Neuroprotective Effects of Lidocaine on Early Postoperative Cognitive Dysfunction in Patients Undergoing Shoulder Arthroscopy with Beach Chair Position: A Randomized Triall

Background: Surgery and general anaesthesia both cause postoperative cognitive dysfunction (POCD). The beach chair position (BCP) is the most often used posture in shoulder arthroscopy. One of the disadvantages of BCP is increasing the risk of cerebral hypoperfusion, hypoxia, hypotension, and bradycardia, which can trigger POCD. This paper investigated the neuroprotective effects of Lidocaine on early POCD in patients undergoing shoulder arthroscopy in the beach chair position.Patients and Methods: A total of 80 patients scheduled for arthroscopic rotator cuff repair (ARCR) under general anesthesia in a beach chair position (BCP) were randomly allocated to the lidocaine group and control group (n = 40). The Lidocaine group received a loading dose of 1 mg/ kg diluted in 10 ml of normal saline that was infused over 5 minutes after induction of anesthesia then, followed by a continuous infusion at 1.5 mg/ kg/ h diluted in normal saline to a volume of 50 ml until the end of surgery. The control group received normal saline after induction of anesthesia with the same volume and rate changes as the lidocaine group until the end of surgery. Mini-Mental State Examination (MMSE) scores, Serum lactate levels, and Hemodynamic variables (mean arterial pressure and heart rate) were compared between the lidocaine and control groups.Results: The MMSE scores were significantly decreased 24 hours after surgery in the control group compared with the lidocaine group. On the other hand, serum lactate levels 30 min after extubation were not significantly different between the two groups.Conclusion: IV lidocaine is safe and effective and has a neuroprotective effect on early POCD in patients who underwent ARCR under general anesthesia in BCP.