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.
As 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. Methods: In 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/hour) 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 hours postoperatively. Results: Two 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. Conclusion: Infusion of esmolol is not inferior to lidocaine in terms of opioid requirement and pain severity in the first 24 hours after surgery. Patients receiving lidocaine were more sedated during their stay in PACU than those receiving esmolol.
Background: As a part of multimodal analgesia for laparoscopic cholecystectomy, administration of systemic lidocaine is a well-known technique. Similarly, esmolol has been found to have an opioid sparing effect in the perioperative setting. The aim of the study was to compare opioid consumption after an intraoperative infusion of lidocaine or esmolol in female patients undergoing elective laparoscopic cholecystectomy. Methods: In this prospective, randomized, double-blind clinical trial, 90 female patients scheduled for elective laparoscopic cholecystectomy received either IV lidocaine bolus 1.5 mg/kg at induction followed by infusion of 1.5 mg/ kg/hr or IV bolus of esmolol 0.5 mg/kg at induction followed by infusion of 5-15 µg/kg/min till the end of surgery. Standard anaesthetic protocol was followed. Postoperatively, patients received either IV morphine or tramadol to maintain VAS scores ≤ 3. The primary outcome was opioid consumption in the first 24 h after surgery. Pain and sedation scores, time to first perception of pain and void, and incidence of nausea/vomiting were secondary parameters measured up to 24 h postoperatively. Results: Two patients in each group were excluded from the analysis. The postoperative median morphine consumption in patients receiving lidocaine and esmolol was 1.5 (1-2) mg and 1 (0-1.5) mg respectively (p=0.27). The median pain scores at various time intervals were comparable between the two groups (p>0.05). More patients receiving lidocaine were sedated in the PACU than those receiving esmolol (p<0.05); however, no difference was detected later. Conclusion: There was no difference in postoperative opioid requirement and VAS score for pain in the first 24 h of surgery between the lidocaine and esmolol group. Patients receiving lidocaine were more sedated than those receiving esmolol in the early period after surgery.
Background: As 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. Methods: In 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/hour) 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 hours postoperatively. Results: Two 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. Conclusion: Infusion of esmolol is not inferior to lidocaine in terms of opioid requirement and pain severity in the first 24 hours after surgery. Patients receiving lidocaine were more sedated during their stay in PACU than those receiving esmolol.
Background: As a part of multimodal analgesia for laparoscopic cholecystectomy, both intraoperative lidocaine and esmolol facilitate postoperative analgesia, but are not widely used. 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. Methods: In 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/hour) 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 hours postoperatively. Results: Two 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). Sedation scores were higher in patients receiving lidocaine than in those receiving esmolol up to 30 min in post-anesthesia care unit (PACU; p<0.05); however, no difference was detected later. Conclusion: Infusion of esmolol is not inferior to lidocaine in terms of opioid requirement and pain severity in the first 24 hours after surgery. Patients receiving lidocaine were more sedated up to 30 min in PACU than those receiving esmolol.
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