Pain, Postoperative
Conditions
Keywords
lidocaine, morphine, analgesia
Brief summary
Postoperative opioid-centric pain management strategies in obese patients are accompanied by the possible development of; opioid-induced ventilatory impairment (OIVI) and hypoxemia. This presents as sedation and respiratory depression, combined with upper airway obstruction and hypercapnia. If it remains undetected and untreated, it can result in increased perioperative morbidity and mortality.Thus, an increased interest in the use of non-opioid analgesic adjuncts has been prompted. Intra-operative intravenous lidocaine infusion has analgesic, anti-inflammatory, anti-hyperalgesic, opioid-sparing effects with an enhanced recovery after surgery (ERAS) profile. Its postoperative analgesia may last after reduction of its plasma concentration. So, lidocaine could be a good alternative in bariatric surgery. Lidocaine has been studied as part of an opioid-free multimodal analgesia in morbidly obese patients. Also, its use in bariatric surgery showed a decrease in postoperative opioid use and improvement in the quality of recovery.
Detailed description
compare the postoperative analgesic effect of intraoperative lidocaine infusion (Study group) used as a sole analgesic agent, to the intraoperative intravenous morphine (Control group) in laparoscopic gastric bypass surgery.
Interventions
DRUGLidocaine Hydrochloride 2% Intravenous Solution [XYLOCAINE]
At induction of anesthesia, patients will receive a loading dose of 1.5mg/kg lidocaine hydrochloride 2% slowly over 3 min followed by IV infusion of 2mg/kg/hr lidocaine hydrochloride 2% till the end of surgery
DRUGmorphine sulphate (10mg/ ml ampoule)
At induction of anesthesia, patients will receive a loading dose of IV 0.1mg/kg morphine sulphate slowly over 3 minutes followed by IV infusion of normal saline via infusion pump. The infusion will be continued till the end of surgery
Sponsors
Ain Shams University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* ASA physical status I- II * body mass index (BMI) ˃ 35 * scheduled to undergo laparoscopic gastric bypass
Exclusion criteria
* Patients' refusal * hypersensitivity to the study medications * patients with known history of; hepatic disease, renal dysfunction * severe renal impairment (eGFR \<30ml/min/1.73m2) * heart failure; left ventricular ejection fraction than 35% * any cardiac dysrhythmias; Adam-Stokes syndrome; Wolff- Parkinson-White syndrome, atrio-ventricular block with heart rate below 50 bpm * chronic pain * concomitantly taking beta blocking drugs •substance abuse disorder * chronic opioid use.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Post-operative pain score at rest | 1hour | Intensity of pain will be monitored ; on arrival to the PACU, at 20, 40 and 60 minutes after arrival to the PACU by the Numeric Pain Rating Scale. The Numeric Pain Rating Scale (NPRS) is a segmented numeric version of the visual analog scale (VAS) in which the patient selects a whole number (0-10 integers) that best reflects the intensity of pain felt.Where 0 is no pain felt and 10 is the worst pain. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Duration of anesthesia | 4 hours | measured in minutes |
| mean values of mean blood pressure (MBP) | 5 hours | mean values of MBP will be recorded as base line value, before induction of anesthesia, 5 minutes after endotracheal intubation, before pneumoperitoneum, after release of pneumoperitoneum and 10 min after extubation in the PACU |
| Number of patients requiring intra-operative morphine | 4hours | Number of patients requiring intra-operative morphine will be recorded |
| sPO2 | 5 hours | recorded in the induction room and in the PACU. |
| Respiratory rate | 5 hours | recorded in the induction room and in the PACU |
| Duration of surgery | 3 hours | measured in minutes |
| Post-operative sedation score | 1 hour | From 0 to 4 |
| Modified Aldrete Score | 1 hour | score from 0 to 10. Higher score means patient is fit to transfer to the ward. In the PACU, patients with score ≥ 9 will be transferred to the surgical unit |
| mean values of heart rate (HR) | 5 hours | mean values of HR will be recorded as base line value, before induction of anesthesia, 5 minutes after endotracheal intubation, before pneumoperitoneum, after release of pneumoperitoneum and 10 min after extubation in the PACU |
| Number of patients requiring postoperative additional morphine doses | 1 hour | Number of patients requiring postoperative additional morphine doses willbe recorded |
| the total dose of morphine given to each patient | 5 hours | the total dose of morphine given to each patient will be recorded in milligrams |
| Post-operative nausea and/or vomiting | 1 hour | number of patients will be recorded |
Countries
Egypt
Outcome results
None listed