Intravenous lidocaine added to multimodal analgesia reduced acute pain compared with dexmedetomidine and ketamine and decreased the hospital length of stay (LOS) in patients who had laparoscopic sleeve gastrectomy, according to a study in the Journal of PeriAnesthesia Nursing.

The prospective, randomized, double-blind study compared the effects of adding ketamine, dexmedetomidine, and lidocaine infusions to multimodal analgesia and assessed the resulting pain scores and analgesic requirement in laparoscopic sleeve gastrectomy.

Eligible participants were aged 18 to 65 years and had obesity (body mass index >35), for which they were to have laparoscopic sleeve gastrectomy from April 2021 to July 2021.


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The patients were randomly assigned 1:1:1 before surgery. Intravenous lidocaine (2 mg/kg lean body weight/h) was initiated for patients in group L (mean age, 34.67±9.68 years; 66.7% women), intravenous ketamine (0.5 mg/kg lean body weight/h) was initiated in group K (mean age, 36.0 years; 75% women), and intravenous dexmedetomidine (0.5 mcg/kg actual body weight/h) was initiated in group D (mean age, 37.64±11.45 years; 68% women). Postoperative infusions were continued for 12 hours after the doses were decreased.

Postoperative pain assessment was done with use of the visual analog scale (VAS). The primary outcome was postoperative pain scores in the first 12 hours.

In the lidocaine group, VASrest was lower at all-time points in the first 24 hours and VASmovement in the first 6 hours and at 24 hours compared with the dexmedetomidine and ketamine groups (P <.001, P <.001, and P =.008, respectively). VASrest scores at 48 hours and VASmovement scores at 12 and 48 hours were lower in the lidocaine group vs the ketamine group (P =.044, P =.001, and P =.011, respectively). No statistically significant difference was observed between the lidocaine and dexmedetomidine groups for VASrest and VASmovement scores at these time points (P >.05).

The postoperative requirement of rescue analgesia on the first day was higher in the K group compared with the D and L groups (95% CI, 38.54±25.52 [27.77-49.32], 14.00±20.51 [5.53-22.47], and 6.25±15.20 [-0.17 to 12.67] mg; P <.001, respectively).

No difference was found among the groups regarding mobilization time (P =.069), and LOS was shorter in the L group vs the other groups (P =.002).

The researchers noted that they could not measure blood levels of the drugs due to the limited facilities of their hospital.

“This study showed that lidocaine used as an adjuvant infusion reduces acute pain in the early postoperative period and enables early discharge compared to ketamine and dexmedetomidine in patients undergoing laparoscopic sleeve gastrectomy,” the study authors concluded. “However, these results need to be supported by studies using infusions of dexmedetomidine following a bolus dose and different doses of ketamine.”

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