Abstract
BackgroundMajor abdominal surgery is associated with endothelial glycocalyx disruption. The anti-inflammatory effects of lidocaine were recently associated with endothelial barrier protection.MethodsThis was a single-centre, parallel group, randomized, controlled, double blind, pilot trial. Forty adult patients scheduled for major abdominal surgery were included between December 2016 and March 2017 in the setting of a University Hospital in Brussels (Belgium); reasons for non-inclusion were planned liver resection and conditions associated to increased risk of local anesthetics systemic toxicity. Patients were randomized to receive either lidocaine by continuous intravenous administration or an equivalent volume of 0.9% saline.The primary endpoint was the postoperative syndecan-1 concentration (difference between groups). Near-infrared spectroscopy of the thenar eminence in association with the vascular occlusion test, and contemporary analysis of flow-mediated dilation of the brachial artery were the secondary outcomes, along with haemodynamic data. Blood samples and data were collected before surgery (T0), and at 1–3 h (T1) and 24 h (T2) post-surgery.ResultsSyndecan-1 concentration increased significantly post-surgery (P < 0.001), but without any difference between groups. The near-infrared spectroscopy-derived and flow-mediated dilation-derived variables showed minor changes unrelated to group assignment. Compared with the placebo group, the intervention group had a significantly lower peri-operative mean arterial pressure and cardiac index, despite equally conducted goal-directed haemodynamic management. Postoperative lactate concentrations were similar between groups.ConclusionsLidocaine failed to have any effect on endothelial function. Since in comparisons to other types of clinical situations, syndecan-1 was only slightly upregulated, endothelial dysfunction after major abdominal surgery might be overestimated.Trial registration« ISRCTN Registry » identifier: ISRCTN63417725. Date: 15/06/2020. Retrospectively registered.
Highlights
Major abdominal surgery is associated with endothelial glycocalyx disruption
The inhibition of tumor necrosis factor alpha (TNF-α) signaling pathway by local anesthetics (LAs) was recently associated with endothelial barrier protection in vitro [5]
We assessed 68 patients for eligibility and excluded 28 patients
Summary
Major abdominal surgery is associated with endothelial glycocalyx disruption. The anti-inflammatory effects of lidocaine were recently associated with endothelial barrier protection. Amide-linked local anesthetics (LAs) such as lidocaine and ropivacaine have an anti-inflammatory effect [1,2,3,4,5]. Continuous intravenous infusion of lidocaine reduced pain scores after major abdominal surgery, improves gastrointestinal recovery and potentially reduces the in-hospital length of stay [6]. Whether these effects are related to sodium-channel blockade is debated. Damage of the EG leads to tissue edema (i.e. decreased tissue access to oxygen and nutrients), increased interaction with leukocytes and platelets, and increased inflammation in a vicious cycle [7]
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