Effect of lidocaine or dexmedetomidine on postoperative recovery in elder patients undergoing colorectal surgery.

BACKGROUND: Opioid sparing techniques have been shown to promote gastrointestinal recovery, shorten length of stay (LOS), and reduce opioid-related complications. We investigated whether intraoperative intravenous lidocaine or dexmedetomidine infusion could improve gastrointestinal recovery in elderly patients undergoing laparoscopic colorectal surgery.

METHODS: Ninety-six patients aged 65 years or older who underwent elective laparoscopic colorectal resection were randomly allocated into the following three groups: the control group (N.=32) received an equal volume of saline, the lidocaine group (N.=32) received intraoperative intravenous lidocaine infusion, and the dexmedetomidine group (N.=32) received intraoperative intravenous dexmedetomidine infusion. The primary outcome was time to first feces. Secondary outcomes were time to first flatus, postoperative pain intensity, patient-controlled intravenous analgesia (PCIA) consumption, postoperative inflammatory response, postoperative complications, anesthetic adverse events, and LOS.

RESULTS: The lidocaine group had a significantly shorter time to first flatus (24.6 [IQR, 14.4-48.8] hours vs. 48.1 [IQR, 30.0-67.1] hours; adjusted P=0.022) and time to first feces (48.0 [IQR, 19.0-67.8] hours vs. 74.8 [IQR, 40.3-113.3] hours; adjusted P=0.032) than the control group. However, no significant differences were found between dexmedetomidine and control group for first flatus or first feces. Intraoperative sufentanil consumption and postoperative plasma concentrations of IL-6 were significantly lower in lidocaine group and dexmedetomidine group compared with control group. No difference could be observed in postoperative PCIA consumption, pain scores, postoperative complications, anesthetic adverse events, and LOS among the groups.

CONCLUSIONS: Intraoperative intravenous lidocaine infusion accelerated return of the bowel function in elderly patients undergoing elective colorectal surgery.