Effects of intravenous lidocaine, dexmedetomidine, and their combination on IL-1, IL-6 and TNF-α in patients undergoing laparoscopic hysterectomy: a prospective, randomized controlled trial

Abstract

Background Surgical-related inflammatory responses have negative effects on postoperative recovery. Intravenous (IV) lidocaine and dexmedetomidine inhibits the inflammatory response. We investigated whether the co-administration of lidocaine and dexmedetomidine could further alleviate inflammatory responses compared with lidocaine or dexmedetomidine alone during laparoscopic hysterectomy. Methods A total of 160 patients were randomly allocated into four groups following laparoscopic hysterectomy: the control group (group C) received normal saline, the lidocaine group (group L) received lidocaine (bolus infusion of 1.5\u2009mg/kg over 10\u2009min, 1.5\u2009mg/kg/h continuous infusion), the dexmedetomidine group (group D) received dexmedetomidine (bolus infusion of 0.5\u2009μg/kg over 10\u2009min, 0.4\u2009μg/kg/h continuous infusion), and the lidocaine plus dexmedetomidine group (group LD) received a combination of lidocaine (bolus infusion of 1.5\u2009mg/kg over 10\u2009min, 1.5\u2009mg/kg/h continuous infusion) and dexmedetomidine (bolus infusion of 0.5\u2009μg/kg over 10\u2009min, 0.4\u2009μg/kg/h continuous infusion). The levels of plasma interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) at different time points were the primary outcomes. Secondary outcomes included hemodynamic variables, postoperative visual analogue scale (VAS) scores, time to first flatus, and incidence of nausea and vomiting after surgery. Results The levels of plasma IL-1, IL-6, and TNF-α were lower in groups D and LD than in group C and were lowest in group LD at the end of the procedure and 2\u2009h after the operation ( P \u2009<\u20090.05). The VAS scores were decreased in groups D and LD compared with group C ( P \u2009<\u20090.05). The heart rate (HR) was decreased at the end of the procedure and 2\u2009h after the operation in groups D and LD compared to groups C and L ( P \u2009<\u20090.001). The mean blood pressure (MBP) was lower at 2\u2009h after the operation in groups L, D, and LD than in group C ( P \u2009<\u20090.001). There was a lower incidence of postoperative nausea and vomiting (PONV) in group LD than in group C ( P \u2009<\u20090.05). Conclusions The combination of lidocaine and dexmedetomidine significantly alleviated the inflammatory responses, decreased postoperative pain, and led to fewer PONV in patients undergoing laparoscopic hysterectomy. Trial registration ClinicalTrials.gov ( NCT03276533 ), registered on August 23, 2017.