Low-Dose Ketamine, Lignocaine, and Dexmedetomidine Combo effectively controls hemodynamics and pain for laparoscopic nephrectomies: Study

Notable numbers of drugs, alone or in combinations, have been tested with variable results in the quest for opioid-free anesthesia. Recently published randomized, single-blind pilot study that compared the analgesic and recovery profiles of a low-dose combination of ketamine, lignocaine, and dexmedetomidine (KeLiDex) versus fentanyl-based anesthesia in patients undergoing laparoscopic nephrectomies. The primary aim was to compare hemodynamic variation as a surrogate marker of adequate analgesia under standardized and controlled balanced anesthesia.

Anesthesia Administration and Comparison

Twenty patients were randomly assigned to receive either the KeLiDex infusion or fentanyl infusion as the analgesic component for balanced general anesthesia. All patients also received paracetamol and a quadratus lumborum block. Intraoperative hemodynamics, time to extubation after reversal (T-tEAR), post-anesthesia care unit (PACU) discharge readiness, sedation, postoperative pain, and rescue analgesia consumption were compared between the two groups.

Comparison of Hemodynamics

The results showed that the KeLiDex group had a significantly lower heart rate between 45-90 minutes and at the time of reversal compared to the fentanyl group. Mean arterial pressure only differed significantly at the 60-minute interval, with the KeLiDex group having lower values. The change in heart rate and mean arterial pressure over time within each group was not statistically significant.

Time to Extubation and Recovery

The mean T-tEAR was 6.37 minutes in the KeLiDex group and 8.18 minutes in the fentanyl group, which was not significantly different. Sedation scores, modified Aldrete scores, pain scores, and rescue analgesic requirements were also comparable between the two groups.

Pain Control and Anesthesia Recovery

This study demonstrates that the KeLiDex combination could effectively control hemodynamics and pain, both at rest and with movement, to a similar degree as fentanyl-based anesthesia for laparoscopic nephrectomies. Recovery from anesthesia, sedation, and PACU discharge readiness were also comparable between the two groups.

Implications and Need for Further Research

The findings suggest that the KeLiDex combination may be an effective opioid-free anesthetic regimen that can replace fentanyl-based anesthesia without compromising analgesic efficacy or recovery profiles. This is an important implication given the increasing focus on opioid-sparing techniques to avoid the adverse effects of opioids. However, the authors note that this was a pilot study with a small sample size, and larger, well-powered studies are needed to further evaluate the efficacy and safety of the KeLiDex combination compared to opioid-based anesthesia.

Key Points

Here are the 6 key points from the research paper: 1. This was a randomized, single-blind pilot study that compared the analgesic and recovery profiles of a low-dose combination of ketamine, lignocaine, and dexmedetomidine (KeLiDex) versus fentanyl-based anesthesia in patients undergoing laparoscopic nephrectomies. 2. The KeLiDex group had a significantly lower heart rate between 45-90 minutes and at the time of reversal compared to the fentanyl group. Mean arterial pressure only differed significantly at the 60-minute interval, with the KeLiDex group having lower values. 3. The mean time to extubation after reversal (T-tEAR) was 6.37 minutes in the KeLiDex group and 8.18 minutes in the fentanyl group, which was not significantly different. Sedation scores, modified Aldrete scores, pain scores, and rescue analgesic requirements were also comparable between the two groups. 4. The study demonstrates that the KeLiDex combination could effectively control hemodynamics and pain, both at rest and with movement, to a similar degree as fentanyl-based anesthesia for laparoscopic nephrectomies. Recovery from anesthesia, sedation, and PACU discharge readiness were also comparable between the two groups. 5. The findings suggest that the KeLiDex combination may be an effective opioid-free anesthetic regimen that can replace fentanyl-based anesthesia without compromising analgesic efficacy or recovery profiles. 6. The authors note that this was a pilot study with a small sample size, and larger, well-powered studies are needed to further evaluate the efficacy and safety of the KeLiDex combination compared to opioid-based anesthesia.

Reference –

Arun T, Karim H R, Singha S K, et al. (June 28, 2024) A Comparison of Analgesic and Recovery Profiles of Ketamine, Lignocaine, and Dexmedetomidine (KeLiDex) Versus Fentanyl-Based Anesthesia in Laparoscopic Nephrectomies: A Randomized, Single-Blind, Pilot Study. Cureus 16(6): e63380. DOI 10.7759/cureus.63380