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Lidocaine-esketamine infusion reduces movement-evoked pain and opioid consumption in hepatic resection patientsNew drug combination reduces pain after liver surgery

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Key Takeaway
Consider lidocaine-esketamine to reduce movement-evoked pain and opioid use post-hepatic resection, though effects are modest.

This randomized controlled trial enrolled 304 patients undergoing elective hepatic resections to evaluate the efficacy of a lidocaine-esketamine infusion. The intervention was administered from induction until the end of surgery, followed by a continuous infusion for 72 hours. The primary outcome was movement-evoked pain 24 hours post-surgery.

At 24 hours, the lidocaine-esketamine group reported a median score of 3 (IQR 2-4 [1-6]) compared to 4 (3-5 [1-9]) in the placebo group (p < 0.001). At 48 hours, the median score was 3 (IQR 2-4 [0-7]) versus 4 (3-5 [0-8]) (p < 0.001). At 72 hours, the median score was 2 (IQR 1-3 [0-6]) versus 3 (2-4 [0-7]) (p < 0.001). In the lidocaine-esketamine group, 34% (52/152) reported moderate-to-severe pain at 24 hours, compared to 56% (85/152) in the placebo group.

Secondary outcomes showed that cumulative sufentanil equivalents were significantly reduced at each measurement time in the lidocaine-esketamine group. Quality of recovery scores were also significantly higher through the first 72 hours. No specific adverse events or tolerability data were reported. While the results are statistically significant, the study notes that the treatment effects were modest and of limited clinical importance. The findings suggest a causal link between the lidocaine-esketamine combination and improved early postoperative management.

How this fits prior evidence

How this fits prior evidence: This finding extends the clinical application of esketamine beyond its use in reducing oculocardiac reflex incidence during pediatric strabismus surgery. While previous evidence established intranasal esketamine and intravenous ketamine as strong treatments for depressive disorders, this study explores the analgesic and recovery benefits of esketamine in a surgical setting. It also provides a different context for lidocaine use compared to its role in reducing pain during IUD insertion.

Surgery on the liver can be incredibly painful, especially when patients need to move. To manage this, doctors are looking for ways to reduce both the intensity of the pain and the amount of heavy-duty pain medication, known as opioids, that patients need to take.

A study of 304 patients undergoing liver surgery found that a specific mix of lidocaine and esketamine helped manage pain. Patients receiving this combination reported lower levels of pain triggered by movement at the 24, 48, and 72-hour marks after surgery. They also used significantly less sufentanil, a type of opioid, and reported a better quality of recovery during those first three days.

While the results show the treatment works, the researchers noted that the actual improvements were modest. This means that while the combination is effective at reducing pain and lowering opioid use, the difference in how patients felt might be small in some cases. Because the study is still early in its evaluation of clinical importance, talk to your doctor about how these findings might apply to your specific care.

What this means for you:
A lidocaine and esketamine mix can lower movement-related pain and opioid use after liver surgery.

Common questions

How does this treatment help with pain after liver surgery?

The combination of lidocaine and esketamine was shown to reduce pain caused by movement at 24, 48, and 72 hours after surgery. In the study, fewer patients in the treatment group reported moderate-to-severe pain compared to those who received a placebo.

Does this treatment reduce the need for opioid medications?

Yes, the study found that patients receiving the lidocaine and esketamine mixture used significantly less sufentanil, which is a type of opioid. This helped improve the overall quality of recovery during the first 72 hours after the procedure.

Is the improvement from this treatment very large?

While the treatment did successfully reduce pain and opioid use, the researchers noted that the effects were modest. This means the improvement, while statistically significant, might be of limited clinical importance for some patients.

Study Details

Study typeRct
EvidenceLevel 2
PublishedSep 2026
View Original 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 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.
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