Kim Hyung Ook, Lee Sung Ryol, Choi Won Joon, Kim Hungdai
Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
ANZ J Surg. 2014 Jul-Aug;84(7-8):539-44. doi: 10.1111/ans.12550. Epub 2014 Feb 24.
Early oral feeding (EOF) following colorectal surgery can accelerate patient recovery and shorten hospital stay. However, some patients are intolerable to postoperative early oral feeding. The aim of this study was to evaluate the tolerability of EOF following laparoscopic colorectal cancer surgery and the effects of intravenous lidocaine.
The cohort in this randomized, placebo-controlled trial (ClinicalTrial.gov, NCT01346917) comprised of 77 patients undergoing elective laparoscopic colorectal cancer surgery. For patients randomized to the lidocaine group, a loading dose of 1 mg/kg lidocaine prior to skin incision, and a continuous dose of 1 mg/kg/h lidocaine with 90 mg ketorolac (non-steroidal anti-inflammatory drug) (in normal saline, total 240 mL) was administered for 24 h. Patients randomized to the placebo group received a loading dose of 5 mL saline and a continuous dose of 90 mg ketorolac in 240 mL saline. The primary outcome measure was prevalence of postoperative nausea/vomiting and intolerance to EOF.
Altogether, 68 patients completed the study and were analyzed. Postoperative nausea and vomiting were higher in the control group but did not reach statistical significance (P = 0.054). Tolerability of EOF was 96.9% in the lidocaine group and 91.7% in the control group (P = 0.62). There was no difference in postoperative pain, opioid consumption, bowel function recovery or postoperative hospital stay.
Perioperative intravenous lidocaine administered for laparoscopic colorectal cancer surgery might reduce postoperative nausea and vomiting. However, a high tolerability to EOF following colorectal surgery can be achieved by laparoscopic surgery alone without other supportive treatment.
结直肠手术后早期经口进食（EOF）可加速患者康复并缩短住院时间。然而，一些患者无法耐受术后早期经口进食。本研究的目的是评估腹腔镜结直肠癌手术后早期经口进食的耐受性以及静脉注射利多卡因的效果。
本随机、安慰剂对照试验（ClinicalTrial.gov，NCT01346917）的队列包括77例行择期腹腔镜结直肠癌手术的患者。随机分配至利多卡因组的患者，在皮肤切开前给予1mg/kg利多卡因负荷剂量，并持续给予1mg/kg/h利多卡因与90mg酮咯酸（非甾体类抗炎药）（溶于生理盐水，共240mL），持续24小时。随机分配至安慰剂组的患者接受5mL生理盐水负荷剂量，并在240mL生理盐水中持续给予90mg酮咯酸。主要结局指标是术后恶心/呕吐的发生率和对早期经口进食的不耐受情况。
共有68例患者完成研究并进行分析。对照组术后恶心和呕吐发生率较高，但未达到统计学意义（P = 0.054）。利多卡因组早期经口进食的耐受性为96.9%，对照组为91.7%（P = 0.62）。术后疼痛、阿片类药物用量、肠功能恢复或术后住院时间无差异。
腹腔镜结直肠癌手术围手术期静脉注射利多卡因可能会减少术后恶心和呕吐。然而，仅通过腹腔镜手术即可实现结直肠手术后对早期经口进食的高耐受性，无需其他支持治疗。
