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已发表论文
术中静脉利多卡因对老年后路腰椎椎间融合术患者术后谵妄的影响
Authors Feng X , Jia J, Sang Y, Zhao Y, Wang Z, Wang P, Chen L, Zhu J , Li C, Liu S, Gao P, Gong T, Hu X , Su X
Received 29 September 2025
Accepted for publication 28 January 2026
Published 30 January 2026 Volume 2026:20 571032
DOI https://doi.org/10.2147/DDDT.S571032
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor Anastasios Lymperopoulos
Xuanzhi Feng,1,* Jindi Jia,1,2,* Yuting Sang,1,* Yanan Zhao,1 Zixuan Wang,3,4 Pengjia Wang,1 Lu Chen,5 Jiayu Zhu,3,4 Chao Li,3,4 Shufang Liu,3,4 Peiyun Gao,1 Tao Gong,1 Xijian Hu,6 Xuesen Su3,4
1Department of Anesthesiology, Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China; 2Department of Anesthesiology, The Second Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China; 3The Department of Anesthesiology, The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China; 4Shanxi Key Laboratory of Geriatric Precision Anesthesia and Complication Prevention, The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China; 5The Department of Anesthesiology, Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China; 6Department of Orthopedics, The Second Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Xuesen Su, The Department of Anesthesiology, The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China, Tel +86 18334720621, Email xuesensu_sxpph@yeah.net
Purpose: This study aimed to evaluate the effect of intraoperative intravenous (IV) lidocaine on the incidence of postoperative delirium (POD) in elderly patients undergoing major spinal surgery.
Patients and Methods: In this prospective, single-center randomized clinical trial, elderly patients scheduled for elective posterior lumbar interbody fusion (PLIF) with instrumentation spanning two or more vertebral segments were enrolled. A total of 270 patients were randomized to receive either intravenous lidocaine (Group L) or saline (Group C). Group L received lidocaine at a bolus dose of 1.5 mg/kg before induction, followed by continuous infusion at 1.5 mg/kg/h until the end of surgery, while Group C received an equivalent volume of saline. All patients underwent standardized general anesthesia. The primary outcome was the incidence of postoperative delirium (POD) within 5 days after surgery. Secondary outcomes included delirium severity, onset, duration, and subtype (hypoactive, hyperactive, or mixed), postoperative visual analog scale (VAS; 0– 100 mm) pain scores, intraoperative anesthetic consumption, 24-hour sufentanil consumption and patient-controlled intravenous analgesia (PCIA) attempts, and perioperative adverse events.
Results: The lidocaine group had a lower incidence of postoperative delirium (8.9% vs 20.7%; RR, 0.43; 95% CI, 0.23– 0.81; P < 0.05). Among patients who developed delirium, the duration was comparable between groups, while severity scores were higher and time to onset was shorter in the control group. Within the first 24 hours postoperatively, the lidocaine group had lower VAS scores, fewer PCIA attempts, and a reduced cumulative sufentanil dose. Opioid-related adverse events, including nausea and vomiting, were less frequent, with no cases of local anesthetic toxicity, and the overall hospital stay was comparable.
Conclusion: In elderly patients undergoing PLIF, intraoperative intravenous lidocaine (1.5 mg/kg administered before induction, followed by continuous infusion at 1.5 mg/kg/h until the end of surgery) lowered the occurrence of postoperative delirium (POD) within the first 5 days after surgery.
Keywords: lidocaine, postoperative delirium, posterior lumbar interbody fusion, elderly patients
1Department of Anesthesiology, Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China; 2Department of Anesthesiology, The Second Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China; 3The Department of Anesthesiology, The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China; 4Shanxi Key Laboratory of Geriatric Precision Anesthesia and Complication Prevention, The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China; 5The Department of Anesthesiology, Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China; 6Department of Orthopedics, The Second Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Xuesen Su, The Department of Anesthesiology, The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China, Tel +86 18334720621, Email xuesensu_sxpph@yeah.net
Purpose: This study aimed to evaluate the effect of intraoperative intravenous (IV) lidocaine on the incidence of postoperative delirium (POD) in elderly patients undergoing major spinal surgery.
Patients and Methods: In this prospective, single-center randomized clinical trial, elderly patients scheduled for elective posterior lumbar interbody fusion (PLIF) with instrumentation spanning two or more vertebral segments were enrolled. A total of 270 patients were randomized to receive either intravenous lidocaine (Group L) or saline (Group C). Group L received lidocaine at a bolus dose of 1.5 mg/kg before induction, followed by continuous infusion at 1.5 mg/kg/h until the end of surgery, while Group C received an equivalent volume of saline. All patients underwent standardized general anesthesia. The primary outcome was the incidence of postoperative delirium (POD) within 5 days after surgery. Secondary outcomes included delirium severity, onset, duration, and subtype (hypoactive, hyperactive, or mixed), postoperative visual analog scale (VAS; 0– 100 mm) pain scores, intraoperative anesthetic consumption, 24-hour sufentanil consumption and patient-controlled intravenous analgesia (PCIA) attempts, and perioperative adverse events.
Results: The lidocaine group had a lower incidence of postoperative delirium (8.9% vs 20.7%; RR, 0.43; 95% CI, 0.23– 0.81; P < 0.05). Among patients who developed delirium, the duration was comparable between groups, while severity scores were higher and time to onset was shorter in the control group. Within the first 24 hours postoperatively, the lidocaine group had lower VAS scores, fewer PCIA attempts, and a reduced cumulative sufentanil dose. Opioid-related adverse events, including nausea and vomiting, were less frequent, with no cases of local anesthetic toxicity, and the overall hospital stay was comparable.
Conclusion: In elderly patients undergoing PLIF, intraoperative intravenous lidocaine (1.5 mg/kg administered before induction, followed by continuous infusion at 1.5 mg/kg/h until the end of surgery) lowered the occurrence of postoperative delirium (POD) within the first 5 days after surgery.
Keywords: lidocaine, postoperative delirium, posterior lumbar interbody fusion, elderly patients