Efficacy of systemic lidocaine on postoperative quality of recovery and analgesia after video-assisted thoracic surgery: A randomized controlled trial

Study objective Intraoperative systemic lidocaine has become widely accepted as an adjunct to general anesthesia, associated with opioid-sparing and enhanced recovery. We hypothesized that perioperative systemic lidocaine improves postoperative pain and enhances the quality of recovery (QoR) in patients following video-assisted thoracic surgery (VATS). Design Prospective, single-center, double-blind, randomized placebo-controlled clinical trial. Setting Single institution, tertiary university hospital. Patients Adult patients aged 18 to 65 undergoing VATS were eligible for participation. Interventions Patients enrolled in this study were randomized to receive either system lidocaine (a bolus of 1.5 mg kg−1, followed by an infusion of 2 mg kg−1 h−1 until the end of the surgical procedure) or identical volumes and rates of 0.9% saline. Measurements The primary outcome was a global QoR-15 score 24 h after surgery. Secondary outcomes included postoperative pain score, cumulative opioid consumption, emergence time, length of PACU stay, adverse events, and patient satisfaction. Main results There was no difference in the global QoR-15 scores at 24 h postoperatively between the lidocaine and saline groups (median 117, IQR 113.5–124, vs. median 116, IQR 111–120, P = 0.067), with a median difference of 3 (95% CI 0 to 6, P = 0.507). Similarly, postoperative pain scores, postoperative cumulative opioid consumption, PACU length of stay, the occurrence of PONV, and patient satisfaction were comparable between the two groups (all P > 0.05). Conclusions Our current findings do not support using perioperative systemic lidocaine as a potential strategy to improve postoperative pain and enhance QoR in patients undergoing VATS. Trial registration Chinese Clinical Trial Registry (identifier: ChiCTR1900027515).