Balanced opioid-free anesthesia with lidocaine and esketamine versus balanced anesthesia with sufentanil for gynecological endoscopic surgery: a randomized controlled trial.
Humans
Sufentanil
/ administration & dosage
Female
Ketamine
/ administration & dosage
Lidocaine
/ administration & dosage
Adult
Gynecologic Surgical Procedures
/ adverse effects
Pain, Postoperative
/ drug therapy
Middle Aged
Analgesics, Opioid
/ administration & dosage
Laparoscopy
/ adverse effects
Anesthesia
/ methods
Anesthetics, Local
/ administration & dosage
Pain Measurement
Journal
Scientific reports
ISSN: 2045-2322
Titre abrégé: Sci Rep
Pays: England
ID NLM: 101563288
Informations de publication
Date de publication:
23 05 2024
23 05 2024
Historique:
received:
05
10
2023
accepted:
21
05
2024
medline:
24
5
2024
pubmed:
24
5
2024
entrez:
23
5
2024
Statut:
epublish
Résumé
In this randomized controlled trial, 74 patients scheduled for gynecological laparoscopic surgery (American Society of Anesthesiologists grade I/II) were enrolled and randomly divided into two study groups: (i) Group C (control), received sufentanil (0.3 μg/kg) and saline, followed by sufentanil (0.1 μg/kg∙h) and saline; and (ii) Group F (OFA), received esketamine (0.15 mg/kg) and lidocaine (2 mg/kg), followed by esketamine (0.1 mg/kg∙h) and lidocaine (1.5 mg/kg∙h). The primary outcome was the 48-h time-weighted average (TWA) of postoperative pain scores. Secondary outcomes included time to extubation, adverse effects, and postoperative sedation score, pain scores at different time points, analgesic consumption at 48 h, and gastrointestinal functional recovery. The 48-h TWAs of pain scores were 1.32 (0.78) (95% CI 1.06-1.58) and 1.09 (0.70) (95% CI 0.87-1.33) for Groups F and C, respectively. The estimated difference between Groups F and C was - 0.23 (95% CI - 0.58 - 0.12; P = 0.195). No differences were found in any of the secondary outcomes and no severe adverse effects were observed in either group. Balanced OFA with lidocaine and esketamine achieved similar effects to balanced anesthesia with sufentanil in patients undergoing elective gynecological laparoscopic surgery, without severe adverse effects.Clinical Trial Registration: ChiCTR2300067951, www.chictr.org.cn 01 February, 2023.
Identifiants
pubmed: 38782997
doi: 10.1038/s41598-024-62824-3
pii: 10.1038/s41598-024-62824-3
doi:
Substances chimiques
Sufentanil
AFE2YW0IIZ
Ketamine
690G0D6V8H
Lidocaine
98PI200987
Esketamine
50LFG02TXD
Analgesics, Opioid
0
Anesthetics, Local
0
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
11759Informations de copyright
© 2024. The Author(s).
Références
Beloeil, H. Opioid-free anesthesia. Best Pract. Res. Clin. Anaesthesiol. 33, 353–360. https://doi.org/10.1016/j.bpa.2019.09.002 (2019).
doi: 10.1016/j.bpa.2019.09.002
pubmed: 31785720
Beloeil, H. et al. Balanced opioid-free anesthesia with dexmedetomidine versus balanced anesthesia with remifentanil for major or intermediate noncardiac surgery. Anesthesiology. 134, 541–551. https://doi.org/10.1097/ALN.0000000000003725 (2021).
doi: 10.1097/ALN.0000000000003725
pubmed: 33630043
Bakan, M. et al. Opioid-free total intravenous anesthesia with propofol, dexmedetomidine and lidocaine infusions for laparoscopic cholecystectomy: A prospective, randomized, double-blinded study. Braz J Anesthesiol. 65, 191–199. https://doi.org/10.1016/j.bjane.2014.05.001 (2015).
doi: 10.1016/j.bjane.2014.05.001
pubmed: 25925031
Hermanns, H. et al. Molecular mechanisms of action of systemic lidocaine in acute and chronic pain: A narrative review. Br J Anaesth. 123, 335–349. https://doi.org/10.1016/j.bja.2019.06.014 (2019).
doi: 10.1016/j.bja.2019.06.014
pubmed: 31303268
Beaussier, M., Delbos, A., Maurice-Szamburski, A., Ecoffey, C. & Mercadal, L. Perioperative use of intravenous lidocaine. Drugs. 78, 1229–1246. https://doi.org/10.1007/s40265-018-0955-x (2018).
doi: 10.1007/s40265-018-0955-x
pubmed: 30117019
Foo, I. et al. The use of intravenous lidocaine for postoperative pain and recovery: International consensus statement on efficacy and safety. Anaesthesia. 76, 238–250. https://doi.org/10.1007/s40265-018-0955-x (2021).
doi: 10.1007/s40265-018-0955-x
pubmed: 33141959
Cha, N. H. et al. Opioid-free anesthesia with lidocaine for improved postoperative recovery in hysteroscopy: A randomized controlled trial. BMC Anesthesiol. 23, 192. https://doi.org/10.1186/s12871-023-02152-7 (2023).
doi: 10.1186/s12871-023-02152-7
pubmed: 37270472
pmcid: 10239123
Li, X., Xiang, P., Liang, J., Deng, Y. & Du, J. Global trends and hotspots in esketamine research: A bibliometric analysis of past and estimation of future trends. Drug Des. Devel. Ther. 16, 1131–1142. https://doi.org/10.2147/DDDT.S356284 (2022).
doi: 10.2147/DDDT.S356284
pubmed: 35478936
pmcid: 9037742
Wang, X., Lin, C., Lan, L. & Liu, J. Perioperative intravenous S-ketamine for acute postoperative pain in adults: A systematic review and meta-analysis. J. Clin. Anesth. 68, 110071. https://doi.org/10.1136/bmjopen-2021-054681 (2021).
doi: 10.1136/bmjopen-2021-054681
pubmed: 33007645
Zanos, P. et al. Ketamine and ketamine metabolite pharmacology: Insights into therapeutic mechanisms. Pharmacol. Rev. 70, 621–660. https://doi.org/10.1124/pr.117.015198 (2018).
doi: 10.1124/pr.117.015198
pubmed: 29945898
pmcid: 6020109
Eberl, S. et al. The effectiveness of a low-dose esketamine versus an alfentanil adjunct to propofol sedation during endoscopic retrograde cholangiopancreatography: A randomised controlled multicentre trial. Eur. J. Anaesthesiol. 37, 394–401. https://doi.org/10.1097/EJA.0000000000001134 (2020).
doi: 10.1097/EJA.0000000000001134
pubmed: 31860599
Kumbhakar, R. et al. Using time-weighted average change from baseline of SARS-CoV-2 viral load to assess impact of hydroxychloroquine as postexposure prophylaxis and early treatment for COVID-19. J. Med. Virol. 94, 6091–6096. https://doi.org/10.1002/jmv.28054 (2022).
doi: 10.1002/jmv.28054
pubmed: 35940869
pmcid: 9538473
Sessler, C. N. et al. The richmond agitation–sedation scale: Validity and reliability in adult intensive care unit patients. Am. J. Respir. Crit. Care Med. 166, 1338–1344. https://doi.org/10.1164/rccm.2107138 (2002).
doi: 10.1164/rccm.2107138
pubmed: 12421743
Pereira, J., Lawlor, P., Vigano, A., Dorgan, M. & Bruera, E. Equianalgesic dose ratios for opioids. A critical review and proposals for long-term dosing. J. Pain Symptom Manag. 22, 672–687. https://doi.org/10.1016/S0885-3924(01)00294-9 (2001).
doi: 10.1016/S0885-3924(01)00294-9
Anderson, R., Saiers, J. H., Abram, S. & Schlicht, C. Accuracy in equianalgesic dosing. Conversion dilemmas. J. Pain Symptom Manag. 21, 397–406. https://doi.org/10.1016/S0885-3924(01)00271-8 (2001).
doi: 10.1016/S0885-3924(01)00271-8
Carcamo-Cavazos, V. & Cannesson, M. Opioid-free anesthesia: The pros and cons. Adv. Anesth. 40, 149–166. https://doi.org/10.1016/j.aan.2022.07.003 (2022).
doi: 10.1016/j.aan.2022.07.003
pubmed: 36333044
Baboli, K. M., Liu, H. & Poggio, J. L. Opioid-free postoperative analgesia: Is it feasible?. Curr. Probl. Surg. 57, 100794. https://doi.org/10.1016/j.cpsurg.2020.100794 (2020).
doi: 10.1016/j.cpsurg.2020.100794
pubmed: 32546291
Shanthanna, H., Ladha, K. S., Kehlet, H. & Joshi, G. P. Perioperative opioid administration. Anesthesiology. 134, 645–659. https://doi.org/10.1097/ALN.0000000000003572 (2021).
doi: 10.1097/ALN.0000000000003572
pubmed: 32991672
Macintyre, P. E., Quinlan, J., Levy, N. & Lobo, D. N. Current issues in the use of opioids for the management of postoperative pain: A review. JAMA Surg. 157, 158–166. https://doi.org/10.1001/jamasurg.2021.6210 (2022).
doi: 10.1001/jamasurg.2021.6210
pubmed: 34878527
Wang, J. et al. Use of various doses of s-ketamine in treatment of depression and pain in cervical carcinoma patients with mild/moderate depression after laparoscopic total hysterectomy. Med. Sci. Monit. 26, e922028. https://doi.org/10.12659/MSM.922028 (2020).
doi: 10.12659/MSM.922028
pubmed: 32565534
pmcid: 7331479
Farmer, A. D. et al. Pathophysiology, diagnosis, and management of opioid-induced constipation. Lancet Gastroenterol. Hepatol. 3, 203–212. https://doi.org/10.1016/S2468-1253(18)30008-6 (2018).
doi: 10.1016/S2468-1253(18)30008-6
pubmed: 29870734
Mallick-Searle, T. & Fillman, M. The pathophysiology, incidence, impact, and treatment of opioid-induced nausea and vomiting. J. Am. Assoc. Nurse Pract. 29, 704–710. https://doi.org/10.1002/2327-6924.12532 (2017).
doi: 10.1002/2327-6924.12532
pubmed: 29131554
Müller-Lissner, S. et al. Opioid-induced constipation and bowel dysfunction: A clinical guideline. Pain Med. 18, 1837–1863. https://doi.org/10.1093/pm/pnw255 (2017).
doi: 10.1093/pm/pnw255
pubmed: 28034973
Massoth, C. et al. Impact of opioid-free anaesthesia on postoperative nausea, vomiting and pain after gynaecological laparoscopy: A randomised controlled trial. J. Clin. Anesth. 75, 110437. https://doi.org/10.1016/j.jclinane.2021.110437 (2021).
doi: 10.1016/j.jclinane.2021.110437
pubmed: 34229292
Tong, C., Miao, Q., Zheng, J. & Wu, J. A novel nomogram for predicting the decision to delayed extubation after thoracoscopic lung cancer surgery. Ann. Med. 55, 800–807. https://doi.org/10.1080/07853890.2022.2160490.PMID:36869647;PMCID:PMC9987746 (2023).
doi: 10.1080/07853890.2022.2160490.PMID:36869647;PMCID:PMC9987746
pubmed: 36869647
pmcid: 9987746
Shajar, M. A., Thompson, J. P., Hall, A. P., Leslie, N. A. & Fox, A. J. Effect of a remifentanil bolus dose on the cardiovascular response to emergence from anaesthesia and tracheal extubation. Br. J. Anaesth. 83, 654–656. https://doi.org/10.1093/bja/83.4.654 (1999) (PMID: 10673886).
doi: 10.1093/bja/83.4.654
pubmed: 10673886
Benyamin, R. et al. Opioid complications and side effects. Pain Phys. 11, S105-120 (2008).
doi: 10.36076/ppj.2008/11/S105
Eberl, S. et al. Sedation with propofol during ERCP: Is the combination with esketamine more effective and safer than with alfentanil? Study protocol for a randomized controlled trial. Trials. 18, 472. https://doi.org/10.1186/s13063-017-2197-8 (2017).
doi: 10.1186/s13063-017-2197-8
pubmed: 29020995
pmcid: 5637240
Untergehrer, G., Jordan, D., Eyl, S. & Schneider, G. Effects of propofol, sevoflurane, remifentanil, and (S)-ketamine in subanesthetic concentrations on visceral and somatosensory pain-evoked potentials. Anesthesiology. 118, 308–317. https://doi.org/10.1097/ALN.0b013e318279fb21 (2013).
doi: 10.1097/ALN.0b013e318279fb21
pubmed: 23254146
Apfel, C. C., Läärä, E., Koivuranta, M., Greim, C. A. & Roewer, N. A simplified risk score for predicting postoperative nausea and vomiting. Anesthesiology. 91, 693–700. https://doi.org/10.1097/00000542-199909000-00022 (1999).
doi: 10.1097/00000542-199909000-00022
pubmed: 10485781
Bahar, E. & Yoon, H. Lidocaine: A local anesthetic, its adverse effects and management. Medicina. 57, 782. https://doi.org/10.3390/medicina57080782 (2021).
doi: 10.3390/medicina57080782
pubmed: 34440986
pmcid: 8399637