Comparing Different Modalities of Opioid Free Anesthesia for Laparoscopic Cholecystectomy

Abstract

Background: Laparoscopic cholecystectomy, though less invasive, can still cause significant postoperative pain. Opioids were traditionally used for pain management but have adverse effects and addiction risks. There's a growing interest in opioid-free approaches, like intraperitoneal lidocaine and magnesium sulfate infusion, to reduce pain and opioid use in laparoscopic cholecystectomy. Objectives: This study aimed to compare intraperitoneal lidocaine and magnesium sulfate infusion as opioid-free anesthesia methods for laparoscopic cholecystectomy patients. Patients and methods: This is prospective clinical-trial at Qena University Hospital involved fifty adult patients divided into Group I (intraperitoneal lidocaine) and Group II (lidocaine with magnesium sulfate infusion). Both groups received anesthesia and postoperative pain assessment using the Visual Analogue Scale (VAS). Intra and post operative hemodynamics monitoring was done. Results: Intra-operative heart rate in Group I was significantly higher in the first 70 min. (p < 0.05) and systolic BP was higher at 20, 30, 40 mins (p < 0.001). Group I had higher SBP, DBP and HR almost for the all 60 mins (p < 0.00001) in PACU. However, in Follow-up SBP was higher for the first 4 hours (p < 0.01) and DBP was higher at 6, 12, 18, 24 hours for Group II (p < 0.05). Follow up VAS pain score was significantly lower in group I for all 24 hours. No complications were recorded in both groups. Conclusion: Magnesium sulfate infusion showed better hemodynamic stability and less disturbance, while intraperitoneal lidocaine provided better pain control although with more hemodynamic instability.

Keywords

• lidocaine magnesium sulfate infusion
• opioid-free anesthesia laparoscopic cholecystectomy