Lidocaine-Based vs Sufentanil-Based PCIA After Pulmonary Resection Surgery: A Randomized Controlled Trial

Abstract

Background: We investigated the efficacy and safety of lidocaine-based patient-controlled intravenous analgesia (PCIA), compared with sufentanil-based PCIA on postoperative pain and recovery quality in patients undergoing thoracoscopic lung surgery. Methods: We recruited 160 patients undergoing thoracoscopic lung surgery who were randomized to receive lidocaine-based PCIA (1.5 mg/kg/h) or sufentanil-based PCIA (2 μg/mL) within 48 hours postoperatively. The primary endpoint was visual analogue scores (VAS) pain scores at 6, 12, 24, and 48 hours postoperatively. Postoperative quality of recovery-15 (QoR-15) scores and other prespecified endpoints were also recorded. Results: VAS pain scores at rest and during coughing in the lidocaine group were significantly lower at 6, 12, and 24 hours postoperatively (P<0.05), with no difference at 48 hours (P>0.05). QoR-15 scores in the lidocaine group were higher on postoperative day (POD) 1 (P<0.001) and POD2 (P<0.001), with significant differences in the two dimensions of postoperative physical comfort and pain (P<0.001). The lidocaine group also experienced a shorter time to first flatus, defecation, and ambulation (P<0.05), with no difference in the length of postoperative hospitalization and thoracic drainage time (P>0.05). The serum IL-6, TNF-α, IL-8, cortisol, and epinephrine concentrations were lower in the lidocaine group on POD1 and POD2 (P<0.05). The incidence of postoperative nausea and vomiting in the lidocaine group was lower (P<0.05), with no differences in other adverse events (P>0.05). Conclusion: Compared with sufentanil-based PCIA, lidocaine-based PCIA significantly relieved postoperative pain and improved recovery quality after thoracoscopic lung surgery with fewer postoperative adverse events, which is a considerable choice for postoperative analgesia. Trial Registration: This study was retrospectively registered at the Chinese Clinical Trial Registry on March 1st, 2023 (number ChiCTR2300068840).