Relative Contributions of Intraoperative Low Dose Ketamine, Lidocaine and Ketamine-Lidocaine Combination in Addition to Intrathecal Morphine for Postoperative Analgesia in Open Liver Resection: A Prospective, Randomized, Four-Arm, Triple Blind, Placebo-Controlled Trial

• 作者: Achal K. Dhir Debashis Roy Janice Yu Shalini Dhir Tim Hall Yves Bureau
• 来源期刊: 麻醉学期刊(英文)
• 学科: 医学
• 关键词: LIDOCAINE KETAMINE INTRATHECAL Morphine ANALGESIA Liver Resection
• 年，卷（期）: 2020,（9）
• 页码范围: 313-326
• 页数: 14页
• 分类号: R73

摘要

<b><span style="font-family:Verdana;">Background and Aims:</span></b><span style="font-family:Verdana;"> Open liver resection requiring an upper abdominal incision is associated with significant opioid use due to postoperative pain. We tested the hypothesis that the intraoperative combination of low dose lidocaine and ketamine would reduce opioid consumption when given in conjunction with intrathecal morphine for liver resection surgery. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> In this triple blind, parallel group four-arm placebo-controlled trial, we randomized 124 adult</span><span style="font-family:Verdana;color:#FF0000;"> </span><span style="font-family:Verdana;">ASA 2</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">4 liver resection patients to receive intraoperative lidocaine 0.33 mg/kg/h (group L), ketamine 70 μg/kg/h (group K), combination of lidocaine 0.33 mg/kg/h and ketamine 70 μg/kg/h (group KL) and saline (group P). All patients received 300 μg intrathecal morphine prior to induction of anesthesia. All infusions were started immediately after intubation and continued until the end of surgery. Primary outcome measurements included opioid consumption at 24-hours. Secondary outcomes included pain scores, opioid consumption at 48 and 72-hours and side effects including nausea, vomiting, dizziness, hallucinations, headaches and signs of local anaesthetic toxicity. Patients were followed up for 12 weeks. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> There was no difference in the primary outcome of opioid consumption within all 4 groups at rest or movement at 24-hours. Secondary outcome of 48-hour rest pain score was significantly higher in the L group (p = 0.03) but without any difference in opioid use.</span><b><span style="font-family:Verdana;"> </span></b><span