Effects on intraoperative haemodynamics and post-operative pain following systemic lidocaine in laparoscopic cholecystectomy surgery

Abstract

Background: Aim of the study is to observe the effectiveness of systemic lidocaine on haemodynamics response during pneumoperitoneum period and to observe the role of systemic lidocaine as a part of multimodal analgesia in laparascopic cholecystectomy surgery.
Methods: Hundred adult patients of ASA grade I and II were enrolled in this prospective observational study. Included patients were randomly allocated to two groups, groups N (n=50) received narmal saline solution during the operation. and groups X (n=50) received intravenous lignocaine (1.5 mg/kg) before induction followed by continuous infusion of 2mg/kg/hr. Baseline hemodynamic parameters including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded immediately before anesthesia induction, before intubation, immediately after intubation. All patients received midazolam 0.03mg/kg, ranitidine 1 mg/kg, ondansetron 0.1 mg/kg followed by fentanyl 2μg/kg. Anaesthesia maintenance was achieved using propofol 4-6 mg/kg during pneumoperitoneum and post operatively they observed in the PACU for the magnitude of pain by verbal pain score and sedation by Ramsay Sedation Score for two hours. Patients received diclofenac 1.5 mg/kg, paracetamol 10-15 mg/kg (preemptively) and fentanyl 1μg/kg/h. Residual muscle relaxation was reversed with Neostigmine 0.05mg/kg and Glycopyrrolate 0.01mg/kg.
Results: The results showed that there was significant rise in heart rate HR, systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) in group N during pneumoperitoneum period. In comparision to that there was only slight increase in these parameters in group X during pneumoperitoneum. There was no evidence of bradycardia or hypotension in group X. Thus group X provides greater haemodynamic stability during pneumoperitoneum period. Conclusion: Using systemic lignocaine in laparoscopic cholecystectomy reduces requirement of anaesthetic agent i.e. decreased propofol requirement, decreased pain and sedation, reducing post-operative opioid requirement and facilitating early discharge from recovery.