The role of lidocaine in cancer progression and patient survival

Abstract

Since its development in 1943, lidocaine has been one of the most commonly used local anesthesia agents for surgical procedures. Lidocaine alters neuronal signal transmission by prolonging the inactivation of fast voltage-gated sodium channels in the cell membrane of neurons, which are responsible for action potential propagation. Recently, it has attracted attention due to emerging evidence suggesting its potential antitumor properties, particularly in the in vitro setting. Further, local administration of lidocaine around the tumor immediately prior to surgical removal has been shown to improve overall survival in breast cancer patients. However, the exact mechanisms driving these antitumor effects remain largely unclear. In this article, we will review the existing literature on the mechanism of lidocaine as a local anesthetic, its effects on the cancer cells and the tumor microenvironment, involved pathways, and cancer progression. Additionally, we will explore recent reports highlighting its impact on clinical outcomes in cancer patients. Taken together, there remains significant ambiguity surrounding lidocaine's functions and roles in cancer biology, particularly in perioperative setting.

Keywords: Cancer; Lidocaine; Local anesthesia; Surgery; Survival; Tumor microenvironment.

Figure 1.. The direct and indirect effect of lidocaine.

(1) Direct effect: Lidocaine affects cancer cells and stromal cells including neurons, blood vessels, and immune cells. (2) Indirect effect: Lidocaine reduces pain, increases mobility, decreases opioid consumption, and alleviates the stress response as an anesthetic (Created with BioRender.com).

Figure 2.. Graphic summary of Badwe et al. 2023 study.

Peritumoral lidocaine was injected 7-10 minutes prior to surgical intervention, significantly enhancing patient survival (Created with BioRender.com).