Lidocaine 5% / Phenylephrine 0.5% nasal spray

Intraoperative penile erection is an uncommon but significant complication encountered during endourological procedures, such as Transurethral Resection of the Prostate (TURP), Transurethral Resection of the Bladder Tumour (TURBT), and ureteroscopy, with incidence rates varying by anaesthetic technique. This phenomenon can impede surgical access, compromise patient safety, and increase the risk of urethral injury and long-term sequelae. Existing practice for its management is shaped by limited evidence and lacks standardised protocols. This review aims to systematically examine the literature on management strategies for intraoperative erection during endourological surgery and to evaluate the efficacy and safety of various interventions, providing evidence-based recommendations for clinical management. The review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, analysing studies from PubMed, EMBASE®, and the Cochrane Library. Search terms included "intraoperative erection" and related phrases. Eligible studies addressed pharmacological or non-pharmacological management of intraoperative erection, excluding those on erectile dysfunction, non-human studies, or non-English articles. Two independent assessors reviewed studies to minimise bias, and quality appraisal was performed using the JBI tool and Oxford Centre for Evidence-Based Medicine grading. Nineteen studies reporting management of intraoperative erection in more than 122 cases over a 40-year period (1983-2023) were included. The majority were case series (n=12) and letters to the editor (n=4), with three case reports. Intracavernosal sympathomimetic agents, particularly phenylephrine (93-100% success rate), ephedrine (100% success rate), and epinephrine (100% success rate), demonstrated the highest efficacy with rapid detumescence (1-5 minutes) and minimal complications. Intravenous sympathomimetics showed variable success rates, with terbutaline achieving 100% success but causing systemic side effects, while ketamine demonstrated inconsistent results (0-78%). Alternative approaches, including dorsal nerve block and cold saline compresses, were effective but less commonly reported. The findings underscore the lack of robust, high-quality evidence for managing intraoperative erection, with current strategies being largely anecdotal or adapted from other contexts. While intracavernosal injection of sympathomimetic agents, particularly phenylephrine, is the most effective first-line management based on available evidence, this is predominantly supported by low-level data (Oxford Level 4-5). The review highlights the urgent need for comprehensive prospective studies, especially randomised controlled trials, to establish standardised, evidence-based treatment protocols. Given the clinical significance of this complication, it also warrants greater attention, including explicit inclusion in preoperative consenting discussions.

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ObjectiveTo assess the effect of low-dose perioperatively continuous infusion of lidocaine on postoperative inflammation, immune function and quality of recovery in patients undergoing video-assisted thoracoscopic surgery (VATS).MethodsPatients with lung cancer aged 18-65 years, undergoing elective VATS were randomized into lidocaine intervention (L) and standard care (C) groups. For patients in Group L, 1 mg/kg lidocaine was intravenously injected within approximately 10 min during the induction of anesthesia, followed by a continuous infusion of lidocaine at a rate of 1.5 mg/kg/h until the patient left the operating room. The postoperative analgesia plan included 2% lidocaine at 5 mg/kg. Group C was given an equal volume of normal saline as a control.The primary outcomes were plasma concentrations of tumor necrosis factor-α (TNF-α), interleukin-1(IL-1), and interleukin-6 (IL-6), along with T lymphocyte counts of CD3+, CD4+, CD8+, and the CD4+/CD8+ ratio before anesthesia induction (T1), and 24 h (T2) and 48 h (T3) postoperatively. Secondary outcomes included the visual analog scale (VAS) for pain at rest and during movement, Time to first post-operative rescue analgesia, Cumulative OME(the oral morphine equivalents) at 24 h, along with the frequency and severity of postoperative nausea and vomiting (PONV) within the initial 48-h after surgery.ResultsIn Group C and Group L, compared with preoperative levels, the levels of CD3 + , CD4 + and the ratio of CD4 + /CD8 + were significantly decreased at 24 and 48 h postoperatively, while the levels of TNF-α, IL-1 and IL-6 were significantly increased (P ConclusionIntravenous infusion of lidocaine during the perioperative period was effective in reducing postoperative inflammatory response and the postoperative suppression of cellular immune function in the body, as well as significantly reducing the level of postoperative pain and the incidence of PONV in patients undergoing VATS.

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BackgroundSame-visit bidirectional endoscopic procedures under sedation are frequently performed in elderly patients. However, the optimal sedation regimen for elderly patients remains uncertain. This study seeks to evaluate the hypothesis that intravenous lidocaine, when used as an adjunct to propofol sedation, reduces the incidence of sedation-related adverse events during these procedures.MethodsThis multicenter, randomized, double-blind, placebo-controlled trial will enroll 648 elderly patients scheduled for same-visit bidirectional endoscopy under sedation at four hospitals in China. Participants will be randomized in a 1:1 ratio to receive either intravenous lidocaine or normal saline (placebo), stratified by study center (n = 324 per group). All patients will receive sufentanil (0.1 μg/kg) followed by either lidocaine (1.5 mg/kg) or an equal volume of normal saline, and then propofol (1.0 mg/kg) for induction. Propofol will be titrated to maintain the target sedation level. The primary outcome is a composite of desaturation (peripheral oxygen saturation 20% reduction from baseline). Secondary outcomes include total propofol dose, incidence of involuntary body movements, postoperative pain and fatigue scores, and recovery time. Analyses will follow a modified intention-to-treat approach.DiscussionWe hypothesize that adjunctive lidocaine with propofol-based sedation will reduce the incidence of intraoperative desaturation and hypotension in elderly patients undergoing same-visit bidirectional endoscopy. The findings will contribute to optimizing sedation strategies in this vulnerable population.Trial registrationChinese Clinical Trial Registry (ChiCTR2400087583).

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BackgroundEsketamine, the S-enantiomer of ketamine, has sympathomimetic and analgesic properties. Intravenous lidocaine provides sedative and analgesic adjuvant effects and blunts airway reflexes during anesthesia induction. However, the role of their combination in elderly patients remains unclear. This study aimed to compare the efficacy and safety of esketamine-lidocaine-propofol induction with those of sufentanil-propofol induction in this population.MethodsIn this prospective, double-blind, randomized trial, 116 elderly patients undergoing elective surgery were assigned to receive esketamine (0.5 mg·kg-1), lidocaine (1.5 mg·kg-1), and propofol (Group E) or sufentanil (0.4 μg·kg-1) and propofol (Group S) for anesthesia induction. The primary outcomes were the incidence of hypotension and the absolute area under the curve (AUC) of mean arterial pressure (MAP) deviation, measured during anesthesia induction (from the initiation of anesthetic drug administration to 5 minutes after tracheal intubation).ResultsThe absolute AUC for Group E was smaller than that for Group S (93.83 [79.74-130.78] mmHg·min vs.147.50 [99.38-210.62] mmHg·min), with a median difference of -51.09 mmHg·min (95% confidence interval (CI), -84.53- -14.00; P = 0.005). The incidence of hypotension in the Group E was lower than Group S (62.1% vs 82.8%), with a relative risk of 0.750 (95% CI, 0.594-0.947; P = 0.013). The incidence of coughing (P P P ConclusionEsketamine-lidocaine-propofol improved hemodynamic stability and reduced adverse events compared with sufentanil-propofol, supporting its use for anesthesia induction in elderly patients.

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IntroductionPost-procedural fatigue is common after sedated gastrointestinal endoscopy and prolongs recovery. We describe a protocol for a prospective, single-center, randomized, controlled, 3 × 3 factorial trial to evaluate the effects of different sedative-analgesic combinations on patient-reported fatigue after gastrointestinal endoscopy.Patients and methodsThree hundred and fifteen patients (aged ≥ 45 years, ASA physical status I or II) presenting for gastrointestinal endoscopy with planned intravenous sedation will be randomly allocated (1:1:1:1:1:1:1:1:1; block sizes 9 and 18) to one of nine equip-sized groups generated by the factorial combination of three sedatives (propofol, ciprofol, remimazolam) with three adjuvant analgesics (sufentanil, esketamine, lidocaine). Sedation will be titrated to Modified Observer's Assessment of Alertness/Sedation scores of 1-2. The primary outcome is the Christensen Fatigue Scale score (range 1-10; higher = worse) 30 min after the procedure. The secondary outcome is the composite incidence of intra-procedural hypotension (mean arterial pressure 2 DiscussionThe results of this trial will provide high-resolution evidence on which sedative or analgesic agent most effectively mitigates early post-endoscopy fatigue, thereby informing patient-centered sedation choices and enhancing recovery.Trial registrationChinese Clinical Trial Registry (ChiCTR2500112657; registered on November 18, 2025).

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BackgroundPostoperative pain is a common concern for patients undergoing modified radical mastectomy (MRM) for breast cancer. Intravenous lidocaine may alleviate acute postsurgical pain. This study aimed to evaluate the analgesic effect of lidocaine in patients receiving sevoflurane or propofol maintenance anesthesia.MethodsThis study is a secondary analysis of a randomized controlled trial evaluating the effect of lidocaine on postoperative outcomes. One hundred patients scheduled for MRM were randomized into four groups (n = 25 per group): sevoflurane (S), sevoflurane plus lidocaine (SL), propofol (P), or propofol plus lidocaine (PL). The primary outcome was the area under the curve (AUC) of the numerical rating scale (NRS) score at rest and during movement within 24 h postoperatively, while secondary outcomes included resting and active NRS within 24 h postoperatively, changes in early inflammatory markers (IL-6, IL-1 β, TNF-α, NF-κ B), consumption of anesthetics and analgesics, adverse events, and patient satisfaction.ResultsCompared with their respective control groups, lidocaine infusion in Groups SL and PL significantly reduced the resting and active AUC for NRS score at 24 h postoperatively (S vs. SL, P P P ConclusionsIntraoperative intravenous lidocaine infusion reduced acute postoperative pain, attenuated the early systemic inflammatory response in MRM patients. These benefits were independent of the maintenance anesthetic used (sevoflurane vs. propofol). However, given the multiple confounding factors that may affect the results of this study due to its design, further randomized controlled trials are required to confirm causality and assess long-term clinical and mechanistic outcomes.Clinical trial registrationChiCTR2300068563 (registered February 23, 2023).

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BackgroundAortocaval compression by the gravid uterus in the supine position may exacerbate spinal hypotension during cesarean delivery. We developed an inflatable lumbar pillow (ILP) to elevate the uterus in the supine position. The aim of this study was to evaluate the effect of the ILP on the dose of phenylephrine to prevent hypotension after spinal anesthesia in cesarean delivery.MethodsOne hundred and twenty-three healthy women undergoing elective cesarean delivery under spinal anesthesia were randomized to the ILP (n = 61) or control group (n = 62). After anesthesia, all women received a phenylephrine infusion started at 25 μg/min and titrated in response to changes in systolic arterial pressure until delivery, and after the woman was positioned supine, the ILP was inflated until uterine incision in the ILP group. The primary outcome was the dose of phenylephrine per minute during the study period.ResultsThe dose of phenylephrine per minute (27.9 ± 3.8 μg/min vs.36.7 ± 8.3 μg/min, P P = 0.042) and nausea (4.9% vs. 22.6%, P = 0.005) were significantly lower in the ILP group than in the control group. There were no significant differences in other maternal side effects or neonatal outcomes between the two groups.ConclusionILP reduces the dose of phenylephrine and the incidence of hypotension and nausea after spinal anesthesia for cesarean delivery. Further studies are needed to morphologically validate the effect of ILP on aortocaval compression.

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