Lidocaine Combined With Low-Dose Esketamine for Movement-Evoked Pain After Hepatectomy: A Double-Blind Randomised Controlled Trial

Authors

• Yan Xu
• Li Zhou
• Qianqian Tang
• Feng Yu
• Jingwen Wu
• Siyu Yan
• Min Cai
• Jialu Wan
• Yi Kang
• Lajing Luowu
• Mengmeng Zhou
• Lulong Bo
• Daniel I Sessler
• Chunling Jiang

Language

English

Publication Date

9-1-2026

Journal

Anaesthesia

DOI

10.1111/anae.70215

PMID

41913698

PMCID

PMC13446845

PubMedCentral® Posted Date

3-31-2026

PubMedCentral® Full Text Version

Post-print

Abstract

Introduction: Pain following hepatectomy may delay recovery and increase opioid use. We tested the primary hypothesis that combining lidocaine and low-dose esketamine would reduce movement-evoked pain 24 h after hepatic resection. We also evaluated whether this approach reduced opioid consumption and improved quality of recovery.

Methods: Patients having elective hepatic resections were allocated randomly to receive lidocaine-esketamine or placebo from induction of anaesthesia until the end of surgery. After surgery, patients allocated to lidocaine-esketamine were given a continuous infusion of lidocaine with esketamine for 72 h. All patients received transversus abdominis plane blocks with ropivacaine 2 mg.kg-1 after induction of anaesthesia. Postoperative analgesia was provided by patient-controlled intravenous analgesia with sufentanil.

Results: In total, 304 patients were included, of whom 145 (48%) had open surgery. Lidocaine-esketamine infusion reduced median (IQR [range]) pain scores with movement at 24 h (3 (2-4 [1-6]) vs. 4 (3-5 [1-9]), p < 0.001); 48 h (3 (2-4 [0-7]) vs. 4 (3-5 [0-8]), p < 0.001); and 72 h (2 (1-3 [0-6]) vs. 3 (2-4 [0-7]), p < 0.001), respectively. Moderate-to-severe movement-evoked pain at 24 h was evident in 52/152 (34%) patients who received lidocaine-esketamine vs. 85/152 (56%) who received placebo (p < 0.001). Cumulative sufentanil equivalents were significantly reduced at each measurement time and quality of recovery scores were significantly higher through the first 72 h for lidocaine-esketamine compared with placebo, but these changes were clinically modest.

Discussion: The combination of lidocaine with esketamine reduced movement-evoked pain and opioid consumption whilst improving quality of recovery during the initial 72 h after hepatic resection. However, treatment effects were modest and of limited clinical importance.

Keywords

Humans, Lidocaine, Double-Blind Method, Postoperative Pain, Female, Male, Hepatectomy, Anesthetics, Local, Ketamine, Middle Aged, Aged, Movement, Analgesics, Opioid, Pain Measurement, Drug Therapy, Combination, Analgesia, Patient-Controlled, Adult, Sufentanil, anaesthesia, analgesics, esketamine, hepatectomy, lidocaine

Published Open-Access

yes

Recommended Citation

Xu, Yan; Zhou, Li; Tang, Qianqian; et al., "Lidocaine Combined With Low-Dose Esketamine for Movement-Evoked Pain After Hepatectomy: A Double-Blind Randomised Controlled Trial" (2026). Faculty, Staff and Student Publications. 1522.
https://digitalcommons.library.tmc.edu/uthsph_docs/1522