Discussion
degenerative lumbar disease, postoperative pain, lumbar spinal stenosis, inflammation, cord injury, pain, lumbago, gastrointestinal tract, constipation, commonNeuropathic bowel dysfunction, LSS, ileus
LUMBAR SPINAL STENOSIS, LUMBAR SPINAL STENOSIS, INFLAMMATORY RESPONSES, NEUROPATHIC BLADDER, INFLAMMATION, SECONDARY, COMPLICATIONS, ILEUS
In this double-blind, placebo, and randomized controlled trial, we demonstrated that perioperative systemic administration of lidocaine for a loading dose of 1.5 mg/kg for 10 min and then infused at 2.0 mg/kg/hour, creatively continued infusion 48 hours by PCIA with the dose of 40 mg/hour could significantly enhance the post-surgical quality of recovery in patients undergoing lumbar spinal stenosis surgery, by improving the recovery of gastrointestinal function, reducing opioid consumption and decreasing levels of cytokines. Many factors may affect the early postoperative recovery, the early postoperative period is the main concern of this study, including the demographic baseline level of the patient, the time of operation and anesthesia, the dosage of anesthetic drugs, and the retention time of intraoperative blood transfusion, relevant data were collected in the anesthetic recovery room. At the same time, early postoperative pain and gastrointestinal function have also attracted our attention, and inflammatory factors that may affect early recovery have also been detected. These are important factors affecting early postoperative rehabilitation. To the best of our knowledge, this is a forefront randomized controlled study evaluating the effects of perioperative intravenous lidocaine infusion on the early postoperative quality of recovery in LSS patients undergoing lumbar spinal stenosis surgery.Lumbar spinal stenosis refers to the abnormal structure of the spinal canal caused by primary or secondary factors, narrowing in the spinal canal, and lumbago and leg pain mainly characterized by intermittent claudicationPostoperative recovery begins at the time of surgery, only when patients have returned to their baseline function or population standard, it is completedIn the present study, the total QoR-15 scores in both groups decreased significantly from baseline, suggesting that surgery and anesthesia significantly negatively impacted postoperative quality. The difference between the lidocaine and placebo groups was 8.0 points. In patients receiving perioperative systemic lidocaine infusion, less moderate-to-severe pain, low NRS scores in the 12Muscularis externa inflammation and an influx of leukocytes are associated with the inhibition of postoperative gastrointestinal transportIn addition, reduces complications and accelerates early recovery of postoperative intestinal function, thereby improving the quality of recovery and shortening hospital staysThe mechanism by which lidocaine accelerates recovery of intestinal function remains unclear. Previous studies have shown that lidocaine could inhibit inflammatory responses which were confirmed by our study, protects epithelial intestinal cellsIn addition, as opioids are a mainstay of pain relief and opioid receptors are densely distributed in the gastrointestinal tract, symptoms and side effects are expected in these patients. Postoperatively, particularly with abdominal surgery, opioid-induced ileus may ensue and opioid-induced constipation is commonNeuropathic bowel dysfunction and neuropathic bladder, which are major consequences of spinal cord injury and occasionally degenerative lumbar disease, were not observed in our study in both groups