Liu Ke-Peng, Dai Jing, Huang Fu-Rong, Deng Hui-Wei, Wang Qi, Liu Yun, Chen Yong, Mo Lilong, Cao Fangni, Zhang Yan, Guo Hua-Jing, Wang Xian-Xue
Department of Anesthesiology, Zhongshan City People's Hospital, Zhongshan, Guangdong, China.
Department of Anesthesiology, Changde Hospital, Xiangya School of Medicine, Central South University (Department of Anesthesiology, The First People's Hospital of Changde City), Changde, China.
Curr Ther Res Clin Exp. 2025 Jul 30;103:100808. doi: 10.1016/j.curtheres.2025.100808. eCollection 2025.
In patients undergoing gastrointestinal surgery, enhancing perioperative cognitive function and facilitating expedited postoperative recovery are critical components for achieving swift rehabilitation. Intravenous administration of lidocaine has been shown to mitigate the perioperative inflammatory response in surgical patients; however, its influence on postoperative cognitive performance remains unassessed. Consequently, this study was conducted to investigate the impact of intravenous lidocaine on postoperative cognitive function in participants undergoing laparoscopic surgery for colorectal cancer.
We performed a prospective, randomized controlled trial at The First People's Hospital of Changde City and Zhongshan People's Hospital to assess the impact of intravenous lidocaine on postoperative cognitive dysfunction (POCD) in patients undergoing laparoscopic radical resection for colorectal carcinoma. The primary endpoints of our investigation included Mini-Mental State Examination (MMSE) scores measured preoperatively and 7 days postoperatively, as well as the incidence of POCD at the 7-day mark following surgery. Secondary outcomes comprised an evaluation of recovery parameters in the postanesthesia care unit, overall length of hospitalization, and the prevalence of postoperative complications in both study cohorts.
The occurrence of POCD at day 7 postsurgery was significantly lower in the lidocaine group compared to the placebo group ( < 0.05). When stratified by age, both elderly patients (≥65 years) and nonelderly patients in the lidocaine group exhibited a significantly reduced incidence of POCD on the seventh day postoperatively compared to the placebo group ( < 0.05). Preoperative MMSE scores were comparable between the two groups; however, on the seventh day after surgery, the lidocaine group had significantly higher MMSE scores than the placebo group ( < 0.05). In the nonelderly cohort, MMSE scores were also significantly elevated in the lidocaine group compared to the placebo group at day 7 postsurgery ( < 0.05). Mediation analysis indicated that lidocaine's influence on the incidence of POCD on the seventh postoperative day was partially mediated by propofol. Furthermore, there were no significant differences observed in intraoperative medication, postoperative recovery, or perioperative adverse events between the groups ( > 0.05).
Perioperative administration of intravenous lidocaine has been shown to significantly enhance cognitive function on the seventh postoperative day following laparoscopic colorectal surgery. The mediating influence of propofol on the association between lidocaine and the occurrence of POCD at this time point was determined to be 10%.
在接受胃肠道手术的患者中，增强围手术期认知功能并促进术后快速康复是实现快速康复的关键要素。已证明静脉注射利多卡因可减轻手术患者的围手术期炎症反应；然而，其对术后认知表现的影响仍未得到评估。因此，本研究旨在调查静脉注射利多卡因对接受腹腔镜结直肠癌手术患者术后认知功能的影响。
我们在常德市第一人民医院和中山市人民医院进行了一项前瞻性随机对照试验，以评估静脉注射利多卡因对接受腹腔镜结直肠癌根治术患者术后认知功能障碍（POCD）的影响。我们调查的主要终点包括术前和术后7天测量的简易精神状态检查表（MMSE）评分，以及术后7天POCD的发生率。次要结果包括对麻醉后护理单元恢复参数、总体住院时间以及两个研究队列中术后并发症发生率的评估。
利多卡因组术后第7天POCD的发生率显著低于安慰剂组（<0.05）。按年龄分层时，利多卡因组的老年患者（≥65岁）和非老年患者术后第7天的POCD发生率均显著低于安慰剂组（<0.05）。两组术前MMSE评分相当；然而，术后第7天，利多卡因组的MMSE评分显著高于安慰剂组（<0.05）。在非老年队列中，术后第7天利多卡因组的MMSE评分也显著高于安慰剂组（<0.05）。中介分析表明，利多卡因对术后第7天POCD发生率的影响部分由丙泊酚介导。此外，两组在术中用药、术后恢复或围手术期不良事件方面未观察到显著差异（>0.05）。
已证明围手术期静脉注射利多卡因可显著提高腹腔镜结直肠癌手术后第7天的认知功能。丙泊酚对利多卡因与此时POCD发生之间关联的中介影响被确定为10%。
