Add on lidocaine to multimodal analgesia effective for pain relief after Sleeve Gastrectomy

According to a research published in the Journal of PeriAnesthesia Nursing, the addition of intravenous lidocaine to multimodal analgesia reduced acute pain compared with dexmedetomidine and ketamine and lowered hospital length of stay (LOS) in patients who underwent laparoscopic sleeve gastrectomy.

The prospective, randomized, double-blind research investigated the effects of adding ketamine, dexmedetomidine, and lidocaine infusions to multimodal analgesia and evaluated the ensuing pain ratings and analgesic demand in laparoscopic sleeve gastrectomy patients.

Participants were to have laparoscopic sleeve gastrectomy between April 2021 and July 2021 if they were between the ages of 18 and 65 and obese (BMI > 35). Before surgery, the patients were randomly allocated 1:1:1 proportions. Intravenous lidocaine (2 mg/kg lean body weight/h) was administered to patients in group L (mean age, 34.679.68 years; 66.7% women), intravenous ketamine (0.5 mg/kg lean body weight/h) was administered to patients in group K (mean age, 36.0 years; 75.0% women), and intravenous dexmedetomidine (0.5 mcg/kg actual body weight/h) was administered to patients After decreasing the dosage, postoperative infusions continued for 12 hours. Utilizing a visual analog scale, postoperative pain was evaluated (VAS). The main outcome was pain ratings in the first 12 hours after surgery.

VAS rest was lower at all time periods in the first 24 hours in the lidocaine group, whereas VASmovement was lower in the first 6 hours and at 24 hours (P.001, P.001, and P =.008, respectively). The lidocaine group had lower VASrest ratings at 48 hours and VASmovement scores at 12 and 48 hours than the ketamine group (P =.044, P =.001, and P =.011, respectively). At these time periods, there was no statistically significant difference between the lidocaine and dexmedetomidine groups in terms of VASrest and VASmovement ratings (P >.05). On the first postoperative day, the K group required more rescue analgesia than the D and L groups (95 percent CI, 38.5425.52 [27.77-49.32], 14.0020.51 [5.53-22.47], and 6.2515.20 [-0.17 to 12.50] mg; P.001, respectively). Mobilization time was comparable amongst groups (P =.069), and LOS was shorter in the L group compared to the other groups (P =.002). Due to the hospital's inadequate resources, the researchers were unable to quantify the medication concentrations in the blood.

Compared to ketamine and dexmedetomidine, lidocaine as an adjuvant infusion lowers acute discomfort in the early postoperative phase and permits earlier discharge in patients having laparoscopic sleeve gastrectomy. Infusions of dexmedetomidine after a bolus dose and varying dosages of ketamine are required to confirm these findings.

Reference –

Ustun YB, Turunc E, Ozbalci GS, et al. Comparison of ketamine, dexmedetomidine and lidocaine in multimodal analgesia management following sleeve gastrectomy surgery: a randomized double-blind trial. J Perianesth Nurs. Published online April 2, 2022. doi:10.1016/j.jopan.2021.12.012.