Effect of Intravenous Lidocaine on Postoperative Cognitive Dysfunction in Patients Undergoing Laparoscopic Colorectal Surgery: A Two-Center, Randomized, Double-Blind Controlled Trial

IF 1.5 Q3 MEDICINE, RESEARCH & EXPERIMENTAL

Current Therapeutic Research-clinical and Experimental Pub Date : 2025-01-01 DOI:10.1016/j.curtheres.2025.100808

Ke-peng Liu , Jing Dai , Fu-rong Huang , Hui-wei Deng , Qi Wang , Yun Liu , Yong Chen , Lilong Mo , Fangni Cao , Yan Zhang , Hua-jing Guo , Xian-xue Wang

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引用次数: 0

Abstract

Background

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.

Methods

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.

Results

The occurrence of POCD at day 7 postsurgery was significantly lower in the lidocaine group compared to the placebo group (P < 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 (P < 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 (P < 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 (P < 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 (P > 0.05).

Conclusions

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%.

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静脉注射利多卡因对腹腔镜结直肠手术患者术后认知功能障碍的影响：一项双中心、随机、双盲对照试验

背景对于胃肠手术患者，增强围手术期认知功能和促进术后快速恢复是实现快速康复的关键组成部分。静脉注射利多卡因已被证明可以减轻手术患者围手术期的炎症反应；然而，其对术后认知能力的影响仍未得到评估。因此，本研究旨在探讨静脉注射利多卡因对结肠直肠癌腹腔镜手术患者术后认知功能的影响。方法在常德市第一人民医院和中山市人民医院进行前瞻性、随机对照试验，评估静脉注射利多卡因对腹腔镜大肠癌根治术患者术后认知功能障碍（POCD）的影响。我们研究的主要终点包括术前和术后7天的迷你精神状态检查（MMSE）评分，以及术后7天POCD的发生率。次要结果包括评估麻醉后护理单元的恢复参数、住院总时间和两个研究队列的术后并发症发生率。结果利多卡因组术后第7天POCD发生率明显低于安慰剂组（P < 0.05）。当按年龄分层时，利多卡因组的老年患者（≥65岁）和非老年患者在术后第7天的POCD发生率均明显低于安慰剂组（P < 0.05）。两组术前MMSE评分具有可比性；但术后第7天，利多卡因组MMSE评分显著高于安慰剂组（P < 0.05）。在非老年队列中，利多卡因组术后第7天MMSE评分也显著高于安慰剂组（P < 0.05）。中介分析表明，利多卡因对术后第7天POCD发生率的影响部分是由异丙酚介导的。此外，两组在术中用药、术后恢复、围手术期不良事件方面均无显著差异（P > 0.05）。结论术中静脉注射利多卡因可显著提高腹腔镜结直肠癌术后第7天患者的认知功能。在此时间点，异丙酚对利多卡因与POCD发生的关联的中介作用确定为10%。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Therapeutic Research-clinical and Experimental 医学-药学

CiteScore

3.50

自引率

0.00%

发文量

审稿时长

3 months

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