【罂粟摘要】静脉输注利多卡因对胸腔镜手术后恢复质量和镇痛效果的影响：一项随机对照试验
静脉输注利多卡因对胸腔镜手术后恢复质量和镇痛效果的影响：一项随机对照试验
术中静脉使用利多卡因作为全身麻醉的辅助药物已被广泛接受，可减少阿片类药物的使用和促进恢复；我们假设胸腔镜手术(VATS)患者围手术期静脉输注利多卡因可改善术后疼痛并提高恢复质量(QOR)。
前瞻性、单中心、双盲、随机、安慰剂对照临床试验。
单一机构、医科大学三甲附属医院。
18-65岁接受VATS的成年患者有资格参加。
本研究纳入的患者被随机分为两组；一组接受静脉使用利多卡因(静脉推注1.5mg/kg，然后以2mg/kg/h 持续泵注，直到手术结束)，另一组接受相同体积和速度的0.9%生理盐水治疗。
主要观察指标是观察术后24小时的QOR-15评分；次要指标包括术后疼痛评分、阿片类药物使用总量、苏醒时间、PACU停留时间、不良事件发生率和患者满意度。
利多卡因组和生理盐水组术后24h的QOR-15评分差异无统计学意义(利多卡因组：中位数为117, 四分位间距（IQR）113.5–124；生理盐水组：中位数为116, IQR 111–120,P=0.067)，中位数差异为3(95%CI为0-6，P=0.507)。同样，两组在术后疼痛评分、术后阿片类药物使用总量、PACU停留时间、PONV发生率和患者满意度方面均无显著性差异(为P>0.05)。
目前研究结果不支持使用围手术期静脉使用利多卡因作为可改善VATS患者术后疼痛和提高QOR的潜在策略。
翻译：吴学艳 编辑：佟睿 审校：曹莹
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.