgesic regimens will reduce the likelihood of patients developing PONV and PDNV after surgery.