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Original Paper   

Minerva Anestesiologica 2022 Apr 05

DOI: 10.23736/S0375-9393.22.16335-2


lingua: Inglese

Efficacy of intravenous versus intraperitoneal lidocaine for postoperative analgesia in laparoscopic cholecystectomy: a randomized, double-blind, placebo-controlled trial

Warangkana LAPISATEPUN 1, Atipa NITAYAMEKIN 1, 2, Prangmalee LEURCHARUSAMEE 1, Isarapong PIANNGARN 1, Kullakanya MAYKANGGOON 1, Anon CHOTIROSNIRAMIT 3, 4, Sunhawit JUNRUNGSEE 3, 4, Trichak SANDHU 3, 4, Wasana KO-IAM 3, 4, Worakitti LAPISATEPUN 3, 4

1 Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 2 Department of Anesthesiology, Chulabhorn Hospital, Bangkok, Thailand; 3 Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 4 Clinical Surgical Research Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

BACKGROUND: Laparoscopic cholecystectomy (LC) has become the gold standard for gallbladder removal due to the low degree of invasiveness. However, postoperative pain still persists. Local anesthetics provide analgesia, reduce opioid consumption, and accelerate the return of bowel activity with a rare incidence of toxicity. However, it is still inconclusive to verify the more superior route of administration. This study aimed to compare the efficacy of intravenous lidocaine infusion, intraperitoneal lidocaine instillation, and placebo in reducing postoperative analgesia.
METHODS: In this prospective, randomized, double-blind, placebo-controlled trial, the participants were randomized into three groups; intravenous lidocaine infusion (IV group), intraperitoneal lidocaine instillation (IP group), and control. The primary outcome was opioid consumption and secondary outcomes were side effects and recovery profiles.
RESULTS: Opioid consumption at 2, 4, and 6 postoperative hours was statistically lower in IV group compared to the IP and control group (p<0.05). VAS for abdominal pain (VASabd) at 6, 12, and 24 hours were reduced in both IV and IP groups compared to the control group. However, VAS at incision site (VASinc) were not different amongst all three groups. Number of patients who met the discharge criteria within 6 hours after surgery was significantly higher in the IV group (p=0.028).
CONCLUSIONS: Intravenous lidocaine is superior to intraperitoneal lidocaine instillation and placebo in reducing postoperative analgesic requirement and visceral pain within the first 6 hours. Intravenous infusion is a simple and reliable method for reducing abdominal pain following laparoscopic cholecystectomy.

KEY WORDS: Cholecystectomy, Laparoscopic, Lidocaine, Analgesics, Ambulatory surgery

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