肝切除术后延长静脉利多卡因输注治疗运动诱发性疼痛的疗效：一项双盲、随机、安慰剂对照试验。

Efficacy of prolonged intravenous lidocaine infusion for postoperative movement-evoked pain following hepatectomy: a double-blinded, randomised, placebo-controlled trial.

机构信息

Department of Anaesthesiology, West China Hospital, Sichuan University & The Research Units of West China, Chinese Academy of Medical Sciences, Chengdu, China.

Department of Anaesthesiology and Translational Neuroscience Centre, Laboratory of Anaesthesia and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.

出版信息

Br J Anaesth. 2023 Jul;131(1):113-121. doi: 10.1016/j.bja.2023.03.026. Epub 2023 May 16.

DOI:10.1016/j.bja.2023.03.026

PMID:37202261

Abstract

BACKGROUND

The analgesic effect of intravenous lidocaine varies with the duration of lidocaine infusion and surgery type. We tested the hypothesis that prolonged lidocaine infusion alleviates postoperative pain in patients recovering from hepatectomy over the first 3 postoperative days.

METHODS

Patients undergoing elective hepatectomy were randomly assigned to receive prolonged i.v. lidocaine treatment or placebo. The primary outcome was incidence of moderate-to-severe movement-evoked pain at 24 h postoperatively. The secondary outcomes included incidence of moderate-to-severe pain during movement and at rest throughout the first 3 postoperative days, postoperative opioid consumption, and pulmonary complications. Plasma lidocaine concentration was also monitored.

RESULTS

We enrolled 260 subjects. Intravenous lidocaine lowered the incidence of moderate-to-severe movement-evoked pain at 24 h and 48 h postoperatively (47.7% vs 67.7%, P=0.001; 38.5% vs 58.5%, P=0.001) and reduced movement-evoked pain scores (3.7 [1.7] vs 4.2 [1.6]; mean difference 0.5 [95% confidence interval {CI}: 0.1-0.9]; P=0.018) and morphine equivalent consumption (47.2 [16.7] mg vs 52.6 [19.2] mg; mean difference 5.4 mg [95% CI: 1.0-9.8]; P=0.016) at 24 h postoperatively. Lidocaine also lowered the incidence of postoperative pulmonary complications (23.1% vs 38.5%; P=0.007). Median plasma lidocaine concentrations were 1.5, 1.9, and 1.1 μg ml (inter-quartile ranges: 1.1-2.1, 1.4-2.6, and 0.8-1.6, respectively) after bolus injection, at the end of the surgery, and 24 h postoperatively.

CONCLUSIONS

Prolonged intravenous lidocaine infusion reduced the incidence of moderate-to-severe movement-evoked pain for 48 h after hepatectomy. However, the reduction in pain scores and opioid consumption by lidocaine was below the minimal clinically important difference.

CLINICAL TRIAL REGISTRATION

NCT04295330.

摘要

背景

静脉利多卡因的镇痛效果随利多卡因输注时间和手术类型而变化。我们假设延长利多卡因输注可以减轻肝切除术后前 3 天患者的术后疼痛。

方法

择期行肝切除术的患者被随机分配接受延长静脉利多卡因治疗或安慰剂。主要结局是术后 24 小时内中度至重度运动诱发疼痛的发生率。次要结局包括术后前 3 天运动和休息时中度至重度疼痛的发生率、术后阿片类药物消耗和肺部并发症。还监测了血浆利多卡因浓度。

结果

我们纳入了 260 例患者。静脉利多卡因降低了术后 24 小时和 48 小时中度至重度运动诱发疼痛的发生率（47.7%比 67.7%，P=0.001；38.5%比 58.5%，P=0.001），并降低了运动诱发疼痛评分（3.7[1.7]比 4.2[1.6]；平均差值 0.5[95%置信区间{CI}：0.1-0.9]；P=0.018）和吗啡等效消耗量（47.2[16.7]mg 比 52.6[19.2]mg；平均差值 5.4mg[95%CI：1.0-9.8]；P=0.016）在术后 24 小时。利多卡因还降低了术后肺部并发症的发生率（23.1%比 38.5%；P=0.007）。在肝切除术后 48 小时内，利多卡因的中位血浆浓度分别为 1.5、1.9 和 1.1μg/ml（四分位间距：1.1-2.1、1.4-2.6 和 0.8-1.6）在推注后、手术结束时和术后 24 小时。