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

Abstract

Introduction: Many clinical trials have demonstrated the benefits of intraoperative systemic lidocaine administration in major abdominal surgeries. We tested the hypothesis that systemic lidocaine is associated with an enhanced early quality of recovery in patients following laparoscopic colorectal resection.

Patients and methods: We randomly allocated 126 patients scheduled for laparoscopic colorectal surgery in a 1:1 ratio to receive either lidocaine (1.5 mg kg^-1 bolus over 10 min, followed by continuous infusion at 2 mg kg^-1 h^-1 until the end of surgery) or identical volumes and rates of saline. The primary outcome was the Quality of Recovery-15 score assessed 24 h after surgery. Secondary outcomes were areas under the pain numeric rating scale curve over time, 48-h morphine consumption, and adverse events.

Results: Compared with saline, systemic lidocaine improved the Quality of Recovery-15 score 24 h postoperatively, with a median difference of 4 (95% confidence interval: 1-6; p = 0.015). Similarly, the area under the pain numeric rating scale curve over 48 h at rest and on movement was reduced in the lidocaine group (p = 0.004 and p < 0.001, respectively). However, these differences were not clinically meaningful. Lidocaine infusion reduced the intraoperative remifentanil requirements but not postoperative 48-h morphine consumption (p < 0.001 and p = 0.34, respectively). Additionally, patients receiving lidocaine had a quicker and earlier return of bowel function, as indicated by a shorter time to first flatus (log-rank p < 0.001), yet ambulation time was similar between groups (log-rank test, p = 0.11).

Conclusions: In patients undergoing laparoscopic colorectal surgery, intraoperative systemic lidocaine resulted in statistically but not clinically significant improvements in quality of recovery (see Graphical Abstract).Trial registration: Chinese Clinical Trial Registry; ChiCTR1900027635.

Keywords: Colorectal surgery; lidocaine; pain management; post-surgical recovery.

Graphical abstract

Figure 1.

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

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).

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.