Lidocaine Infusion on Optic Nerve Sheath Diameter in Laparoscopic Hysterectomy in Trendelenburg Position

Tanta University66 enrolled

Overview

We hypothesize that intravenous lidocaine infusion may have beneficial effect to patients undergoing laparoscopic surgeries in Trendelenburg position by preventing ICP elevation.

Lidocaine use, both intravenous (IV) and laryngotracheal (LT), has been reported to blunt the ICP elevations during intubation. Also, Lidocaine injected IV has been shown in models to induce cerebral vasoconstriction leading to a decrease in cerebral blood volume and thus ICP. Furthermore, IV lidocaine leads to sodium channel inhibition and thus a reduction in cerebral activity and metabolic demands, as well as excitotoxicity, leading to a potential ICP reduction effect.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

DOUBLE

Enrollment

Conditions

Lidocaine Optic Nerve Sheath Diameter Laparoscopic Hysterectomy Trendelenburg

Interventions

LidocaineDRUG

intravenous lidocaine 2% bolus of 1.5 mg/kg over 5 min before induction of anesthesia followed by lidocaine infusion at 1.5 mg/kg/h intraoperatively until desufflation

sodium chloride 0.9% solutionDRUG

intravenous sodium chloride 0.9% solution volume matched bolus and infusion.

Eligibility

Sex: FEMALEMin age: 35 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Aged between 35 to 65 years * American society of anesthesiology (ASA) physical status I - II * Body mass index (BMI) between 18.5 to 28.0 kg/m2 * Scheduled for total laparoscopic hysterectomy taking approximately 2 h with a 30° Trendelenburg position for management of uterine fibroids or refractory dysfunctional uterine bleeding. Exclusion Criteria: 1. Patients with eye diseases, central nervous system diseases, cardiovascular diseases, cerebrovascular diseases or diabetes. 2. If these events occurred intraoperative: * Ultrasound scans or measurements failed to clearly show the structure of Optic Nerve Sheath Diameter (ONSD). * Surgical time less than 1 h. * Interruption of carbon dioxide (CO2) pneumoperitoneum and Trendelenburg position. * Peak airway pressure exceeding 35 cm H2O 3. Patients with a history of allergy to lidocaine.

Locations (1)

Tanta University Hospitals

Tanta, ElGharbiaa, Egypt

Outcomes

Primary Outcomes

Optic Nerve Sheath Diameter (ONSD)

ONSD at 5 min before induction of anesthesia in supine position (T1), 5 min after CO2 pneumoperitoneum in Trendelenburg position (T2), 30 min after CO2 pneumoperitoneum in Trendelenburg position (T3), 60 min after CO2 pneumoperitoneum in Trendelenburg position (T4) and 5 min after the closure of pneumoperitoneum in supine position (T5).

Time frame: 5 min before induction of anesthesia till 5 min after the closure of pneumoperitoneum

Secondary Outcomes

Heart rate

Heart rate at 5 min before induction of anesthesia in supine position (T1), 5 min after CO2 pneumoperitoneum in Trendelenburg position (T2), 30 min after CO2 pneumoperitoneum in Trendelenburg position (T3), 60 min after CO2 pneumoperitoneum in Trendelenburg position (T4) and 5 min after the closure of pneumoperitoneum in supine position (T5).

Time frame: 5 min before induction of anesthesia till 5 min after the closure of pneumoperitoneum

Mean arterial blood pressure

Mean arterial blood pressure at 5 min before induction of anesthesia in supine position (T1), 5 min after CO2 pneumoperitoneum in Trendelenburg position (T2), 30 min after CO2 pneumoperitoneum in Trendelenburg position (T3), 60 min after CO2 pneumoperitoneum in Trendelenburg position (T4) and 5 min after the closure of pneumoperitoneum in supine position (T5).

Time frame: 5 min before induction of anesthesia till 5 min after the closure of pneumoperitoneum

The incidence of postoperative adverse reactions

The incidence of adverse reactions, such as dizziness, postoperative nausea and vomiting (PONV) and postoperative headache (POHA) within 3 hours after surgery will be recorded in both groups.

Time frame: Within 3 hours after surgery

Data from ClinicalTrials.gov

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