Comparative evaluation of the perioperative anesthesia methods for cancer patients undergoing pancreaticoduodenectomy

Abstract

Background. Pancreatoduodenal resections (PDR) are one of the most traumatic and technically complex interventions in abdominal surgery. The correct anesthetic management correct and pain relief allow to substantially reduce the risk of perioperative complications, which remains high even in high-volume oncology centers with extensive experience. Finding new components and methods of anesthesia combined with evaluation of their effectiveness and safety remains actual issue. Aim. To evaluate the efficacy and safety of using intravenous lidocaine infusion as a component of anesthesia and postoperative analgesia in cancer patients during PDR. Material and methods. We analyzed the course of anesthesia, operation and postoperative period of 43 patient (mean age 63.2 ± 7.1 years) undergoing pancreaticoduodenectomy. For the purposes of the study, patients were randomly divided into 2 groups: epidural anesthesia (EA group, n=19) and lidocaine (L group, n=24). For EA group (n=19) we used epidural analgesia as a component of perioperative anesthesia, for L group (n=24) we used prolonged intravenous infusion of lidocaine at an average dose of 1 mg/kg/h. We analyzed the severity of pain syndrome according to NRS in postoperative period, opioid requirement, the time of gastrointestinal function recovery, post-operative complications frequency. In order to prevent systemic toxicity, drug monitoring was carried out - the determination of the plasma concentration of lidocaine. Results. Perioperative opioid requirement was comparable between groups, with no statistically significant differences observed. The degree of pain syndrome according to the NRS scale did not differ statistically, except for the number of NRS scores during activation on day 3, which was significantly lower in the lidocaine group: EA 4.00 (95% CI [3.49 - 4.51] and lidocaine 3, 12 (95% CI [2.64 – 3.61], p = 0.014. In the EA group, there was a statistically significant increase in infusion volume (8.83 ml/kg/h [[(Q1) 7.90 – (Q3) 10 .06] and 7.33 [(Q1) 6.28 - (Q3) 8.49], p = 0.034) and the need for intraoperative vasopressor support than in the lidocaine group (15 (78.9%) and 10 (43 .5%), respectively, p = 0.029. In the lidocaine group, the time to onset of peristalsis was significantly shorter than in the EA group (Me 48.0 h [(Q1) 48.00 - (Q3) 72.00] and Me 60 0 h [(Q1) 36.00 - (Q3) 64.50], p=0.042) The frequency of postoperative complications did not differ between the groups. Conclusions. Based on a comparative analysis of the study results, it can be concluded that prolonged intravenous infusion of lidocaine as a component of perioperative anesthetic protection during pancreatoduodental resections is safe and comparable in terms of analgesic efficacy to epidural blockade.