Effect of intraoperative paravertebral or intravenous lidocaine infusion on postoperative complications and inflammation after lung resection surgery: a randomised controlled trial.

Background: The potential for the anti-inflammatory effects of lidocaine to reduce complications after lung resection has not been evaluated. We assessed whether intraoperative i.v. or paravertebral lidocaine, compared with remifentanil, reduced complications after lung resection. We also quantified pulmonary and systemic inflammatory responses.

Methods: This single-centre study randomised participants undergoing lung resection (video-assisted thoracoscopy) to receive continuous infusion of either (1) i.v. lidocaine and paravertebral saline, (2) paravertebral lidocaine and i.v. saline, or (3) remifentanil and paravertebral saline. The primary outcome was the proportion of participants with all-cause complications (Clavien-Dindo classification). Cytokines were measured in bronchoalveolar lavage fluid before and after one-lung ventilation and in plasma during the first 24 h.

Results: In 154 patients (mean age 65 yr; 42% female), fewer major (Clavien-Dindo Grade ≥III) complications were recorded in participants randomised to intraoperative paravertebral (two of 49; 4.1%) or i.v. (two of 54; 3.7%) lidocaine, compared with six of 51 (11.8%) participants who received remifentanil (P=0.037). Severe complications were less likely with lidocaine from either i.v. or paravertebral sources, compared with remifentanil (odds ratio: 0.44 [95% confidence interval: 0.22-0.88]). Pulmonary complications occurred in 23/103 (22.3%) participants allocated to intraoperative lidocaine from either i.v. or paravertebral routes, compared with 23/51 (45.1%) participants who received remifentanil (odds ratio: 0.35 [95% confidence interval: 0.17-0.72]; P=0.004). Cytokine levels after one-lung ventilation were lower with lidocaine treatment.

Conclusions: Intraoperative lidocaine infusion administered either intravenously or through paravertebral catheter reduces the incidence and severity of complications after lung resection surgery compared with remifentanil. Lidocaine might confer this benefit through reducing systemic and lung inflammation.

Clinical Trial Registration: NCT03905837.