Abstract
BackgroundSurgical-related inflammatory responses have negative effects on postoperative recovery. Intravenous (IV) lidocaine and dexmedetomidine inhibits the inflammatory response. We investigated whether the co-administration of lidocaine and dexmedetomidine could further alleviate inflammatory responses compared with lidocaine or dexmedetomidine alone during laparoscopic hysterectomy.MethodsA total of 160 patients were randomly allocated into four groups following laparoscopic hysterectomy: the control group (group C) received normal saline, the lidocaine group (group L) received lidocaine (bolus infusion of 1.5 mg/kg over 10 min, 1.5 mg/kg/h continuous infusion), the dexmedetomidine group (group D) received dexmedetomidine (bolus infusion of 0.5 μg/kg over 10 min, 0.4 μg/kg/h continuous infusion), and the lidocaine plus dexmedetomidine group (group LD) received a combination of lidocaine (bolus infusion of 1.5 mg/kg over 10 min, 1.5 mg/kg/h continuous infusion) and dexmedetomidine (bolus infusion of 0.5 μg/kg over 10 min, 0.4 μg/kg/h continuous infusion). The levels of plasma interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) at different time points were the primary outcomes. Secondary outcomes included hemodynamic variables, postoperative visual analogue scale (VAS) scores, time to first flatus, and incidence of nausea and vomiting after surgery.ResultsThe levels of plasma IL-1, IL-6, and TNF-α were lower in groups D and LD than in group C and were lowest in group LD at the end of the procedure and 2 h after the operation (P < 0.05). The VAS scores were decreased in groups D and LD compared with group C (P < 0.05). The heart rate (HR) was decreased at the end of the procedure and 2 h after the operation in groups D and LD compared to groups C and L (P < 0.001). The mean blood pressure (MBP) was lower at 2 h after the operation in groups L, D, and LD than in group C (P < 0.001). There was a lower incidence of postoperative nausea and vomiting (PONV) in group LD than in group C (P < 0.05).ConclusionsThe combination of lidocaine and dexmedetomidine significantly alleviated the inflammatory responses, decreased postoperative pain, and led to fewer PONV in patients undergoing laparoscopic hysterectomy.Trial registrationClinicalTrials.gov (NCT03276533), registered on August 23, 2017.
Highlights
Surgical-related inflammatory responses have negative effects on postoperative recovery
We hypothesized that the coadministration of lidocaine and dexmedetomidine could further decrease the levels of plasma tumor necrosis factor-α (TNF-α), IL-6, and IL-1 compared with lidocaine and dexmedetomidine alone after laparoscopic hysterectomy
Patients in group LD received a bolus infusion of lidocaine (2%; 1.5 mg/kg) and dexmedetomidine (0.5 μg/kg) over 10 min before the induction of anesthesia, and lidocaine and dexmedetomidine were infused at a rate of 1.5 mg/kg/h and 0.4 μg/kg/h, respectively, which were ceased 30 min before the end of the operation
Summary
Surgical-related inflammatory responses have negative effects on postoperative recovery. Laparoscopic procedures are widely adopted for gynecological patients due to certain benefits, including decreased intensity of pain after surgery, improved postoperative recovery of intestinal function, and improved cosmetic effects [1]. Animal and clinical studies have revealed that the systemic administration of dexmedetomidine may exert anti-inflammatory effects [11, 12]. Our previous study indicated that dexmedetomidine plus lidocaine infusion may further decrease the intensity of postoperative pain, lower the requirement of fentanyl after surgery, and accelerate bowel function recovery than lidocaine or dexmedetomidine infusion alone [16]. Intravenous lidocaine and dexmedetomidine infusion alone may exert anti-inflammatory efficacy, the degree to which the combination of lidocaine and dexmedetomidine infusion inhibits the inflammatory response has not been evaluated. We hypothesized that the coadministration of lidocaine and dexmedetomidine could further decrease the levels of plasma TNF-α, IL-6, and IL-1 compared with lidocaine and dexmedetomidine alone after laparoscopic hysterectomy
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