The Effect of Lidocaine Infusion during General Anesthesia on Neutrophil-Lymphocyte-Ratio in Breast Cancer Patients Candidate for Mastectomy; a Clinical Trial
Journal of Cellular & Molecular Anesthesia,
Vol. 1 No. 4 (2016),
26 August 2016
Introduction: Considering the anti-inflammatory role of intravenous (IV) lidocaine, its analgesic properties, and its ability to reduce the need for opioids during and after surgery, in this study we decided to evaluate the effect of IV lidocaine infusion on levels of inflammatory factors based on neutrophil to lymphocyte ratio (NLR) in breast cancer surgery candidates.
Methods: The present study is a randomized clinical trial. All the patients with ASA: I, II breast cancer, who were candidates of mastectomy elective surgery were included. The patients were allocated to 2 groups of IV lidocaine and normal saline based on a random numbers table. After inducing anesthesia similarly for all the patients, using 0.02 mg/kg midazolam, 2-4 µg/kg fentanyl, 1-2 mg/kg propofol and 0.5 mg/kg atracurium, either 1.5 mg/kg/hr IV lidocaine or the same volume of normal saline was infused intravenously. Glasgow prognostic score and NLR were calculated before and 6, 24, and 48 hours and 14 days after surgery.
Results: A total of 63 women suffering from breast cancer, with the mean age of 49.25 ± 9.32 years, were included, and allocated to lidocaine and control groups using simple randomization. There was no statistically significant difference between the 2 groups regarding mean age (p = 0.591), incision size (p = 1.000), and duration of surgery (p = 0.752). Using mixture model regression analysis and after adjusting the effect of baseline variables, a significant difference was detected between the groups regarding NLR during the follow-up period (p = 0.006).
Conclusion: Based on the findings of the present study, it seems that NLR changes were smaller in breast cancer patients, who had received lidocaine infusion during surgery, compared to the control group.
- Breast neoplasm
Babu GR, Samari G, Cohen SP, Mahapatra T, Wahbe RM, Mermash S, et al. Breast cancer screening among females in Iran and recommendations for improved practice: a review. Asian Pac J Cancer Prev. 2011;12(7):1647-55.
Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. cell. 2011;144(5):646-74.
Singh RR, Kumar R. Steroid hormone receptor signaling in tumorigenesis. Journal of cellular biochemistry. 2005;96(3):490-505.
Amani D, Khalilnezhad A, Ghaderi A, Niikawa N, Yoshiura K-i. Transforming growth factor beta1 (TGFβ1) polymorphisms and breast cancer risk. Tumor Biology. 2014;35(5):4757-64.
Matsumoto A, Jinno H, Ando T, Fujii T, Nakamura T, Saito J, et al. Biological markers of invasive breast cancer. Japanese journal of clinical oncology. 2016;46(2):99-105.
Caracas HCPM, Maciel JVB, de Souza MMG, Maia LC. The use of lidocaine as an anti-inflammatory substance: a systematic review. journal of dentistry. 2009;37(2):93-7.
WAL S, Vaneker M, Steegers M, Berkum Bv, Kox M, LAAK J, et al. Lidocaine increases the anti‐inflammatory cytokine IL‐10 following mechanical ventilation in healthy mice. Acta Anaesthesiologica Scandinavica. 2015;59(1):47-55.
Tavare AN, Perry NJ, Benzonana LL, Takata M, Ma D. Cancer recurrence after surgery: direct and indirect effects of anesthetic agents. International journal of cancer. 2012;130(6):1237-50.
Colonna S, Werner TL. Breast Cancer Bone Metastases. Metastatic Bone Disease: Springer; 2016. p. 45-54.
Kemal Y, Yucel I, Ekiz K, Demirag G, Yilmaz B, Teker F, et al. Elevated serum neutrophil to lymphocyte and platelet to lymphocyte ratios could be useful in lung cancer diagnosis. Asian Pacific journal of cancer prevention: APJCP. 2013;15(6):2651-4.
Minardi D, Scartozzi M, Montesi L, Santoni M, Burattini L, Bianconi M, et al. Neutrophil-to-lymphocyte ratio may be associated with the outcome in patients with prostate cancer. SpringerPlus. 2015;4(1):1.
BONE RC. Inhibitors of complement and neutrophils: a critical evaluation of their role in the treatment of sepsis. Critical care medicine. 1992;20(6):891-8.
Redl H, Nikolai A, Kneidinger R, Schlag G. Endothelial and leukocyte activation in experimental polytrauma and sepsis. Behring Institute Mitteilungen. 1993(92):218-28.
Garutti I, Rancan L, Simón C, Cusati G, Sanchez-Pedrosa G, Moraga F, et al. Intravenous lidocaine decreases tumor necrosis factor alpha expression both locally and systemically in pigs undergoing lung resection surgery. Anesthesia & Analgesia. 2014;119(4):815-28.
Lan W, Harmon D, Wang J, Ghori K, Shorten G, Redmond P. The effect of lidocaine on in vitro neutrophil and endothelial adhesion molecule expression induced by plasma obtained during tourniquet-induced ischaemia and reperfusion. European journal of anaesthesiology. 2004;21(11):892-7.
Templeton AJ, McNamara MG, Šeruga B, Vera-Badillo FE, Aneja P, Ocaña A, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. Journal of the National Cancer Institute. 2014;106(6):dju124.
Cook VL, Shults JJ, McDowell MR, Campbell NB, Davis JL, Marshall JF, et al. Anti-inflammatory effects of intravenously administered lidocaine hydrochloride on ischemia-injured jejunum in horses. American journal of veterinary research. 2009;70(10):1259-68.
Azuma Y, Shinohara M, Wang P-L, Suese Y, Yasuda H, Ohura K. Comparison of inhibitory effects of local anesthetics on immune functions of neutrophils. International journal of immunopharmacology. 2000;22(10):789-96.
Berger C, Rossaint J, Van Aken H, Westphal M, Hahnenkamp K, Zarbock A. Lidocaine reduces neutrophil recruitment by abolishing chemokine-induced arrest and transendothelial migration in septic patients. The Journal of Immunology. 2014;192(1):367-76.
Schmidt W, Schmidt H, Bauer H, Gebhard MM, Martin E. Influence of lidocaine on endotoxin-induced leukocyte-endothelial cell adhesion and macromolecular leakage in vivo. The Journal of the American Society of Anesthesiologists. 1997;87(3):617-24.
Li K, Yang J, Han X. Lidocaine sensitizes the cytotoxicity of cisplatin in breast cancer cells via up-regulation of RARβ2 and RASSF1A demethylation. International journal of molecular sciences. 2014;15(12):23519-36.
Lucchinetti E, Awad AE, Rahman M, Feng J, Lou P-H, Zhang L, et al. Antiproliferative Effects of Local Anesthetics on Mesenchymal Stem CellsPotential Implications for Tumor Spreading and Wound Healing. The Journal of the American Society of Anesthesiologists. 2012;116(4):841-56.
Yoon JR, Whipple RA, Balzer EM, Cho EH, Matrone MA, Peckham M, et al. Local anesthetics inhibit kinesin motility and microtentacle protrusions in human epithelial and breast tumor cells. Breast cancer research and treatment. 2011;129(3):691-701.
Chen J, Deng Q, Pan Y, He B, Ying H, Sun H, et al. Prognostic value of neutrophil‐to‐lymphocyte ratio in breast cancer. FEBS open bio. 2015;5(1):502-7.
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