The Effects of Perioperative Intravenous Lidocaine Injection on Postoperative Pain following Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: Although a laparoscopic cholecystectomy results in less pain than an open cholecystectomy, it is not a pain-free procedure. Therefore, this study was conducted to determine whether perioperative intravenous lidocaine would reduce postoperative pain after a laparoscopic cholecystectomy. METHODS: Fifty patients undergoing laparoscopic cholecystectomy were divided into two groups; a lidocaine group, in which patients were injected with a lidocaine bolus (1.5 mg/kg) and infusion (1.5 mg/kg/h); and a control group, in which patients were injected with the same volume of saline bolus and infusion. Intravenous lidocaine was initiated before anesthesia was administered and continued for 1 hour postoperatively. The intensity of abdominal and shoulder pain was then assessed 1, 6, 12 and 24 hours after surgery and recorded using a visual analog pain score (VAS) and verbal rating score (VRS). RESULTS: The abdominal pain score (VAS and VRS) was significantly lower in the lidocaine group than in the control group at all times evaluated during the first 24 hours after surgery (P < 0.05). In addition, the shoulder pain score and incidence were significantly lower in the lidocaine group than the control group at 12 hours and 24 hours after surgery (P < 0.05). In the lidocaine group, the incidences of epigastric, right flank, and back pain were lower than that of the control group, but these differences were not statistically significant. CONCLUSIONS: Perioperative intravenous lidocaine reduces shoulder and abdominal pain for 24 hours after laparoscopic cholecystectomy.

Measurement of Hemodynamic Changes Caused by Administration of Atracurium Besylate after Pretreatment with Anti-histamine Agent / 대한마취과학회지

BACKGROUND: Hemodynamic changes through the histamine-induced release of atracurium are relatively common, but can be particularly dangerous in hemodynamically unstable patients. This study evaluated the effectiveness of a pretreatment with an anti-histamine agent before the administration of atracurium in the prevention of histamine-induced hemodynamic changes. METHODS: Forty-eight ASA class I and II patients were assigned to four groups. Groups 1 and 2 were assigned to receive atracurium through a bolus 0.5 mg/kg. Groups 3 and 4 were assigned to receive atracurium through a bolus 1.0 mg/kg. Group 1 and 3 were pretreated with pheniramine (H1-blocker) and ranitidine (H2-blocker) intravenously before the induction of general anesthesia. After induction, HemosonicTM 100 was installed and the following hemodynamic parameters were measured: systemic vascular resistance (SVR), cardiac index (CI), heart rate (HR) and blood pressure (BP) immediately before, 1, 2, 3, 5 and 10 min after the rapid administration of the atracurium bolus before the skin incision. RESULTS: Groups 1 and 3 showed more stable hemodynamics than groups 2 and 4. Group 2 showed more significant changes in the SVR, CI, BP, HR than group 1 (P< 0.05). Group 4 showed more significant changes in the SVR, CI, BP, HR than group 3, and some cases were significant hemodynamically (P< 0.05). Group 4 showed more significant changes in the SVR, CI, BP, HR than group 2 (P <0.05). CONCLUSIONS: Pretreatment with an anti-histamine drug prior to the administration of atracurium can be effective in attenuating the hemodynamic responses.