Systemic lidocaine shortens length of hospital stay after colorectal surgery: a double-blinded, randomized, placebo-controlled trial

Abstract

Objective: To characterize the beneficial effects of perioperative systemic lidocaine on length of hospital stay, gastrointestinal motility, and the inflammatory response after colorectal surgery.

Summary background data: 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. This double-blinded, randomized, and placebo-controlled trial aimed to evaluate beneficial effects of systemic lidocaine and to provide insights into underlying mechanisms.

Methods: Sixty patients undergoing colorectal surgery, not willing or unable to receive an epidural catheter, were randomly assigned to lidocaine or placebo treatment. Before induction of general anesthesia, an intravenous lidocaine bolus (1.5 mg/kg) was administered followed by a continuous lidocaine infusion (2 mg/min) until 4 hours postoperatively. Length of hospital stay, gastrointestinal motility, and pain scores were recorded and plasma levels or expression of pro- and anti-inflammatory mediators determined.

Results: 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. Elevated plasma levels of IL-6, IL-8, complement C3a, and IL-1ra as well as expression of CD11b, L- and P-selectin, and platelet-leukocyte aggregates were significantly attenuated by systemic lidocaine.

Conclusions: 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.

Figures

FIGURE 1. Study design according to the CONSORT statement.

FIGURE 2. Effects of continuous administration of systemic lidocaine on length of hospital stay. Data are shown as median with 25th and 75th percentiles. *Statistical significance (P = 0.004) compared with control (Mann-Whitney U test).

FIGURE 3. First occurrence of bowel sounds and flatus (A) and defecation (B) postoperatively. Data are mean ± SD. *Statistical significance (P < 0.05) compared with control (unpaired Student t test). Black bars, control patients; white bars, lidocaine-treated patients.

FIGURE 4. Visual analog scale (VAS) pain scores at rest (A) and during coughing (B). Data are mean ± SD. Black dots, control patients; white dots, lidocaine-treated patients.