Efficacy of intravenous lidocaine infusions for pain relief in children undergoing laparoscopic appendectomy: a randomized controlled trial.

Intravenous lidocaine, a potent local anesthetic with analgesic and anti-inflammatory properties, has been shown to be an effective adjunct that reduces intra- and postoperative opioid consumption and facilitates pain management in adults. While it shows promise for use in the pediatric population, limited evidence is available. OBJECTIVES: To determine if general anesthesia with intraoperative intravenous lidocaine infusion versus general anesthesia without intravenous lidocaine infusion in children undergoing laparoscopic appendectomy decreased opioid requirements intra- and postoperatively. DESIGN: A single-center parallel single-masked randomized controlled study. A computer-generated blocked randomization list was used to allocate participants. The study was conducted between March 2019 and January 2020. SETTING: Pediatric teaching hospital in Poland. PARTICIPANTS: Seventy-four patients aged between 18 months and 18 years undergoing laparoscopic appendectomy. Seventy-one patients fulfilled the study requirements. INTERVENTION: Intravenous lidocaine bolus of 1.5 mg/kg over 5 min before induction of anesthesia followed by lidocaine infusion at 1.5 mg/kg/h intraoperatively. The infusion was discontinued before the patients' transfer to the postanesthesia care unit (PACU). PRIMARY OUTCOME MEASURE: The primary outcome measure was total nalbuphine requirement in milligrams during the first 24 h after surgery. SECONDARY OUTCOME MEASURES: The secondary outcome measures were intraoperative fentanyl consumption, intraoperative sevoflurane consumption, time to the first rescue analgesic request, incidence of postoperative nausea and vomiting during the first 24 h after surgery, frequency of side effects of lidocaine. RESULTS: Children (n = 74) aged 5-17 randomly allocated to receive intraoperative lidocaine infusion (n = 37) or no intervention (n = 37). Seventy-one were included in the analysis (35 in the study group and 36 in the control group). There was no difference in the cumulative dose of nalbuphine in the first 24 h after removal of the endotracheal tube between groups [median of 0.1061 (IQR: 0.0962-0.2222) mg/kg in the lidocaine group, compared to the control group median of 0.1325 (IQR: 0.0899-0.22020) mg/kg, p = 0.63]. Intraoperative fentanyl consumption was lower in the lidocaine group [median of 5.091 (IQR: 4.848-5.714) µg/kg] than in the control group [median of 5.969 (IQR: 5.000-6.748), p = 0.03]. Taking into account the additional doses administered based on clinical indications, the reduction in the requirement for fentanyl in the lidocaine group was even greater [median of 0.0 (IQR: 0.0-0.952) vs 0.99 (IQR: 0.0-1.809) µg/kg, p = 0.01]. No difference was observed in the sevoflurane consumption between the two groups [median of 32.5 ml (IQR 25.0-43.0) in the lidocaine group vs median of 35.0 ml (IQR: 23.5-46.0) in the control group, p = 0.56]. The time to first analgesic request in the lidocaine group was prolonged [median of 55 (IQR: 40-110) min in the lidocaine group vs median of 40.5 (IQR: 28-65) min in the control group, p = 0.05]. There was no difference in the frequency of PONV between the two groups (48.57% in the lidocaine group vs 61.11% in the control group, p = 0.29). No lidocaine related incidence of anaphylaxis, systemic toxicity, circulatory disturbances or neurological impairment was reported, during anesthesia or postoperative period. CONCLUSIONS: Intraoperative systemic lidocaine administration reduced the intraoperative requirement for opioids in children undergoing laparoscopic appendectomy. This effect was time limited, and hence did not affect opioid consumption in the first 24 h following discontinuation of lidocaine infusion. TRIAL REGISTRATION: NCT03886896 .

Expression of E-cadherin, ß-catenin, and epithelial membrane antigen does not predict survival in patients with high-risk non-muscle-invasive bladder cancer.

THE AIM OF THE STUDY: The aim of the study was to validate the value of E-cadherin and ß-catenin expression and to test an alternative prognostic marker, epithelial membrane antigen (EMA). MATERIAL AND METHODS: Forty-nine consecutive patients with primary stage T1 non-muscle-invasive bladder cancer (NMIBC) were enrolled in this study. Tissue specimens were stained with the following mouse anti-human antibodies: anti-E-cadherin, anti-ß-catenin, and anti-EMA. Reaction intensity within cancer cells was assessed according to the immunoreactive score (IRS). Finally, the association between the expression of selected proteins and patient survival was assessed. RESULTS: The mean follow-up was 34.8 months. Recurrence-free survival, progression-free survival, and overall survival (OS) were 47.5%, 72.5%, and 72.5%, respectively. Differences in the IRS for ß-catenin and EMA were found clinically, but were not statistically significant in prediction of the risk of disease progression (p > 0.05). No difference in protein expression was observed regarding the risk of recurrence, OS, or cancer-specific mortality (p > 0.05). Stratification of patients based on the IRS into three groups (poor, moderate, and intensive reaction) failed to identify a prognostic marker among the tested proteins (p > 0.05). CONCLUSIONS: Expression of E-cadherin, ß-catenin, and EMA cannot reliably predict survival in patients with high-risk NMIBC. Further searches are needed to identify tissue markers of progression and recurrence in NMIBC.

The incidence of renal cancer in Polish National Cancer Registry: is there any epidemiological data we can rely on?

INTRODUCTION: The Polish National Cancer Registry (KRN) is the most commonly used sources of data on the incidence of cancers including renal cancer in Poland. Until today, the accuracy and completeness of these data has never been verified. MATERIAL AND METHODS: The aim of this study was to assess the completeness and reliability of data on the incidence of renal cancer published by the KRN. KRN data on newly diagnosed cases of renal cancer in Poland (for the whole country) and separately in subjectively selected provinces between 2009 and 2011 were retrospectively compared to the data received from the National Health Fund (NFZ) on the number of radical and partial nephrectomies performed due to renal cancer in the same time frame and regions. RESULTS: The concordance between the analysed two sources of data was 86%. Calculated ratio of the number of cases in the KRN database to number of cases in the NFZ database in selected provinces were as follows: 109% in Lubuskie, 60% in Mazowieckie, 123% in Podkarpackie and 66% in Podlaskie. No significant differences were observed between analyzed years (89% in 2009, 88% in 2010, 82% in 2011). The number of unreported cases of renal cancer in KRN was lower among male patients comparing to female patients (concordance: 78% vs. 72%). CONCLUSIONS: The incidence of renal cancer published by KRN is underestimated, thus KRN does not seem to be a fully reliable source of epidemiological data. Due to the fact that this data is crucial for the planning of the health policy in Poland, improving urooncological reporting should be a priority for the health system managers.