Key result
Intravenous lidocaine during thoracic surgery significantly reduced serum NT-proBNP levels at 3 days postoperatively, which were 2.3 times higher in the control group (p=0.004).
Why the study?
Thoracic cancer surgeries carry high anesthetic and cardiovascular risk, while early postoperative myocardial infarction diagnosis is difficult, prompting investigation into intravenous lidocaine for perioperative cardiac protection.
Does intraoperative intravenous lidocaine reduce postoperative NT-proBNP levels in lung cancer patients with cardiovascular comorbidities undergoing thoracic surgery?
RCT (n=30)
randomized
Does intraoperative intravenous lidocaine reduce postoperative NT-proBNP levels in lung cancer patients with cardiovascular comorbidities undergoing thoracic surgery?
Effect estimate: 2.3 times higher in control group
p-value: p=0.004
Intravenous lidocaine as an adjuvant anesthetic during thoracic surgery may provide cardiac protection by reducing postoperative NT-proBNP elevation in patients with cardiovascular comorbidities.
May support cardiac protection with intraoperative lidocaine in thoracic surgery; extends RCT evidence on NT-proBNP reduction.
In addition to technical complexity of thoracic surgeries, these procedures are characterized by high anesthetic risk. The last one is determined by functional reserves of the patient and comorbidities. Diagnosis of myocardial infarction in early postoperative period is difficult due to systemic analgesic therapy and unclear clinical picture. Therefore, international professional medical communities recommend laboratory markers of enhanced load on myocardium to assess perioperative cardiovascular risk including non-cardiac surgery. Objective. To analyze the prospects for intravenous administration of lidocaine for adjuvant intraoperative cardiac protection in lung cancer patients with cardiovascular comorbidities considering serum NT-proBNP and clinical data in early postoperative period. Material and methods. The study included 30 patients aged 55-79 years with localized non-small cell lung cancer and cardiovascular comorbidities who underwent segmentectomy or lobectomy. Patients were randomized into two groups: the lidocaine group (intraoperative intravenous bolus + infusion) and the control group. Serum NT-proBNP was assessed before skin incision, after 1 and 3 postoperative days. Results. Serum NT-proBNP at baseline and after 1 postoperative day was similar (p=0.065 and p=0.237, respectively). Significant differences were obtained in 3 days after surgery. This indicator was approximately 2.3 times higher in the control group (p=0.004). At the same time, we observed direct correlation between serum NT-proBNP on the 1st postoperative day and minimum/maximum intraoperative heart rate (p=0.02). There were no clinical signs of myocardial ischemia. One patient in the control group developed postoperative delirium. Conclusion. Intravenous administration of lidocaine can be recommended as adjuvant anesthetic in thoracic surgery for cardiac protection in cancer patients with cardiovascular comorbidities. However, further prospective large-scale studies are required.
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Aleksandrova et al. (2023) conducted an RCT in Localized non-small cell lung cancer with cardiovascular comorbidities (n=30). Lidocaine vs. Control group was evaluated on Serum NT-proBNP at 3 days after surgery (2.3 times higher in control group, p=0.004). Intravenous lidocaine during thoracic surgery significantly reduced serum NT-proBNP levels at 3 days postoperatively, which were 2.3 times higher in the control group (p=0.004).
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