Effects of lidocaine and esmolol infusions on hemodynamic changes, analgesic requirement, and recovery in laparoscopic cholecystectomy operations

Dogan, Serpil Dagdelen; Üstün, Faik Emre; Şener, Elif Bengi; Köksal, Ersin; Üstün, Yasemin Burcu; Kaya, Cengiz; Özkan, Fatih

doi:10.1016/j.bjane.2014.08.005

Cited by 22 publications

(24 citation statements)

References 15 publications

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“…Similar to our findings, Dogan et al found no difference between the two groups in postoperative 24 hours opioid consumption after laparoscopic cholecystectomy. 16 In contrast, Kavak Akelma et al found significantly less fentanyl requirement in patients receiving esmolol than those receiving lidocaine infusion or placebo in the first 24 hours of surgery. 17 This difference might be due to the higher dose of esmolol (fixed dose, 50 µg/kg/min) used in their patients in comparison to ours (esmolol infusion limited to 15 µg/kg/min).…”

Section: Discussionmentioning

confidence: 92%

“…15 However, the significant difference in postoperative opioid consumption was limited to the PACU stay only (standard mean difference, −1.21; 95% CI, −1.66 to −0.77). Trials by Dogan et al 16 and Kavak et al 17 were not included, and perhaps inclusion of these studies might have further influenced the treatment effects. In a similar model to ours (laparoscopic cholecystectomy), 21 however, with a conventional control consisting of general anesthesia with opioids, the intraoperative fentanyl consumption was 200.5 µg in placebo group while it was null in esmolol group.…”

Section: Discussionmentioning

confidence: 99%

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The effect of intraoperative lidocaine versus esmolol infusion on postoperative analgesia in laparoscopic cholecystectomy: A randomized clinical trial

Bajracharya

Subedi²,

Pokharel

et al. 2019

Preprint

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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.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

The effect of intraoperative lidocaine versus esmolol infusion on postoperative analgesia in laparoscopic cholecystectomy: A randomized clinical trial

Bajracharya

Subedi²,

Pokharel

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…15 However, the significant difference in postoperative opioid consumption was limited to the PACU stay only (standard mean difference, −1.21; 95% CI, −1.66 to −0.77; p ≤ 0.001). Trials by Dogan et al 16 and Kavak et al 17 were not included, and perhaps inclusion of these studies might have further influenced the treatment effects. In a similar model to ours (laparoscopic cholecystectomy), 21 however, with a conventional control consisting of general anesthesia with opioids, the intraoperative fentanyl consumption was 200.5 µg in placebo group while it was null in esmolol group.…”

Section: Discussionmentioning

confidence: 99%

The effect of intraoperative lidocaine versus esmolol infusion on postoperative analgesia in laparoscopic cholecystectomy: A randomized clinical trial

Bajracharya

Subedi²,

Pokharel

et al. 2019

Preprint

View full text Add to dashboard Cite

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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“…However, single model analgesia is adequate for aged patients after surgery and multimodal analgesia is recommended to decrease postoperative pain intensity, opioid consumption and short length of hospital stay. Some published articles [13,[42][43][44] have shown that IV lidocaine reduced pain and shorten length of hospital stay, in addition, there was a lower inflammatory in IV lidocaine and lower risk of postoperative nausea and vomiting. Thus, IV lidocaine was more preferred to use in intraoperation and after surgery.…”

Section: Summary Of Evidencementioning

confidence: 99%

“…Nevertheless none of them has indicated identical efficacy and opioid medications can caused side effects including nausea and vomiting, megrim, constipation and delay of postoperative early recovery. Recently, some studies have revealed that perioperative continuous intravenous lidocaine infusion improved postoperative outcomes in postoperative pain, consumption of opioid medications and length of hospital stay (LOS) [13][14][15][16] . However, its effect on postoperative outcomes is not well identified due to their small sample and the deficiency of multicenter and large sample randomized controlled trials.…”

Section: Introductionmentioning

confidence: 99%

Effects of perioperative intravenous lidocaine infusion for postoperative pain and recovery in elderly patients undergoing surgery: a systematic review and meta-analysis of randomized controlled trials

Zhu

Wang

Yang

et al. 2020

Preprint

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Background Improving postoperative pain and other potential benefits of IV lidocaine remains a significant debate in elderly patients. This meta-analysis aims to estimate the effect perioperative continuous IV lidocaine in elderly patients undergoing surgery. Method Pubmed/Medline, Web of Science, Embase and CENTRAL through OVID SP were independently searched until November 1, 2019 by two authors. This systematic review and meta-analysis included all randomized controlled trials that compared the effect of continuous IV lidocaine and any placebo or no treatment in aged patients after surgery. Primary outcomes were length of hospital stay and postoperative pain score and second outcomes were postoperative nausea and vomiting, opioid consumption, gastrointestinal recovery and postoperative neuropsychological function status scale. Result Eighteen studies(1175 patients) were included. Meta-analysis suggested that IV lidocaine reduce the postoperative pain scores(visual analogue scale, 0-10cm) at 2h(SMD:-1.30, 95% CI -1.90 to -0.70), 4h(SMD:-1.20, 95% CI -1.91 to -0.49), 6h(SMD:-0.87, 95%CI -1.72 to 0.02), 8h(SMD:-0.84, 95%CI -1.40 to -0.27), 12h(SMD:-0.73, 95%CI -1.14 to -0.32), 24h(SMD:-0.39, 95%CI -0.66 to -0.11), shorten length of hospital stay(MD: -0.30, 95%CI -0.50 to -0.09), decrease the requirement of opioid drugs(SMD: -0.31, 95%CI -0.31 to -0.01) and the incidence of postoperative nausea(OR: 0.52, 95%CI 0.31 to 0.87) in elderly patients undergoing surgery. Conclusion The evidence suggested that IV lidocaine significantly reduce postoperative pain intensity and opioid consumption and shorten the length of hospital stay in aged patients. In addition, it was shown that IV lidocaine decrease the requirement of postoperative opioid and incidence of postoperative nausea compared to control group. IV lidocaine maybe a useful assistant during general anesthesia owing to its beneficial effect in several outcomes in geratic patients undergoing surgery.

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Effects of lidocaine and esmolol infusions on hemodynamic changes, analgesic requirement, and recovery in laparoscopic cholecystectomy operations

Cited by 22 publications

References 15 publications

The effect of intraoperative lidocaine versus esmolol infusion on postoperative analgesia in laparoscopic cholecystectomy: A randomized clinical trial

The effect of intraoperative lidocaine versus esmolol infusion on postoperative analgesia in laparoscopic cholecystectomy: A randomized clinical trial

The effect of intraoperative lidocaine versus esmolol infusion on postoperative analgesia in laparoscopic cholecystectomy: A randomized clinical trial

Effects of perioperative intravenous lidocaine infusion for postoperative pain and recovery in elderly patients undergoing surgery: a systematic review and meta-analysis of randomized controlled trials

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