Fatma AKELMA KAVAK, Jülide ERGİL, Derya ÖZKAN, MELİH AKINCI, Mustafa ÖZMEN, Haluk GÜMÜŞ

A comparıson of the effects of ıntraoperatıve esmolol and lıdocaıne ınfusıons on postoperatıve analgesıa

Amaç: Bu çalışmada laparaskopik kolesistektomi yapılan hastalarda intraoperatif esmolol, lidokain ve salin infuzyonunun postoperatif ağrı ve opioid gereksinimi üzerine etkilerini karşılaştırmayı amaçladık. Yöntem: Bu prospektif randomize çalışlmaya ASA I-II olan 48 hasta dahil edildi. Hastalara anestezi indüksiyonu öncesi 1 mg kg -1 esmolol (Grub E), 1.5 mg kg-1 lidokain (Grup L) veya 10 mcg remifentanil (Grup C) intravenöz (IV) enjeksiyonu uygulandı. Aynı zamanda, ameliyat boyunca hastalara 50 mcg kg-1 dk-1 esmolol (IV, E Grubu) veya 2 mg kg-1 dk-1 lidokain (IV, Grup L) veya 10 mL saat-1 serum fizyolojik (C Grubu) infüzyonu verildi. Tüm hastaların görsel analog skalası (VAS), 24.saatte hastaların gaz çıkarma zamanları, toplam fentanil tüketim miktarı ve ilaç yan etkileri kaydedildi. Bulgular: Anestezi sonrası bakım ünitesinde (PACU) fentanil tüketimi Grup E için 50±11 mcg, Grup L için 75±18 mcg, Grup C için 100± 27 mcg idi (p< 0.05). Cerrahi sonrası 24 saat içinde fentanil tüketimi Grup Ede, Grup L ve Ce göre önemli oranda düşük saptandı (p=0.000). Sonuç: Esmolol infüzyonu, lidokain ve salin infüzyonuna göre postoperatif 24 saatlik dönemdeki fentanil ihtiyacını belirgin olarak azaltmaktadır. Aynı zamanda, esmolol postoperatif barsak fonksiyonlarının erken düzelmesinde yararlı olabilir.

Postoperatif ağrı üzerine intraoperatif infüzyon esmolol ve lidokain etkilerinin karşılaştırılması

Objective: In this study, we aimed to compare the effects of intraoperative esmolol, lidocaine and saline infusions on postoperative pain and opioid requirement in laparoscopic cholecystectomy. Method: In this prospective randomized study 48 ASA physical status I-II patients were enrolled. Patients received an intravenous (IV) injection of 1 mg kg-1 esmolol (Group E), 1.5 mg kg-1 lidocaine (Group L) or 10 mcg remifentanyl (Group C) prior to the induction of anesthesia. Throughout surgery patients were infused with 50 mcg kg-1 min-1 esmolol (IV, Group E) or 2 mg kg-1 min-1 lidocaine (IV, Group L) or 10mL h-1 saline (Group C). Visual analog scale (VAS) in the postoperative 24 hours total fentanyl consumption and adverse drug events were recorded. Results: Fentanyl consumption in the post-anesthesia care unit (PACU) was 50±11 mcg for Group E, 75±18 mcg for Group L and 100± 27 mcg for Group C (p< 0.05). In the postoperative 24 hours patients in Group E consumed significantly less fentanyl than those in Group L and C (p=0.000). Conclusion: Esmolol infusion decreased opioid consumption during the 24-h postoperative period more effectively than lidocaine infusion and saline. Also esmolol might be a useful adjuvant for early recovery of bowel functions.

PDF

___

1. White PF. The role of non-opioid analgesic techniques in the management of pain after ambulatory surgery. Anesth Analg 2002; 94: 577-585.
2. Bisgaard T. Analgesic treatment after laparoscopic cholecystectomy: a critical assessment of the evidence. Anesthesiology 2006; 104: 835-846.
3. Lauwick S, Kim do J, Michelagnoli G et al. Intraoperative infusion of lidocaine reduces postoperative fentanyl requirements in patients undergoing laparoscopic cholecystectomy. Can J Anaesth 2008; 55: 754-760.
4. Rimbäck G, Cassuto J, Tollesson PO. Treatment of postoperative paralytic ileus by intravenous lidocaine infusion. Anesth Analg 1990; 70: 414-419.
5. Selden R, Sasahara AA. Central nervous system toxicity induced by lidocaine. Report of a case in a patient with liver disease. JAMA 1967; 27: 908-909.
6. Scott DB. Toxic effects of local anaesthetic agents on the central nervous system. Br J Anaesth 1986; 58: 732-735.
7. Davidson EM, Doursout MF, Szmuk P, Chelly JE. Antinociceptive and cardiovascular properties of esmolol following formalin injection in rats. Can J Anaesth 2001; 48: 59-64.
8.Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesth 1995; 7: 89-91.
9.Coloma M, Chiu JW, White PF, Armbruster SC. The use of esmolol as an alternative to remifentanil during desflurane anesthesia for fast-track outpatient gynecologic laparoscopic surgery. Anesth Analg 2001; 92: 352-357.
10. Agarwal A, Gautam S, Gupta D, Agarwal S, Singh PK, Singh U. Evaluation of a single preoperative dose of pregabalin for attenuation of postoperative pain after laparoscopic cholecystectomy. Br J Anaesth 2008; 101: 700-704.
11. Blanski L, Lutz J, Laddu A. Esmolol the first ultra-short-acting intravenous beta blocker for use in critically ill patients. Heart Lung 1988; 17: 80-89.
12. Chia YY, Chan MH, Ko NH, Liu K. Role of beta-blockade in anaesthesia and postoperative pain management after hysterectomy. Br J Anaesth 2004; 93: 799-805.
13. Menigaux C, Guignard B, Adam F, Sessler DI, Joly V, Chauvin M. Esmolol prevents movement and attenuates the BIS response to orotracheal intubation. Br J Anaesth 2002; 89: 857-862.
14. White PF, Wang B, Tang J, Wender RH, Naruse R, Sloninsky A. The effect of intraoperative use of esmolol and nicardipine on recovery after ambulatory surgery. Anesth Analg 2003; 97: 1633- 1638.
15. Mitrovic I, Margeta-Mitrovic M, Bader S, Stoffel M, Jan LY, Basbaum AI. Contribution of GIRK2-mediated postsynaptic signaling to opiate and alpha 2-adrenergic analgesia and analgesic sex differences. Proc Natl Acad Sci U S A 2003; 100: 271-276.
16. Taira Y, Kakinohana M, Kakinohana O, Okuda Y. ONO 1101, a novel ultra-short-acting β1 blocker can reduce pain behaviour in the rat formalin test. Anesthesiology 1998; 89: A1128.
17. Collard V, Mistraletti G, Taqi A et al. Intraoperative esmolol infusion in the absence of opioids spares postoperative fentanyl in patients undergoing ambulatory laparoscopic cholecystectomy. Anesth Analg 2007; 105: 1255-1262
18. Berkenstadt H, Loebstein R, Faibishenko I, Halkin H, Keidan I, Perel A. Effect of a single dose of esmolol on the bispectral index scale (BIS) during propofol/fentanyl anaesthesia. Br J Anaesth 2002; 89: 509-511.
19. Pypendop BH, Ilkiw JE. The effects of intravenous lidocaine administration on the minimum alveolar concentration of isoflurane in cats. Anesth Analg 2005; 100: 97-101
20. Hollmann MW, Gross A, Jelacin N, Durieux ME. Local anesthetic effects on priming and activation of human neutrophils. Anesthesiology 2001; 95: 113-122.
21. Yardeni IZ, Beilin B, Mayburd E, Levinson Y, Bessler H. The effect of perioperative intravenous lidocaine on postoperative pain and immune function. Anesth Analg 2009; 109: 1464-1469.
22. Groudine SB, Fisher HA, Kaufman RP Jr et al. Intravenous lidocaine speeds the return of bowel function, decreases postoperative pain, and shortens hospital stay in patients undergoing radical retropubic prostatectomy. Anesth Analg 1998; 86: 235-239.
23. Davison R, Parker M, Atkinson AJ Jr. Excessive serum lidocaine levels during maintenance infusions: mechanisms and prevention. Am Heart J 1982; 104: 203-208.
24. Kaba A, Laurent SR, Detroz BJ et al. Intravenous lidocaine infusion facilitates acute rehabilitation after laparoscopic colectomy. Anesthesiology 2007; 106: 11-18.
25. Wu CT, Borel CO, Lee MS et al. The interaction effect of perioperative cotreatment with dextromethorphan and intravenous lidocaine on pain relief and recovery of bowel function after laparoscopic cholecystectomy. Anesth Analg 2005; 100: 448-453
26. Manara L, Croci T, Aureggi G et al. Functional assessment of beta adrenoceptor subtypes in human colonic circular and longitudinal (taenia coli) smooth muscle. Gut 2000; 47: 337-342
27. Lyrenäs E, Abrahamsson H. Beta adrenergic influence on oesophageal peristalsis in man. Gut 1986; 2: 260 -26 6.