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Randomized Controlled Trial
. 2023 Aug 3:18:1275-1283.
doi: 10.2147/CIA.S419835. eCollection 2023.

Comparison of the Effects of Dexmedetomidine and Lidocaine on Stress Response and Postoperative Delirium of Older Patients Undergoing Thoracoscopic Surgery: A Randomized Controlled Trial

Yuan Lai #  1   2 , Qi Chen #  1   3 , Chunfang Xiang  4 , Guanzhu Li  5 , Ke Wei  1
Affiliations
Randomized Controlled Trial

Comparison of the Effects of Dexmedetomidine and Lidocaine on Stress Response and Postoperative Delirium of Older Patients Undergoing Thoracoscopic Surgery: A Randomized Controlled Trial

Yuan Lai et al. Clin Interv Aging. .

Abstract

Purpose: We investigated the effects of intraoperative intravenous lidocaine or dexmedetomidine infusion on inflammatory factors and cognitive function in patients undergoing thoracoscopic surgery.

Patients and methods: Patients aged >65 years undergoing elective thoracoscopic lobectomy or segmentectomy were randomly grouped as dexmedetomidine group (group D), lidocaine group (group L), and control group (group C). The plasma cortisol, interleukin-6, and tumor necrosis factor-α concentrations were measured before anesthesia (T0) and immediately (T1), 24 h (T2), and 48 h postoperatively (T3). Postoperative delirium (POD) was assessed by 3D-CAM on days 2 and 7.

Results: The cortisol concentrations decreased for all groups at T1 from T0 although they were significantly higher at T2. Group L had significantly lower interleukin-6 concentrations at T1 and T2 than the other groups (P<0.05). The interleukin-6 concentrations were significantly higher at T1, T2, and T3 than at T0 for all the groups, significantly lower for groups D and L than for group C at T1 and T2 (P<0.05), and significantly lower for group L than for group D at T2 (P<0.05). The tumor necrosis factor-α concentrations were significantly higher at T1, T2, and T3 than at T0 for all the groups and significantly lower for groups D and L than for group C at T1 and T2 (P<0.05), although they were not statistically significantly different for groups D and L. There were no statistically significant differences in the postoperative incidence of POD between the three groups on days 2 and day 7.

Conclusion: Intraoperative continuous intravenous lidocaine or dexmedetomidine infusion reduced surgical stress and inflammatory responses. The inhibitory effect of lidocaine on surgical stress remained significant for up to 24 h postoperatively without affecting patient awakening. However, the administration of either drug failed to prevent postoperative POD.

Keywords: delirium; dexmedetomidine; elderly; inflammation; lidocaine; thoracoscopic surgery.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
CONSORT flow diagram showing the number of patients at each phase of the study.
Figure 2
Figure 2
Changes in cortisol at different time points.
Figure 3
Figure 3
Changes in IL-6 at different time points.
Figure 4
Figure 4
Changes in TNF-α at different time points.
See this image and copyright information in PMC

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