Lidocaine for LESS Postoperative Shoulder Pain Alleviation

Official title

Subdiaphragmatic Infiltration of Diluted Lidocaine During Single-incision Laparoscopic Surgery for Postoperative Shoulder Pain Alleviation

Overview

Objective: To evaluate the efficacy of subdiaphragmatic spray of 0.08% lidocaine in relieving postoperative acute pain and psychological status of patients undergoing single-port laparoscopic surgery for benign gynecological diseases, and to provide evidence-based basis for optimizing postoperative analgesic strategies. Methods: A single-center, prospective randomized controlled study was conducted. A total of 100 patients scheduled for elective single-port laparoscopic surgery due to uterine fibroids, ovarian cysts, or other benign gynecological conditions were selected from the General Gynecology Center of Peking Union Medical College Hospital. They were divided into the experimental group (n=50) and the control group (n=50) using a random number table. The experimental group received 50 ml of 0.08% lidocaine solution sprayed on the bilateral subdiaphragmatic regions at the start of surgery, while the control group underwent standard ERAS without any pharmaceutical intervention in the subdiaphragmatic area. The primary endpoint was the Numerical Rating Scale (NRS) score for resting pain at 6 hours postoperatively. The secondary endpoints included NRS scores at 1, 2, 12, and 24 hours postoperatively, total consumption of analgesics within 48 hours after surgery, incidence of adverse reactions, patient satisfaction, and scores of psychological and sleep scales (Distress Thermometer, GAD-7, etc.) at 30 days postoperatively. SPSS 25.0 software was used for data analysis. Quantitative data were analyzed by t-test or Mann-Whitney U test, and qualitative data were analyzed by χ² test or Fisher's exact test. Repeated measurement data were analyzed by repeated measures analysis of variance. Results: After the completion of the study, differences in NRS scores, analgesic consumption, psychological status and other indicators between the two groups will be compared. Conclusion: The results of this study will clarify the clinical value of intraoperative diaphragmatic infiltration with low-concentration lidocaine in postoperative analgesia after single-port laparoscopic gynecological surgery, and provide references for postoperative pain management and psychological intervention.

Interventions

• Other subdiaphragmatic lidocaine sprayed
  After adjusting the patient's position, a catheter is inserted through the single-port laparoscopic operating channel, and 50ml of 0.08% lidocaine solution is evenly sprayed on the bilateral subdiaphragmatic regions under laparoscopic direct vision.
• Procedure standard ERAS
  Standard Enhanced Recovery After Surgery (ERAS) protocol for single-port laparoscopic surgery is performed, with no drug intervention in the subdiaphragmatic region at the end of surgery.

Primary outcome measures

• Numerical Rating Scale (NRS) score at rest 6 hours postoperatively [Time frame: From operation to 6 hours after operation]

Secondary outcome measures (11)

• NRS scores at rest 1, 2, 12, and 24 hours postoperatively [Time frame: from operation to 1, 2, 12, and 24 hours after operation]
• Total consumption of postoperative analgesic drugs：type of additional postoperative analgesic drugs [Time frame: from operation to 48 hours after operation]
• Total consumption of postoperative analgesic drugs： dosage of additional postoperative analgesic drugs [Time frame: from operation to 48 hours after operation]
• Incidence of postoperative nausea and vomiting [Time frame: from operation to 48 hours after operation]
• Overall patient satisfaction score with postoperative analgesic effect (using a 5-point Likert scale, including five levels: Very Dissatisfied, Dissatisfied, Neutral, Satisfied, Very Satisfied) [Time frame: from operation to 48 hours after operation]
• Distress Thermometer [Time frame: from enrollment to 30 days after operation]
• Generalized Anxiety Disorder 7-item Scale (GAD-7) [Time frame: from enrollment to 30 days after operation]
• Patient Health Questionnaire 2-item Scale (PHQ-2) [Time frame: from enrollment to 30 days after operation]
• Patient Health Questionnaire 9-item Scale (PHQ-9) [Time frame: from enrollment to 30 days after operation]
• Impact of Event Scale - Revised (IES-R) [Time frame: from enrollment to 30 days after operation]
• Pittsburgh Sleep Quality Index (PSQI) [Time frame: from enrollment to 30 days after operation]

Eligibility criteria

Inclusion criteria

• Age: Female patients aged 18-65 years;
• Clear preoperative diagnosis, suitable for single-port laparoscopic surgery, and American Society of Anesthesiologists (ASA) physical status classification I-II;
• Patients or their family members can understand the study protocol, are willing to participate in the study, and provide written informed consent.

Exclusion criteria

• Allergy to lidocaine or amide-type local anesthetics;
• Severe medical comorbidities;
• Long-term preoperative use of opioid drugs or sedatives;
• Pregnant or lactating women;
• Conversion to laparotomy or addition of surgical ports during surgery.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Double blind

Primary purpose

Prevention

Study locations

China · 1 center

• Peking Union Medical College — Beijing

Identifiers

NCT: NCT07537127 · DKFQJGXJRMZ-1

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗