The clinical effects of an intravenous perioperative lidocaine infusion during hepatectomy: a pilot study

Abstract

Background. Intravenous (i.v.) lidocaine exhibits multimodal analgesic, anti-inflammatory, and anticancer properties. However, concerns regarding systemic toxicity and impaired hepatic drug clearance during liver resection necessitate caution in perioperative dosing protocols. This study aimed to evaluate the clinical recovery parameters and systemic inflammatory markers following continuous perioperative i.v. lidocaine infusion in patients undergoing elective hepatectomy for hepatocellular carcinoma (HCC).

Methods. In this prospective, randomized controlled trial, 60 patients undergoing elective surgical resection for HCC were assigned (1:1 ratio) to either a lidocaine group (n=30) or a control group (n=30). The lidocaine group received an intraoperative IV bolus (1.5 mg/kg) followed by a continuous infusion (1 mg/kg/h), maintained throughout surgery and for 24 hours postoperatively. Primary endpoints evaluated 24 hour opioid consumption, Numeric Rating Scale pain scores, return of bowel function, length of hospital stay, and perioperative inflammatory response.

Results. No statistically significant differences were observed between the lidocaine and control groups across clinical recovery outcomes. Intraoperative fentanyl consumption was identical between groups 0.8±0.1 mg (vs. 0.8±0.2 mg; p=0.957). The lidocaine group demonstrated a non-significant trends toward reduced 24-hour postoperative morphine consumption (13.5±13.3 mg vs. 19.5±15.8 mg; p=0.224), lower mean 24-hour NRS pain scores (3.36±1.77 vs. 3.80±1.85; p=0.275), and faster recovery of bowel motility (3.0±0.9 vs. 3.4±1.5 days; p=0.215). Length of hospital stay was comparable (9.46±3.15 vs. 8.47±3.09 days; p=0.340). Both groups exhibited significant postoperative increases in CRP and leukocyte levels (p<0.05), with no significant between-group differences postoperatively.

Conclusion. A modified, lower-dose perioperative i.v. lidocaine regimen tailored for toxicity safety in patients with liver resection is well-tolerated but does not yield statistically significant reductions in postoperative opioid consumption, pain scores, bowel recovery time, systemic inflammatory markers, or hospital stay following open hepatectomy. Further, adequately powered studies are needed.