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 videoassisted 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).