Multimodal, non-opioid based analgesia for women presented for laparoscopic hysterectomy

Abstract

Objectives Evaluation of outcome of women undergoing laparoscopic hysterectomy under general anesthesia with intraoperative (IO) multimodal analgesia. Patients & Methods 129 women were allocated into three groups: Group F received fentanyl loading dose and IO infusion; Group D received loading doses of dexmedetomidine (DEX) and lidocaine (LID) and infusions; Group M included patients received parecoxib sodium infusion (80 µg/ml), 30 minutes prior to induction of anesthesia and loading doses and IO infusions as group D in addition to parecoxib infusion. Heart rate (HR) and mean arterial pressure (MAP) were continuously non-invasively monitored. Blood samples were obtained for ELISA estimation of serum levels of inflammatory cytokines. Outcomes included adequacy of IO analgesia to control intraoperative MAP changes and postoperative (PO) pain scores and its relation to change in serum cytokines’ levels. Results Fentanyl infusion induced significantly higher incidence and extent of decreased MAP in relation to preoperative MAP, while IO analgesia used for groups M and D allowed more hemodynamic stability. Patients of groups D and M had significantly shorter duration of PACU stay, longer duration of PO analgesia and lower number requests of rescue analgesia with significantly lower 24-hr pain score. Serum cytokines’ levels were significantly lower in patients of group M than in groups D and F with significantly lower levels in patients of group D compared to group F. Conclusion Multimodal IO analgesia was efficient to provide IO hemodynamic stability, reduce PO pain, consumption of rescue analgesia and serum cytokines’ levels.

Keywords

• multimodal analgesia
• intraoperative infusions
• hemodynamic stability
• inflammatory cytokines
• postoperative pain