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

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.

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.

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.

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.