Effect of perioperative lidocaine application on inflammatory factors, immune function, and quality of early postoperative recovery in patients undergoing video-assisted thoracoscopic surgery: a randomized controlled trial.
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OBJECTIVE: To assess the effect of low-dose perioperatively continuous infusion of lidocaine on postoperative inflammation, immune function and quality of recovery in patients undergoing video-assisted thoracoscopic surgery (VATS). METHODS: Patients with lung cancer aged 18-65 years, undergoing elective VATS were randomized into lidocaine intervention (L) and standard care (C) groups. For patients in Group L, 1 mg/kg lidocaine was intravenously injected within approximately 10 min during the induction of anesthesia, followed by a continuous infusion of lidocaine at a rate of 1.5 mg/kg/h until the patient left the operating room. The postoperative analgesia plan included 2% lidocaine at 5 mg/kg. Group C was given an equal volume of normal saline as a control.The primary outcomes were plasma concentrations of tumor necrosis factor-α (TNF-α), interleukin-1(IL-1), and interleukin-6 (IL-6), along with T lymphocyte counts of CD3+, CD4+, CD8+, and the CD4+/CD8+ ratio before anesthesia induction (T1), and 24 h (T2) and 48 h (T3) postoperatively. Secondary outcomes included the visual analog scale (VAS) for pain at rest and during movement, Time to first post-operative rescue analgesia, Cumulative OME(the oral morphine equivalents) at 24 h, along with the frequency and severity of postoperative nausea and vomiting (PONV) within the initial 48-h after surgery. RESULTS: In Group C and Group L, compared with preoperative levels, the levels of CD3 + , CD4 + and the ratio of CD4 + /CD8 + were significantly decreased at 24 and 48 h postoperatively, while the levels of TNF-α, IL-1 and IL-6 were significantly increased (P < 0.05). Compared with Group C, in Group L, the levels of CD3 + , CD4 + and the ratio of CD4 + /CD8 + were significantly increased at 24 and 48 h postoperatively, while the levels of TNF-α, IL-1 and IL-6 were significantly decreased (P < 0.05).Additionally, the L group experienced less pain on the movement VAS, the decreased OME dosage and a lower rate of PONV within 48 h postoperatively than the C group (P < 0.05). CONCLUSION: Intravenous infusion of lidocaine during the perioperative period was effective in reducing postoperative inflammatory response and the postoperative suppression of cellular immune function in the body, as well as significantly reducing the level of postoperative pain and the incidence of PONV in patients undergoing VATS.