The effect of perioperative lidocaine during modified radical mastectomy on postoperative pain and immune response: A randomized clinical trial.

PURPOSE: Breast cancer is the most common cancer among women. Surgical resection of the breast mass could induce an inflammatory response, which increases cytokines, such as interleukin IL beta-1 and IL-6. These mediators lead to peripheral and central sensitization and induce hyperalgesia. In this study, we hypothesized that perioperative lidocaine infusion could not only reduce serum interleukin levels but also reduce postoperative pain severity.

METHODS

In this randomized clinical trial, 90 women who were candidates for elective mastectomy under general anesthesia were enrolled and randomly allocated into two groups. In group A, patients received 2 mg/kg of lidocaine stat and 1.5 mg/kg/hr of lidocaine infusion perioperatively, and patients in group B received normal saline. Serum levels of interleukin 1 beta and 6 were measured before the start of infusions and 24 hours after. Also, postoperative pain was evaluated until 24 hours postoperatively.

RESULTS

The mean visual analog post-operation was significantly lower in the lidocaine group compared to the control group (P < 0.001). The baseline mean serum levels of interleukin 1 beta and 6 in preoperative time in both groups were not different (P > 0.05). However, 24 hours postoperatively, the mean serum level of interleukin 6 was higher in the control group compared to the lidocaine group (P < 0.001).

CONCLUSION

Perioperative systemic lidocaine infusion in patients with breast cancer could modulate the production of IL-6, and through the reduction of this cytokine, patients experienced better pain control in the immediate postoperative period.

TRIAL REGISTRATION: Iranian Registry of Clinical Trials: IRCT20121204011662N11, date of registration: 09-01-2018.