Adneksiyel Kitle Operasyonlarında İntraoperatif Lidokain'in Kusmayı Önlemesi

Year 2020, Volume: 30 Issue: 1, 11 - 15, 01.03.2020

Bilge Aslan Feray Aydın

Abstract

Amaç: Postoperatif kusma POK , batın içi operasyonlarda sık görülen bir komplikasyondur. Karın ameliyatı geçiren erişkin hastalarda intravenöz lidokain infüzyonu kullanımı POK'yi önleyebilir. Karın içi operasyonlarda genel anesteziye yardımcı olarak kullanılan intravenöz lidokain infüzyonunun anti-emetik etkisini değerlendirmeyi amaçladık.Hastalar: Elektif olarak adneksiyel kitleden opere olan, 30-70 yaşları arasında, ASA I-III erişkin kadınlar seçildi. Müdahale: Anestezinin indüksiyonunu ve idamesini genel olarak onkolojik cerrahi odalarımızda standart hale getirilmiştir. Hastalara rastgele olarak 5 dakika boyunca lidokain 1.5 mg/kg intravenöz lidokain, ardından 2 mg/kgsaat veya sadece % 0.9 saline aynı oranda ve hacimde verildi. İnfüzyonlar ameliyatın sonuna kadar devam edilmiştir.Bulgular: 200 tane adneksiyel kitleden opere olan bayan hasta tarandı. Lidokain grubunda, 100 hastanın 60'ında % 60 Saline grubunda 100 hastanın 80'inde % 80 POK görüldü. POK sahibi olma olasılığı, Lidokain alan hastalarda Salin verilen gruba göre% 20 daha az bulundu. Ortalama lidokain plazma konsantrasyonu 4.3 µg/ml idi 0.87 - 4.88 .Sonuç: Genel anesteziye yardımcı olarak intravenöz lidokain infüzyonunun kullanılması, elektif adneksiyel kitle operasyonu uygulanan onkoloji hastalarında POBK’yu Postoperatif Bulantı Kusma azaltmıştır

Keywords

Genel anestezi, kusma, bulantı, lidokain

Intraoperative lidocaine prevention of vomiting in adnexal mass operations

Abstract

Objective: Postoperative vomiting POV is a common complication in intra-abdominal operations. The use of intravenous lidocaine infusion in adult patients who underwent abdominal surgery may prevent POV. We aimed to evaluate the anti-emetic effect of intravenous lidocaine infusion used as an adjuvan to general anesthesia in intra-abdominal operations.Patients: ASA I-III adult women aged 30 to 70 years scheduled for elective adnexal mass operations were selected. Intervention: We have standardized the induction and maintenance of anesthesia in our oncological surgery rooms. Patients were randomly administered lidocaine 1.5 mg/kg intravenous i.v lidocaine followed by 2 mg/kg/h or only 0.9% saline same proportion and volume for 5 minutes. Infusions were continued until the end of the surgery.Results: 200 women with adnexal mass were operated. In the lidocaine group, 60 60% of the 100 patients had POV and 80 80% of the 100 patients had POV in the Saline group. The probability of having POV was 20% less in patients receiving lidocaine than in the Saline group. The mean lidocaine plasma concentration was 4.3 µg/ml range: 0.87 to 4.88 . Conclusion: The use of intravenous lidocaine infusion as an adjunct to general anesthesia reduced POVN in oncology patients undergoing elective adnexal mass surgery

Keywords

General anesthesia, vomiting, nausea, lidocaine

References

• Koppert W, Weigand M, Neumann F, et al. Perioperative intravenous lidocaine has preventive effects on postoperati- ve pain and morphine consumption after major abdominal surgery. Anesth Analg 2004; 98(4): 1050–5.
• Gan TJ, Meyer T, Apfel CC, et al. Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg 2003; 97:62–71.
• Carlisle JB, Stevenson CA. Drugs for preventing postope- rative nausea and vomiting. Cochrane Database Syst Rev 2006.
• McCarthy GC, Megalla SA, Habib AS. Impact of intrave- nous lidocaine infusion on postoperative analgesia and recovery from surgery: a systematic review of randomized controlled trials. Drugs 2010; 70:1149–63.
• Kranke P, Jokinen J, Pace NL, et al. Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery. Cochrane Database Syst Rev 2015;16, CD009642.
• Striebel HW, Klettke U. Is intravenous lidocaine infusi- on suitable for postoperative pain management? Schmerz 1992; 6:245–50.
• Royal M. Pediatric safety review of OFIRMEV (acetami- nophen) injection. Clinical development & medical affairs 2012; 1–12.
• Elgueta MF, Echevarria GC, De la Fuente N, et al. Effect of intravenous fluid therapy on postoperative vomiting in children undergoing tonsillectomy. Br J Anaesth 2013; 110:607–14.
• Bajwa SA, Costi D, Cyna AM. A comparison of emergence delirium scales following general anesthesia in children. Pa- ediatr Anaesth 2010; 20:704–11.
• Barat SA, Kardos SA, Abdel-Rahman MS. Development and validation of a high-performance liquid chromatograp- hy method for the determination of cocaine, its metabolites and lidocaine. J Appl Toxicol 1996; 16:215–9.
• O’Neal CL, Poklis A. Sensitive HPLC for simultaneous quantification of lidocaine and its metabolites monoethy- lglycinexylidide and glycinexylidide in serum. Clin Chem 1996; 42:330–1.
• Czarnetzki C, Elia N, Lysakowski C, et al. Dexamethasone and risk of nausea and vomiting and postoperative bleeding after tonsillectomy in children: a randomized trial. JAMA 2008; 300:2621–30.
• Saquib N, Saquib J, Ioannidis JP. Practices and impact of primary outcome adjustment in randomized controlled tri- als: meta-epidemiologic study. BMJ 2013; 347:f4313.
• Yu LM, Chan AW, Hopewell S, et al. Reporting on covariate adjustment in randomised controlled trials before and after revision of the 2001 CONSORT statement: a literature re- view. Trials 2010; 11:59.
• Gan TJ. Mechanisms underlying postoperative nausea and vomiting and neurotransmitter receptor antagonist-based pharmacotherapy. CNS Drugs 2007; 21:813–33.
• Lapin GA, Hochman B, Maximino JR, et al. Effects of lido- caine, bupivacaine, and ropivacaine on calcitonin gene-re- lated peptide and substance P levels in the incised rat skin. Adv Skin Wound Care 2016; 29:169–77.
• Diemunsch P, Joshi GP, Brichant JF. Neurokinin-1 receptor antagonists in the prevention of postoperative nausea and vomiting. Br J Anaesth 2009; 103:7–13.
• Cruthirds D, Sims PJ, Louis PJ. Review and recommenda- tions for the prevention, management, and treatment of postoperative and postdischarge nausea and vomiting. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:601–611.
• Cummins TR. Setting up for the block: the mechanism un- derlying lidocaine's use-dependent inhibition of sodium channels. J Physiol 2007; 582:11.
• Weibel S, Jokinen J, Pace NL, et al. Efficacy and safety of intravenous lidocaine for postoperative analgesia and reco- very after surgery: a systematic review with trial sequential analysis. Br J Anaesth 2016; 116:770–83.
• Li YM, Wingrove DE, Too HP, et al. Local anesthetics inhi- bit substance P binding and evoked increases in intracellu- lar Ca++. Anesthesiology 1995; 82:166–73.
• Becker DE, Reed KL. Local anesthetics: review of pharma- cological considerations. Anesth Prog 2012; 59:90–101.
• Weibel S, Jelting Y, Pace NL, et al. Continuous intrave- nous perioperative lidocaine infusion for postoperative pain and recovery in adults.Cochrane Database Syst Rev. 2016;6,CD009642.