| ObjectivePneumoperitoneum stimulation and pain in gynecological laparoscopic surgery disorder autonomic nervous system and affect postoperative bowel function.Intravenous lidocaine was demonstrated to stabilize autonomic nervous function during endotracheal intubation in general anesthesia.Heart rate variability（HRV）has been used to evaluate autonomic nervous function in recent years.The purpose of this study was to explore the effect of intravenous lidocaine on postoperative autonomic nervous system by HRV in patients undergoing gynecological laparoscopic surgery and observe the postoperative bowel function.MethodsA total of eighty patients scheduled for laparoscopic panhysterectomy with bilateral adnexectomy under general anesthesia were involved.All patients aged 40 to 60 years,body mass index（BMI）18 to 28 kg/m2,ASA Ⅰ～Ⅱ,were randomly divided into lidocaine group（group L）and control group（group C）.A bolus of 1.5 mg/kg lidocaine was infused intravenously,1.5 mg·kg-1·h-1 lidocaine was infused continuously until the end of surgery in the group L.Patients in the group C received the equal volume saline instead.Anaesthesia were conducted by midazolam 0.035 mg/kg,propofol 2 mg/kg,sufentanil 0.5 ug/kg and cisatracurium 0.15 mg/kg injected.Remifentanil 3～10 ug·kg-1·h-1,propofol 4～8 mg·kg-1·h-1 until the end of surgery and cisatracurium 0.1～0.15 mg·kg-1·h-1 were administrated to maintain anesthesia depth.HRV parameters were collected at the following time:the day before surgery（T0）,5 min before the induction of anesthesia（T1）,endotracheal intubation（T2）,pneumoperitoneum（T3）,10 min after pneumoperitoneum（T4）,20 min（T5）,30 min（T6）,extubation（T7）,on the first day（T9）and second day（T10）after surgery.The indicators included the normalized unit of low frequency band power（LFnu）,the normalized unit of high frequency band power（HFnu）,the ratio of low to high frequency power（LF/HF）and the logtransformed measure of total frequency band power（lnTP）.The time of first flatus,defecation,bowel sound and eating were measured.Patients’ venous blood was drawn at 5 min before induction of anesthesia（T1）,the end of surgery（T8）and on the second postoperative day（T10）to measure the serum concentrations of endotoxin,D-lactate,diamine oxidase（DAO）and interleukin-6（IL-6）.The mean arterial pressure and heart rate from T1 to T7,durations of the operation,anesthesia,pneumoperitoneum,drug dosage,volume of urine and fluid replacement,and abdominal pressure value immediately after formation of pneumoperitoneum were summarized during surgery.Awake time,extubation time,PACU residence time,and Steward scores immediately after extubation were all recorded.In addition,the visual analogue scale（VAS）scores,QoR-40 postoperative recovery quality scores were assessed at T9 and T10.The dosage of rescue analgesia within 48 h after surgery and hospitalization days and lidocainerelated adverse events were noted as well.Results（1）General data including the age,BMI and ASA grade were well balanced between two groups（P>0.05）.（2）Compared with T1,LF/HF and LFnu rised significantly while HFnu decreased at T2,T3,T7 in group C（P<0.05）.LF/HF and LFnu were obviously increased while HFnu was decreased at T2,T7 in group L（P<0.05）.LF/HF,LFnu and lnTP decreased while HFnu rised from T5 to T6 in group L（P<0.05）.LF/HF and LFnu in group L were lower than those in group C,but HFnu was higher than that in group C from T2 to T7（P<0.05）.From T4 to T6,lnLF in group L was clearly lower than that in group C（P<0.05）.（3）Compared with T1,MAP at T2～T4 and T7 in group C was meaningfully increased（P<0.05）,MAP at T3,T7 was increased,while decreased at T6 in group L（P<0.05）.At T2～T7,MAP in group L was significantly lower than that in group C（P<0.05）.Compared with T1,HR in group C was significantly increased at T2,T7,and meaningfully decreased from T3 to T6（P<0.05）.HR in group L was significantly decreased from T3 to T6（P<0.05）.At T2～T5 and T7,HR in group L was significantly lower than that of group C（P<0.05）.（4）Compared with T0 in group C,lnTP and HFnu significantly declined with LFnu and LF/HF meaningfully increased at T10（P<0.05）.In group L,LFnu and LF/HF significantly dropped at T9（P<0.05）while HFnu obviously rised（P<0.05）.lnTP obviously dropped at T10（P<0.05）.At T9,lnTP and HFnu in group L were significantly higher than those in group C,while LFnu and LF/HF were significantly lower than those in group C（P<0.05）.（5）The time of first exhaust,defecation,bowel sound,and eating in group L was obviously shorter than in group C（P<0.05）.The serum concentrations of endotoxin,D-lactate,DAO and IL-6 in group L were significantly lower than those in group C at T10（P<0.05）.（6）The dosage of propofol and remifentanil in group L were lower compared with group C（P<0.05）.There was also no significant difference in awake time,extubation time,PACU residence time and Steward scores immediately after extubation between two groups（P>0.05）.（7）VAS scores during rest and activity were obviously lower in group L than those in group C at T9（P<0.05）.At T9 and T10,the QoR-40 scores in group L were meaningfully higher than those in group C（P<0.05）.There was no significant difference in the dosage of rescue analgesics within 48 h after operation between two groups（P>0.05）.There was also no obvious difference in hospitalization days between two groups（P>0.05）.No lidocaine-related adverse events occurred in both groups.Conclusions（1）Intravenous lidocaine could reduce sympathetic nervous excitability to increase parasympathetic nervous function relatively during airway manipulation,pneumoperitoneum and the first postoperative day.（2）Intravenous lidocaine could maintaine stable intraoperative circulation and reduce early postoperative pain levels and inflammatory responses.（3）Intravenous lidocaine could improve postoperative bowel function and the quality of postoperative recovery. |
