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

Abstract

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.

Comparison of the Agitation-Reducing Effects of Esmolol and Lidocaine in Pediatric Strabismus Surgery: A Double-Blind, Randomized Clinical Study

“…However, we expect higher bolus doses or the use of extra infusion to reduce agitation because anxiety, pain, and sympathetic activation are causes of agitation [5]. Furthermore, one study reported that esmolol reduced postoperative pain and sympathetic activation [41]. However, similar to dexmedetomidine, esmolol can cause severe bradycardia in patients undergoing eye surgery; therefore, we concluded that additional infusion of esmolol in the case of eye surgery is risky and did not use it in this study.…”