Tian Bin, Wu Yumin, Zhang Wenjie, Liu Ruijuan, Qu Song, Zhang Zhenying, Yan Wenjun
Department of Anesthesiology, Gansu Provincial Hospital, Lanzhou, People's Republic of China.
Department of Anesthesiology, Nanzhang People's Hospital, Xiangyang, People's Republic of China.
Drug Des Devel Ther. 2025 Sep 19;19:8541-8553. doi: 10.2147/DDDT.S538226. eCollection 2025.
We investigated the efficacy and safety of lidocaine-based patient-controlled intravenous analgesia (PCIA), compared with sufentanil-based PCIA on postoperative pain and recovery quality in patients undergoing thoracoscopic lung surgery.
We recruited 160 patients undergoing thoracoscopic lung surgery who were randomized to receive lidocaine-based PCIA (1.5 mg/kg/h) or sufentanil-based PCIA (2 μg/mL) within 48 hours postoperatively. The primary endpoint was visual analogue scores (VAS) pain scores at 6, 12, 24, and 48 hours postoperatively. Postoperative quality of recovery-15 (QoR-15) scores and other prespecified endpoints were also recorded.
VAS pain scores at rest and during coughing in the lidocaine group were significantly lower at 6, 12, and 24 hours postoperatively (<0.05), with no difference at 48 hours (0.05). QoR-15 scores in the lidocaine group were higher on postoperative day (POD) 1 (<0.001) and POD2 (<0.001), with significant differences in the two dimensions of postoperative physical comfort and pain (<0.001). The lidocaine group also experienced a shorter time to first flatus, defecation, and ambulation (<0.05), with no difference in the length of postoperative hospitalization and thoracic drainage time (0.05). The serum IL-6, TNF-α, IL-8, cortisol, and epinephrine concentrations were lower in the lidocaine group on POD1 and POD2 (<0.05). The incidence of postoperative nausea and vomiting in the lidocaine group was lower (<0.05), with no differences in other adverse events (>0.05).
Compared with sufentanil-based PCIA, lidocaine-based PCIA significantly relieved postoperative pain and improved recovery quality after thoracoscopic lung surgery with fewer postoperative adverse events, which is a considerable choice for postoperative analgesia.
This study was retrospectively registered at the Chinese Clinical Trial Registry on March 1st, 2023 (number ChiCTR2300068840).
我们研究了利多卡因自控静脉镇痛（PCIA）与舒芬太尼自控静脉镇痛相比，对胸腔镜肺手术患者术后疼痛及恢复质量的疗效和安全性。
我们招募了160例接受胸腔镜肺手术的患者，将其随机分为两组，分别在术后48小时内接受基于利多卡因的PCIA（1.5毫克/千克/小时）或基于舒芬太尼的PCIA（2微克/毫升）。主要终点是术后6、12、24和48小时的视觉模拟评分（VAS）疼痛评分。还记录了术后恢复质量-15（QoR-15）评分及其他预先设定的终点指标。
利多卡因组术后6、12和24小时静息及咳嗽时的VAS疼痛评分显著更低（<0.05），48小时时无差异（>0.05）。利多卡因组术后第1天（POD1）（<0.001）和第2天（POD2）（<0.001）的QoR-15评分更高，术后身体舒适度和疼痛这两个维度有显著差异（<0.001）。利多卡因组首次排气、排便和下床活动时间也更短（<0.05），术后住院时间和胸腔引流时间无差异（>0.05）。利多卡因组术后第1天和第2天血清白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、白细胞介素-8（IL-8）、皮质醇和肾上腺素浓度更低（<0.05）。利多卡因组术后恶心呕吐发生率更低（<0.05），其他不良事件无差异（>0.05）。
与基于舒芬太尼的PCIA相比，基于利多卡因的PCIA能显著减轻胸腔镜肺手术后的疼痛，提高恢复质量，且术后不良事件更少，是术后镇痛不错的选择。
本研究于2023年3月1日在中国临床试验注册中心进行回顾性注册（注册号ChiCTR2300068840）。
