围手术期利多卡因输注对接受电视辅助胸腔镜根治性肺切除术患者慢性术后疼痛的影响。

Effect of lidocaine perioperative infusion on chronic postsurgical pain in patients undergoing thoracoscopic radical pneumonectomy.

机构信息

Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325027, China.

Department of Anesthesiology, People's Hospital of Ruian, The Third Affiliated Hospital of Wenzhou Medical University, Ruian, 325200, Zhejiang, People's Republic of China.

出版信息

BMC Anesthesiol. 2022 Aug 9;22(1):255. doi: 10.1186/s12871-022-01795-2.

DOI:10.1186/s12871-022-01795-2

PMID:35945486

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9361613/

Abstract

BACKGROUND

Thoracoscopic radical pneumonectomy is associated with a high incidence of postoperative chronic pain. Studies on the benefits of lidocaine intravenous infusion during the perioperative period were still controversial in thoracoscopic surgery.

METHODS

Sixty-four lung cancer patients scheduled for thoracoscopic radical pneumonectomy were randomly divided into two groups: normal saline group (control group) or lidocaine group. In the lidocaine group, 1.5 mg/kg lidocaine was administered during the anesthesia induction, and 2 mg·kg·h lidocaine was continuously intravenous infused until the end of the surgery. After the surgery, a mixture of 2 μg/kg sufentanil and 10 mg/kg lidocaine was continuously intravenous infused by postoperative patient-controlled intravenous analgesia pump (100 ml). In the control group, the same volume of normal saline was administered according to the calculation of lidocaine during anesthesia induction, maintenance and postoperative patient-controlled intravenous analgesia. The primary outcome was the incidence of chronic postoperative pain at 3 months after the surgery. The secondary outcomes include the incidence of chronic postoperative pain at 6 months after the surgery; the effect of lidocaine on postoperative pain within the first 24 and 48 h; total amount of sufentanil administered during entire procedure and the number of PCA triggers within 48 h after surgery.

RESULTS

Compared with the control group, the incidence of chronic pain at 3 months after the surgery was significantly lower (13 cases, 46.4% vs. 6 cases, 20.7%, p < 0.05), but no significant difference at 6 months between two group. The cumulative dosage of sufentanil in perioperative period was significantly lower (149.64 ± 18.20 μg vs. 139.47 ± 16.75 μg) (p < 0.05), and the number of PCA triggers (8.21 ± 4.37 vs. 5.83 ± 4.12, p < 0.05) was significantly greater in the control group. The NRS pain scores at 24 h (1.68 ± 0.72 vs. 1.90 ± 0.86) and 48 h (1.21 ± 0.42 vs. 1.20 ± 0.41) after the operation were no significant difference.

CONCLUSION

Perioperative infusion lidocaine significantly reduced the number of PCA triggers and the incidence of chronic postoperative pain at 3 months after the thoracoscopic radical pneumonectomy.

TRIAL REGISTRATION

http://www.chictr.org.cn : ChiCTR1900024759, frist registration date 26/07/2019.

摘要

背景

胸腔镜根治性肺切除术与术后慢性疼痛的高发生率有关。在胸腔镜手术中，关于围手术期利多卡因静脉输注的益处的研究仍存在争议。

方法

64 例计划行胸腔镜根治性肺切除术的肺癌患者随机分为两组：生理盐水组（对照组）或利多卡因组。在利多卡因组，在麻醉诱导时给予 1.5mg/kg 利多卡因，在手术结束时持续静脉输注 2mg·kg·h 利多卡因。手术后，通过术后患者自控静脉镇痛泵（100ml）持续输注 2μg/kg 舒芬太尼和 10mg/kg 利多卡因的混合物。在对照组中，根据麻醉诱导、维持和术后患者自控静脉镇痛期间利多卡因的计算，给予相同体积的生理盐水。主要结局是术后 3 个月慢性术后疼痛的发生率。次要结局包括术后 6 个月慢性术后疼痛的发生率；利多卡因对术后 24 小时和 48 小时内疼痛的影响；整个过程中舒芬太尼的总用量和术后 48 小时内 PCA 触发次数。

结果

与对照组相比，术后 3 个月慢性疼痛的发生率显著降低（13 例，46.4%比 6 例，20.7%，p<0.05），但两组术后 6 个月差异无统计学意义。围手术期舒芬太尼的累积剂量显著降低（149.64±18.20μg比 139.47±16.75μg）（p<0.05），对照组 PCA 触发次数（8.21±4.37 比 5.83±4.12，p<0.05）显著增加。术后 24 小时（1.68±0.72 比 1.90±0.86）和 48 小时（1.21±0.42 比 1.20±0.41）的 NRS 疼痛评分无显著差异。