Postoperative opioid-centric pain management strategies in obese patients are accompanied by the possible development of; opioid-induced ventilatory impairment (OIVI) and hypoxemia. This presents as sedation and respiratory depression, combined with upper airway obstruction and hypercapnia. If it remains undetected and untreated, it can result in increased perioperative morbidity and mortality.Thus, an increased interest in the use of non-opioid analgesic adjuncts has been prompted. Intra-operative intravenous lidocaine infusion has analgesic, anti-inflammatory, anti-hyperalgesic, opioid-sparing effects with an enhanced recovery after surgery (ERAS) profile. Its postoperative analgesia may last after reduction of its plasma concentration. So, lidocaine could be a good alternative in bariatric surgery. Lidocaine has been studied as part of an opioid-free multimodal analgesia in morbidly obese patients. Also, its use in bariatric surgery showed a decrease in postoperative opioid use and improvement in the quality of recovery.
compare the postoperative analgesic effect of intraoperative lidocaine infusion (Study group) used as a sole analgesic agent, to the intraoperative intravenous morphine (Control group) in laparoscopic gastric bypass surgery.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
60
At induction of anesthesia, patients will receive a loading dose of 1.5mg/kg lidocaine hydrochloride 2% slowly over 3 min followed by IV infusion of 2mg/kg/hr lidocaine hydrochloride 2% till the end of surgery
At induction of anesthesia, patients will receive a loading dose of IV 0.1mg/kg morphine sulphate slowly over 3 minutes followed by IV infusion of normal saline via infusion pump. The infusion will be continued till the end of surgery
Ain-Shams University
Cairo, Egypt
Post-operative pain score at rest
Intensity of pain will be monitored ; on arrival to the PACU, at 20, 40 and 60 minutes after arrival to the PACU by the Numeric Pain Rating Scale. The Numeric Pain Rating Scale (NPRS) is a segmented numeric version of the visual analog scale (VAS) in which the patient selects a whole number (0-10 integers) that best reflects the intensity of pain felt.Where 0 is no pain felt and 10 is the worst pain.
Time frame: 1hour
Duration of surgery
measured in minutes
Time frame: 3 hours
Duration of anesthesia
measured in minutes
Time frame: 4 hours
mean values of mean blood pressure (MBP)
mean values of MBP will be recorded as base line value, before induction of anesthesia, 5 minutes after endotracheal intubation, before pneumoperitoneum, after release of pneumoperitoneum and 10 min after extubation in the PACU
Time frame: 5 hours
Number of patients requiring intra-operative morphine
Number of patients requiring intra-operative morphine will be recorded
Time frame: 4hours
sPO2
recorded in the induction room and in the PACU.
Time frame: 5 hours
Respiratory rate
recorded in the induction room and in the PACU
Time frame: 5 hours
Post-operative nausea and/or vomiting
number of patients will be recorded
Time frame: 1 hour
Post-operative sedation score
From 0 to 4
Time frame: 1 hour
Modified Aldrete Score
score from 0 to 10. Higher score means patient is fit to transfer to the ward. In the PACU, patients with score ≥ 9 will be transferred to the surgical unit
Time frame: 1 hour
mean values of heart rate (HR)
mean values of HR will be recorded as base line value, before induction of anesthesia, 5 minutes after endotracheal intubation, before pneumoperitoneum, after release of pneumoperitoneum and 10 min after extubation in the PACU
Time frame: 5 hours
Number of patients requiring postoperative additional morphine doses
Number of patients requiring postoperative additional morphine doses willbe recorded
Time frame: 1 hour
the total dose of morphine given to each patient
the total dose of morphine given to each patient will be recorded in milligrams
Time frame: 5 hours
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