Effects of lidocaine, dexmedetomidine, and their combination infusion on postoperative nausea and vomiting following laparoscopic hysterectomy: a randomized controlled trial

Abstract

Background A few studies have reported that administration of lidocaine and dexmedetomidine relieves the incidence of postoperative nausea and vomiting (PONV). We explored whether combined infusion of lidocaine plus dexmedetomidine had lower occurrence of PONV undergoing laparoscopic hysterectomy with general anesthesia. Methods A total of 248 women undergoing elective laparoscopic hysterectomy were allocated into the following four groups: the control group (group C, n = 62) received an equal volume of saline, the lidocaine group (group L, n = 62) received intravenous lidocaine (bolus infusion of 1.5 mg/kg over 10 min, 1.5 mg/kg/h continuous infusion), the dexmedetomidine group (group D, n = 62) received dexmedetomidine administration (bolus infusion of 0.5 µg/kg over 10 min, 0.4 µg/kg/h continuous infusion), and the lidocaine plus dexmedetomidine group (group LD, n = 62) received combination of lidocaine (bolus infusion of 1.5 mg/kg over 10 min, 1.5 mg/kg/h continuous infusion) and dexmedetomidine administration (bolus infusion of 0.5 µg/kg over 10 min, 0.4 µg/kg/h continuous infusion). The primary outcome was the incidence of nausea, vomiting, and PONV during the first 48 h after surgery. The secondary outcomes included the incidence of total 24 h PONV after surgery, intraoperative remifentanil requirement, postoperative pain visual analogue scale (VAS) scores and fentanyl consumption, the incidence of bradycardia, agitation, shivering, and mouth dry during post-anesthesia care unit (PACU) stay period. Results The occurrence of nausea and PONV in group LD (5.0 and 8.3%) at 0–2 h after operation was lower than group C (21.7 and 28.3%) (P < 0.05). There was no statistically significant difference with respect to occurrence of nausea and PONV in groups L (13.3 and 20.0%) and D (8.3 and 13.3%) at 0–2 h after operation compared to group C (21.7 and 28.3%). The incidence of nausea, vomiting, and PONV at 2–24 and 24–48 h after surgery in all four groups was not statistically significant. The incidence of total 24 h PONV in group LD (33.3%) was significantly decreased compared to group C (60.0%) (P < 0.05). The cumulative consumption of fentanyl at 6 and 12 h after surgery was significantly reduced in group LD compared to other three groups (P < 0.05). The pain VAS scores were significantly decreased at 2, 6, and 12 h after operation in group LD compared to other three groups (P < 0.05). Remifentanil dose in the intraoperative period was significantly lower in groups LD and D compared with groups C and L (P < 0.05). The number of mouth dry, bradycardia, and over sedation during the PACU stay period was markedly increased in group LD (28.3, 30.0, and 35.0%, respectively) compared with groups C (1.7, 1.7, and 3.3%, respectively) and L (3.3, 5.0, and 6.7%, respectively) (P < 0.05). Conclusions Lidocaine combined with dexmedetomidine infusion markedly decreased the occurrence of nausea and PONV at 0–2 h as well as the total 24 h PONV. However, it significantly increased the incidence of mouth dry, bradycardia, and over sedation during the PACU stay period after laparoscopic hysterectomy with general anesthesia. Trial registration ClinicalTrials.gov (NCT03809923), registered on January 18, 2019.

The effect of opioid-free anaesthesia on the quality of recovery after endoscopic sinus surgery

“…Therefore, OFA should be considered as a strategy in preventing PONV, especially in those high-risk patients. The formulation of dexmedetomidine and lidocaine in OFA may play an antiemetic role 5,28 . In our study, the incidence of nausea and vomiting in the first 24 h after surgery was significantly less in the OFA group than in the opioid anaesthesia group.…”

“…The formulation of dexmedetomidine and lidocaine in OFA may play an antiemetic role. 5,28 In our study, the incidence of nausea and vomiting in the first 24 h after surgery was significantly less in the OFA group than in the opioid anaesthesia group. Our finding is in line with previous observations.…”

Endometriosis: Where are we today? An Anesthesiologist’s Point of View

“…Since many years, the highly selective alpha-2 Agonist has been established in postoperative pain therapy and many other indications [23,24]. Among others, these drugs have a place as co-anaesthetics in the perioperative setting [25] . In daily use, the value of dexmedetomidine is based not only on reducing perioperative analgesia, but also on infl uencing delirium or Postoperative Cognitive Dysfunction (POCD) and preventing it, as well as reducing Postoperative Nausea and Vomiting (PONV) [19,[26][27][28][29][30].…”

Lidocaine aerosol preoperative application for improving the comfort of pediatric patients undergoing tonsillectomy and adenoidectomy: A prospective randomized controlled trial

“…For example, it can reduce the incidence of PONV; in patients undergoing partial laryngectomy, lidocaine aerosol can effectively prevent postoperative cough, and patients have good postoperative analgesia and rapid postoperative recovery; lidocaine aerosol is effective in reducing the frequency of cough in patients with refractory chronic cough (RCC), and so on. [11][12][13][14] However, there are very few reports of lidocaine aerosol application in pediatric tonsillectomy and adenoidectomy. Therefore, this study was conducted to observe the clinical effects of lidocaine aerosol applied before the induction of general anesthesia to improve perioperative comfort in pediatric patients undergoing tonsillectomy and adenoidectomy.…”

“…Lidocaine is widely used in clinical practice and can effectively improve patient comfort. For example, it can reduce the incidence of PONV; in patients undergoing partial laryngectomy, lidocaine aerosol can effectively prevent postoperative cough, and patients have good postoperative analgesia and rapid postoperative recovery; lidocaine aerosol is effective in reducing the frequency of cough in patients with refractory chronic cough (RCC), and so on 11–14 …”