Abstract：
OBJECTIVE: To compare intravenous lidocaine, ultrasound-guided erector spinae plane block (ESPB), and placebo on the quality of recovery and analgesia after laparoscopic cholecystectomy.
METHODS: A prospective, triple-arm, double-blind, randomized, placebo-controlled non-inferiority trial.
METHODS: A single tertiary academic medical center.
METHODS: 126 adults aged 18-65 years undergoing elective laparoscopic cholecystectomy.
METHODS: Patients were randomly allocated to one of three groups: intravenous lidocaine infusion (1.5 mg/kg bolus followed by 2 mg/kg/h) plus bilateral ESPB with saline (25 mL per side); bilateral ESPB with 0.25% ropivacaine (25 ml per side) plus placebo infusion; or bilateral ESPB with saline (25 ml per side) plus placebo infusion.
METHODS: The primary outcome was the 24-h postoperative Quality of Recovery-15 (QoR-15) score. The non-inferiority of lidocaine versus ESPB was assessed with a margin of -6 points and 97.5% confidence interval (CI). Secondary outcomes included 24-h area under the curve (AUC) for pain scores, morphine consumption, and adverse events.
RESULTS: 124 patients completed the study. Median (IQR) 24-h QoR-15 scores were 123 (117-127) for lidocaine, 124 (119-126) for ESPB, and 112 (108-117) for placebo. Lidocaine was non-inferior to ESPB (median difference -1, 97.5% CI: -4 to ∞). Both lidocaine (median difference 9, 95% CI: 6-12, P < 0.001) and ESPB (median difference 10, 95% CI: 7-13, P < 0.001) were superior to placebo. AUC for pain scores and morphine use were lower with lidocaine and ESPB versus placebo (P < 0.001 for all), with no significant differences between lidocaine and ESPB. One ESPB patient reported a transient metallic taste; no other block-related complications occurred.
CONCLUSIONS: For patients undergoing laparoscopic cholecystectomy, intravenous lidocaine provides a non-inferior quality of recovery compared to ESPB without requiring specialized regional anesthesia procedures. Lidocaine may offer a practical and accessible alternative within multimodal analgesia pathways.
METHODS: A prospective, triple-arm, double-blind, randomized, placebo-controlled non-inferiority trial.
METHODS: A single tertiary academic medical center.
METHODS: 126 adults aged 18-65 years undergoing elective laparoscopic cholecystectomy.
METHODS: Patients were randomly allocated to one of three groups: intravenous lidocaine infusion (1.5 mg/kg bolus followed by 2 mg/kg/h) plus bilateral ESPB with saline (25 mL per side); bilateral ESPB with 0.25% ropivacaine (25 ml per side) plus placebo infusion; or bilateral ESPB with saline (25 ml per side) plus placebo infusion.
METHODS: The primary outcome was the 24-h postoperative Quality of Recovery-15 (QoR-15) score. The non-inferiority of lidocaine versus ESPB was assessed with a margin of -6 points and 97.5% confidence interval (CI). Secondary outcomes included 24-h area under the curve (AUC) for pain scores, morphine consumption, and adverse events.
RESULTS: 124 patients completed the study. Median (IQR) 24-h QoR-15 scores were 123 (117-127) for lidocaine, 124 (119-126) for ESPB, and 112 (108-117) for placebo. Lidocaine was non-inferior to ESPB (median difference -1, 97.5% CI: -4 to ∞). Both lidocaine (median difference 9, 95% CI: 6-12, P < 0.001) and ESPB (median difference 10, 95% CI: 7-13, P < 0.001) were superior to placebo. AUC for pain scores and morphine use were lower with lidocaine and ESPB versus placebo (P < 0.001 for all), with no significant differences between lidocaine and ESPB. One ESPB patient reported a transient metallic taste; no other block-related complications occurred.
CONCLUSIONS: For patients undergoing laparoscopic cholecystectomy, intravenous lidocaine provides a non-inferior quality of recovery compared to ESPB without requiring specialized regional anesthesia procedures. Lidocaine may offer a practical and accessible alternative within multimodal analgesia pathways.
摘要：
目的：比较静脉注射利多卡因，超声引导竖脊肌平面阻滞（ESPB），和安慰剂对腹腔镜胆囊切除术后恢复和镇痛质量的影响。
方法：前瞻性，三臂，双盲,随机化，安慰剂对照非劣效性试验。
方法：一个单一的三级学术医学中心。
方法：126名18-65岁的成年人接受择期腹腔镜胆囊切除术。
方法：将患者随机分为三组：静脉注射利多卡因（1.5mg/kg推注，然后2mg/kg/h）加双侧ESPB加生理盐水（每侧25mL）；双侧ESPB加0.25％罗哌卡因（每侧25ml）加安慰剂；或双侧ESPB加生理盐水（每侧25ml）加安慰剂。
方法：主要结局是术后24小时恢复质量-15（QoR-15）评分。利多卡因与ESPB的非劣效性以-6分和97.5％置信区间（CI）的边缘进行评估。次要结果包括疼痛评分的24小时曲线下面积（AUC），吗啡消耗,和不良事件。
结果：124名患者完成了研究。利多卡因的24小时QoR-15得分中位数（IQR）为123（117-127），124（119-126）用于ESPB，和112（108-117）安慰剂。利多卡因不劣于ESPB（中位数差异-1，97.5％CI：-4至∞）。利多卡因（中位数差异9，95％CI：6-12，P<0.001）和ESPB（中位数差异10，95％CI：7-13，P<0.001）均优于安慰剂。与安慰剂相比，利多卡因和ESPB的疼痛评分和吗啡使用的AUC较低（全部P<0.001），利多卡因和ESPB之间无显著差异。一名ESPB患者报告了短暂的金属味；没有发生其他与阻塞相关的并发症。
结论：对于接受腹腔镜胆囊切除术的患者，与ESPB相比,静脉注射利多卡因的恢复质量不差,无需专门的区域麻醉程序.利多卡因可以在多模式镇痛途径中提供实用且可获得的替代方案。
方法：前瞻性，三臂，双盲,随机化，安慰剂对照非劣效性试验。
方法：一个单一的三级学术医学中心。
方法：126名18-65岁的成年人接受择期腹腔镜胆囊切除术。
方法：将患者随机分为三组：静脉注射利多卡因（1.5mg/kg推注，然后2mg/kg/h）加双侧ESPB加生理盐水（每侧25mL）；双侧ESPB加0.25％罗哌卡因（每侧25ml）加安慰剂；或双侧ESPB加生理盐水（每侧25ml）加安慰剂。
方法：主要结局是术后24小时恢复质量-15（QoR-15）评分。利多卡因与ESPB的非劣效性以-6分和97.5％置信区间（CI）的边缘进行评估。次要结果包括疼痛评分的24小时曲线下面积（AUC），吗啡消耗,和不良事件。
结果：124名患者完成了研究。利多卡因的24小时QoR-15得分中位数（IQR）为123（117-127），124（119-126）用于ESPB，和112（108-117）安慰剂。利多卡因不劣于ESPB（中位数差异-1，97.5％CI：-4至∞）。利多卡因（中位数差异9，95％CI：6-12，P<0.001）和ESPB（中位数差异10，95％CI：7-13，P<0.001）均优于安慰剂。与安慰剂相比，利多卡因和ESPB的疼痛评分和吗啡使用的AUC较低（全部P<0.001），利多卡因和ESPB之间无显著差异。一名ESPB患者报告了短暂的金属味；没有发生其他与阻塞相关的并发症。
结论：对于接受腹腔镜胆囊切除术的患者，与ESPB相比,静脉注射利多卡因的恢复质量不差,无需专门的区域麻醉程序.利多卡因可以在多模式镇痛途径中提供实用且可获得的替代方案。
