Effects of intravenous single-bolus lidocaine infusion versus intravenous single-bolus magnesium sulfate infusion on postoperative pain, emotional status, and quality of life in patients undergoing spine fusion surgery: a randomized study.

BACKGROUND: We assessed the efficiency of intravenous adjuvants in decreasing opioid intake and pain scores after spine fusion surgery. METHODS: This study included 120 patients aged 18-60 listed for spine fusion surgery under general anesthesia. Patients were randomly assigned to four groups: Group (Lidocaine): received IV lidocaine 4 mg/kg in 50 mL volume over 30 min. Group (Magnesium): received IV magnesium sulfate 30mg/kg in 50 mL volume over 30 min. Group (combined Lidocaine and Magnesium): received IV lidocaine 4 mg/kg in 50 mL volume over 30 min.+IV magnesium sulfate 30mg/kg in 50 mL volume over 30 min. Group (Control): received IV saline 50 mL. The time to the first request analgesia, the postoperative pain score, total analgesic use, patient satisfaction, anxiety, depression, mental state, quality of life, and side effects were measured. RESULTS: The combined group had more extended time for the first analgesic request and fewer rescue analgesia doses than the other groups. NRS scores at rest or movement were statistically significantly lower in the lidocaine group and the combined group compared to the control group (P1, P3<0.05) at almost all times. This combination reduces anxiety and depression and improves overall health up to three months after a single infusion. The combined group had higher patient satisfaction. CONCLUSIONS: A synergistic effect of a combination of lidocaine and magnesium sulfate on perioperative pain was found. It reduces analgesic consumption, depression, and anxiety and improves overall health up to three months after a single infusion dose.

Ventilatory performance of BASKA mask as an alternative to endotracheal intubation in short-term gynecologic laparoscopic procedures: a prospective randomized clinical trial.

BACKGROUND: Using laryngeal mask airways (LMAs) in laparoscopic surgery is still controversial because of the risk of insufficient ventilation and gastric overinflation. We investigated the use of BASKA LMA as an alternative to endotracheal intubation in low-risk females undergoing short-term gynecologic laparoscopic surgeries in Trendelenburg position under general anesthesia and positive pressure ventilation. METHODS: Sixty-five females (19-43 years), ASA (I-II) were scheduled to receive endotracheal tube (ETT group, N.=32) or BASKA mask (BASKA group, N.=33) for airway management. Assessments included insertion time and score, intraoperative lung mechanics, oropharyngeal leak pressure (OLP), ventilatory score, leak fraction, perioperative lung spirometry, and adverse effects. Timepoints were after device insertion, pneumoperitoneum inflation, Trendelenburg position, at 15, 30, 45 minutes intraoperatively and at end of surgery. RESULTS: The median insertion time was shorter in BASKA group (21.0 [18-38] s), compared with ETT group (27.0 [24-33] s, P=0.000). First-time success rate for insertion of BASKA mask was 87.9% (29 patients). The peak inflation pressure, calculated dynamic compliance, ventilatory score and lung spirometry data showed no significant difference between the two groups. The median leak fraction was higher in BASKA group after insertion (P=0.012) and after Trendelenburg position (P=0.032), with no significant differences afterwards. The median OLP after insertion was 32.0 (29-35) cmH2O which decreased after pneumoperitoneum inflation (31.0 [27-33] cmH2O, P=0.000), and after Trendelenburg position (30.0 [27-32] cmH2O, P=0.000) and remained stable at this range. CONCLUSIONS: BASKA mask can be considered as a safe alternative to ETT with comparable ventilatory performance in low-risk females undergoing short-term gynecologic laparoscopic surgeries.

Comparison of intraperitoneal versus intravenous dexamethasone on postoperative nausea and vomiting after gynecological laparoscopy: a randomized clinical trial.

BACKGROUND: Postoperative nausea and vomiting (PONV) is a common complication following laparascopic surgery. This study compared the effect of intraperitoneal versus intravenous dexamethasone for reducing PONV after gynecological laparoscopic surgeries. METHODS: Eighty adult female patients, American Society of Anesthesiologists physical status I-II, scheduled for gynecological laparoscopic surgery were randomized to receive 8 mg dexamethasone intravenously (IV) (n = 40) or intraperitoneally (IP) (n = 40). The primary outcome was the PONV incidence during the first 24 h after laparoscopy. Secondary outcomes included visual analogue scale (VAS) pain scores, total rescue analgesic consumption during the first 24 h postoperatively, the need for rescue antiemetic drugs, and the incidence of complications that may accompany these medications. RESULTS: Eleven women (27.5%) in the IV group, versus only 3 (7.5%) women in the IP group, experienced nausea during the first 24 h postlaparoscopy (P = 0.037). However, 5 patients (12.5%) in the IV group, versus only 2 patients (5.0%) in the IP group, experienced vomiting (P = 0.424). No statistically significant differences were seen in the severity of nausea or the need for rescue antiemetics. The IV group had a higher rate of side-effects than the IP group (27.5% vs. 7.5%, P = 0.037). Headache and dizziness were common side effects in the IV dexamethasone group. The groups did not differ significantly in terms of mean VAS score for pain and total meperidine consumption during the first 24 h postoperatively. CONCLUSIONS: Intraperitoneal dexamethasone at a dose of 8 mg at the end of gynecological laparoscopy reduces the incidence of postoperative nausea.