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Awan B, Elsaigh M, Elkomos BE, Sohail A, Asqalan A, Baqar SOM, Elgendy NA, Saleh OS, Szul JM, Juan AS, Alasmar M, Marzouk MM. The use of lidocaine infusion in laparoscopic cholecystectomy: An updated systematic review and meta-analysis. J Minim Access Surg 2024; 20:239-246. [PMID: 38240330 DOI: 10.4103/jmas.jmas_265_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/17/2023] [Indexed: 07/26/2024] Open
Abstract
ABSTRACT Being one of the most common abdominal surgical procedures, numerous techniques have been adapted to decrease post-operative pain post cholecystectomy. However, the efficacy of intravenous (IV) lidocaine in managing post operative pain after LC is still controversial, according to many recent studies. This study aims to detect the effectiveness of IV lidocaine compared to other medications in managing post-operative pain. PubMed, Scopes, Web of Science and Cochrane Library were searched for eligible studies from inception to June 2023, and a systematic review and meta-analysis was done. According to eligibility criteria, 14 studies (898 patients) were included in our study. The pooled results of the included studies showed that the pain score after 6, 12 and 24 h after the surgery was significantly lower in those who received IV lidocaine as a painkiller (Visual Analogue Scale [VAS] 6H, mean difference [MD] = -1.20, 95% confidence interval [CI] = -2.20, -0.20, P = 0.02; I2 = 98%, VAS 12H, MD = -0.90, 95% CI = -1.52, -0.29, P = 0.004; I2 = 96% and VAS 24H, MD = -0.86, 95% CI = -1.48, -0.24, P = 0.007; I2 = 92%). In addition, IV lidocaine is associated with a significant decrease in the opioid requirement after the surgery (opioid requirements, MD = -29.53, 95% CI = -55.41, -3.66, P = 0.03; I2 = 98%). However, there was no statistically significant difference in the incidence of nausea and vomiting after the surgery between the two groups (nausea and vomiting, relative risk = 0.91, 95% CI = 0.57, 1.45, P = 0.69; I2 = 50%). Lidocaine infusion in LC is associated with a significant decrease in post operative pain and in opioid requirements after the surgery.
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Affiliation(s)
- Bakhtawar Awan
- Department of General and Emergency Surgery, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Mohamed Elsaigh
- Department of General and Emergency Surgery, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Beshoy Effat Elkomos
- Department of General and Emergency Surgery, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Azka Sohail
- Department of General and Emergency Surgery, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Ahmad Asqalan
- Department of Thoracic Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - Safa Owhida Mousa Baqar
- Department of Colorectal Surgery, Derriford Hospital, University Hospital Plymouth, Plymouth, UK
| | - Noha Ahmed Elgendy
- Department of Acute and Emergency Medicine, Frimley Park Hospital, Frimley, UK
| | - Omnia S Saleh
- Division of General and GI Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Justyna Malgorzata Szul
- Department of General and Emergency Surgery, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Anna San Juan
- Department of General and Emergency Surgery, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Mohamed Alasmar
- Laboratory for Surgical and Metabolic Research, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mohamed Mustafa Marzouk
- Department of General and Emergency Surgery, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
- Department of General Surgery, Ain Shams University Hospital, Cairo, Egypt
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Mendonça FT, Tramontini AJ, Miake HI, Seixas LF, de Carvalho LSF, Sposito AC. Intra-operative esmolol and pain following mastectomy: A randomised clinical trial. Eur J Anaesthesiol 2021; 38:735-743. [PMID: 33831899 DOI: 10.1097/eja.0000000000001512] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Esmolol is a beta-1 selective blocker that has been shown to reduce postoperative pain. Its antinociceptive effects have not been tested following mastectomy. OBJECTIVE To evaluate the safety, efficacy and antinociception of intra-operative esmolol infusion after mastectomy. DESIGN Randomised, double-blinded, placebo-controlled trial. SETTING Tertiary referral centre, Brasília, Brazil. Recruitment: July 2015 to July 2017. PATIENTS Seventy women scheduled for mastectomy, ASA I to III, aged 18 to 75 years. Four were excluded. INTERVENTIONS All underwent general anaesthesia. The intervention group received a bolus of 0.5 mg kg-1 of esmolol over 10 min followed by a continuous infusion of 100 μg kg-1 min-1. The placebo group received saline. MAIN OUTCOME MEASURES The primary outcome was pain at rest 24 h after mastectomy as measured by a 0 to 10 numeric rating scale. RESULTS Pain scores at rest 24 h after mastectomy were lower in esmolol-treated patients compared with placebo (mean difference = -1.51, 95% confidence interval (CI), -2.36 to -0.65, P = 0.001). On arrival in the postanaesthesia care unit (PACU), the occurrence of pain was also lower in the esmolol group, at rest and on effort (P = 0.009 and P = 0.013, respectively), on discharge from PACU (P = 0.009 and P = 0.015), 12 h (P = 0.01 and P = 0.007) and on effort in the 24 postoperative hours (P = 0.003). Mean morphine consumption was reduced by 77% in the esmolol group compared with the placebo group (mean difference = -2.52 mg, 95% CI = -3.67 to -1.38, P < 0.001). The length of hospital stay was shorter for the esmolol group (mean difference = -6.9 h, 95% CI, -13.4 to -0.31, P = 0.040). CONCLUSION Esmolol was well tolerated, allowed a notable reduction in the dose of rescue analgesics and demonstrated superior efficacy compared to placebo for pain management after mastectomy. TRIAL REGISTRATION ClinicalTrials/NCT02466542.
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Affiliation(s)
- Fabrício T Mendonça
- From the Department of Anaesthesiology, Base Hospital of the Federal District, Brasilia, DF (FTM, AJT, HIM, LFS) and Cardiology Department, State University of Campinas (Unicamp), Campinas, Sao Paulo, Brazil (LSFdC, ACS)
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Lončar-Stojiljković D. Effects of esmolol infusion on cardiovascular parameters and quality of general anaesthesia in younger and older patients. SCRIPTA MEDICA 2021. [DOI: 10.5937/scriptamed52-32892] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background: Esmolol is a cardioselective b-adrenergic antagonist that is used during general anaesthesia to blunt the sympathetic reflex tachycardia and hypertension. The aim of the study was to investigate whether the potential beneficial and adverse effects of esmolol differ depending on the patient age. Methods: A total of 50 ASA I/II patients scheduled for elective upper abdominal surgery were divided in two groups: younger (patients aged up to 35 years) and older (patients older than 65). After premedication with Diazepam, they were infused with esmolol during the first 5 min at a rate of 0.3 mg/kg/min and 0.1 mg/kg/min thereafter. Anaesthesia was induced with thiopental sodium 3-5 mg/kg intravenously (iv) and fentanyl 1.5 µg/kg IV. Tracheal intubation was facilitated with suxamethonium 1-2 mg/kg IV. Long-term neuromuscular blockade was induced with pancuronium bromide 0.07 mg/kg IV bolus and maintained with incremental IV boluses of 0.01 mg/ kg. Inhalational anaesthesia was maintained with a mixture of oxygen and nitrous oxide (O2 /N2 O) 2 : 1. Results: The systolic blood pressure remained constant during the intubation phase in the group of older patients, at the same time being around 89 % of the pre-induction values, while in younger patients it rose up to 100 %. During the same phase of anaesthesia, the diastolic blood pressure in older patients remained at about 91 %, while in younger patients it rose up to 107 % of the pre-induction values. The consumption of drugs and the speed and quality of the recovery from anaesthesia did not differ between the two groups of patients. Conclusion: Infusion of esmolol contributes to the concept of general balanced anaesthesia in elective patients scheduled for upper abdominal surgery equally in younger and older patients.
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Abdelfatah FA, Amin SR. Does esmolol infusion have an adjuvant effect on transversus abdominis plane block for pain control in laparoscopic cholecystectomy? A randomized controlled double-blind trial. EGYPTIAN JOURNAL OF ANAESTHESIA 2021. [DOI: 10.1080/11101849.2021.1975959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Fatma Ahmed Abdelfatah
- Department of Anaesthesia, Faculty of Medicine, Benha University, Benha, Arab Republic of Egypt
| | - Samar Rafik Amin
- Department of Anaesthesia, Faculty of Medicine, Benha University, Benha, Arab Republic of Egypt
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Hamed JME, Ataalla WM. Esmolol Infusion Reduces Blood Loss and Opiate Consumption during Fertility Preserving Myomectomy. Anesth Essays Res 2019; 13:423-429. [PMID: 31602056 PMCID: PMC6775852 DOI: 10.4103/aer.aer_118_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objectives The objective of this study is to evaluate the effect of esmolol-induced hypotensive anesthesia (EIHA) on intra-operative (IO) bleeding during open myomectomy. Patients and Methods Eighty-eight women were randomly divided into the study group received EIHA without uterine tourniquet and control group who received normotensive anesthesia with uterine tourniquet. EIHA was provided as priming dose of esmolol (0.5 mg.kg-1) before the induction of anesthesia and esmolol infusion (0.05-0.3 mg.kg-1.min-1) to maintain mean arterial pressure at 60-70 mmHg that was stopped on completion of myomectomy. Fentanyl was used as IO analgesia (loading dose: 1.0 μg.kg-1 then infusion of 0.2-0.4 μg.kg-1.h-1). All patients received 6% hydroxyethyl starch (HES; initially, 3 mL.kg-1 over 5-10 minutes and supplemental doses according to requirements) and Lactated Ringer's solution (LR; 5 mL.kg-1.h-1). Trigger for blood transfusion was hemoglobin concentration (HBC) <7 g.dL-1. Study outcomes included the extent of postoperative (PO) HBC deficit in relation to preoperative HBC, frequency of tourniquet application for the study patients, and total fentanyl consumption. Results EIHA significantly reduced blood pressure measures since laryngoscopy and tracheal intubation till the end of surgery in the study group compared to control group. Eight study patients (18.9%) required tourniquet application for control of bleeding; however, amount of IO blood loss; total field visibility score and PO HBC deficit were non significantly lower in the study group. EIHA allowed significant reduction of the IO amount of LR and additional amounts of HES infusions. Study patients group consumed significantly lower IO fentanyl doses with significantly longer duration till the 1st PO request and the number of additional fentanyl, and lower numeric rating scale scores in study group compared to controls. Conclusion Open myomectomy under EIHA is feasible and safe and allows fertility-sparing with minimal risk of blood transfusion. The applied procedure of EIHA allowed blunting of pressor reflexes secondary to LIT, surgical stresses and extubation, and allowed reduction of IO and PO opioid doses.
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Affiliation(s)
| | - Walid Mamdouh Ataalla
- Department of Obstetrics and Gynecology, Faculty of Medicine, Tanta University, Tanta, Egypt
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Barazanchi A, MacFater W, Rahiri JL, Tutone S, Hill A, Joshi G, Kehlet H, Schug S, Van de Velde M, Vercauteren M, Lirk P, Rawal N, Bonnet F, Lavand'homme P, Beloeil H, Raeder J, Pogatzki-Zahn E. Evidence-based management of pain after laparoscopic cholecystectomy: a PROSPECT review update. Br J Anaesth 2018; 121:787-803. [DOI: 10.1016/j.bja.2018.06.023] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/19/2018] [Accepted: 07/09/2018] [Indexed: 02/07/2023] Open
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De Oliveira GS, Kendall MC, McCarthy RJ. Esmolol does not improve quality of postsurgical recovery after ambulatory hysteroscopy: A prospective, randomized, double-blinded, placebo-controlled, clinical trial. Medicine (Baltimore) 2018; 97:e12647. [PMID: 30313053 PMCID: PMC6203464 DOI: 10.1097/md.0000000000012647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Intraoperative systemic esmolol has been shown to reduce postsurgical pain. Nonetheless, it is unknown whether the use of intraoperative systemic esmolol can improve patient-reported postsurgical quality of recovery. The main objective of the current investigation was to evaluate the effect of intraoperative esmolol on postsurgical quality of recovery. We hypothesized that patients receiving intraoperative esmolol would report better quality of postsurgical recovery than the ones receiving saline. METHODS The study was a prospective randomized double-blinded, placebo-controlled, clinical trial. Healthy female subjects undergoing outpatient hysteroscopic surgery under general anesthesia were randomized to receive intravenous esmolol administered at a rate of 0.5 mg/kg bolus followed by an infusion of 5 to 15 μg/kg/min or the same volume of saline. The primary outcome was the Quality of Recovery 40 (QOR-40) questionnaire at 24 hours after surgery. Other data collected included postoperative opioid consumption and pain scores. Data were analyzed using group t tests and the Wilcoxon exact test. RESULTS Seventy subjects were randomized and 58 completed the study. There was not a clinically significant difference in the global QoR-40 scores between the esmolol and saline groups at 24 hours, median (interquartile range) of 179 (171-190) and 182 (173-189), respectively, P = .82. In addition, immediate post-surgical data in the post-anesthesia care unit did not show a benefit of using esmolol compared to saline in regard to pain scores, morphine consumption, and postoperative nausea and vomiting. CONCLUSIONS Despite current evidence in the literature that intraoperative esmolol improves postsurgical pain, we did not detect a beneficial effect of intraoperative esmolol on patient-reported quality of recovery after ambulatory surgery. Our results confirm the concept that the use of patient-centered outcomes rather than commonly used outcomes (e.g., pain scores and opioid consumption) can change the practice of perioperative medicine.
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Affiliation(s)
- Gildasio S. De Oliveira
- Department of Anesthesiology, Rhode Island Hospital, Alpert School of Medicine, Brown University, Providence, RI
- Department of Healthcare Policy and Practice, School of Public Health, Brown University, Providence, RI
| | - Mark C. Kendall
- Department of Anesthesiology, Rhode Island Hospital, Alpert School of Medicine, Brown University, Providence, RI
- Department of Healthcare Policy and Practice, School of Public Health, Brown University, Providence, RI
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