Peng, Y., Zhang, W., Zhou, X., Ji, Y., Kass, I.S., & Han, R. (2016). Lidocaine did not reduce neuropsychological-cognitive decline in patients 6 months after supratentorial tumor surgery: A randomized, controlled trial. Journal of Neurosurgical Anesthesiology, 28, 6–13.

To investigate the effect of intraoperative lidocaine infusion on postoperative cognitive function after craniotomy for supratentorial tumor resection

Patients in the experimental group received lidocaine (2%) as an IV bolus (1.5 mg/kg) after anesthesia induction followed by infusion at 2 mg/kg per hour throughout surgery (lidocaine group). Patients in the control group received normal saline at the same rate (normal saline group).

• N = 80   
• AGE: Mean = 44.5 years (SD = 9.5) (as calculated with the reported values from each group)
• MALES: 49%  
• FEMALES: 51%
• CURRENT TREATMENT: Other
• KEY DISEASE CHARACTERISTICS: Supratentorial brain tumor (e.g., glioma, meningioma) 
• OTHER KEY SAMPLE CHARACTERISTICS: 35% college or higher level of education. American Society of Anesthesiologists physical status I or II; body mass index (BMI) < 30; no history of systemic malignant tumors, diabetes, psychiatric disorders, or alcohol or drug abuse; ability to complete neuropsychological tests. To reduce the influence of potential preoperative cognitive dysfunction, patients with a preoperative Mini-Mental State Examination (MMSE) score < 24 or intracerebral vascular surgery were excluded.

• SITE: Single site   
• SETTING TYPE: Inpatient    
• LOCATION: Academic hospital in China

PHASE OF CARE: Active anti-tumor treatment

Double-blind randomized controlled trial of lidocaine versus placebo with repeated measures

• Mini-Mental State Examination (MMSE)
• Information-Memory Concentration Test (IMCT)
• Hamilton Rating Scale for Depression (HRSD)
• Hamilton Rating Scale for Anxiety (HAMA)
• Outcome data were collected at six time points: before surgery, and at 24 hours, 1 week, 1 month, 3 months, and 6 months after surgery.

There were no significant demographic or clinical differences between the lidocaine group and normal saline group at baseline. Postoperative neuropsychological-cognitive decline was defined as a decline greater than or equal to the preoperative standard deviation on two or more of the four tests (MMSE, IMCT, HRSD, and HAMA). Using this criteria, there were a greater proportion of patients with postoperative decline in the saline group as compared to the lidocaine group at 1 week after surgery (40% versus 16%, p < 0.05), but this was not statistically significant after correcting for multiple comparisons. There were no significant differences between the groups in the incidence of postoperative cognitive decline at 1 day, 1 month, 3 months, or 6 months. Additional analyses using less stringent criteria for cognitive decline on MMSE and IMCT alone also did not reveal any differences.

Intraoperative lidocaine had no effect on cognitive functioning after supratentorial tumor resection.

• Small sample (< 100)
• Measurement validity/reliability questionable
• Intervention expensive, impractical, or training needs
• Questionable protocol fidelity
• Other limitations/explanation: Measures for anxiety (HAMA) and depressive symptoms (HAMD) were considered measures of neuropsychological functioning in this study; however, findings were unchanged in post-hoc analyses that excluded these measures. MMSE and IMCT are typically used as screening measures for dementia rather than as an outcome measure for subtle cognitive changes.

There is insufficient evidence to support the use of intraoperative lidocaine to reduce the incidence of cognitive decline after supratentorial tumor surgery.