Zatsarynnyi R. Efficacy and safety of continuous administration of lidocaine as a component of intraoperative anesthesia and postoperative intensive care for extensive liver resections. – Qualification scientific work on the rights of a manuscript

To achieve the purpose, 108 patients who underwent extensive liver resection from 2020 to 2021 in the Department of Surgery and Liver Transplantation at the National Institute of Surgery and Transplantology named after O. O. Shalimov had been examined and analyzed. Inclusion criteria: patients scheduled for elective liver resection of more than 3 segments of the liver (extensive resection); age from 18 to 80 years; physical status I–III according to the American Society of Anesthesiologists (ASA) scale. Exclusion criteria: body weight < 40 kg or > 120 kg; metastases in other distant organs; severe hepatic impairment (aspartate aminotransferase or alanine transaminase or bilirubin > 2,5 times the upper limit of normal); renal impairment (creatinine clearance < 60 ml/min); cardiac arrhythmias or systolic heart failure (II ‒ III degree heart block, ejection fraction <50%); allergy to any of the study drugs; chronic use of opioids; inability to understand the numerical scale of assessments; age less than 18 years and over 80 years; lack of consent to the use of methods of anesthesia. The investigated patients were divided into three groups depending on the choice of intra- and postoperative anesthesia. The first group (22 patients) was the study group (intravenous lidocaine group). These patients were prescribed intravenous lidocaine as an adjuvant during multicomponent anesthesia (endotracheal anesthesia + phentanili 0.005% 2 ‒ 3 μg/kg·h + rocuronium 0,2 mg/kg·h + sevoflurane inhalation anesthetic (MAC 0,7–1,0)) according to the following method: intraoperatively ‒ a loading dose of 1,5 mg/kg of a 1,5% solution and the start of maintenance administration of 1,0 mg/kg·h, early postoperative period for 2–3 days – maintenance administration of 0,7–1 mg/kg·h. During the indicated time of postoperative use, all patients were in the conditions of the intensive care unit (ICU) to ensure a high level of care. Group II (73 patients) – comparison group (group of epidural anesthesia (EDA) in the thoracic spine). In such cases, classical multicomponent anesthesia (endotracheal anesthesia + phentanili 0,005% 1–2 μg/kg·h IV + rocuronium 0,15 mg/kg·h + sevoflurane inhalation anesthetic (MAC 0,7–0,9 )) was supplemented with epidural analgesia through a catheter inserted in the thoracic spine at the level of Th8‒Th9. For analgesia, lidocaine 1,5% solution was also used, which was administered both intra- and postoperatively at a rate of 70–80 mg/h (for 2–3 days). Group III (13 patients) – the control group, in which the classic multicomponent (endotracheal anesthesia + phentanili 0,005% 4–5 μg/kg·h + rocuronium 0,2–0,3 mg/kg·h + sevoflurane inhalation anesthetic (MAC 0,8–1,0)). Intraoperative analgesia and anesthesia with narcotic and non-narcotic analgesics in the postoperative period, so all groups received the same scheme: paracetamol 3 g/day + dexketoprofen trometamol 50 mg three times a day, and narcotic analgesia as required.