Perioperative lidocaine infusion safe in field of liver surgery, suggests study

Recently published prospective monocentric study aimed to investigate the safety and efficacy of perioperative lidocaine infusion in patients undergoing liver surgery. The study was conducted from 2020 to 2021 in Caen University Hospital, France. The protocol included a bolus dose of 1.5 mg kg−1, followed by a continuous infusion of 2 mg kg−1 h‑1 until the beginning of hepatic transection. Plasma concentrations of lidocaine were measured four times during and after the lidocaine infusion.

The study included 20 subjects who underwent liver resection, with 35% having preexisting liver disease before tumor diagnosis, and 75% undergoing major hepatectomy. The plasmatic levels of lidocaine were within the therapeutic range, and no blood sample showed a concentration above the toxicity threshold throughout the infusion. Comparative analysis between the presence of preexisting liver disease or not and the association of intraoperative vascular clamping did not show significant differences concerning lidocaine blood levels.

The findings suggested that perioperative lidocaine infusion is safe in the field of liver surgery, and it was concluded that additional prospective studies are needed to assess the clinical usefulness in terms of analgesia and antitumoral effects. The study also highlighted the potential implications of intravenous lidocaine in liver surgery, mentioning its analgesic effects in the context of enhanced recovery after surgery. The paper discussed the metabolism of lidocaine in the liver, the recommended lidocaine infusion protocol, and the therapeutic range of lidocaine levels.

The study found that the intravenous lidocaine infusion used in the protocol maintained effective concentrations until surgical closure, and no adverse events related to lidocaine infusion were reported. Additionally, the study explored the pharmacokinetics of lidocaine during liver surgery, emphasizing the safety and tolerability of the lidocaine dosage used in the study. The limitations of the study, such as the small sample size and early termination of lidocaine infusion, were also noted, and it was suggested that further studies are necessary to assess the safety and efficacy of intravenous lidocaine in liver surgery.

In conclusion, the pilot study demonstrated the safety of intravenous lidocaine in the context of liver surgery and suggested further studies to evaluate its efficacy on postoperative pain. The study emphasized the need for additional research to understand the potential benefits of lidocaine infusion in liver surgery, including analgesia and antitumoral effects.

Key Points

- The study aimed to investigate the safety and efficacy of perioperative lidocaine infusion in patients undergoing liver surgery. This monocentric study was conducted at Caen University Hospital, France, from 2020 to 2021. The protocol included a bolus dose of 1.5 mg kg−1, followed by a continuous infusion of 2 mg kg−1 h‑1 until the beginning of hepatic transection. Plasma concentrations of lidocaine were measured four times during and after the lidocaine infusion.

- The study included 20 subjects who underwent liver resection, with 35% having preexisting liver disease before tumor diagnosis, and 75% undergoing major hepatectomy. The plasmatic levels of lidocaine were within the therapeutic range, and no blood sample showed a concentration above the toxicity threshold throughout the infusion. Comparative analysis between the presence of preexisting liver disease or not and the association of intraoperative vascular clamping did not show significant differences concerning lidocaine blood levels. The intravenous lidocaine infusion used in the protocol maintained effective concentrations until surgical closure, and no adverse events related to lidocaine infusion were reported.

- The findings of the study suggested that perioperative lidocaine infusion is safe in the field of liver surgery. The study highlighted the potential implications of intravenous lidocaine in liver surgery, mentioning its analgesic effects in the context of enhanced recovery after surgery. The study also emphasized the need for additional research to understand the potential benefits of lidocaine infusion in liver surgery, including analgesia and antitumoral effects. The paper discussed the metabolism of lidocaine in the liver, the recommended lidocaine infusion protocol, and the therapeutic range of lidocaine levels. The limitations of the study, such as the small sample size and early termination of lidocaine infusion, were noted, and it was suggested that further studies are necessary to assess the safety and efficacy of intravenous lidocaine in liver surgery.

Reference –

Grassin, Pierre; Descamps, Richard; Bourgine, Joanna1; Lubrano, Jean2; Fiant, Anne-Lise; Lelong-Boulouard, Véronique1; Hanouz, Jean-Luc. Safety of perioperative intravenous lidocaine in liver surgery – A pilot study. Journal of Anaesthesiology Clinical Pharmacology 40(2):p 242-247, Apr–Jun 2024. | DOI: 10.4103/joacp.joacp_391_22