Evaluation of lignocaine, dexmedetomidine, lignocaine-dexmedetomidine infusion on pain and quality of recovery for robotic abdominal hysterectomy: a prospective randomized controlled trial
Avaliação da infusão de lignocaína, dexmedetomidina, lignocaína-dexmedetomidina na dor e qualidade da recuperação para histerectomia abdominal robótica: um estudo prospectivo randomizado controlado
Pudi Shivaji, Sanjay Agrawal, Ajay Kumar, Anupama Bahadur
Abstract
Background: Acute postoperative pain is associated with poor quality of recovery after surgery. Perioperative use of intravenous lignocaine or dexmedetomidine have demonstrated better pain control, early return of bowel function, and effects on quality of recovery.
Methods: Ninety-six women planned for elective Robotic abdominal hysterectomy were randomized into four groups. Groups received lignocaine infusion (1.5 mg.kg−1 loading, 2 mg.kg−1.h−1 infusion) (Group I), dexmedetomidine infusion (1 µg.kg−1 loading, 0.6 µg.kg−1.h−1 infusion) (Group 2), lidocaine (1.5 mg.kg−1 loading, 2 mg.kg−1.h−1 infusion), and dexmedetomidine infusions (1 µg.kg−1 loading, 0.5 µg.kg−1.h−1 infusion) (Group 3),and normal saline 10 mL loading, 1 mL.kg−1.h−1 infusion) (Group 4). Primary outcome was visual analogue pain scores at 1, 2, 4, 12, and 24 hours after surgery. Secondary outcomes included postoperative fentanyl requirement, time of return of bowel sounds and flatus, QoR15 score on day 1, 2, and discharge.
Results: The VAS was significantly lower in Groups 2 and 3 compared to Groups 1 and 4. Total postoperative fentanyl consumption in the first 24 hours was 256.25 ± 16.36 mcg (Group 1), 177.71 ± 16.81 mcg (Group 2), 114.17 ± 16.19 mcg (Group 3), and 304.42 ± 31.26 mcg (Group 4), respectively. Time to return of bowel sounds and passage of flatus was significantly shorter in Groups 2 and 3 (p < 0.01). QoR15 scores after surgery were higher in Group 3 compared to Groups 1, 2, and 4, (p < 0.01) respectively.
Conclusion: Combined infusion of lignocaine and dexmedetomidine significantly decreased postoperative pain, fentanyl consumption, and improved quality of recovery score after surgery in patients undergoing Robotic abdominal hysterectomy.
Keywords
Resumo
Justificativa: A dor aguda pós-operatória está associada à má qualidade da recuperação após a cirurgia. O uso perioperatório de lignocaína intravenosa ou dexmedetomidina demonstrou melhor controle da dor, retorno precoce da função intestinal e efeitos na qualidade da recuperação. Métodos: Noventa e seis mulheres planejadas para histerectomia abdominal robótica eletiva foram randomizadas em quatro grupos. Os grupos receberam infusão de lignocaína (carga de 1,5 mg/kg-1, infusão de 2 mg/kg-1/h-1) (Grupo I), infusão de dexmedetomidina (carga de 1 µg/kg-1, infusão de 0,6 µg/kg-1/h-1) (Grupo 2), lignocaína (1,5 mg /kg de carga, 2 mg/kg-1/h-1 de infusão) e infusões de dexmedetomidina (1 µg/kg-1 de carga, 0,5 µg/kg-1/h-1 de infusão) (Grupo 3) e solução salina normal 10 ml de carga, 1 ml/kg-1/h-1 de infusão ) (Grupo 4). O desfecho primário foi escores de dor analógica visual em 1, 2, 4, 12 e 24 horas após a cirurgia. Os desfechos secundários incluíram necessidade de fentanil no pós-operatório, tempo de retorno dos sons intestinais e flatos, pontuação QoR15 no dia 1, 2 e alta. Resultados: A EVA foi significativamente menor nos Grupos 2 e 3 em relação aos Grupos 1 e 4. O consumo total de fentanil pós-operatório nas primeiras 24 horas foi de 256,25±16,36 mcg (Grupo 1), 177,71±16,81 mcg (Grupo 2), 114,17±16,19 mcg (Grupo 3) e 304,42±31,26 mcg (Grupo 4), respectivamente. O tempo de retorno dos ruídos intestinais e passagem de flatos foi significativamente menor nos Grupos 2 e 3 (p < 0,01). Os escores do QoR15 após a cirurgia foram maiores no Grupo 3 em comparação aos Grupos 1, 2 e 4 (p < 0,01), respectivamente. Conclusão: A infusão combinada de lignocaína e dexmedetomidina diminuiu significativamente a dor pós-operatória, o consumo de fentanil e melhorou a qualidade do escore de recuperação após a cirurgia em pacientes submetidas à histerectomia abdominal robótica.
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References
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