Effects Of Perioperative Intravenous Infusion Of Lidocaine On Plasma IL-17/IL-35 Balance And Stress Response In Patients Undergoing Thoracoscopic Radical Resection Of Lung Cancer

Objective:The purpose of this study was to investigate the effect and mechanism of lidocaine on immune protection and stress regulation during perioperative period through detecting immune-related factors(IL-17,IL-35)and stress hormones(EPI,NA)levels in patients undergoing thoracoscopic radical lung cancer resection.Methods:This study was approved by the medical ethics committee of the First Affiliated Hospital of Soochow University.From August to December 2019,the total of 60 patients who met the inclusion criteria and voluntarily participated in and signed the informed consent were selected to undergo thoracoscopic radical resection of lung cancer at an elective time in our hospital.All patients were divided into two groups by random number table method:lidocaine(L group)and control group(C group).Lidocaine(L group):10 min before anesthesia induction,intravenous injection of lidocaine 1.0mg/kg,followed by continuous pumping at the rate of 0.5%lidocaine 1.0mg/kg·h(maximum speed not more than 200 mg/h)until the end of surgery;control(C group):10 min before the induction of anesthesia,normal saline of the same volume was injected statically and then continuously pumped at the same rate until the end of the operation.Data collection for all patients:1.General information of patients;2.TMN stage of the patient's tumor;3.4-5ml blood was collected before(T0),0h(T1)and 24h(T2).The concentrations of IL-17,IL-35,EPI and NA were determined by ELISA;4.Intraoperative dosage of sufentanil and remifentanil;5.Visual analogue score(VAS)of patients 0h and 24h after surgery;6.Postoperative adverse reactions;7.ECG changes and adverse reactions during intraoperative lidocaine injection.Results:1.The dosage of sufentanil and remifentanil in lidocaine group was significantly lower than that in control group(P<0.05).2.At time point T1,the MAP and HR of lidocaine group were significantly lower than that of control group(P<0.05).3.At time point before out of the PACU,the VAS score of lidocaine group was significantly lower than that of control group(P<0.05).4.The incidence of vomiting in lidocaine group was significantly lower than that in control group(P<0.05).5.At time points T1 and T2,IL-35 concentration in lidocaine group was significantly lower than that in control group(P<0.05).Meanwhile,the concentration of IL-17 was significantly higher than that of the control group(P<0.05).6.At time points T1 and T2,the IL-17/IL-35 ratio in lidocaine group was significantly higher than that in control group(P<0.05).7.At time points T1 and T2,NA concentration and EPI concentration in lidocaine group were significantly lower than those in control group(P<0.05).Conclusion:Perioperative intravenous infusion of lidocaine can promote Th17/Treg cell balance transfer to the dominant direction of Th17 and reduce the effect of postoperative NA and EPI levels,significantly reduce the opioid dosage,and thus reduce the adverse reactions and complications of opioids.