Peri-procedural Lidocaine Administration for Radiofrequency Ablation of Hepatocellular Carcinoma: A Pilot Study

Sergiu Sargarovschi; Zeno Adrian Sparchez; Alexandru Leonard Alexa; Andreea Paunescu; Ioana Rucsanda; Dan Valean; Andreea Benea; Daniela Ionescu

doi:10.15403/jgld-7414

Authors

Sergiu Sargarovschi Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca; Research Association in Anesthesia and Intensive Care (ACATI), Cluj-Napoca; Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Cluj-Napoca, Romania https://orcid.org/0000-0002-5610-9510
Zeno Adrian Sparchez Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca; Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Cluj-Napoca, Romania
Alexandru Leonard Alexa Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca; Research Association in Anesthesia and Intensive Care (ACATI), Cluj-Napoca; Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Cluj-Napoca, Romania https://orcid.org/0000-0002-2393-7248
Andreea Paunescu The OncoGen Association, Timisoara, Romania
Ioana Rucsanda Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Cluj-Napoca, Romania
Dan Valean Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
Andreea Benea Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Cluj-Napoca, Romania
Daniela Ionescu Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca; Research Association in Anesthesia and Intensive Care (ACATI), Cluj-Napoca; Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Cluj-Napoca, Romania; Romania Onco-Anaesthesia Research Group, ESAIC, 1000 Brussels, Belgium

DOI:

https://doi.org/10.15403/jgld-7414

Keywords:

procedural sedation, hepatocellular carcinoma, radiofrequency ablation, lidocaine, NETosis

Abstract

Background and Aims: Radiofrequency ablation (RFA) is a curative option for early-stage hepatocellular carcinoma (HCC) when liver resection or transplantation is not a suitable option. This study evaluated whether a peri-procedural intravenous lidocaine infusion could reduce neutrophil extracellular trap formation (NETosis), neutrophil-to-lymphocyte ratio (NLR) and improve 1-year outcomes after RFA.

Methods: In this single-centre, randomized trial, 50 adult HCC patients undergoing RFA were allocated 1:1 to receive propofol-fentanyl sedation alone (PF group, n=25) or combined with intravenous lidocaine (1.5 mg/kg bolus, then 1 mg/kg/h for 24 hours; PF-L group, n=25). Serum citrullinated histone H3 (H3Cit), NLR, and C-reactive protein (CRP) were assessed at baseline and 24 hours post-ablation. The primary endpoint was the change in H3Cit expression. Secondary endpoints included changes in NLR and C-reactive protein (CRP), as well as 1-year overall mortality, disease-free survival, and local recurrence rates.

Results: 24 patients in PF-L group and 25 patients in PF group completed the study. Intra-group H3Cit levels significantly decreased from baseline at 24 hours only in the PF-L group (p=0.031). However, the between-group difference in H3Cit variation levels was not significant (p=0.352). Postoperative NLR changes were also comparable between groups (p=0.354). The overall 1-year mortality rate was 12%, with no significant variance between the two arms.

Conclusions: Adding intravenous lidocaine to sedation resulted in an intra-group reduction in H3Cit expression following RFA but did not produce a statistically significant reduction compared to standard propofol-fentanyl sedation alone. 1-year survival and local recurrence rates did not differ between groups. However, our preliminary findings justify the need for larger, baseline-balanced trials to evaluate periprocedural NETosis modulation by sedation regimen.