Department of Anaesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Anaesthesiology, Fudan University Shanghai Cancer Centre, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Department of Anaesthesiology, Fudan University Shanghai Cancer Centre, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Br J Anaesth. 2020 Aug;125(2):141-148. doi: 10.1016/j.bja.2020.03.034. Epub 2020 May 28.
Intravenous lidocaine has been shown to reduce opioid consumption and is associated with favourable outcomes after surgery. In this study, we explored whether intraoperative lidocaine reduces intraoperative opioid use and length of stay (LOS) and improves long-term survival after pancreatic cancer surgery.
This retrospective study included 2239 patients who underwent pancreatectomy from January 2014 to December 2017. The patients were divided into non-lidocaine and lidocaine (bolus injection of 1.5 mg kg at the induction of anaesthesia followed by a continuous infusion of 2 mg kg h intraoperatively) groups. The overall use of postoperative rescue analgesia and LOS were recorded. Propensity score matching was used to minimise bias, and disease-free survival and overall survival were compared between the two groups.
After propensity score matching, patient characteristics were not significantly different between groups. Intraoperative sufentanil consumption and use of postoperative rescue analgesia in the lidocaine group were significantly lower than those in the non-lidocaine group. The LOS was similar between groups. There was no significant difference in disease-free survival between groups (hazard ratio [HR]=0.913; 95% confidence interval [CI], 0.821-1.612; P=0.316). The overall survival rates at 1 and 3 yr were significantly higher in the lidocaine group than in the non-lidocaine group (68.0% vs 62.6%, P<0.001; 34.1% vs 27.2%, P=0.011). The multivariable analysis indicated that intraoperative lidocaine infusion was associated with a prolonged overall survival (HR=0.616; 95% CI, 0.290-0.783; P=0.013).
Intraoperative intravenous lidocaine infusion was associated with improved overall survival in patients undergoing pancreatectomy.
静脉注射利多卡因已被证明可减少阿片类药物的消耗，并与手术后的良好结果相关。在这项研究中，我们探讨了术中利多卡因是否可以减少术中阿片类药物的使用量和住院时间（LOS），并改善胰腺癌手术后的长期生存。
本回顾性研究纳入了 2014 年 1 月至 2017 年 12 月期间接受胰腺切除术的 2239 例患者。患者分为非利多卡因组和利多卡因组（麻醉诱导时给予 1.5mg/kg 单次推注，随后术中持续输注 2mg/kg/h）。记录总体术后补救性镇痛使用和 LOS。采用倾向评分匹配法来最小化偏倚，并比较两组间无病生存率和总生存率。
在进行倾向评分匹配后，两组患者的特征无显著差异。利多卡因组术中舒芬太尼消耗和术后补救性镇痛使用明显低于非利多卡因组。两组 LOS 相似。两组间无病生存率无显著差异（风险比[HR]=0.913；95%置信区间[CI]，0.821-1.612；P=0.316）。利多卡因组的 1 年和 3 年总生存率显著高于非利多卡因组（68.0% vs 62.6%，P<0.001；34.1% vs 27.2%，P=0.011）。多变量分析表明，术中利多卡因输注与总生存率延长相关（HR=0.616；95%CI，0.290-0.783；P=0.013）。
术中静脉内利多卡因输注与接受胰腺切除术的患者总生存率的提高相关。
