Lidocaine for the Prevention of Myocardial Injury After Noncardiac Surgery (LEMONADE TRIAL)

Lidocaine for the Prevention of Myocardial Injury After Noncardiac Surgery (LEMONADE TRIAL)

 

CIA: Dr Justin Nazareth

Myocardial injury after noncardiac surgery (MINS) is the most common perioperative cardiovascular complication affecting up to 8 million adults worldwide annually. 

Project summary

Myocardial injury after noncardiac surgery (MINS) is the most common perioperative cardiovascular complication affecting up to 8 million adults worldwide annually. Patients who suffer MINS are at increased risk of postoperative mortality and major non-fatal cardiovascular complications with this elevated risk persisting well beyond the early postoperative period.
 
Lidocaine is a cheap and widely available local anaesthetic agent. It has good evidence for safety, is an effective analgesic, is cardioprotective a variety of settings, and has a number of anti-inflammatory effects. Although the utility of lidocaine in the prevention or treatment of MINS has not been widely studied, our initial work in this area has yielded promising results. Based on pilot data from the ANZCA funded Volatile Anaesthesia and Perioperative Outcomes Related to Cancer (VAPOR-C) feasibility study, lidocaine was associated with a significant reduction in the occurrence of MINS as well as a reduction in some markers of inflammation in patients following major cancer surgery.
 
The NHMRC funded VAPOR-C trial is a large international study of lung and colorectal cancer patients comparing the effect of propofol anaesthesia to volatile anaesthesia and lidocaine to placebo on cancer outcomes and survival.  The LEMONADE trial will be run as a sub study of VAPOR-C and aims to examine the effect of lidocaine administered intravenously during major surgery on the occurrence of myocardial injury postoperatively. The LEMONADE trial will co-enrol 1,200 participants and collect additional blood samples on the day of surgery and for two days postoperatively to assess for the occurrence of cardiac injury.
 
Although the clinical significance of MINS is increasingly being recognised, treatments are limited. Intravenous lidocaine is cheap, accessible, and commonly used in perioperative practice, with clear guidelines supporting its safe practice. If the results of the LEMONADE study find intravenous lidocaine to be preventative of MINS, it provides a unique opportunity to intervene early to prevent the occurrence of MINS and the associated morbidity and mortality. Given the high incidence of MINS, the potential impact to future surgical patients is considerable.
 

Chief investigators

Dr Justin Nazareth, Austin Hospital, Melbourne, Dr Tim Coulson, The Alfred Hospital, Melbourne, Dr Julia Dubowitz, Professor Bernhard Riedel, Peter MacCallum Cancer Centre, Melbourne.
 

Funding

The project was awarded $A70,000 through the ANZCA research grants program for 2022.   

Last updated 14:35 8.03.2022