Vasoactive-inotropic score and major cardiovascular events in patients undergoing esophagectomy: a retrospective analysis of intravenous lidocaine and thoracic epidural anesthesia.
Metwaly S, Kamphausen A, et al. • BMC anesthesiology • 2026
The lidocaine group demonstrated significantly higher intraoperative and postoperative vasoactive-inotropic scores and more frequent postoperative atrial fibrillation compared to the TEA group after propensity-score matching and multivariable covariate adjustment in patients undergoing esophagectomy.
Key Findings
Results
Patients receiving intravenous lidocaine had significantly higher intraoperative maximum vasoactive-inotropic scores (VISmax OP) compared to those receiving thoracic epidural anesthesia.
Adjusted mean VISmax OP was 14.6 (95% CI: 13.0–16.3) in the lidocaine group versus 12.5 (95% CI: 11.3–13.8) in the TEA group.
Adjusted mean difference was 2.14 (95% CI: 0.22–4.10; p = 0.029).
Analysis used propensity-score full matching followed by multivariable covariate adjustment for BMI, age, sex, Lee Revised Cardiac Risk Index, operative time, surgical approach, and year of surgery.
Study included 169 patients in the lidocaine group and 272 in the TEA group from a single center over 2013–2023.
Results
Patients receiving intravenous lidocaine had significantly higher postoperative maximum vasoactive-inotropic scores (VISmax ICU) compared to those receiving thoracic epidural anesthesia.
Adjusted mean VISmax ICU was 37.1 (95% CI: 26.1–48.1) in the lidocaine group versus 22.7 (95% CI: 17.1–28.3) in the TEA group.
Adjusted mean difference was 14.4 (95% CI: 2.48–26.3; p = 0.019).
VISmax ICU was a secondary endpoint in the study.
The absolute difference in postoperative vasoactive requirements between groups was substantially larger than the intraoperative difference.
Results
Postoperative atrial fibrillation occurred significantly more frequently in the lidocaine group than in the TEA group.
Atrial fibrillation occurred in 40.4% of the lidocaine group versus 21.4% of the TEA group.
Adjusted ratio was 0.55 (95% CI: 0.38–0.79; p = 0.001), indicating TEA was associated with lower odds of postoperative atrial fibrillation.
Postoperative arrhythmias were a pre-specified secondary endpoint.
Higher VISmax was associated with significantly increased odds of postoperative arrhythmias.
Results
No significant differences were observed between the lidocaine and TEA groups in pulmonary complications, 30-day mortality, or cardiopulmonary arrest after matching and adjustment.
Pulmonary complications, 30-day mortality, and cardiopulmonary arrest were all pre-specified secondary endpoints.
These outcomes showed no statistically significant differences between groups after propensity-score full matching and covariate adjustment.
The study enrolled 441 total patients undergoing esophagectomy from 2013 to 2023 at a single center.
Methods
The study population consisted of 441 patients undergoing esophagectomy, with 169 receiving lidocaine infusion and 272 receiving thoracic epidural anesthesia over a 10-year period.
This was a retrospective single-center cohort study spanning 2013 to 2023.
Propensity-score full matching was performed using age, sex, body mass index, Lee Revised Cardiac Risk Index, operative time, surgical approach, and year of surgery.
The primary endpoint was intraoperative maximum vasoactive-inotropic score (VISmax OP).
Both analgesic regimens were used in conjunction with opioids.
What This Means
This research suggests that patients who had their esophagus removed (esophagectomy) and received a continuous lidocaine infusion for pain management needed significantly more medications to maintain blood pressure and heart function — both during surgery and afterward in the ICU — compared to patients who received thoracic epidural anesthesia (a form of regional nerve block placed in the spine). The researchers measured this need using a scoring system called the Vasoactive-Inotropic Score (VIS), which combines the doses of multiple heart and blood pressure-supporting drugs into a single number. Higher scores indicate greater cardiovascular instability requiring more pharmaceutical support.
Beyond needing more cardiovascular support drugs, patients in the lidocaine group also developed an irregular heart rhythm called atrial fibrillation at nearly twice the rate (40.4% vs. 21.4%) compared to those who received epidural anesthesia. However, the two groups did not differ significantly in lung complications, deaths within 30 days, or cardiac arrest. The study analyzed 441 patients over 10 years and used statistical methods (propensity-score matching) to account for differences between the groups in factors like age, weight, surgical approach, and cardiac risk.
This research suggests that the choice of pain management strategy during and after esophagectomy may influence how much cardiovascular support patients need and their risk of developing abnormal heart rhythms. However, the authors caution that because this was a retrospective (looking back at existing records) single-center study, the findings need to be confirmed in future prospective studies before firm conclusions about optimal pain management strategies for esophagectomy patients can be drawn.
Metwaly S, Kamphausen A, Hitzl W, Giulini L, Heger P, Diener M, et al.. (2026). Vasoactive-inotropic score and major cardiovascular events in patients undergoing esophagectomy: a retrospective analysis of intravenous lidocaine and thoracic epidural anesthesia.. BMC anesthesiology. https://doi.org/10.1186/s12871-026-04198-9