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, 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/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. 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 h after surgery. Patients receiving lidocaine were more sedated during their stay in PACU than those receiving esmolol. Trial registration ClinicalTrials.gov- NCT02327923. Date of registration: December 31, 2014.

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

10.21203/rs.2.10393/v5 ◽

2019 ◽

Author(s):

Joshan Lal Bajracharya ◽

Asish Subedi ◽

Krishna Pokharel ◽

Balkrishna Bhattarai

Keyword(s):

Clinical Trial ◽

Laparoscopic Cholecystectomy ◽

Postoperative Analgesia ◽

Multimodal Analgesia ◽

Opioid Consumption ◽

Double Blind ◽

Lidocaine Group ◽

Pain Scores ◽

Sedation Scores ◽

Vas Scores

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

10.21203/rs.2.10393/v6 ◽

2019 ◽

Author(s):

Joshan Lal Bajracharya ◽

Asish Subedi ◽

Krishna Pokharel ◽

Balkrishna Bhattarai

Keyword(s):

Clinical Trial ◽

Laparoscopic Cholecystectomy ◽

Postoperative Analgesia ◽

Multimodal Analgesia ◽

Opioid Consumption ◽

Double Blind ◽

Lidocaine Group ◽

Pain Scores ◽

Sedation Scores ◽

Vas Scores

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

10.21203/rs.2.10393/v3 ◽

2019 ◽

Author(s):

Joshan Lal Bajracharya ◽

Asish Subedi ◽

Krishna Pokharel ◽

Balkrishna Bhattarai

Keyword(s):

Clinical Trial ◽

Laparoscopic Cholecystectomy ◽

Postoperative Analgesia ◽

Multimodal Analgesia ◽

Opioid Consumption ◽

Double Blind ◽

Lidocaine Group ◽

Pain Scores ◽

Sedation Scores ◽

Vas Scores

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

10.21203/rs.2.10393/v4 ◽

2019 ◽

Author(s):

Joshan Lal Bajracharya ◽

Asish Subedi ◽

Krishna Pokharel ◽

Balkrishna Bhattarai

Keyword(s):

Clinical Trial ◽

Laparoscopic Cholecystectomy ◽

Postoperative Analgesia ◽

Multimodal Analgesia ◽

Opioid Consumption ◽

Double Blind ◽

Lidocaine Group ◽

Pain Scores ◽

Sedation Scores ◽

Vas Scores

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

10.21203/rs.2.10393/v1 ◽

2019 ◽

Author(s):

Joshan Lal Bajracharya ◽

Asish Subedi ◽

Krishna Pokharel ◽

Balkrishna Bhattarai

Keyword(s):

Clinical Trial ◽

Laparoscopic Cholecystectomy ◽

Early Period ◽

Multimodal Analgesia ◽

Opioid Consumption ◽

Double Blind ◽

Female Patients ◽

Double Blind Clinical Trial ◽

Elective Laparoscopic Cholecystectomy ◽

Sparing Effect

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.

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Local Infiltrative Anesthetic Effect of Tramadol Compared to Lidocaine for Excision of Cutaneous Lesions: Pilot Randomized, Double-Blind Clinical Study

Journal of Cutaneous Medicine and Surgery ◽

10.2310/7750.2011.11015 ◽

2012 ◽

Vol 16 (2) ◽

pp. 101-106 ◽

Cited By ~ 5

Author(s):

Despoina Kakagia ◽

Theodosia Vogiatzaki ◽

Savvas Eleftheriadis ◽

Gregory Trypsiannis ◽

Christos Iatrou

Keyword(s):

Injection Site ◽

Postoperative Analgesia ◽

Rating Scale ◽

Numerical Rating Scale ◽

Demographic Data ◽

Randomized Study ◽

Cutaneous Lesions ◽

Double Blind ◽

Lidocaine Group ◽

Pain Scores

Background: In this double-blind, randomized study, the efficacy of tramadol, an atypical opioid, was tested versus lidocaine in excision of cutaneous lesions of the face. Methods: Eighty-eight patients were randomly assigned to receive either 2 mg/kg tramadol 2% plus adrenaline 1:200,000 (group T, n = 46) or 3 mg/kg lidocaine 2% plus adrenaline 1:200,000 (group L, n = 42) for excision of cutaneous lesions. Pain at the injection site, 2 and 20 minutes postinjection and 3, 6, and 12 hours postoperatively, was monitored on a 0 to 10 numerical rating scale (NRS). Irritation at the injection point and the duration of postoperative analgesia were also recorded. Results: There were no significant differences in demographic data, topography, size of the lesions removed, and operative time between the two groups. A tendency toward lower injection NRS pain scores was observed in group L compared to group T (p = .064). No statistically significant differences between the two groups were found at 2 and 20 minutes postinjection (p = .741 and p = .142, respectively); however, pain scores were significantly higher in group L at 3, 6, and 12 hours postoperatively (all p < .001). Erythema at the injection site was observed in nine group T and two group L patients (p = .076). No postoperative analgesics were required in the tramadol group of patients, whereas acetaminophen with or without codeine was administered in all but five lidocaine group patients during the first 12 hours. Conclusion: Tramadol may be used as a reliable local anesthetic agent, providing longer postoperative analgesia compared to lidocaine; however, it bears a higher incidence of irritation at the injection site.

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Effects of perioperative S (+) ketamine infusion added to multimodal analgesia in patients undergoing ambulatory haemorrhoidectomy

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2010.01.001 ◽

2010 ◽

Vol 1 (2) ◽

pp. 100-105 ◽

Cited By ~ 5

Author(s):

Ulrich J. Spreng ◽

Vegard Dahl ◽

Johan Ræder

Keyword(s):

Side Effects ◽

Postoperative Analgesia ◽

Analgesic Effect ◽

Low Dose ◽

Isotonic Saline ◽

Multimodal Analgesia ◽

Controlled Study ◽

Double Blind ◽

Pain Scores ◽

Pacu Stay

AbstractBackground and objectivePerioperative low-dose ketamine has been useful for postoperative analgesia. In this study we wanted to assess the analgesic effect and possible side-effects of perioperative low-dose S (+) ketamine when added to a regime of non-opioid multimodal pain prophylaxis.MethodsSeventy-seven patients scheduled for haemorrhoidectomy were enrolled in this randomized, double-blind, controlled study. They received oral paracetamol 1–2 g, total intravenous anaesthesia, intravenous 8 mg dexamethasone, 30 mg ketorolac and local infiltration with bupivacaine/epinephrine. Patients randomized to S (+) ketamine received an intravenous bolus dose of 0.35 mg kg−1 S (+) ketamine before start of surgery followed by continuous infusion of 5 μg kg−1 min−1 until 2 min after end of surgery. Patients in the placebo group got isotonic saline (bolus and infusion). BISTM monitoring was used. Pain intensity and side-effects were assessed by blinded nursing staff during PACU stay and by phone 1, 7 and 90 days after surgery.ResultsIn patients randomized to S (+) ketamine emergence from anaesthesia was significantly longer (13.1 min vs. 9.3 min; p < 0.001). BIS values were significantly higher during anaesthesia (maximal value during surgery: 62 vs. 57; p = 0.01) and when opening eyes (81 vs. 70, p < 0.001). Pain scores (NRS and VAS) did not differ significantly between groups.ConclusionsThe addition of perioperative S (+) ketamine for postoperative analgesia after haemorrhoidectomy on top of multimodal non-opioid pain prophylaxis does not seem to be warranted, due to delayed emergence and recovery, more side-effects, altered BIS readings and absence of additive analgesic effect.

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Management of Neuropathic Chronic Pain with Methadone Combined with Ketamine: A Randomized, Double Blind, Active-Controlled Clinical Trial

January 2018 - Pain Physician ◽

10.36076/ppj.2017.215 ◽

2017 ◽

Vol 3 (20;3) ◽

pp. 207-215

Author(s):

Juliano Ferreira

Keyword(s):

Clinical Trial ◽

Neuropathic Pain ◽

Multimodal Analgesia ◽

Primary Objective ◽

Controlled Clinical Trial ◽

Double Blind ◽

Oral Ketamine ◽

Pain Scores ◽

Oral Methadone ◽

Pain Symptoms

Background: Methadone and ketamine are used in neuropathic pain management. However, the benefits of both drugs association are uncertain in the treatment of neuropathic pain. Objective: Our primary objective was test the hypothesis that oral methadone combined with oral ketamine is more effective than oral methadone or ketamine alone in reducing neuropathic pain. Study Design: We conducted a randomized, double blind, active-controlled parallelgroup clinical trial. Methods: Forty-two patients with neuropathic pain refractory to conventional therapy were randomly assigned to receive oral methadone (n = 14), ketamine (n = 14), or methadone plus ketamine (n = 14) over a 3-month period. Results: During these 90 days, we observed pain scores using a visual analogical scale (VAS), allodynia, burning/shooting pain, and some side effects. All treatments were effective in reducing pain scores by at least 40%. However, a significant improvement in pain was observed only in the ketamine alone group compared with both the methadone or methadone/ketamine groups. No significant differences were observed among the treatment groups for the reduction of burning or shooting pain, while ketamine alone was more effective than methadone or methadone/ketamine for the reduction of allodynia. Limitations: Formal assessment for awareness of the allocation was not performed, some co-intervention bias may have occurred, our results could be only relevant to the patient population investigated and the use of VAS as the primary outcome detect changes in pain intensity but not to assess neuropathic pain symptoms. Conclusion: This study indicates that ketamine was better than methadone or methadone/ketamine for treating neuropathic pain. Key words: Multimodal analgesia, refractory pain, NMDA receptor, opioid

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Intravenous Tenoxicam for Analgesia following Laparoscopic Cholecystectomy

Anaesthesia and Intensive Care ◽

10.1177/0310057x9802600108 ◽

1998 ◽

Vol 26 (1) ◽

pp. 56-60 ◽

Cited By ~ 15

Author(s):

F. J. Munro ◽

S. J. Young ◽

I. J. Broome ◽

H. M. Robb ◽

G. J. Wardall

Keyword(s):

Clinical Trial ◽

Laparoscopic Cholecystectomy ◽

Placebo Group ◽

Adverse Effects ◽

Controlled Clinical Trial ◽

Patient Controlled Analgesia ◽

Double Blind ◽

Rescue Analgesia ◽

Double Blind Placebo ◽

Pain Scores

In a double-blind, placebo-controlled clinical trial (power of 80% to detect a 30% reduction in morphine consumption, P<0.05) we have determined that intraoperative intravenous administration of tenoxicam 40 mg during laparoscopic cholecystectomy, when compared with placebo, was associated with a significant reduction in consumption of morphine at 6 hours and 12 hours (P<0.05) but not at 24 hours, when assessed by patient-controlled analgesia. Furthermore there was a significantly greater requirement for “rescue” analgesia with intramuscular morphine in the placebo group during the period of the study. There was no difference between the groups in pain scores, either at rest or on movement, nor in the incidence of nausea and vomiting. No patient in either group suffered a respiratory rate less than 8/min or oversedation at any time, and there were no other adverse effects.

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