Intravenous infusion of lidocaine as a component of opioid-free anesthesia in thoracic surgery: prospective randomized single-center observational study

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

BACKGROUND: The possibility of reducing doses of narcotic analgesics during the perioperative period is widely discussed in modern scientific literature. This direction is called opioid-free anesthesia and is used in abdominal surgery, oncology, gynecology, and other areas. Publications on the use of opioid-free anesthesia in thoracic surgery are scarce.

OBJECTIVE: To evaluate the analgesic effectiveness of intravenous lidocaine infusion as a component of anesthesia in thoracic surgery.

MATERIALS AND METHODS: Ninety patients who underwent open lobectomy or pneumonectomy were examined. Depending on the analgesic component, patients were divided into three groups: group 1 (n=30) received intravenous infusion of lidocaine, group 2 (n=30) received epidural block, and group 3 (n=30) had fentanyl infusion. Blood pressure, heart rate, cortisol, and blood serum glycemia levels were measured. The intensity of postoperative pain syndrome and the need for promedol, tramadol, and sanitation fibrobronchoscopy were assessed. Arterial hypotension and frequency of postoperative nausea and vomiting were recorded. The length of stay of the patients in the intensive care unit and hospital was recorded.

RESULTS: Cortisol levels did not differ between groups (p=0.26). The glucose level in the epidural block group was significantly lower than that in other groups (p=0.011). A significant increase in mean blood pressure and heart rate was observed in the opioid analgesia group (p <0.001). The lowest severity of pain 6 h after surgery was observed in the epidural blockade and lidocaine groups (p <0.001). Perioperative hypotension was more common in the epidural analgesia group (p=0.045). The incidence of postoperative nausea and vomiting was higher in the opioid anesthesia group (p=0.004). In the fentanyl infusion group, sanitary fibrobronchoscopy was more often required to eliminate atelectasis (p=0.039). The number of bed days spent in the ICU was significantly higher in the opioid analgesic group (p=0.002); however, no significant differences were noted between the groups regarding the number of days spent in the hospital (p=0.228).

CONCLUSION: Opioid-free anesthesia based on intravenous lidocaine infusion, as a component of anesthetic management in thoracic surgery, provides sufficient perioperative stability of hemodynamic and neuroendocrine status, has a pronounced analgesic effect, with less opioid consumption on the first day after surgery, and helps reduce the length of stay in the intensive care unit and hospital.

Full Text

Restricted Access

About the authors

Lyudmila A. Zimina

Scientific Research Institution – Ochapovsky Regional Clinical Hospital No. 1

Email: bolotina.lyuda@gmail.com
ORCID iD: 0009-0001-1819-5913
SPIN-code: 1407-4571

anesthesiologist-resuscitator

Russian Federation, 167 1st May Str., 350000, Krasnodar

Vasiliy A. Zhikharev

Scientific Research Institution – Ochapovsky Regional Clinical Hospital No. 1; Kuban State Medical University

Email: Vasilii290873@mail.ru
ORCID iD: 0000-0001-5147-5637
SPIN-code: 7406-7687

MD, Dr. Sci. (Med.), anesthesiologist-resuscitator, department assistant

Russian Federation, Krasnodar; Krasnodar

Alexander S. Bushuev

Scientific Research Institution – Ochapovsky Regional Clinical Hospital No. 1

Email: ksmukubris@mail.ru
ORCID iD: 0000-0002-1427-4032
SPIN-code: 3640-7080

MD, Cand. Sci. (Med.), anesthesiologist-resuscitator

Russian Federation, Krasnodar

Viktor A. Koriachkin

St. Petersburg State Pediatric Medical University

Email: vakoryachkin@mail.ru
ORCID iD: 0000-0002-3400-8989
SPIN-code: 6101-0578

MD, Dr. Sci. (Med.), Professor

Russian Federation, Saint Petersburg

Yuri P. Malyshev

Kuban State Medical University

Author for correspondence.
Email: malyshevyp@mail.ru
ORCID iD: 0000-0002-4191-4496
SPIN-code: 2523-3594

MD, Dr. Sci. (Med.), department professor

Russian Federation, Krasnodar

References

  1. Olausson A, Svensson CJ, Andréll P, et al. Total opioid-free general anaesthesia can improve postoperative outcomes after surgery, without evidence of adverse effects on patient safety and pain management: A systematic review and meta-analysis. Acta Anaesthesiol Scand. 2022;66(2):170–185. doi: 10.1111/aas.13994
  2. Lavand’homme P, Estebe JP. Opioid-free anesthesia: a different regard to anesthesia practice. Curr Opin Anaesthesiol. 2018;31(5):556–561. doi: 10.1097/ACO.0000000000000632
  3. Ovechkin AM, Yavorovsky AG. Opioid-free analgesia in surgery. From theory to practice. Moscow: GEOTAR-Media; 2022. (In Russ).
  4. Long YQ, Wang D, Chen S, et al. Effect of balanced opioid-free anaesthesia on postoperative nausea and vomiting after video-assisted thoracoscopic lung resection: protocol for a randomised controlled trial. BMJ Open. 2022;12(11):e066202. doi: 10.1136/bmjopen-2022-066202
  5. Massoth C, Schwellenbach J, Saadat-Gilani K, et al. Impact of opioid-free anaesthesia on postoperative nausea, vomiting and pain after gynaecological laparoscopy — a randomised controlled trial. J Clin Anesth. 2021;75:110437. doi: 10.1016/j.jclinane.2021.110437
  6. Hublet S, Galland M, Navez J, et al. Opioid-free versus opioid-based anesthesia in pancreatic surgery. BMC Anesthesiol. 2022;22(1):9. doi: 10.1186/s12871-021-01551-y
  7. Toleska M, Dimitrovski A, Dimitrovska NT. Comparation Among Opioid-Based, Low Opioid and Opioid Free Anesthesia in Colorectal Oncologic Surgery. Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2023;44(1):117–126. doi: 10.2478/prilozi-2023-0013
  8. Tochie JN, Bengono Bengono RS, Metogo JM, et al. The efficacy and safety of an adapted opioid-free anesthesia regimen versus conventional general anesthesia in gynecological surgery for low-resource settings: a randomized pilot study. BMC Anesthesiol. 2022;22(1):325. doi: 10.1186/s12871-022-01856-6
  9. Ulbing S, Infanger L, Fleischmann E, et al. The Performance of Opioid-Free Anesthesia for Bariatric Surgery in Clinical Practice. Obes Surg. 2023;33(6):1687–1693. doi: 10.1007/s11695-023-06584-5
  10. Bello M, Oger S, Bedon-Carte S, et al. Effect of opioid-free anaesthesia on postoperative epidural ropivacaine requirement after thoracic surgery: A retrospective unmatched case-control study. Anaesth Crit Care Pain Med. 2019;38(5):499–505. doi: 10.1016/j.accpm.2019.01.013
  11. Tripathy S, Rath S, Agrawal S, et al. Opioid-free anesthesia for breast cancer surgery: an observational study. J Anaesthesiol Clin Pharmacol. 2018;34(1):35–40. doi: 10.4103/joacp.JOACP_143_17
  12. Frauenknecht J, Kirkham KR, Jacot-Guillarmod A, Albrecht E. Analgesic impact of intra-operative opioids vs. opioid-free anaesthesia: a systematic review and meta-analysis. Anaesthesia. 2019;74(5):651–662. doi: 10.1111/anae.14582
  13. Bugada D, Lorini LF, Lavand’homme P. Opioid free anesthesia: evidence for short and long-term outcome. Minerva Anestesiol. 2021;87(2):230–237. doi: 10.23736/S0375-9393.20.14515-2
  14. Lersch F, Correia PC, Hight D, et al. The nuts and bolts of multimodal anaesthesia in the 21st century: a primer for clinicians. Curr Opin Anaesthesiol. 2023;36(6):666–675. doi: 10.1097/ACO.0000000000001308
  15. Strashnov VI, Zabrodin ON, Mamedov AD, Strashnov AV. Prevention of intraoperative stress and its consequences. St. Petersburg: ELBI-SPb; 2015. (In Russ).
  16. Özmen Ö, Özçelik F, Kaygın MA, et al. Evaluation of pain scoring and free cortisol levels of postoperative analgesic methods in cardiac surgery: A new perspective. Turk Gogus Kalp Damar Cerrahisi Derg. 2019;27(3):294–303. doi: 10.5606/tgkdc.dergisi.2019.15143
  17. Glushchenko VA, Mikhnin EA, Levchenko EV, Yurin RI. Markers of surgery stress in comparison of thoracoscopic and thoracotomic resections in lung cancer. Voprosy Onkologii. 2017;63(2):199–207. (In Russ). doi: 10.37469/0507-3758-2017-63-2-199-207
  18. Telegan VO, Tsagkaris C, Singh SK, Tarasenko KV. Subjective Assessments and Serum Cortisol Levels as Risk Factors of Pain Persistence in the Late Postoperative Period in Old and Oldest-Old Patients. Eur J Investig Health Psychol Educ. 2023;13(2):450–459. doi: 10.3390/ejihpe13020034
  19. Prete A, Yan Q, Al-Tarrah K, et al. The cortisol stress response induced by surgery: A systematic review and meta-analysis. Clin Endocrinol (Oxf). 2018;89(5):554–567. doi: 10.1111/cen.13820
  20. Egan TD. Are opioids indispensable for general anaesthesia? Br J Anaesth. 2019;122(6):127–135. doi: 10.1016/j.bja.2019.02.018
  21. van der Wal SE, van den Heuvel SA, Radema SA, et al. The in vitro mechanisms and in vivo efficacy of intravenous lidocaine on the neuroinflammatory response in acute and chronic pain. Eur J Pain. 2016;20(5):655–674. doi: 10.1002/ejp.794
  22. Yang W, Geng Y, Liu Y, et al. Comparison of Effects of Thoracic Epidural and Intravenous Administration of Lidocaine on Target-Controlled Infusion of Propofol and Tracheal Intubation Response During Induction of Anesthesia. J Cardiothorac Vasc Anesth. 2013;27(6):1295–1300. doi: 10.1053/j.jvca.2012.12.020
  23. Frauenknecht J, Kirkham KR, Jacot-Guillarmod A, Albrecht E. Analgesic impact of intra-operative opioids vs. opioid-free anaesthesia: a systematic review and meta-analysis. Anaesthesia. 2019;74(5):651–662. doi: 10.1111/anae.14582
  24. Grape S, Kirkham KR, Frauenknecht J, Albrecht E. Intra-operative analgesia with remifentanil vs. dexmedetomidine: a systematic review and meta-analysis with trial sequential analysis. Anaesthesia. 2019;74(6):793–800. doi: 10.1111/anae.14657
  25. Ismail S, Siddiqui AS, Rehman A. Postoperative pain management practices and their effectiveness after major gynecological surgery: An observational study in a tertiary care hospital. J Anaesthesiol Clin Pharmacol. 2018;34(4):478–484. doi: 10.4103/joacp.JOACP_387_17
  26. Bohringer C, Astorga C, Liu H. The Benefits of Opioid Free Anesthesia and the Precautions Necessary When Employing It. Transl Perioper Pain Med. 2020;7(1):152–157.
  27. Agarwala R, Morrison B. Neuraxial anaesthesia and its role in enhanced recovery after surgery: a narrative review. Digestive Medicine Research. 2022;5:20. doi: 10.21037/dmr-21-86
  28. Ovechkin AM, Bayalieva AZh, Ezhevskaya AA, et al. Postoperative analgesia. Guidelines. Annals of Critical Care. 2019;(4):9–33. (In Russ). doi: 10.21320/1818-474X-2019-4-9-33
  29. Ashagrie HE, Filatie TD, Melesse DY, Mustefa SY. The incidence and factors associated with intraoperative nausea and vomiting during cesarean section under spinal anesthesia, July 2019. An institution based cross sectional study. International Journal of Surgery Open. 2020;26:49–54. doi: 10.1016/j.ijso.2020.08.007
  30. Behem CR, Wegner JC, Pinnschmidt HO, et al. Effect of thoracic epidural anesthesia on postoperative outcome in major liver surgery: a retrospective cohort study. Langenbecks Arch Surg. 2023;408(1):168. doi: 10.1007/s00423-023-02900-w
  31. Radke JB, Owen KP, Sutter ME, et al. The effects of opioids on the lung. Clin Rev Allergy Immunol. 2014;46(1):54–64. doi: 10.1007/s12016-013

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. The level of blood cortisol in the intraoperative period (p=0.263)

Download (101KB)
Indexing metadata
3. Fig. 2. Intergroup differences in blood glucose levels at the drug removal stage Note. * — significant differences between group 2 and groups 1 and 3 (p=0.011).

Download (104KB)
Indexing metadata
4. Fig. 3. Intergroup differences in mean arterial pressure (a) and heart rate (b) at the stage of drug removal Note. * — significant differences between group 3 and groups 1 and 2, (p <0.001 and p <0.001 respectively).

Download (147KB)
Indexing metadata
5. Fig. 4. Intergroup differences in the severity of pain syndrome according to VAS 6 hours after surgery Note. * — significant differences between group 3 and groups 1 and 2 (p <0.001).

Download (94KB)
Indexing metadata
6. Fig. 5. Postoperative consumption of opioid Note. * — significant differences between groups 2 and groups 1 and 3 (p <0,001).

Download (130KB)
Indexing metadata

Copyright (c) 2023 Eco-Vector

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ ФС 77 - 55827 от 30.10.2013 г. 
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ЭЛ № ЭЛ № ФС 77 - 80651 от 15.03.2021 г.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies