Koshyari Harish S, Asthana Veena, Agrawal Sanjay
Department of Anaesthesiology, Himalayan Institute of Medical Sciences, Swami Ram Himalayan University, Dehradun, Uttarakhand, India.
Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
J Anaesthesiol Clin Pharmacol. 2019 Oct-Dec;35(4):528-532. doi: 10.4103/joacp.JOACP_209_18.
Multimodal analgesia entrains the use of drugs in perioperative period producing adequate pain relief without affecting the quality of recovery by decreasing drug-related adverse effects. Systemic lignocaine has effective analgesic, anti-inflammatory, and anti-hyperalgesic properties and improves the quality of recovery after surgery.
Ninety women scheduled for elective transabdominal hysterectomy under general anesthesia were randomized to receive infusion of lignocaine (1.5 mg/kg over 15 min followed by a 2 mg/kg/h infusion until the end of surgery) (Group 1) or normal saline (10 mL over 15 min followed by infusion 1 mL/kg/h till end of surgery) (Group 2). Standard anesthesia techniques were used in both the groups. The patients received inj. tramadol for postoperative analgesia. Perioperative hemodynamics, extubation variables, postoperative analgesic requirement, and quality of recovery score were evaluated.
Hemodynamics were maintained in both the groups. Time for extubation was also similar. Demand for first postoperative analgesic was after 70.8 ± 70.4 min (Group 1) and 40.7 ± 30.0 min (Group 2) ( = 0.006). Total tramadol usage was 477.0 ± 133.2 mg (Group 1) and 560.0 ± 115.0 mg (Group 2) ( < 0.001). Return of bowel function was faster in Group 2 compared with Group 1 (37.1 ± 5 vs 41.8 ± 7.4 h, < 0.001). The median (interquartile range) recovery score (QoR-40) was 184 (178-191) in Group 1 and 178 (171-180) in Group 2 ( < 0.001).
Perioperative use of intravenous infusion of lignocaine is associated with decreased analgesic requirement postoperatively, and improved quality of recovery score signifying greater patient satisfaction.
多模式镇痛涉及围手术期药物的使用，通过减少药物相关不良反应，在不影响恢复质量的情况下实现充分的疼痛缓解。全身性利多卡因具有有效的镇痛、抗炎和抗痛觉过敏特性，并可改善术后恢复质量。
90例计划在全身麻醉下行择期经腹子宫切除术的女性被随机分为两组，一组接受利多卡因输注（15分钟内输注1.5mg/kg，随后以2mg/kg/h的速度输注直至手术结束）（第1组），另一组接受生理盐水输注（15分钟内输注10mL，随后以1mL/kg/h的速度输注直至手术结束）（第2组）。两组均采用标准麻醉技术。患者术后接受曲马多注射用于镇痛。评估围手术期血流动力学、拔管变量、术后镇痛需求及恢复质量评分。
两组血流动力学均维持稳定。拔管时间也相似。术后首次镇痛需求时间在第1组为70.8±70.4分钟，在第2组为40.7±30.0分钟（P = 0.006）。曲马多总用量在第1组为477.0±133.2mg，在第2组为560.0±115.0mg（P < 0.001）。与第1组相比，第2组肠功能恢复更快（37.1±5小时对41.8±7.4小时，P < 0.001）。第1组恢复评分（QoR - 40）中位数（四分位间距）为184（178 - 191），第2组为178（171 - 180）（P < 0.001）。
围手术期静脉输注利多卡因与术后镇痛需求减少及恢复质量评分改善相关，意味着患者满意度更高。
