Сравнение эффективности и безопасности продленной внутривенной инфузии лидокаина и эпидуральной аналгезии при лапароскопических операциях на толстом кишечнике: рандомизированное контролируемое исследование

INTRODUCTION: Colorectal cancer ranks as the third most prevalent oncological disease worldwide. While laparoscopic procedures reduce complication rates, postoperative pain management remains a significant challenge. OBJECTIVE: To compare the efficacy and safety of continuous lidocaine infusion and epidural analgesia (EA) in laparoscopic colorectal surgery. MATERIALS AND METHODS: This was a single-center, randomized controlled trial conducted under single-blind conditions (patients blinded). A total of 160 adult patients undergoing elective laparoscopic resections of the colon and/or rectum were enrolled; 154 completed the study protocol and were included in the per-protocol analysis. Patients were randomized into three groups: control (standard anesthesia, n = 53), EA (0.2 % ropivacaine 8–16 mg/h × 48h, n = 51), and lidocaine (1.5 mg/kg bolus followed by 1 mg/kg/h infusion × 48h, n = 50). Outcome measures included pain scores using Visual Analog Scale (VAS), opioid requirements, cortisol and glucose levels, gastrointestinal function recovery, and postoperative nausea and vomiting (PONV) incidence. RESULTS: Immediate postoperative pain intensity was significantly lower in both EA (2.16 ± 0.76) and lidocaine (1.80 ± 0.81) groups compared to control (3.66 ± 0.90; p < 0.001). These differences persisted at 12 hours post-surgery (p < 0.001). Fentanyl consumption was reduced by 283.6 μg in the EA group and by 218.9 μg in the lidocaine group (p < 0.001). Cortisol and glucose levels were significantly lower in both intervention groups (p < 0.05). Gastrointestinal motility and flatus passage recovered more rapidly, particularly in the lidocaine group. PONV incidence was lower in both EA (31.37 %) and lidocaine (34.0 %) groups compared to control (56.6 %, p < 0.05 for EA). No serious adverse events were recorded. СONCLUSIONS: Both techniques demonstrated comparable efficacy in pain reduction, opioid-sparing effects, stress response attenuation, and accelerated gastrointestinal recovery. Continuous lidocaine infusion may serve as a less invasive alternative to epidural analgesia in laparoscopic colorectal surgery.