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Research article
Intravenous lidocaine to prevent endothelial dysfunction after major abdominal surgery: A randomized controlled pilot trial
Marco Pustetto
Centre Hospitalier Universitaire Grenoble Alpes
Corresponding Author
ORCiD: https://orcid.org/0000-0002-8738-3280
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This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Anesthesiology.
Background. Major abdominal surgery is associated with endothelial glycocalyx disruption. The anti-inflammatory effects of lidocaine were recently associated with endothelial barrier protection.
Methods. This was a single-centre, parallel group, randomized, controlled, double blind, pilot trial. Forty adult patients scheduled for major abdominal surgery were included between December 2016 and March 2017 in the setting of a University Hospital in Brussels (Belgium); reasons for non-inclusion were planned liver resection and conditions associated to increased risk of local anesthetics systemic toxicity. Patients were randomized to receive either lidocaine by continuous intravenous administration or an equivalent volume of 0.9% saline.
The primary endpoint was the postoperative syndecan-1 concentration (difference between groups). Near-infrared spectroscopy of the thenar eminence in association with the vascular occlusion test, and contemporary analysis of flow-mediated dilation of the brachial artery were the secondary outcomes, along with haemodynamic data. Blood samples and data were collected before surgery (T0), and at 1–3 h (T1) and 24 h (T2) post-surgery.
Results. Syndecan-1 concentration increased significantly post-surgery (P<0.001), but without any difference between groups. The near-infrared spectroscopy-derived and flow-mediated dilation-derived variables showed minor changes unrelated to group assignment. Compared with the placebo group, the intervention group had a significantly lower peri-operative mean arterial pressure and cardiac index, despite equally conducted goal-directed haemodynamic management. Postoperative lactate concentrations were similar between groups.
Conclusions. Lidocaine failed to have any effect on endothelial function. Since in comparisons to other types of clinical situations, syndecan-1 was only slightly upregulated, endothelial dysfunction after major abdominal surgery might be overestimated.
Keywords
endothelial glycocalyx, lidocaine, major abdominal surgery, endothelial dysfunction
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Peer Review Timeline
CURRENT STATUS: Published
Version 3
Posted 17 Jun, 2020
No comments provided
Editorial decision: Minor revision
On 03 Jun, 2020
Review #2 received
Received 27 May, 2020
Reviewer #1 agreed
On 27 May, 2020
Reviewer #2 agreed
On 27 May, 2020
Review #1 received
Received 27 May, 2020
Editor assigned
On 26 May, 2020
Reviewers invited
Invitations sent on 26 May, 2020
Submission checks complete
On 25 May, 2020
Editor invited
On 25 May, 2020
No comments provided
Review #2 received
Received 02 May, 2020
Editorial decision: Major revision
On 02 May, 2020
Reviewer #2 agreed
On 26 Apr, 2020
Review #1 received
Received 22 Apr, 2020
Reviewers invited
Invitations sent on 06 Apr, 2020
Reviewer #1 agreed
On 06 Apr, 2020
Editor assigned
On 31 Mar, 2020
Submission checks complete
On 30 Mar, 2020
Editor invited
On 30 Mar, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Surgery
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This preprint is under consideration at BMC Anesthesiology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Intravenous lidocaine to prevent endothelial dysfunction after major abdominal surgery: A randomized controlled pilot trial
Marco Pustetto
Centre Hospitalier Universitaire Grenoble Alpes
Corresponding Author
ORCiD: https://orcid.org/0000-0002-8738-3280
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 3
Posted 17 Jun, 2020
No comments provided
Editorial decision: Minor revision
On 03 Jun, 2020
Review #2 received
Received 27 May, 2020
Reviewer #1 agreed
On 27 May, 2020
Reviewer #2 agreed
On 27 May, 2020
Review #1 received
Received 27 May, 2020
Editor assigned
On 26 May, 2020
Reviewers invited
Invitations sent on 26 May, 2020
Submission checks complete
On 25 May, 2020
Editor invited
On 25 May, 2020
No comments provided
Review #2 received
Received 02 May, 2020
Editorial decision: Major revision
On 02 May, 2020
Reviewer #2 agreed
On 26 Apr, 2020
Review #1 received
Received 22 Apr, 2020
Reviewers invited
Invitations sent on 06 Apr, 2020
Reviewer #1 agreed
On 06 Apr, 2020
Editor assigned
On 31 Mar, 2020
Submission checks complete
On 30 Mar, 2020
Editor invited
On 30 Mar, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Surgery
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Anesthesiology.
Background. Major abdominal surgery is associated with endothelial glycocalyx disruption. The anti-inflammatory effects of lidocaine were recently associated with endothelial barrier protection.
Methods. This was a single-centre, parallel group, randomized, controlled, double blind, pilot trial. Forty adult patients scheduled for major abdominal surgery were included between December 2016 and March 2017 in the setting of a University Hospital in Brussels (Belgium); reasons for non-inclusion were planned liver resection and conditions associated to increased risk of local anesthetics systemic toxicity. Patients were randomized to receive either lidocaine by continuous intravenous administration or an equivalent volume of 0.9% saline.
The primary endpoint was the postoperative syndecan-1 concentration (difference between groups). Near-infrared spectroscopy of the thenar eminence in association with the vascular occlusion test, and contemporary analysis of flow-mediated dilation of the brachial artery were the secondary outcomes, along with haemodynamic data. Blood samples and data were collected before surgery (T0), and at 1–3 h (T1) and 24 h (T2) post-surgery.
Results. Syndecan-1 concentration increased significantly post-surgery (P<0.001), but without any difference between groups. The near-infrared spectroscopy-derived and flow-mediated dilation-derived variables showed minor changes unrelated to group assignment. Compared with the placebo group, the intervention group had a significantly lower peri-operative mean arterial pressure and cardiac index, despite equally conducted goal-directed haemodynamic management. Postoperative lactate concentrations were similar between groups.
Conclusions. Lidocaine failed to have any effect on endothelial function. Since in comparisons to other types of clinical situations, syndecan-1 was only slightly upregulated, endothelial dysfunction after major abdominal surgery might be overestimated.
Figure 1
Figure 2
Due to technical limitations, tables are only available as a download in the supplemental files section.