INTRAVENOUS LIDOCAINE INFUSION AS A PERSPECTIVE COMPONENT OF MULTIMODAL ANALGESIA, WHICH AFFECTS ON EARLY POSTOPERATIVE OUTCOME

The review represents the analysis of literature data on the effectiveness of intravenous lidocaine infusion as a component of multimodal analgesia. The data suggests that intraoperative lidocaine infusion at the rate of 1-1.5 mg /kg /h (if it’s possible - with the prolongation to the early postoperative period) is an advisable component of the multimodal analgesia. This technique can reduce the intraoperative doses of propofol, MAC of inhalation anesthetics, also reduces the postoperative need for analgesics and the frequency of postoperative nausea and vomiting. Furthermore, lidocaine infusion permits to shorten the time of resolution of postoperative ileus (approaching in this the effect of epidural analgesia) and, perhaps, to reduce the frequency and severity of postoperative cognitive dysfunction. The most effective use of this technique is in laparoscopic surgery on the abdominal and pelvic organs.

Download Full-text

Dehydration before Major Urological Surgery and the Perioperative Pattern of Plasma Creatinine: A Prospective Cohort Series

Journal of Clinical Medicine ◽

10.3390/jcm10245817 ◽

2021 ◽

Vol 10 (24) ◽

pp. 5817

Author(s):

Lukas M. Löffel ◽

Dominique A. Engel ◽

Christian M. Beilstein ◽

Robert G. Hahn ◽

Marc A. Furrer ◽

...

Keyword(s):

Water Conservation ◽

Composite Index ◽

Postoperative Nausea And Vomiting ◽

Postoperative Outcome ◽

Early Postoperative Period ◽

Plasma Creatinine ◽

Quality Of Recovery ◽

Urological Surgery ◽

Single Center Study

Preoperative dehydration is usually found in 30–50% of surgical patients, but the incidence is unknown in the urologic population. We determined the prevalence of preoperative dehydration in major elective urological surgery and studied its association with postoperative outcome, with special attention to plasma creatinine changes. We recruited 187 patients scheduled for major abdominal urological surgery to participate in a single-center study that used the fluid retention index (FRI), which is a composite index of four urinary biomarkers that correlate with renal water conservation, to assess the presence of dehydration. Secondary outcomes were postoperative nausea and vomiting (PONV), return of gastrointestinal function, in-hospital complications, quality of recovery, and plasma creatinine. The proportion of dehydrated patients at surgery was 20.4%. Dehydration did not correlate with quality of recovery, PONV, or other complications, but dehydrated patients showed later defecation (p = 0.02) and significant elevations of plasma creatinine after surgery. The elevations were also greater when plasma creatinine had increased rather than decreased during the 24 h prior to surgery (p < 0.001). Overall, the increase in plasma creatinine at 6 h after surgery correlated well with elevations on postoperative days one and two. In conclusion, we found preoperative dehydration in one-fifth of the patients. Dehydration was associated with delayed defecation and elevated postoperative plasma creatinine. The preoperative plasma creatinine pattern could independently forecast more pronounced increases during the early postoperative period.

Download Full-text

Effects of pre-emptive pregabalin and multimodal anesthesia on postoperative opioid requirements in patients undergoing robot-assisted laparoscopic prostatectomy

BMC Urology ◽

10.1186/s12894-021-00785-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

K. Sisa ◽

S. Huoponen ◽

O. Ettala ◽

H. Antila ◽

T. I. Saari ◽

...

Keyword(s):

Postoperative Nausea And Vomiting ◽

Multimodal Analgesia ◽

Opioid Consumption ◽

Anesthesia Induction ◽

Anesthesia Care ◽

Post Anesthesia Care Unit ◽

Robot Assisted ◽

Ctrl Group ◽

Laparoscopic Prostatectomy ◽

The Impact

Abstract Background Previous findings indicate that pre-emptive pregabalin as part of multimodal anesthesia reduces opioid requirements compared to conventional anesthesia in patients undergoing robot-assisted laparoscopic prostatectomy (RALP). However, recent studies show contradictory evidence suggesting that pregabalin does not reduce postoperative pain or opioid consumption after surgeries. We conducted a register-based analysis on RALP patients treated over a 5-year period to evaluate postoperative opioid consumption between two multimodal anesthesia protocols. Methods We retrospectively evaluated patients undergoing RALP between years 2015 and 2019. Patients with American Society of Anesthesiologists status 1–3, age between 30 and 80 years and treated with standard multimodal anesthesia were included in the study. Pregabalin (PG) group received 150 mg of oral pregabalin as premedication before anesthesia induction, while the control (CTRL) group was treated conventionally. Postoperative opioid requirements were calculated as intravenous morphine equivalent doses for both groups. The impact of pregabalin on postoperative nausea and vomiting (PONV), and length of stay (LOS) was evaluated. Results We included 245 patients in the PG group and 103 in the CTRL group. Median (IQR) opioid consumption over 24 postoperative hours was 15 (8–24) and 17 (8–25) mg in PG and CTRL groups (p = 0.44). We found no difference in postoperative opioid requirement between the two groups in post anesthesia care unit, or within 12 h postoperatively (p = 0.16; p = 0.09). The length of post anesthesia care unit stay was same in each group and there was no difference in PONV Similarly, median postoperative LOS was 31 h in both groups. Conclusion Patients undergoing RALP and receiving multimodal analgesia do not need significant amount of opioids postoperatively and can be discharged soon after the procedure. Pre-emptive administration of oral pregabalin does not reduce postoperative opioid consumption, PONV or LOS in these patients.

Download Full-text

Impact of the Endoscopic Submucosal Dissection on Early Postoperative Outcome after Additional Gastric Resections for Early Gastric Cancer

Journal of Minimally Invasive Surgery ◽

10.7602/jmis.2016.19.1.14 ◽

2016 ◽

Vol 19 (1) ◽

pp. 14-18

Author(s):

Jin Sung Kim ◽

Hong Rae Cho ◽

Song Su Yang ◽

Young Chul Im ◽

Gyu Yeol Kim

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Endoscopic Submucosal Dissection ◽

Postoperative Outcome ◽

Submucosal Dissection ◽

Early Postoperative Outcome

Download Full-text

Intravenous Lidocaine for Rib Fractures: Effect on Pain Control and Outcome

The American Surgeon ◽

10.1177/00031348211050838 ◽

2021 ◽

pp. 000313482110508

Author(s):

Sarah King ◽

Lou Smith ◽

Christopher Harper ◽

Zachary Beam ◽

Eric Heidel ◽

...

Keyword(s):

Pain Score ◽

Pain Control ◽

Multimodal Analgesia ◽

Rib Fractures ◽

Intravenous Lidocaine ◽

Score System ◽

Before And After ◽

Future Prospective Study ◽

Crossover Analysis ◽

Level I

Background Multimodal analgesia in rib fractures (RFs) is designed to maximize pain control while minimizing narcotics. Prior research with intravenous lidocaine (IVL) efficacy produced conflicting results. We hypothesized IVL infusion reduces opioid utilization and pain scores. Methods A retrospective review of RF patients at an ACS-verified Level I trauma center from April 2018 to 2/2020 was conducted. Patients (pts) stratified as receiving IVL vs no IVL. Initial lidocaine dose: 1 mg/kg/hr with a maximum of 3 mg/kg/hr. Duration of infusion: 48 h. Pain quantified by the Stanford Pain Score system (PS). Bivariate and multivariate analyses of variables were performed on SPSS, version 21 (IBM Corp). Results 414 pts met inclusion criteria: 254 males and 160 females. The average age for the non-IVL = 67.4 ± 15.2 years vs IVL = 58.3 ± 17.1 years ( P < .001). There were no statistically significant differences between groups for ISS, PS for initial 48 h, and ICU length of stay (LOS). There was a difference in morphine equivalents per hour: non-IVL = 1.25 vs IVL = 1.72 ( P = .004) and LOS non-IVL = 10.2+/−7.6 vs IVL = 7.82+/−4.94. By analyzing IVL pts in a crossover comparison before and after IVL, there was reduction in opiates: 3.01 vs 1.72 ( P < .001) and PS: 7.0 vs 4.9 ( P < .001). Stanford Pain Score system reduction in the IVL = 48.3 ± 23.9%, but less effective in narcotic dependency (27 ± 22.9%, P = .035); IVL pts had hospital cost reduction: $82,927 vs $118,202 ( P < .01). Discussion In a crossover analysis, IVL is effective for reduction of PS and opiate use and reduces hospital LOS and costs. Patient age may confound interpretation of results. Our data support IVL use in multimodal pain regimens. Future prospective study is warranted.

Download Full-text

Sarcomas Involving the Abdominal and Pelvic Cavity

Tumori Journal ◽

10.1177/030089169307900201 ◽

1993 ◽

Vol 79 (2) ◽

pp. 77-91 ◽

Cited By ~ 14

Author(s):

Vicente Fernández-Trigo ◽

Paul H. Sugarbaker

Keyword(s):

Side Wall ◽

Early Postoperative Period ◽

Pelvic Cavity ◽

Surgical Removal ◽

Primary Malignancy ◽

Pelvic Organs ◽

Retroperitoneal Sarcomas ◽

Histologic Types ◽

Tumor Spillage ◽

Adequate Margin

The principles of management of all sarcomas that involve the abdominal and pelvic cavity are presented. The anatomic sites for the primary malignancy include retroperitoneal sarcomas, pelvic side-wall sarcomas, sarcomas arising from the abdominal viscera, and sarcomas arising from the pelvic organs. All histologic types of sarcomas may be considered together when therapeutic options are being discussed. This presentation stresses surgical removal with an adequate margin of resection as the principal goal of management. The curative treatment of these cancers places great emphasis on the surgeon's knowledge of anatomy, technical skills, innovation, and surgical courage. Systemic chemotherapy and radiotherapy have not shown reproducible efficacy. Complete resection in the absence of tumor spillage remains the only reliable treatment option. Possible benefits of induction chemotherapy and intraperitoneal chemotherapy using cisplatin and doxorubicin in the early postoperative period are presented.

Download Full-text

Day-case anaesthesia in the elderly

10.1093/med/9780198735571.003.0005 ◽

2017 ◽

Author(s):

Chris Dodds ◽

Chandra M. Kumar ◽

Frédérique Servin

Keyword(s):

Postoperative Cognitive Dysfunction ◽

Postoperative Nausea And Vomiting ◽

The Elderly ◽

Day Surgery ◽

Good Choice ◽

Successful Outcome ◽

Multimodal Approach ◽

Day Case ◽

Education Of Patients ◽

Case Anaesthesia

Successful outcome from day surgery depends on good preoperative preparation, education of patients, day-surgery pathways, informed decisions regarding planned procedures, and postoperative care. Day surgery is widely accepted as the default position for the vast majority of patients requiring surgery, with inpatient stay chosen only by exclusion. Day surgery remains a good choice in the elderly, subject to appropriate home care after surgery. Patients should be assessed sufficiently ahead of the surgery to allow preparation, management of associated chronic diseases, and optimization. General anaesthesia may be associated with higher incidence of postoperative cognitive dysfunction, and it should be avoided as much as possible. Regional anaesthesia is the preferred choice when applicable because it provides good postoperative analgesia. Spinal anaesthesia is useful, but it can be associated with delayed discharge. A multimodal approach to pain relief and management of postoperative nausea and vomiting (PONV) are essential because inadequate management can significantly delay discharge.

Download Full-text