Department of Anesthesiology, The Affiliated Anqing Hospital of Anhui Medical University, Anqing, 246000, China.
Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230032, China.
BMC Anesthesiol. 2021 Jan 6;21(1):3. doi: 10.1186/s12871-020-01219-z.
Surgical-related inflammatory responses have negative effects on postoperative recovery. Intravenous (IV) lidocaine and dexmedetomidine inhibits the inflammatory response. We investigated whether the co-administration of lidocaine and dexmedetomidine could further alleviate inflammatory responses compared with lidocaine or dexmedetomidine alone during laparoscopic hysterectomy.
A total of 160 patients were randomly allocated into four groups following laparoscopic hysterectomy: the control group (group C) received normal saline, the lidocaine group (group L) received lidocaine (bolus infusion of 1.5 mg/kg over 10 min, 1.5 mg/kg/h continuous infusion), the dexmedetomidine group (group D) received dexmedetomidine (bolus infusion of 0.5 μg/kg over 10 min, 0.4 μg/kg/h continuous infusion), and the lidocaine plus dexmedetomidine group (group LD) received a combination of lidocaine (bolus infusion of 1.5 mg/kg over 10 min, 1.5 mg/kg/h continuous infusion) and dexmedetomidine (bolus infusion of 0.5 μg/kg over 10 min, 0.4 μg/kg/h continuous infusion). The levels of plasma interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) at different time points were the primary outcomes. Secondary outcomes included hemodynamic variables, postoperative visual analogue scale (VAS) scores, time to first flatus, and incidence of nausea and vomiting after surgery.
The levels of plasma IL-1, IL-6, and TNF-α were lower in groups D and LD than in group C and were lowest in group LD at the end of the procedure and 2 h after the operation (P < 0.05). The VAS scores were decreased in groups D and LD compared with group C (P < 0.05). The heart rate (HR) was decreased at the end of the procedure and 2 h after the operation in groups D and LD compared to groups C and L (P < 0.001). The mean blood pressure (MBP) was lower at 2 h after the operation in groups L, D, and LD than in group C (P < 0.001). There was a lower incidence of postoperative nausea and vomiting (PONV) in group LD than in group C (P < 0.05).
The combination of lidocaine and dexmedetomidine significantly alleviated the inflammatory responses, decreased postoperative pain, and led to fewer PONV in patients undergoing laparoscopic hysterectomy.
ClinicalTrials.gov ( NCT03276533 ), registered on August 23, 2017.
手术相关的炎症反应对术后恢复有负面影响。静脉内（IV）利多卡因和右美托咪定可抑制炎症反应。我们研究了在腹腔镜子宫切除术中，与单独使用利多卡因或右美托咪定相比，联合使用利多卡因和右美托咪定是否能进一步减轻炎症反应。
160 例患者随机分为四组：对照组（C 组）接受生理盐水，利多卡因组（L 组）接受利多卡因（1.5mg/kg 静脉推注 10 分钟，1.5mg/kg/h 持续输注），右美托咪定组（D 组）接受右美托咪定（0.5μg/kg 静脉推注 10 分钟，0.4μg/kg/h 持续输注），利多卡因加右美托咪定组（LD 组）接受利多卡因（1.5mg/kg 静脉推注 10 分钟，1.5mg/kg/h 持续输注）和右美托咪定（0.5μg/kg 静脉推注 10 分钟，0.4μg/kg/h 持续输注）联合治疗。不同时间点的血浆白细胞介素-1（IL-1）、白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）水平为主要结局。次要结局包括血流动力学变量、术后视觉模拟评分（VAS）、首次排气时间和术后恶心呕吐发生率。
与 C 组相比，D 组和 LD 组的血浆 IL-1、IL-6 和 TNF-α 水平较低，且在手术结束和术后 2 小时时 LD 组最低（P<0.05）。与 C 组相比，D 组和 LD 组的 VAS 评分降低（P<0.05）。与 C 组和 L 组相比，D 组和 LD 组在手术结束和术后 2 小时时心率（HR）降低（P<0.001）。与 C 组相比，L 组、D 组和 LD 组在术后 2 小时时平均血压（MBP）降低（P<0.001）。与 C 组相比，LD 组术后恶心呕吐（PONV）发生率较低（P<0.05）。
利多卡因和右美托咪定联合使用可显著减轻炎症反应，减轻术后疼痛，减少腹腔镜子宫切除术后 PONV 的发生。
ClinicalTrials.gov（NCT03276533），注册于 2017 年 8 月 23 日。
