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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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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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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