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

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.

In the Arms of Morpheus without Morphia; Mitigating the United States Opioid Epidemic by Decreasing the Surgical Use of Opioids

“…The preoperative, preemptive dosing of oxycontin, a common practice in joint replacement surgery, also may result in increased postoperative pain and opioid requirements [ 54 ]. Esmolol infusions administered during surgery decrease intraoperative opioid requirements, and while not classified as an analgesic medication, subsequently decreased opioid requirement in the recovery room [ 55 , 56 , 57 ]. This is currently attributed to the avoidance of OIH.…”

Effects of the ultra-short-acting beta-blocker Esmolol infusion on cardiovascular parameters and quality of postoperative recovery in patients scheduled for elective plastic surgery

“…34 There are some reports that esmolol, similarly like local anaesthetic lidocaine, decreases pain and withdrawal movements after the administration of non-depolarising neuromuscular relaxant rocuronium, via yet unclear mechanisms. 35,36 It is possible that such mechanisms are responsible for the decreased consumption of pancuronium noted in the present study.…”

“…10,[16][17][18][19] Like in the present study, esmolol prevented increases in blood pressure and heart rate during the phase of tracheal extubation. [20][21][22] Esmolol also assured a more stable haemodynamics during the non-cardiac [23][24][25] and cardiac surgery. 26,27 Esmolol-induced continuous β-adrenergic receptor blockade leads to a more sparing use of opioid analgesics, which was demonstrated in the present study and other clinical trials alike.…”

Effects of intravenous lidocaine, dexmedetomidine, and their combination on IL-1, IL-6 and TNF-α in patients undergoing laparoscopic hysterectomy: a prospective, randomized controlled trial

“…Patients were randomized into four groups (groups L, D, LD, and C) by a nurse in the postanesthesia care unit (PACU) who did not participate in the study according to computer-generated random numbers and sealed envelopes. Patients in group L received a bolus infusion of lidocaine (2%; 1.5 mg/kg over 10 min before the induction of anesthesia), and then lidocaine was infused at a rate of 1.5 mg/kg/h, which was ceased 30 min before the end of the operation [ 17 ]. Patients in group D received a bolus infusion of dexmedetomidine (0.5 μg/kg over 10 min before the induction of anesthesia), and then dexmedetomidine was infused at a rate of 0.4 μg/kg/h, which was ceased 30 min before the end of operation [ 16 ].…”