Systemic lidocaine versus erector spinae plane block for improving quality of recovery after laparoscopic cholecystectomy: A randomized controlled trial.
J Clin Anesth
; 97: 111528, 2024 Oct.
Article
em En
| MEDLINE
| ID: mdl-38905964
ABSTRACT
STUDY OBJECTIVE:
To compare intravenous lidocaine, ultrasound-guided erector spinae plane block (ESPB), and placebo on the quality of recovery and analgesia after laparoscopic cholecystectomy.DESIGN:
A prospective, triple-arm, double-blind, randomized, placebo-controlled non-inferiority trial.SETTING:
A single tertiary academic medical center. PATIENTS 126 adults aged 18-65 years undergoing elective laparoscopic cholecystectomy.INTERVENTIONS:
Patients were randomly allocated to one of three groups intravenous lidocaine infusion (1.5 mg/kg bolus followed by 2 mg/kg/h) plus bilateral ESPB with saline (25 mL per side); bilateral ESPB with 0.25% ropivacaine (25 ml per side) plus placebo infusion; or bilateral ESPB with saline (25 ml per side) plus placebo infusion. MEASUREMENTS The primary outcome was the 24-h postoperative Quality of Recovery-15 (QoR-15) score. The non-inferiority of lidocaine versus ESPB was assessed with a margin of -6 points and 97.5% confidence interval (CI). Secondary outcomes included 24-h area under the curve (AUC) for pain scores, morphine consumption, and adverse events. MAINRESULTS:
124 patients completed the study. Median (IQR) 24-h QoR-15 scores were 123 (117-127) for lidocaine, 124 (119-126) for ESPB, and 112 (108-117) for placebo. Lidocaine was non-inferior to ESPB (median difference -1, 97.5% CI -4 to ∞). Both lidocaine (median difference 9, 95% CI 6-12, P < 0.001) and ESPB (median difference 10, 95% CI 7-13, P < 0.001) were superior to placebo. AUC for pain scores and morphine use were lower with lidocaine and ESPB versus placebo (P < 0.001 for all), with no significant differences between lidocaine and ESPB. One ESPB patient reported a transient metallic taste; no other block-related complications occurred.CONCLUSIONS:
For patients undergoing laparoscopic cholecystectomy, intravenous lidocaine provides a non-inferior quality of recovery compared to ESPB without requiring specialized regional anesthesia procedures. Lidocaine may offer a practical and accessible alternative within multimodal analgesia pathways.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Dor Pós-Operatória
/
Medição da Dor
/
Colecistectomia Laparoscópica
/
Anestésicos Locais
/
Lidocaína
/
Bloqueio Nervoso
Limite:
Adolescent
/
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
J Clin Anesth
/
J. clin. anesth
/
Journal of clinical anesthesia
Assunto da revista:
ANESTESIOLOGIA
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
China