最近有越来越多的证据表明,围手术期静脉输注利多卡因具有镇痛作用,手术患者的阿片类药物保护和抗炎作用。尽管阿片类药物的保留和镇痛特性得到了大力支持,在择期手术中抗炎功能尚未得到很好的确立.因此,本系统综述的目的是研究围手术期静脉输注利多卡因对择期手术患者术后抗炎状态的影响.在PubMed,Scopus,WebofScienceandClinicaltrials.gov数据库至2023年1月。评估静脉输注利多卡因效果的随机对照试验,与安慰剂相比,接受择期手术的成年患者,在炎症标志物反应被包括在内。排除标准包括儿科患者,动物研究,非RCT方法,不静脉注射利多卡因的干预,对照组不足,重复的样本,正在进行的研究和缺乏任何相关的临床结果措施。以下炎症标志物白细胞介素(IL)-6,肿瘤坏死因子(TNF)-α,IL-1RA,IL-8,IL-10,C反应蛋白(CRP),IL-1,IL-1β,干扰素(IFN)-γ,皮质醇,IL-4,IL-17,高迁移率族蛋白B1(HMGB1)和转化生长因子(TGF)-β-在这篇综述中被评估为结果。共21项研究,包括1254名患者,已确定。与安慰剂相比,静脉输注利多卡因显著降低了手术结束时IL-6基线水平的变化(标准化平均差[SMD]:-0.647,95%置信区间[CI]:-1.034至-0.260)。利多卡因的使用与其他术后促炎标志物的显著减少有关,如TNF-α,IL-1RA,IL-8、IL-17、HMGB-1和CRP。其他标记没有显著差异,如IL-10,IL-1β,IL-1,IFN-γ,IL-4、TGF-β和皮质醇。这项系统评价和荟萃分析为围手术期静脉输注利多卡因作为择期手术的抗炎策略提供了支持。
There has recently been increasing evidence that the use of perioperative intravenous lidocaine infusion possesses analgesic, opioid-sparing and anti-inflammatory effects in surgical patients. Although opioid-sparing and analgesic properties have been strongly supported, the anti-inflammatory features are not well established in elective surgery. Therefore, the aim of this systematic
review is to examine the effect of perioperative intravenous lidocaine infusion on postoperative anti-inflammatory status in patients undergoing elective surgery. A search strategy was created to identify suitable randomised clinical trials (RCTs) in PubMed, Scopus, Web of Science and Clinicaltrials.gov databases until January 2023. RCTs that evaluated the effect of intravenous lidocaine infusion, compared with placebo, on adult patients who underwent elective surgery, in inflammatory markers response were included. Exclusion criteria consisted of paediatric patients, animal studies, non-RCT methodology, intervention without intravenous lidocaine, inadequate control group, duplicated samples, ongoing studies and lack of any relevant clinical outcome measures. The following inflammatory markers-interleukin (IL)-6, tumour necrosis factor (TNF)-α, IL-1RA, IL-8, IL-10, C-reactive protein (CRP), IL-1, IL-1β, interferon (IFN)-γ, cortisol, IL-4, IL-17, high-mobility group protein B1 (HMGB1) and transforming growth factor (TGF)-β-were evaluated as outcomes in this
review. A total of 21 studies, including 1254 patients, were identified. Intravenous lidocaine infusion significantly reduced the change from IL-6 baseline levels at the end of surgery compared to a placebo (standardised mean difference [SMD]: -0.647, 95% confidence interval [CI]: -1.034 to -0.260). Usage of lidocaine was associated with a significant reduction in other postoperative pro-inflammatory markers, such as TNF-α, IL-1RA, IL-8, IL-17, HMGB-1 and CRP. There was no significant difference in other markers, such as IL-10, IL-1β, IL-1, IFN-γ, IL-4, TGF-β and cortisol. This systematic
review and meta-analysis provide support for the administration of perioperative intravenous lidocaine infusion as an anti-inflammatory strategy in elective surgery.