Intravenous Lidocaine Modulates the Perioperative Hepatic Inflammatory Response: Implications for Personalized Medicine in Thoracic Surgery

Purpose: Lung resection surgery (LRS) induces a strong local and systemic inflammatory response that may extend to peripheral organs, including the liver. This study aimed to evaluate the potential effect of intravenous lidocaine on hepatic inflammatory and apoptotic responses during lung resection surgery with one-lung ventilation (OLV) in an experimental porcine model. Methods: Eighteen mini pigs were randomly assigned to three groups: lidocaine (LIDO), control (CON), and sham (SHAM). Animals underwent left caudal lobectomy. The LIDO group received a continuous intravenous infusion of lidocaine (1.5 mg/kg/h) during surgery. The CON group received the same volume of saline, and the SHAM group underwent thoracotomy without lobectomy or OLV. Different samples were collected at baseline, during surgery, and 24 h postoperatively to assess inflammatory cytokines and apoptosis-related proteins. Liver biopsy was taken 24 h after de surgery. Results: One-lung ventilation and lung resection surgery increased the expression of proinflammatory markers in the liver biopsy and enhanced apoptotic protein expression and iNOS production. Lidocaine administration attenuated these effects, showing lower levels of inflammatory mediators, a better balance between iNOS and eNOS, and reduced apoptotic activity compared with controls. Conclusions: Our findings suggest that intravenous lidocaine may serve as a personalized perioperative strategy to attenuate systemic inflammatory and apoptotic responses, contributing to improved hepatic protection during thoracic surgery.