Haemodynamic responses to intubation, extubation and post‐operative analgesia after intravenous lignocaine in laparoscopic cholecystectomy surgeries: a randomized control study

Authors

  • srikanth gujja Geetanjali Medical College & Hospital, Udaipur, Rajasthan
  • Varun Arora UNMICRC, Ahmedabad
  • Sravanthi Yelagandula Geetanjali Institute of Pharmacy
  • Chanchal Bhandari UNMICRC, Ahmedabad
  • Mittapalli Jeevanbabu UNMICRC, Ahmedabad

DOI:

https://doi.org/10.22159/ajpcr.2024.v17i4.50550

Keywords:

lignocaine, infusion, intubation, extubation, hemodynamic changes

Abstract

Objectives: To evaluate the effect of intravenous lignocaine on haemodynamic responses to intubation, extubation and post‐operative analgesia in laparoscopic cholecystectomy surgeries.

Methods: This prospective, randomized, double blinded study was conducted in patients for elective laparoscopic cholecystectomy surgery in tertiary care hospital of Tamil Nadu. Group A (n=60) received 0.9% normal saline for perioperative intravenous infusion and Group B (n=60) received preservative free lignocaine 2% (20mg/ml) as intravenous infusion Hemodynamic responses were recorded to intubation, extubation and post‐operative analgesia in both groups. VAS scores and pain free period were also compared.

Results: Pulse rate (PR) and mean arterial pressure (MAP) were significantly increased in both the groups during laryngoscopy and intubation, though the rise of both in lignocaine group was significantly less than normal saline group. (p<0.0001)  Similarly, both PR and MAP were significantly increased during extubation in both the groups. (p<0.0001) However, the rise of both the parameters in lignocaine group was significantly less as compared to normal saline group. (p<0.0001) VAS scores in immediate post operative period were better in lignocaine group than normal saline group. The mean pain free period was less than an hour in normal saline group, while it was approximately 4 hours in lignocaine group. (p<0.0001)

Conclusions: This study concluded that i.v infusion of lignocaine had significantly increased the pain free period post operatively. So those who are not affordable for epidural block, lignocaine i.v infusion is better alternative for post operative analgesia.

Downloads

Download data is not yet available.

Author Biographies

srikanth gujja, Geetanjali Medical College & Hospital, Udaipur, Rajasthan

Assistant professor, Department of Cardiac Anesthesia

Varun Arora, UNMICRC, Ahmedabad

Assistant Professor, Department of Cardiac Anesthesia

Sravanthi Yelagandula, Geetanjali Institute of Pharmacy

Assistant Professor

Chanchal Bhandari, UNMICRC, Ahmedabad

Resident, Department of Cardiac Anesthesia

Mittapalli Jeevanbabu, UNMICRC, Ahmedabad

Assistant professor, Department of Cardiac Anesthesia

References

Weibel S, Jokinen J, Pace NL, Schnabel A, Hollmann MW, Hahnenkamp K, et al. Efficacy and safety of intravenous lidocaine for postoperative analgesia and recovery after surgery: A systematic review with trial sequential analysis. Br J Anaesth. 2016;116(6):770-83. doi: 10.1093/bja/aew101, PMID 27199310.

Koppert W, Weigand M, Neumann F, Sittl R, Schuettler J, Schmelz M, et al. Perioperative intravenous lidocaine has preventive effects on postoperative pain and morphine consumption after major abdominal surgery. Anesth Analg. 2004;98(4):1050-5. doi: 10.1213/01. ANE.0000104582.71710.EE, PMID 15041597.

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(5):1464-9. doi: 10.1213/ ANE.0b013e3181bab1bd, PMID 19843784.

Altermatt FR, Bugedo DA, Delfino AE, Solari S, Guerra I, Muñoz HR, et al. Evaluation of the effect of intravenous lidocaine on propofol requirements during total intravenous anaesthesia as measured by bispectral index. Br J Anaesth. 2012;108(6):979-83. doi: 10.1093/bja/ aes097, PMID 22490315.

Attal N, Gaudé V, Brasseur L, Dupuy M, Guirimand F, Parker F, et al. Intravenous lidocaine in central pain A double-blind, placebo-controlled, psychophysical study. Neurology. 2000;54(3):564-74. doi: 10.1212/wnl.54.3.564, PMID 10680784.

Sugimoto M, Uchida I, Mashimo T. Local anaesthetics have different mechanisms and sites of action at the recombinant N‐methyl‐D‐aspartate (NMDA) receptors. Br J Pharmacol. 2003;138(5):876-82. doi: 10.1038/sj.bjp.0705107, PMID 12642389.

Aouad MT, Sayyid SS, Zalaket MI, Baraka AS. Intravenous lidocaine as adjuvant to sevoflurane anesthesia for endotracheal intubation in children. Anesth Analg. 2003;96(5):1325-7. doi: 10.1213/01. ANE.0000061586.63978.DE, PMID 12707127.

Lev R, Rosen P. Prophylactic lidocaine use preintubation: A review. J Emerg Med. 1994;12(4):499-506. doi: 10.1016/0736- 4679(94)90347-6, PMID 7963397.

Wang YM, Chung KC, Lu HF, Huang YW, Lin KC, Yang LC, et al. Lidocaine: The optimal timing of intravenous administration in attenuation of increase of intraocular pressure during tracheal intubation. Acta Anaesthesiol Sin. 2003;41(2):71-5. PMID 12934420.

Singh SP, Quadir A, Malhotra P. Comparison of esmolol and labetalol, in low doses, for attenuation of sympathomimetic response to laryngoscopy and intubation. Saudi J Anaesth. 2010;4(3):163-8. doi: 10.4103/1658-354X.71573, PMID 21189853.

Keniya VM, Ladi S, Naphade R. Dexmedetomidine attenuates sympathoadrenal response to tracheal intubation and reduces perioperative anaesthetic requirement. Indian J Anaesth. 2011;55(4):352-7. doi: 10.4103/0019-5049.84846, PMID 22013250. 12. Rimbäck G, Cassuto J, Tollesson PO. Treatment of postoperative paralytic ileus by intravenous lidocaine infusion. Anesth Analg. 1990;70(4):414-9. PMID 2316883.

Gordon D, Shroeder M. Intravenous lidocaine for postoperative analgesia: Renewed interest in an old strategy. Am Pain Soc Bull. 2008;18:3.

Cassuto J, Wallin G, Högström S, Faxén A, Rimbäck G. Inhibition of postoperative pain by continuous low-dose intravenous infusion of lidocaine. Anesth Analg. 1985;64(10):971-4. doi: 10.1213/00000539- 198510000-00005, PMID 3898920.

Gladston DV, Padmam S, Amma RO, Koshy RC, Krishna KM, Vijayan J, et al. A randomized controlled trial to study the effect of intratracheal and intravenous lignocaine on airway and hemodynamic response during emergence and extubation following general anesthesia. North Clin Istanb. 2022;9(4):323-30. doi: 10.14744/nci.2021.33407, PMID 36276564.

Wu CT, Borel CO, Lee MS, Yu JC, Liou HS, Yi HD, 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(2):448-53. doi: 10.1213/01.ANE.0000142551.92340.CC, PMID 15673874.

Wallace MS, Dyck BJ, Rossi SS, Yaksh TL. Computer-controlled lidocaine infusion for the evaluation of neuropathic pain after peripheral nerve injury. Pain. 1996;66(1):69-77. doi: 10.1016/0304- 3959(96)02980-6, PMID 8857633.

Alkaya MA, Saraçoğlu KT, Pehlivan G, Eti Z, Göğüş FY. Effects of esmolol on the prevention of haemodynamic responses to tracheal extubation after craniotomy operations. Turk J Anaesthesiol Reanim. 2014;42(2):86-90. doi: 10.5152/TJAR.2013.57, PMID 27366396.

Figueredo E, Garcia‐Fuentes EM. Assessment of the efficacy of esmolol on the haemodynamic changes induced by laryngoscopy and tracheal intubation: A meta-analysis. Acta Anaesthesiol Scand. 2001;45(8):1011-22. doi: 10.1034/j.1399-6576.2001.450815.x, PMID 11576054.

Bidwai AV, Bidwai VA, Rogers CR, Stanley TH. Blood-pressure and pulse-rate responses to endotracheal extubation with and without prior injection of lidocaine. The Journal of the American Society of Anesthesiologists. Anesthesiology. 1979;51(2):171-3. doi: 10.1097/00000542-197908000-00020, PMID 453622.

Nishina K, Mikawa K, Maekawa N, Obara H. Attenuation of cardiovascular responses to tracheal extubation with diltiazem. Anesth Analg. 1995;80(6):1217-22. doi: 10.1097/00000539-199506000- 00026, PMID 7762855.

Mikawa K, Nishina K, Takao Y, Shiga M, Maekawa N, Obara H. Attenuation of cardiovascular responses to tracheal extubation: Comparison of verapamil, lidocaine, and verapamil-lidocaine combination. Anesth Analg. 1997;85(5):1005-10. doi: 10.1097/00000539-199711000-00009, PMID 9356091.

Jain S, Khan RM. Effect of peri-operative intravenous infusion of lignocaine on haemodynamic responses to intubation, extubation and post-operative analgesia. Indian J Anaesth. 2015;59(6):342-7. doi: 10.4103/0019-5049.158733, PMID 26195829.

McCarthy GC, Megalla SA, Habib AS. Impact of intravenous lidocaine infusion on postoperative analgesia and recovery from surgery: A systematic review of randomized controlled trials. Drugs. 2010;70(9):1149-63. doi: 10.2165/10898560-000000000-00000, PMID 20518581.

De Jong RH, Nace RA. Nerve impulse conduction during intravenous lidocaine injection. Anesthesiology. 1968;29(1):22-8. doi: 10.1097/00000542-196801000-00008, PMID 5634564.

Cassuto J, Sinclair R, Bonderovic M. Anti‐inflammatory properties of local anesthetics and their present and potential clinical implications. Acta Anaesthesiol Scand. 2006;50(3):265-82. doi: 10.1111/j.1399- 6576.2006.00936.x, PMID 16480459.

Published

07-04-2024

How to Cite

gujja, srikanth, V. Arora, S. Yelagandula, C. . Bhandari, and M. Jeevanbabu. “Haemodynamic Responses to Intubation, Extubation and post‐operative Analgesia After Intravenous Lignocaine in Laparoscopic Cholecystectomy Surgeries: A Randomized Control Study”. Asian Journal of Pharmaceutical and Clinical Research, vol. 17, no. 4, Apr. 2024, pp. 32-36, doi:10.22159/ajpcr.2024.v17i4.50550.

Issue

Section

Original Article(s)