The Postoperative Lidocaine and Ketamine Effects on Morphine Requirement in Bariatric Surgery

doi:10.21203/rs.3.rs-4706757/v1

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The Postoperative Lidocaine and Ketamine Effects on Morphine Requirement in Bariatric Surgery

https://doi.org/10.21203/rs.3.rs-4706757/v1

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Background

Effective postoperative pain management in obese patients undergoing bariatric surgery is challenging due to the adverse effects associated with opioid use. Multimodal analgesic approaches during the intraoperative period have shown to effectively reduce postoperative opioid consumption This study evaluates the impact of prolonged postoperative lidocaine and ketamine infusion for 90 minutes on postoperative morphine consumption as a complementary multimodal analgesic approach.

Methods

This retrospective cohort study included 64 patients who underwent elective sleeve gastrectomy and gastric bypass. Thirty-two patients who received lidocaine and ketamine infusions postoperatively (Group A) were compared with 32 patients who received standard postoperative analgesia (Group B). The primary outcome measured was total morphine consumption within the first 48 hours post-surgery. Pain was assessed using the Visual Analog Scale (VAS) at 1, 2, 4, 24, and 48 hours post-surgery.

Results

Mean cumulative morphine consumption at 48 hours was 0.82 ± 1.55 mg in Group A versus 2.03 ± 2.61 mg in Group B (p = 0.0696). : In total, 62.5% of patients did not require morphine during the first 48 postoperative hours. VAS scores were significantly lower in Group A at the four postoperative hour (1.03 ± 1.36) vs Group B (2.16 ± 1.65), p-value 0.0024.

Conclusion

Postoperative morphine consumption and pain scores were low with the current multimodal analgesic approach. Prolonging lidocaine and ketamine infusion for 90 minutes postoperatively is not justified based on current results.

opiod-free anaesthesia

bariatric surgery

multimodal anaesthesia

postoperative pain

Postoperative pain management in obese patients scheduled for bariatric surgery remains challenging, particularly because of the adverse effects associated with opioid use, including postoperative nausea and vomiting (PONV), respiratory depression, and the potential for dependency. Recent advancements in anesthetic techniques have focused on reducing opioid consumption through multimodal analgesia by incorporating adjuvants, such as lidocaine, ketamine, and dexmedetomidine. These agents have been explored for their potential to provide effective analgesia while minimizing opioid-related side effects.

The efficacy of lidocaine in the context of bariatric surgery has been explored with varying outcomes. A randomized controlled trial (RCT) by Plass et al. (2020)[1] reported that IV lidocaine was associated with reduced opioid consumption and improved quality of recovery. The study showed that the lidocaine-induced decrease in postoperative oxycodone consumption was significant but clinically non-relevant, with a median decrease of 1.7 mg in intravenous oxycodone equivalents (approximately 3–4 mg of morphine). In contrast, Sakata et al. (2019) [2] demonstrated a significant reduction in 24-hour morphine consumption, with patients receiving IV lidocaine averaging 10–16 mg of morphine. Despite these promising results, there was no significant difference in the time to meet the discharge criteria or in the occurrence of side effects, such as nausea and vomiting.

Ketamine's analgesic properties, particularly at sub-anesthetic doses, have been investigated in various studies [3–4]. Its incorporation into opioid-free anaesthesia (OFA) protocols has shown significant benefits. Seman et al. (2021) [5] reported that total perioperative opioid consumption was significantly lower in the ketamine group compared to the control group (179.9 morphine equivalents (ME) versus 248.7 ME, P = 0.03). Postoperative patient-controlled analgesia (PCA) opioid administration was also significantly lower in the ketamine group (90.6 ME versus 137.6 ME, p = 0.04).

Systematic reviews and network meta-analyses comparing OFA and opioid-sparing anaesthesia (OSA) protocols have shown that OFA is more effective in reducing PONV than either OSA or traditional opioid-based anaesthesia (OBA) [6–7]. However, there were no significant differences in postoperative pain control or opioid consumption between the OFA and OSA groups. Some of these studies reported that lidocaine and ketamine infusions were continued until the end of the recovery period. In the protocol by Clanet et al [8], one syringe of lidocaine 2% (49 ml = 980 mg) and ketamine 50 mg (1 ml) was infused intraoperatively at 2 ml.kg.hour^− 1 and continued at a reduced rate of 1 ml.kg.hour^− 1 until the end of the PACU stay. They found no significant difference in postoperative morphine consumption between the groups (median [interquartile range]: 16 [13–26] mg vs. 15 [10–24] mg, P = 0.183). The SOFA trial [9], a monocentre, randomised, controlled, investigator- and patient-blinded clinical trial, compared opioid-free anaesthesia with standard anaesthesia and continued lidocaine in the PACU for up to 1 hour after surgery. The opioid-free protocol improved the quality of recovery after major elective surgery in a statistically, but not clinically significant way compared to standard anaesthesia. To the best of our knowledge, no previous studies have formally compared the opioid-sparing effects of prolonging lidocaine and ketamine infusions during the postoperative period.

This retrospective study aims to assess the justification for prolonging lidocaine and ketamine administration for the first 90 minutes following bariatric surgery based on their impact on morphine consumption. We hypothesize that extending ketamine and lidocaine administration during the initial postoperative period does not have an additional effect on morphine consumption within 48 hours post-surgery.

Ethics approval

for this retrospective cohort study was provided by the Ethics and Drug Research Committee (Comité Ético de Investigación con Medicamentos, CEIm), Madrid, Spain (CEIm 23.04.2191-GHM), and the requirement for informed consent was waived. We included all patients who underwent elective sleeve gastrectomy and gastric bypass at HM Nou Delfos in Barcelona, Spain. Data were collected from the medical records from June 2023 to January 2024. All the operative procedures included in the study were performed by the same surgeon. Patients converted to open procedures, undergoing gastric band placement or removal, duodenal switch, or those with surgical complications requiring reoperation were excluded. All patients were managed according to the guidelines of our departmental ERAS pathway for bariatric surgery.

Anaesthesia technique:

Standard ASA monitors were used in the operating room, including the qCON index (Conox Technology, Quantium Medical, Barcelona, Spain) and train-of-four (TOF Watch SX accelerometer, Organon Ltd., Dublin, Ireland). Premedication included midazolam (0.02–0.03 mg.kg^− 1), magnesium sulfate (40 mg.kg^− 1), antibiotic prophylaxis (cefazolin 2 g, metronidazole 1 g), dexamethasone (8 mg IV), ondansetron (8 mg IV), and dexketoprofen (50 mg IV). After 5 min of pre-oxygenation in the beach chair position, all patients were induced with target-controlled infusion of propofol (TCI, Schnider model Cte 3–5 µg.ml^− 1), dexmedetomidine (1 µg.kg.hour^− 1), fentanyl (3 µg.kg^− 1 IV), ketamine (0.3 mg.kg^− 1 IV), lidocaine (1.5 mg.kg^− 1 IV), and rocuronium (1 mg.kg^− 1 IV) to facilitate tracheal intubation. General anaesthesia was maintained with TCI of propofol to maintain a Conox® value between 40–60, ketamine (0.3 mg.kg.hour^− 1), lidocaine (2 mg.kg.hour^− 1), and dexmedetomidine (0.5 µg.kg.hour^− 1). Neuromuscular blocking was maintained using rocuronium to maintain a post-tetanic count of 1/10. The patients were extubated in the operating room after reversal with sugammadex (2–4 mg.kg^− 1). All drug doses were calculated according to patients’ adjusted body weight (ABW). Anaesthetic management was consistent across all patients and administered by the same anesthesiologist.

In the Postoperative Care Unit (PACU), all patients received standard analgesics, which included intravenous paracetamol (1000 mg), dexketoprofen (50 mg), metamizole (2000 mg), and ondansetron (4 mg) every eight hours. In addition to the standard analgesics, some patients received infusions of lidocaine (1 mg.kg.hour-1) and ketamine (0.15 mg.kg.hour-1) for a period of 90 minutes. Rescue doses of morphine were administered as required, based on the visual analogue scale (VAS) pain assessment, in all patients. A pain monitoring regimen was implemented, with assessments conducted at hourly intervals during the initial four postoperative hours in the recovery room. Subsequent assessments were conducted at four- to six-hour intervals in the surgical ward.

Data collection on postoperative pain

Pain levels were assessed using the Visual Analog Scale (VAS) at predetermined intervals throughout the first 48 postoperative hours: at 1, 2, 4, 24, and 48 hours after surgery. Data on postoperative pain were systematically collected by a member of the anaesthesia staff during the initial four hours of the patient's stay in the PACU, and subsequently by an anaesthesia technician.

Outcomes

The primary outcome was the total morphine consumption within the first 48 hours post-surgery. It was the sum of morphine titrated by the PACU nurses at 1, 2, 4 h, and the morphine administered by nurse until 48 h after surgery.

The secondary outcome was the evaluation of pain relief, which was assessed using the Visual Analog Scale (VAS) at predetermined intervals: 1, 2-, 4-, 24-, and 48-hours post-surgery.

Statistical analysis

The sample size was calculated using the pwr.t.test function in R to detect significant differences in morphine requirements. Based on an assumed effect size (Cohen's d) of 0.8, two-sided alpha level of 5%, and target power of 80%, it was determined that 32 patients per group would be necessary.

The Shapiro–Wilk test was used to evaluate the data's normality. Continuous variables were compared with an unpaired t-test or the Mann-Whitney U test according to their distribution. Differences in morphine requirements and postoperative pain, as measured by the EVA score, were examined using Welch's ANOVA when the assumption of equal variance was violated, as indicated by Levene’s test. Post hoc tests were employed, such as Tukey or Dunnett’s test for normally distributed data and Dunn's test for not normally distributed data.

All analyses were conducted at a 5% significance level, with the results presented alongside their respective p-values and, where appropriate, 95% confidence intervals. Data visualization in R included boxplots and scatter plots. Statistical analysis was performed using SPSS and R.

The study included 64 morbidly obese patients who underwent bariatric surgery (sleeve gastrectomy and Roux-en-Y gastric bypass), divided into two groups: Thirty-two patients who continued to receive lidocaine and ketamine plus standard analgesia in the recovery room for 90 minutes were identified as group A, and thirty-two patients who received standard analgesia alone were identified as group B. Demographic characteristics and surgical details are summarized in Table 1.

Table 1. Demographics characteristic,type and duration of laparoscopic surgical by group. Values are mean (standard deviation)
Variable	Group A (n = 32) Mean^† ± SD^‡	Group B (n = 32) Mean^†± SD^‡	p-value*
Gender female/male	17/15	23/9	0.031
Age [year]	42.13 ± 11.49	42.28 ± 10.72	0.478
Weight [kg]	119.89 ± 17.97	111.44 ± 18.05	0.033
Height [cm]	168.06 ± 9.04	167.00 ± 7.38	0.304
BMI [kg.m²]	42.25 ± 3.78	39.82 ± 4.53	0.012
ABW [kg]	85.34 ± 10.78	81.46 ± 9.87	0.069
Type of laparoscopic Surgery [n / duration(min)]
Gastric Bypass	12 / 123 ± 44.3	12 / 128 ± 19.8	0.725
Sleeve Gastrectomy	20 / 80,6 ± 25,8	20 / 87,1 ± 32,2	0.485
Combined Surgical Time [n / duration(min)]
Bypass vs Sleeve	24 / 125.08 ± 33.67	40 / 83.83 / ± 28.99	<0.0001

*p-value were calculated using ANOVA

Mean: The average value of a data set

‡ SD: Standard Deviation, a measure of the amount of variation in a data set

§ BMI = body mass index

¶ AWB = adjusted body weight

** min = minutes.

Primary Outcome

We observed that 40 patients of the total analyzed (62.5%) did not require morphine. Of the remaining 24 (37.5%) patients who required morphine, they mostly required it during the first 4 postoperative hours and no patient required morphine after 24 hours. The maximum morphine consumption was 10 mg in a patient of group B after a sleeve gastrectomy.

Postoperative opioid consumption was low in both groups. The mean cumulative morphine consumption at 48 hours was 0.82 ± 1.55 mg in group A and 2.03 ± 2.61 mg in group B [p = 0.0696]. Details of total morphine consumption are shown in Tables 2, 3 and 4.

Table 2

Morphine analysis: Mean (mg), Standard Deviation and p-values for Groups A and B at Different Postoperative Time Points.
Time Point	Group A		Group B
Time Point	Mean‡ (mg)	SD†	Mean‡(mg)	SD†	p-value*
1 Hour PO	0.19	0.59	0.38	0.94	0.434
2 hours PO	0.38	0.94	0.94	1.24	0.031
4 hour PO	0.31	0.74	0.78	1.09	0.052
24 hour PO	0.0	0.0	0.0	0.0	1.0
48 hour PO	0.0	0.0	0.0	0.0	1.0
‡ Mean: The average value of a data set
† Std Dev: Standard Deviation, a measure of the amount of variation in a data set
* p-value were calculated using the Mann-Whitney U test

Table 3

Average total postoperative morphine consumption at 48 hours by group and surgery. Values are mean (standard deviation).
Surgery	Group	N	Mean‡(mg)	SD† (mg)	Min (mg)	Max (mg)	p value*
Bypas Gastric	A	12	0.5	1.24	0	4	0.5
	B	12	0.5	1.24	0	4
Sleeve Gastrectomy	A	20	1.1	1.77	0	6	0.007
	B	20	3.05	2.86	0	10
‡ Mean: The average value of a data set
† SD: Standard Deviation, a measure of the amount of variation in a data set
* p-value were calculated using the Mann-Whitney U test

Table 4

Post-hoc Dunn's Test Comparisons with Bonferroni Adjustment for Morphine Total Post-Operative by Group and Surgery InteractionComparison of median (SD) values between different surgical groups.
Comparison	z_value	p_value*	p_adjusted^†
A.Bypass Gastric - A.Sleeve Gastrectomy	-0,913811749	0,180407886	1
A.Bypass Gastric - B.Bypass Gastric	0	0,5	1
A.Sleeve Gastrectomy - B.Bypass Gastric	0,913811749	0,180407886	1
A.Bypass Gastric - B.Sleeve Gastrectomy	-3,001715991	0,001342313	0,008053875
A.Sleeve Gastric - B.Sleeve Gastrectomy	-2,410904153	0,007956515	0,047739089
B.Bypass Gastric - B.Sleeve Gastrectomy	-3,001715991	0,001342313	0,008053875
* p-value from Dunn's test.
† p-adjusted using the Bonferroni method.

Secundary Outcome

All patients had VAS scores below 4 at 1, 2, 4, 24 and 48 hours, as shown in Figs. 1. The difference between groups was statistically significant in the first 4 hours after surgery. Details in Table 5.

Table 5

Median and Standard Deviation of VAS score at at Different Postoperative Time Points.
Time Point	Group A Mean (SD)	Group A IQR	Group B Mean (SD)	Group B IQR	p-value*
VAS 1hr PO	0.36 (1.14)	0.0	0.95 (1.54)	1.50	0.0138
VAS 2hr PO	0.92 (1.44)	1.5	2.14 (1.86)	4.50	0.0042
VAS 4hr PO	1.03 (1.36)	1.5	2.16 (1.65)	2.63	0.0024
VAS 24hr PO	0.86 (0.74)	1.5	1.08 (0.57)	0.50	0.5387
VAS 48hr PO	0.59 (0.71)	1.5	0.89 (0.67)	1.50	0.1191
Notes:
* p-values were calculated using the Mann-Whitney U test
- VAS: Visual Analog Scale
- SD: Standard Deviation
- IQR: Interquartile Range

This retrospective observational study in morbidly obese patients undergoing bariatric surgery (sleeve gastrectomy and Roux-en-Y gastric bypass) under intravenous anaesthesia using a multimodal analgesic approach was conducted to test the hypothesis that prolonged ketamine and lidocaine perfusion during the first 90 minutes in the recovery room would have no additional effect on morphine consumption during the first 48 hours after surgery. Our analysis revealed very low postoperative morphine consumption in both groups with the current multimodal analgesic approach. Therefore extending ketamine and lidocaine infusions during the postoperative period is not justified .

Ahmed et al. [10] conducted a study to assess the impact of opioid-free anaesthesia on postoperative opioid consumption in laparoscopic bariatric surgery. Their findings indicated that the OFA technique led to a notable reduction in postoperative morphine consumption at 24 hours (5.8 ± 1.9 mg) compared to the control group (7.2 ± 2.3 mg). Feld et al. [11] compared fentanyl analgesia with non-opioid analgesia in gastric bypass surgery and reported that total morphine consumption 16 hours after surgery was 41.3 ± 18.0 mg and 45.1 ± 25.3 mg in the non-opioid and fentanyl groups, respectively (P > 0.05). A number of different OFA protocols have been published [12–13], which have been modified and adapted as necessary. However, there is still no consensus on this matter. Most of these protocols have one thing in common: they combine an inhaled anaesthetic with dexmedetomidine, lidocaine, ketamine, and magnesium sulfate, without including an opioid. In contrast to the methodology employed in this report, all patients received a total intravenous anaesthesia technique with propofol as the hypnotic agent plus dexmedetomidine, lidocaine, and ketamine, with a single dose of fentanyl was for induction. It is therefore possible that the synergic effect of fentanyl with the other analgesic employed can partially explain the low opioid consumption observed in both groups. In addition, it is also possible that propofol administration during anesthesia maintenance has also contributed to the relatively lower postoperative opioid consumption. (peng et al A&A 2016 vol 123 systematic review) We believe that the low doses of morphine are explained by a synergistic effect between the multiple analgesics administered.

Extending non-opioid medications in the immediate postoperative period is highly variable in current OFA protocols. Ulbing et al. (2023) [14] continued syringe perfusion with the mixture (dexmedetomidine, lidocaine and ketamine) at 5 ml.hour^− 1 as the first line of analgesia in the recovery room. Mauermann et al (2017) [12] continued lidocaine (1.5 mg.kg.hour^− 1) and dexmedetomidine (0.7 µg.kg.hour^− 1) perfusions in the recovery room as needed. The SOFA trial [9, 15] protocol only prolonged the lidocaine perfusion to 1.5 mg.kg.hour^− 1. Clanet et al. [8] continued the syringe with the lidocaine and ketamine mixture at 1 ml.hour^− 1. In our study, the mixture of lidocaine (1 mg.kg.hour^− 1) and ketamine (0.15 mg.kg.hour^− 1) was continued for 90 minutes as part of the analgesic protocol. The potential benefits of prolonging the postoperative administration of drugs such as lidocaine, ketamine, and dexmedetomidine in obese patients undergoing bariatric surgery remain inconclusive. The current analysis demonstrated that the sub-group of sleeve gastrectomy patients who did not receive lidocaine and ketamine in the recovery room consumed the highest cumulative morphine at 48 hours (3.05 ± 2.86, p-value = 0.007). The most painful period was observed at 4 hours (VAS score 2.0, IQR: 2.0), and after 24 hours, no further morphine was required. This finding aligns with the observations reported by Mulier (2018) [16] and Mieszczańsk (2023) [17], who found that the difference in opioid consumption was not significant anymore on the second day after surgery. Our hypothesis is that the discrepancies observed in the first four postoperative hours are due to the limited duration of action of intraoperative coadjuvants. Sleeve surgery is a relatively shorter procedure compared to bypass surgery, which may limit the time for non-opioid agents to effectively interact with pain receptors (alpha-2 adrenergic receptor agonists, NMDA antagonists, sodium and calcium channels) [18].

Our study found relatively low doses of morphine consumption. However, it is more accurate to attribute this to the synergistic interaction of multiple drugs rather than solely to dexmedetomidine. Dexmedetomidine has been demonstrated to reduce anesthetic and opioid requirements both intraoperatively and postoperatively. A number of meta-analyses have demonstrated the efficacy of dexmedetomidine as a postoperative pain control agent [21–24]. Furthermore, this alpha-2 agonist can enhance the effect of morphine and help prevent tolerance [25]. However, its analgesic effect is less pronounced than that of ketamine and NSAIDs [22]. In aditio, the combination of ketamine and magnesium sulphate produces a super-additive effect, resulting in more effective analgesia than either compound alone [26]. Therefore, we conclude that the observed low doses of morphine are a result of the combined effect of the non-opioid drugs used and the fentanyl administered during induction.

This study has numerous limitations. Firstly, this was a retrospective study that analyzed data from a single center. The sample size was small (n = 64), which may have limited our ability to detect differences in clinical outcomes. Second, morphine wasn't given through a PCA pump, which is a better technique to adequately administer opioids according to patients need. However, it is clear from our results that pain scores remained low during the observation period which support the low dose requirements observed.

In conclusion, extending lidocaine and ketamine perfusions in theearly recovery period did not affect pain scores and morphine requirements in patients receiving the current multimodal analgesic regime. The benefits of off-label use of lidocaine and ketamine might be justified in the subgroup of patients scheduled for sleeve gastrectomy. However, further research is needed to support that hypothesis .

The authors declare that it was carried out in accordance with the rules established by the Ethics Committee of HM Hospitales, registered with code 23.04.2019-GHM, and that it is in accordance with the ethical principles of the Declaration of Helsinki. The authors declare that they have no competing interests. We have received no funding.

Author Contribution

G.C.P contributions to the conception and design of the work and data acquisition, approved the version to be published, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.C.F.A and L.I.C made substantial contributions: wrote the main manuscrito, statistical analysis, interpretation of data, drafted the work and revised it critically for important intellectual content, approved the version to be published, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.J.G.C statistical analysis.A.C approved the version to be published.

Plass F, Nicolle C, Zamparini M, Al Issa G, Fiant AL, Le Roux Y, Gérard JL, Fischer MO, Alvès A, Hanouz JL. Effect of intra-operative intravenous lidocaine on opioid consumption after bariatric surgery: a prospective, randomised, blinded, placebo-controlled study. Anaesthesia. 2021;76(2):189–198.
Sakata RK, de Lima RC, Valadão JA, Leal PC, Moura EC, Cruz VP, de Oliveira CM. Randomized, Double-Blind Study of the Effect of Intraoperative Intravenous Lidocaine on the Opioid Consumption and Criteria for Hospital Discharge After Bariatric Surgery. Obes Surg. 2020;30(4):1189–1193.
Jacob Gitlin, Shubham Chamadia, Joseph J. Locascio, Breanna R. Ethridge, Juan C. Pedemonte, Eunice Y. Hahm, Reine Ibala, Jennifer Mekonnen, Katia M. Colon, Jason Qu, Oluwaseun Akeju; Dissociative and Analgesic Properties of Ketamine Are Independent. Anesthesiology 2020; 133:1021–1028 doi: https://doi.org/10.1097/ALN.0000000000003529.
Bell, Rae Francesa,*; Kalso, Eija Annelib. Ketamine for pain management. PAIN Reports 3(5):p e674, September/October 2018. | DOI: 10.1097/PR9.0000000000000674.
Seman MT, Malan SH, Buras MR, Butterfield RJ, Harold KL, Madura JA, Rosenfeld DM, Gorlin AW. Low-Dose Ketamine Infusion for Perioperative Pain Management in Patients Undergoing Laparoscopic Gastric Bypass: A Prospective Randomized Controlled Trial. Anesthesiol Res Pract. 2021; 2021:5520517.
Ao, Yichan MD^*; Ma, Jingyue MD^*; Zheng, Xiaozhuo MD^†; Zeng, Jie MD^‡; Wei, Ke MD^*. Opioid-Sparing Anaesthesia Versus Opioid-Free Anaesthesia for the Prevention of Postoperative Nausea and Vomiting after Laparoscopic Bariatric Surgery: A Systematic Review and Network Meta-Analysis. Anaesthesia & Analgesia ():10.1213/ANE.0000000000006942, April 05, 2024. | DOI: 10.1213/ANE.0000000000006942.
Frauenknecht J, Kirkham KR, Jacot-Guillarmod A, Albrecht E. Analgesic impact of intra-operative opioids vs. opioid-free anaesthesia: a systematic review and meta-analysis. Anaesthesia. 2019;74(5):651–662. doi: 10.1111/anae.14582. Epub 2019 Feb 25. PMID: 30802933.
Clanet M, Touihri K, El Haddad C, Goldsztejn N, Himpens J, Fils JF, Gricourt Y, Van der Linden P, Coeckelenbergh S, Joosten A, Dandrifosse AC. Effect of opioid-free versus opioid-based strategies during multimodal anaesthesia on postoperative morphine consumption after bariatric surgery: a randomised double-blind clinical trial. BJA Open. 2024;9:100263. doi: 10.1016/j.bjao.2024.100263. PMID: 38435809; PMCID: PMC10906147.
Léger M, Pessiot-Royer S, Perrault T, Parot-Schinkel E, Costerousse F, Rineau E, Lasocki S. The effect of opioid-free anaesthesia protocol on the early quality of recovery after major surgery (SOFA trial): study protocol for a prospective, monocentric, randomized, single-blinded trial. Trials. 2021;22(1):855. doi: 10.1186/s13063-021-05829-x. PMID: 34838109; PMCID: PMC8627013.
Ahmed SA, Abdelghany MS, Afandy ME. The effect of opioid-free anaesthesia on the post-operative opioid consumption in laparoscopic bariatric surgeries: A randomized controlled double-blind study. J Opioid Manag. 2022 Jan-Feb;18(1):47–56.
Feld JM, Laurito CE, Beckerman M, Vincent J, Hoffman WE. Non-opioid analgesia improves pain relief and decreases sedation after gastric bypass surgery. Can J Anesth. 2003;50:336–41.
Mauermann E, Ruppen W, Bandschapp O. Different protocols used today to achieve total opioid-free general anaesthesia without locoregional blocks. Best Pract Res Clin Anaesthesiol. 2017; 31(4):533–545.
Hung KC, Chiu CC, Hsu CW, et al. Impact of opioid-free anaesthesia on analgesia and recovery following bariatric surgery: a meta-analysis of randomized controlled studies. Obes Surg 2022; 32: 3113e24.
Ulbing S, Infanger L, Fleischmann E, Prager G, Hamp T. The Performance of Opioid-Free Anaesthesia for Bariatric Surgery in Clinical Practice. Obes Surg. 2023;33(6):1687–1693.
Maxime Léger, Tristan Perrault, Solène Pessiot-Royer, Elsa Parot-Schinkel, Fabienne Costerousse, Emmanuel Rineau, Sigismond Lasocki; Opioid-free Anaesthesia Protocol on the Early Quality of Recovery after Major Surgery (SOFA Trial): A Randomized Clinical Trial. Anesthesiology 2024; 140:679–689.
Mulier, J.P.,Wouters,R.,Dillemans,B.&DeKock,M.Arandomizedcontrolled,double-blindtrialevaluatingtheeffectofopioid- free versus opioid general anaesthesia on postoperative pain and discomfort measured by the QoR-40. J. Clin. Anesth. Pain Med. 2, 1:015 (2018).
Mieszczański P, Górniewski G, Ziemiański P, Cylke R, Lisik W, Trzebicki J. Comparison between multimodal and intraoperative opioid free anaesthesia for laparoscopic sleeve gastrectomy: a prospective, randomized study. Sci Rep. 2023;13(1):12677.
Goff J, Hina M, Malik N, McLardy H, Reilly F, Robertson M, Ruddy L, Willox F, Forget P. Can Opioid-Free Anaesthesia Be Personalised? A Narrative Review. J Pers Med. 2023;13(3):500.
Tufanogullari, Burcu MD; White, Paul F. PhD, MD; Peixoto, Mariana P. MD; Kianpour, Daniel MS; Lacour, Thomas MD; Griffin, James MD; Skrivanek, Gary MD; Macaluso, Amy MD; Shah, Mary MD; Provost, David A. MD. Dexmedetomidine Infusion During Laparoscopic Bariatric Surgery: The Effect on Recovery Outcome Variables. Anesthesia & Analgesia 106(6):p 1741–1748, June 2008. | DOI: 10.1213/ane.0b013e318172c47c.
Kaye AD, Chernobylsky DJ, Thakur P, Siddaiah H, Kaye RJ, Eng LK, Harbell MW, Lajaunie J, Cornett EM. Dexmedetomidine in Enhanced Recovery After Surgery (ERAS) Protocols for Postoperative Pain. Curr Pain Headache Rep. 2020;24(5):21. doi: 10.1007/s11916-020-00853-z. PMID: 32240402; PMCID: PMC7223065.
Bellon M, Le Bot A, Michelet D, Hilly J, Maesani M, Brasher C, et al. Efficacy of intraoperative dexmedetomidine compared with placebo for postoperative pain management: a meta-analysis of published studies. Pain Ther. 2016;5:63–80. doi: 10.1007/s40122-016-0045-2.
Blaudszun G, Lysakowski C, Elia N, Tramèr MR. Effect of perioperative systemic α2 agonists on postoperative morphine consumption and pain intensity: systematic review and meta-analysis of randomized controlled trials. Anesthesiology. 2012;116:1312–1322. doi: 10.1097/ALN.0b013e31825681cb.
Singh PM, Panwar R, Borle A, Mulier JP, Sinha A, Goudra B. Perioperative analgesic profile of dexmedetomidine infusions in morbidly obese undergoing bariatric surgery: a meta-analysis and trial sequential analysis. Surg Obes Relat Dis. 2017;13:1434–1446. doi: 10.1016/j.soard.2017.02.025.
Wang X, Liu N, Chen J, Xu Z, Wang F, Ding C. Effect of Intravenous Dexmedetomidine During General Anesthesia on Acute Postoperative Pain in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Clin J Pain. 2018;34(12):1180–1191. doi: 10.1097/AJP.0000000000000630. PMID: 29771731.
Avci O, Taskiran AS, Gundogdu O. Dexmedetomidine, an α₂ agonist, increases the morphine analgesic effect and decreases morphine tolerance development by suppressing oxidative stress and TNF/IL-1 signalling pathway in rats. Rev Esp Anestesiol Reanim (Engl Ed). 2023 Jun-Jul;70(6):327–340.
Liu, Hong-Tao MD^†,; Hollmann, Markus W. MD^†§,; Liu, Wei-Hua MD^†,; Hoenemann, Christian W. MD^†‡,; Durieux, Marcel E. MD, PhD^*†. Modulation of NMDA Receptor Function by Ketamine and Magnesium: Part I. Anesthesia & Analgesia 92(5):p 1173–1181, May 2001. | DOI: 10.1097/00000539-200105000-00019.

No competing interests reported.

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The Postoperative Lidocaine and Ketamine Effects on Morphine Requirement in Bariatric Surgery

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Abstract

Background

Methods

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Conclusion

Introduction

Methods

Anaesthesia technique:

Data collection on postoperative pain

Outcomes

Statistical analysis

Results

Discusion

Declarations

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Version 1