Asmaa Moatasem has completed her Master’s Degree from Assiut University, Egypt. She has a Fellowship in Pain Management at the University of Würzburg, Germany. She completed the European Diploma in Anaesthesiology and Intensive Care in 2015, and her PhD from Assiut University, Egypt. She is a Consultant of Anesthesia, Intensive Care and Pain Management at Assiut University, Egypt.
Introduction: Postoperative pain following open abdominal surgeries could cause a restrictive respiratory dysfunction, which is associated with poor postoperative outcomes. Thoracic epidural analgesia provides solid pain control; however, it can lead to complications, has some contraindications, and occasionally fails. Intravenous lidocaine infusion has been suggested as an alternative due to its anti-nociceptive and anti-inflammatory properties. This trial aimed at comparing perioperative intravenous lidocaine infusion with thoracic epidural analgesia for open abdominal surgery with regard to postoperative pain, opioid consumption and respiratory function. Methods: scheduled for upper abdominal surgery were randomly allocated into two groups. Intravenous lidocaine groups received 1.5 mg/kg IV bolus before induction, then intraoperative IV infusion of 2–3 mg/min and then reduced postoperatively to 0.5–1 mg/min. The thoracic epidural group received bupivacaine 0.125% epidural infusion of 5–8 ml/hour intraoperatively, and then reduced postoperatively to 4–5 ml/hour. The infusions in both groups continued for 24 hours postoperatively. Results: Sixty-nine patients (35 in the lidocaine group and 34 in the epidural group) were analyzed. There was not a statistically significant difference between the two groups with respect to the verbal numeric rating scale measured at rest at the 4th, 8th. 12th or 24th hours postoperatively, with ambulation (P=0.163) or coughing (P=0.079). Opioid consumption in the first postoperative day showed no statistically significant difference (P=0.356). Postoperative lung function (FVC–forced vital capacity, FEV1– forced expiratory volume in one second, and PEF–peak expiratory flow) showed slightly lower values than the preoperative ones in both groups. However, there was no statistically significant difference between the two groups as regard to postoperative FVC (P=0.560), FEV1 (P=0.657) or PEF (P=0.167). Conclusions: Intravenous lidocaine infusion provides postoperative analgesia comparable to that of thoracic epidural analgesia for upper abdominal surgery with opioid sparing properties.
Ah-Young Oh is an Anesthesiologist, specializing in Pediatric Anesthesia and Anesthesia Pharmacology. She has published articles in international journals regarding pediatric anesthesia, the safety and efficiency of muscle relaxants and inhalational anesthetics, monitoring the level of consciousness during general anesthesia, and postoperative pain management. She graduated from and had a Doctorship at the Seoul National University, College of Medicine.
Background: Changes in acute reactive substances of cytokines after surgery are related to the degree of tissue damage and are related to the occurrence of side effects. We evaluated the effect of deep neuromuscular blockade on the responses of inflammatory cytokines following laparoscopic gastrectomy. Method: Patients undergoing elective laparoscopic gastrectomy were randomized to either moderate (train-of-four count of 1 or 2) or deep group (post-tetanic count of 1 or 2). Neuromuscular blockade was induced and maintained with rocuronium that was reversed with sugammadex in the deep group and with neostigmine in the moderate group. Plasma TNF-α, IL-1β, IL-6, IL-8, and CRP were measured before operation and post- incision of 3, 4 and 48 hours. Results: Intraoperative spontaneous breathing (26.7% vs. 4.7%, P=0.005), and request for neuromuscular blockade (75% vs. 47.6%, P=0.015) were more frequent in the moderate group compared to the deep group. There were no statistically significant differences in post-incisional plasma TNF-α, IL-1β, IL-6, IL-8, and CRP between the two groups. Conclusion: In patients undergoing elective laparoscopic gastrectomy, intraoperative conditions were favorable during a deep neuromuscular blockade compared to a moderate neuromuscular blockade. However, the depth of neuromuscular blockade did not affect the release of inflammatory cytokines during laparoscopic gastrectomy.