Abstract
BackgroundAs a part of multimodal analgesia for laparoscopic cholecystectomy, both intraoperative lidocaine and esmolol facilitate postoperative analgesia. Our objective was to compare these two emerging strategies that challenge the use of intraoperative opioids. We aimed to assess if intraoperative esmolol infusion is not inferior to lidocaine infusion for opioid consumption after laparoscopic cholecystectomy.MethodsIn this prospective, randomized, double-blind, non-inferiority clinical trial, 90 female patients scheduled for elective laparoscopic cholecystectomy received either intravenous (IV) lidocaine bolus 1.5 mg/kg at induction followed by an infusion (1.5 mg/ kg/h) or IV bolus of esmolol 0.5 mg/kg at induction followed by an infusion (5–15 μg/kg/min) till the end of surgery. Remaining aspect of anesthesia followed a standard protocol apart from no intraoperative opioid supplementation. Postoperatively, patients received either morphine or tramadol IV to maintain visual analogue scale (VAS) scores ≤3. The primary outcome was opioid consumption (in morphine equivalents) during the first 24 postoperative hours. Pain and sedation scores, time to first perception of pain and void, and occurrence of nausea/vomiting were secondary outcomes measured up to 24 h postoperatively.ResultsTwo patients in each group were excluded from the analysis. The postoperative median (IQR) morphine equivalent consumption in patients receiving esmolol was 1 (0–1.5) mg compared to 1.5 (1–2) mg in lidocaine group (p = 0.27). The median pain scores at various time points were similar between the two groups (p > 0.05). More patients receiving lidocaine were sedated in the post-anesthesia care unit (PACU) than those receiving esmolol (p < 0.05); however, no difference was detected later.ConclusionInfusion of esmolol is not inferior to lidocaine in terms of opioid requirement and pain severity in the first 24 h after surgery. Patients receiving lidocaine were more sedated during their stay in PACU than those receiving esmolol.Trial registrationClinicalTrials.gov- NCT02327923. Date of registration: December 31, 2014.
Highlights
Acute pain after laparoscopic cholecystectomy (LC) is complex in nature, and opioids alone might not be sufficient to achieve quality analgesia [1, 2]
Female patients aged 18 to 60 years, American society of Anesthesiologist physical status I and II, scheduled for general anesthesia for elective laparoscopic cholecystectomy were enrolled. Exclusion criteria included those with inability to comprehend visual analogue scale (VAS) or severe mental impairment, difficult intubation, pregnancy, morbid obesity, history of epilepsy or allergy to any drugs used in the study, current use of opioids or beta-adrenergic receptor antagonists, baseline heart rate < 50 beats/min, acute cholecystitis, and chronic pain other than cholelithiasis
Among the 104 consecutive patients assessed for eligibility, 90 met the inclusion criteria and they were randomly assigned to lidocaine or esmolol group
Summary
Acute pain after laparoscopic cholecystectomy (LC) is complex in nature, and opioids alone might not be sufficient to achieve quality analgesia [1, 2]. Usage of only opioids in perioperative settings is associated with undesirable effects [3,4,5,6]. In this regard, multimodal regimen (a combination of opioids and nonopioid drug) is recommended for LC, as it provides superior analgesia and improves quality of recovery after surgery [7]. As a part of multimodal analgesia for laparoscopic cholecystectomy, both intraoperative lidocaine and esmolol facilitate postoperative analgesia. We aimed to assess if intraoperative esmolol infusion is not inferior to lidocaine infusion for opioid consumption after laparoscopic cholecystectomy
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