Systemic lidocaine shortens length of hospital stay after colorectal surgery: a double-blinded, randomized, placebo-controlled trial.
OBJECTIVE
To characterize the beneficial effects of perioperative systemic lidocaine on length of hospital stay, gastrointestinal motility, and the inflammatory response after colorectal surgery.


BACKGROUND
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.
Laboratory of Experimental Intensive Care & Anesthesiology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
Susanne
S
Herroeder
Sabine
S
Pecher
Marianne E
ME
Schönherr
Grit
G
Kaulitz
Klaus
K
Hahnenkamp
Helmut
H
Friess
Bernd W
BW
Böttiger
Harry
H
Bauer
Marcel G W
MG
Dijkgraaf
Omarcel G W
OG
Dijkgraaf
Marcel E
ME
Durieux
Markus W
MW
Hollmann
D000293:Adolescent; D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D039481:CD11b Antigen / Q000096:biosynthesis / Q000097:blood; D003082:Colectomy / Q000379:methods*; D003108:Colonic Diseases / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D015926:Complement C3a / Q000096:biosynthesis; D004311:Double-Blind Method; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D005769:Gastrointestinal Motility / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007262:Infusions, Intravenous; D007378:Interleukins / Q000096:biosynthesis / Q000097:blood; D019041:L-Selectin / Q000096:biosynthesis / Q000097:blood; D007902:Length of Stay / Q000639:trends*; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D019007:P-Selectin / Q000096:biosynthesis / Q000097:blood; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D012002:Rectal Diseases / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies
D000779:Anesthetics, Local; D015415:Biomarkers; D039481:CD11b Antigen; C509295:ITGAM protein, human; D007378:Interleukins; D019007:P-Selectin; D019041:L-Selectin; D015926:Complement C3a; D008012:Lidocaine