全身麻醉下静脉输注利多卡因在肾脏外科手术中的作用
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Intravenous lidocaine as adjuvant to general anesthesia in renal surgery
背景与目的
研究表明静脉输注利多卡因可减轻疼痛、炎性反应，且能加速术后康复，这一作用在腹部手术患者尤为明显。本研究主要观察静脉输注利多卡因对非腹腔镜肾脏疾病手术患者异氟烷、瑞芬太尼用量及术后康复情况的影响。
方 法
本实验共纳入60例择期非腹腔镜肾脏疾病手术患者，随机分为两组：利多卡因输注组（group L）:切皮前0.1%利多卡因1.5mg/kg/h持续静脉输注，切皮后0.1%利多卡因2.0mg/kg/h持续静脉输注，封顶剂量为100mg/h；0.9%生理盐水组（groupC）：对照组持续输注等单位剂量0.9%的生理盐水；麻醉深度采用BIS值监测；主要指标为BIS值40-60下异氟烷使用浓度，次要指标为术中瑞芬太尼消耗量及拔管时间。
结 果
与groupC比较，group L异氟烷浓度明显降低(0.63% ± 0.10% vs 0.92% ±0.11%, P<10–3)；与groupC比较，group L瑞芬太尼消耗量明显减少(0.13±0.04 μg/kg/min vs 0.18±0.04 μg/kg/min, P<10–3)；与groupC比较，group L拔管时间明显缩短5.8±1.8 min vs 7.9 ± 2.0 min, P<10–3 (5.8±1.8 min vs 7.9±2.0 min,P<10–3)。
结 论
肾脏手术中，静脉输注利多卡因可减少异氟烷及瑞芬太尼的使用量，且对患者安全。
原始文献摘要
Nakhli M S, Kahloul M, Guizani T, et al. Intravenous lidocaine as adjuvant to general anesthesia in renal surgery:[J]. Libyan Journal of Medicine, 2018, 13(1):1433418.
Bacground:The role of intraoperative intravenous lidocaine infusion has been previously evaluated for pain relief, inflammatory response, and post-operative recovery, particularly in abdominal
surgery.
Methods:The present study is a randomized double-blinded trial in which we evaluated whether IV lidocaine infusion reduces isoflurane requirement, intraoperative remifentanil consumption and time to post-operative recovery in non-laparoscopic renal surgery. Sixty patients scheduled to undergo elective non-laparoscopic renal surgery under general anesthesia were enrolled to receive either systemic lidocaine infusion (group L: bolus 1.5 mg/kg followed by a continuous infusion at the rate of 2 mg/kg/hr until skin closure) or
normal saline (0.9% NaCl solution) (Group C). The depth of anesthesia was monitored using the Bispectral Index Scale (BIS), which is based on measurement of the patient’s cerebral electrical activity. Primary outcome of the study was End-tidal of isoflurane concentration (Et-Iso) at BIS values of 40–60. Secondary outcomes include remifentanil consumption during the operation and time to extubation.
Results:Et-Iso was significantly lower in group L than in group C(0.63% ± 0.10% vs 0.92% ± 0.11%, p < 10–3). Mean remifentanil consumption of was significantly lower in group L than in group C (0.13 ± 0.04 μg/kg/min vs 0.18 ± 0.04 μg/kg/min, p < 10–3). Thus, IV lidocaine infusion permits a reduction of 31% in isoflurane concentration requirement and 27% in the intraoperative remifentanil need. In addition, recovery from anesthesia and extubation time was shorter in group L (5.8 ± 1.8 min vs 7.9 ± 2.0 min, p < 10–3). By reducing significantly isoflurane and remifentanil requirements during renal surgery,
Conclusions:intravenous lidocaine could provide effective strategy to limit volatile agent and intraoperative opioids consumption especially in low and middle income countries.
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