| Objective: Oxygen inhalation of lidocaine and Intravenous(i.v.)lidocaine,while being an effective analgesic,has the added benefit of anti-operative stress response.The study was done to assess the effects of lidocaine on throat soreness?swallowing difficulty?swollen throat on patients with OSAHS after H-UPPP.Moreover,its effect on serum levels of interleukin-6?interleukin-27?interleukin-33?8-isomerie prostaglandin-2? and 25-hydroxyvitamin D,as well as side effects were recorded and compared.Methods: 70 patients undergoing H-UPPP surgery were randomly divided into two groups:experimental group(n=40,patient-Oxygen inhalation of 100 mg lidocaine+5mg dexamethasone+4ml NS at the postoperative 0h/3h meanwhile an i.v.infusion of lidocaine 100 mg every time,2 times in total at 24 h post-surgery)and control group(n=30,patient-inhalation of 5mg dexamethasone+9ml NS and i.v.infusion of NS 100 mg every time,2 times in total at 24 h post-surgery).Subjective ratings of throat soreness,difficulty swallowing,swollen throat,numbing and sore throat/uncomfortable relief were observed after returned to the ward 0h?1h?2h?3h?4h?5h and 6h.The levels of interleukin-6 ? interleukin-27 ? interleukin-33 ? 8-isomerie prostaglandin-2? and 25-hydroxyvitamin D in serum were measured in the preoperative and postoperative 24 h by elisa assay kit.Results:1.Throat soreness scores for the control group were 5.80 ± 0.76,the experimental group were 6.00 ± 0.91 before oxygen inhalation(after returned to the ward 0h).While,the control group were 6.10 ± 0.55,the experimental group were 3.90 ± 1.39 after oxygen inhalation(after returned to the ward 1h).Throat soreness scores for the lidocaine group were significantly better than placebo at 1h(P?0.001).Difficulty swallowing scores for the control group were 5.50 ± 0.34 cm,the experimental group were 5.48 ± 0.35 cm before oxygen inhalation(after returned to the ward 0h).While,the control group were 5.64 ± 0.31 cm,the experimental group were 3.09 ± 0.42 cm after oxygen inhalation(after returned to the ward 1h).Difficulty swallowing scores for the lidocaine group were significantly better than placebo at 1h(P?0.001).Swollen throat scores for the control group were 7.49 ± 0.42 cm,the experimental group were 7.58 ± 0.61 cm before oxygen inhalation(after returned to the ward 0h).While,the control group were 7.56 ± 0.50 cm,the experimental group were 3.96 ± 0.46 cm after oxygen inhalation(after returned to the ward 1h).Swollen throat scores for the lidocaine group were significantly better than placebo at 1h(P?0.001).In control group,two patients reported slightly relief on sore throat,the others did not reported any relief after oxygen inhalation(postoperative 1h).In experimental group,three patients reported slightly relief on sore throat,nineteen reported moderately relief,fifteen considerable relief and three almostly relief.The effective rate of the two groups were respectively 6.67% and 100%.Sorethroat relief was significantly better versus placebo at 1h(P?0.001).In control group,one patient reported moderatly throat numbness,two patients reported mildly throat numbness and the others did not reported any throat numbness after oxygen inhalation(postoperative 1h).Inexperimental group,thirty-one patients reported mildly throat numbness,seven patients reported moderatly throat numbness,one patient reported considerablely throat numbness and one patient did not reported any throat numbness.The numbness rate of the two groups were respectively 10% and 98%.Subjective assessment scales of throat numbness was significantly better versus lidocaine at 1h(P?0.001).2.The median AUC of Throat soreness scores?difficulty swallowing scores ? swollen throat scores on the control group were respectively 39.30 ± 2.51?37.80 ± 1.85?46.34 ± 1.84 assessed by 0-6h.The median AUC of Throat soreness scores?difficulty swallowing scores?swollen throat scores on the experimental group were respectively 23.20 ± 3.34 ? 19.26 ± 1.64 ? 26.24 ± 2.82 assessed by 0-6h.Throat soreness ? difficulty swallowing and swollen throat were significantly improved versus placebo,assessed by AUC 0-6h(P?0.001).3.The levels of IL-6 for the control group were 1.31 ± 0.03pg/ml,the experimental group were 1.31 ± 0.06pg/ml at preoperation.While,the control group were 3.02 ± 0.08pg/ml,the experimental group were 1.40 ± 0.11pg/ml at 24 h post-surgery.The levels of IL-6 were significantly attenuated in experimental group at 24 h post-surgery(P?0.001).The levels of IL-27 for the control group were 6.40 ± 0.33pg/ml,the experimental group were 6.69 ± 0.12pg/ml at preoperation.While,the control group were 7.78 ± 0.36pg/ml,the experimental group were 6.74 ± 0.37pg/ml at 24 h post-surgery.The levels of IL-27 were significantly attenuated in experimental group at 24 h post-surgery(P?0.001).The levels of IL-33 for the control group were 39.84 ± 1.38pg/ml,the experimental group were 38.16 ± 1.51pg/ml at preoperation.While,the control group were 40.68 ± 1.16pg/ml,the experimental group were 33.32 ± 1.51pg/ml at 24 h post-surgery.The levels of IL-33 were significantly attenuated in experimental group at 24 h post-surgery(P?0.001).The levels of 8-iso-PGF2 ? for the control group were 0.46 ± 0.02pg/ml,the experimental group were0.17 ± 0.02pg/ml at preoperation.While,the control group were 8.09 ± 0.47pg/ml,the experimental group were 0.46 ± 0.02pg/ml at 24 h post-surgery.The levels of 8-iso-PGF2? were significantly attenuated in experimental group at 24 h post-surgery(P?0.001).The levels of 25-OH-VD for the control group were 4.61 ± 0.03ng/ml,the experimental group were 4.01 ± 0.16 ng/ml at preoperation.While,the control group were 5.01 ± 0.28ng/ml,the experimental group were2.67 ± 0.07ng/ml at 24 h post-surgery.The levels of 25-OH-VD were significantly attenuated in experimental group at 24 h post-surgery(P?0.001).There were no statistically significant differences between groups in the proportion of patients reporting treatment-emergent toxic effect.Conclusion: 1.lidocaine demonstrated superiority over control for 0-6h postoperation efficacy variables including those related to throat soreness,sore throat relief and difficulty swallowing;2.lidocaine can significantly reduce IL-6?IL-27?IL-33?8-iso-PGF2? and 25-OH-VD levels and attenuates the operative stress response.3.There were no statistically significant differences between groups in the proportion of patients reporting treatment-emergent toxic effect.4.Lidocaine provided rapid and effective protective effects in patients with OSAHS after H-UPPP.Lidocaine is conducive to maintaining the stability of pro/anti-inflamatory cytokines,reducing the immune suppression and oxidative stress response.It is worth using widely. |
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