الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
The effective relief of pain is a paramount importance for patients undergoing surgery. This should be achieved for humanitarian reasons, but there is now evidence that pain relief has significant physiological effects. Not only does effective pain relief means a smoother post-operative course with earlier discharge from hospital, but it may also reduce the onset of chronic pain syndromes.
Opioid analgesics continue to play an important role in the acute treatment of moderate-to-severe pain in the early post-operative period. However, nonopioid analgesics are increasingly being used as adjuvant before, during, and after surgery to facilitate the recovery process after ambulatory surgery because of their ability to reduce post-operative pain (with movement) and absence of opioid-related side effects thereby shortening the duration of the hospital stay and the convalescence period.
The administration of IV lidocaine infusions for the same purpose recently received renewed attention as an analgesic intervention.
The aim of study was to evaluate the analgesic efficacy of intra-operative lidocaine infusion in patients undergoing laparoscopic cholecystectomy.
The present study was carried out after approval from ethics committee of El Menoufia University Hospitals and informed written consent the present study was conducted on sixty patients of both sexes. Patients’ age was between 40 and 50 years, American society of anesthesiologists (ASA) I and II physical status, and scheduled for laparoscopic cholecystectomy.
Patients in the study were classified in a randomized, double- blind trial study. Patients were randomly assigned using computerized software into two groups, thirty patients in each group to receive either intra-operative lidocaine infusion (L group) or Placebo saline group (S group).
Lidocaine and placebo infusions labeled the same and can only be identified by independent anaesthetic trainee who prepared the infusion. At the end of the study, the independent trainee identified the patients in the two groups:
• group L (study group) infused with 2mg/kg/h lidocaine.
• group S (control group) infused with normal saline with the same infusion rate.
Pre-operative evaluation & preparation:
Evaluations of the patients were carried out through proper history taking, clinical examination and routine laboratory investigations.
Intra-operative technique:
• On arrival to the operating room each patient was attached to a multi-channel monitor (Dräger Infinity Kappa XLT) to display MAP, ECG and SaO2. • 20G cannula was inserted and anaesthesia was induced by intravenous fentanyl 2 μcg/kg, propofol 2-3 mg/kg. The direct laryngoscopy and intubation was facilitated with atracurium 0.5 mg/kg. • Maintenance of anaesthesia was carried out using Isoflurane 1.2 % and increments of atracurium when needed.
• Patients received lidocaine infusion through infusion sets.
• Patients received supplemental IV dose of morphine 0.1mg/kg intra-operative if needed. • At the end of surgery, all patients received local anaesthetics in the skin incision, anaesthesia was terminated and atracurium was reversed by neostigmine 0.04 – 0.07 mg/kg and atropine 0.02 mg/kg and patients were extubated after full return of consciousness, reflexes and muscle power.
Post-operative management: • Patients were transferred to post-anaesthesia care unit (PACU) for post-operative close observation and monitoring.
• Post-operative analgesia protocol was guided by the visual analogue score as follow:
- 2-3 mg morphine was given intravenously if VAS ≥ 4.
- 30 mg ketorolac IV every 8 hours if needed (PRN).
- Paracetamol 1grm every 6 hours if needed (PRN).
• All patients received ondansteron 4 mg IV every 8 hours if needed.
Measurements, data collection and timing:
- Patients’ Demographic data: age, sex, body weight in kg, body mass index, operative time, and PACU stay.
- Haemodynamics: intra-operative heart rate and mean arterial blood pressure (MAP) were recorded every 15 min.
- Haemodynamics were recorded every 15 min during PACU stay.
Pain assessment:
By visual analogue scale (VAS).
The following results were obtained:
• Heart rate and mean arterial blood pressure showed significant difference between both groups. Heart rate and MABP were significantly attenuated in lidocaine group as compared to control group.
• Visual analogue scale (VAS) was significantly lower in lidocaine group at 4, 8, 12, 24 hours post-operatively.
• Total rescue analgesic dose required (morphine) was significantly lower in lidocaine group.
• The observed side effects (nausea and vomiting) were significantly lower in lidocaine group than control group.