Surgery-induced stimulation of the inflammatory response plays a major role in the development of several postoperative disorders.
Local anesthetics possess anti-inflammatory activity and are thought to positively affect patients' outcome after surgery.
Dr Susanne Herroeder and colleagues from Germany characterized the beneficial effects of perioperative systemic lidocaine on length of hospital stay, gastrointestinal motility, and the inflammatory response after colorectal surgery.
|Lidocaine significantly accelerated return of bowel function|
|Annals of Surgery|
The research team undertook a double-blinded, randomized, and placebo-controlled trial.
The team evaluated beneficial effects of systemic lidocaine to provide insights into underlying mechanisms.
The team found 60 patients undergoing colorectal surgery, not willing or unable to receive an epidural catheter.
The researchers randomly assigned the patients to lidocaine or placebo treatment.
Before induction of general anesthesia, an intravenous lidocaine bolus was administered followed by a continuous lidocaine infusion until 4 hours postoperatively.
Length of hospital stay, gastrointestinal motility, and pain scores were recorded.
The research team also determined plasma levels or expression of pro- and anti-inflammatory mediators.
The researchers found that lidocaine significantly accelerated return of bowel function, and shortened length of hospital stay by one day.
No difference could be observed in daily pain ratings.
The team noted that elevated plasma levels of IL-6, IL-8, complement C3a, and IL-1ra were attenuated by systematic lidocaine.
In addition, the researchers observed that expression of CD11b, l- and P-selectin, and platelet-leukocyte aggregates were significantly attenuated by systemic lidocaine.
Dr Herroeder‘s team concluded, "Perioperative intravenous lidocaine not only improved gastrointestinal motility but also shortened length of hospital stay significantly."
"Anti-inflammatory activity modulating the surgery-induced stress response may be one potential mechanism."
"Systemic lidocaine may thus provide a convenient and inexpensive approach to improve outcome for patients not suitable for epidural anesthesia."