The impact of dexmedetomidine or xylocaine continuous infusion on opioid consumption and recovery after laparoscopic sleeve gastrectomy

Abstract

Background: Postoperative pain control for morbidly obese patients represents a challenge because of their sensitivity towards opioid-induced respiratory depression. We elected both dexmedetomidine and xylocaine (lidocaine) continuous infusions as adjuvants because they lack respiratory depression side effect.

Methods: A total of 150 ASA I to III patients were enrolled in the study, randomly allocated into three equal parallel groups; the control, lidocaine or dexmedetomidine group. Patients received either dexmedetomidine 1 µg/kg bolus over 10 minutes followed by 0.4 µg/kg/h continuous infusion, lidocaine 2 mg/kg bolus over 10 minutes followed by 1.5 mg/kg/h continuous infusion or saline bolus and continuous infusion during the whole operation period. The total morphine consumption was designed to be the primary outcome variable, pain score, and quality of recovery 40 was set as secondary outcome variables. Pain score was measured by numerical rating scale while the quality of recovery score was estimated by the QOR-40 questionnaire. P<0.05 was considered significant.

Results: Both dexmedetomidine and lidocaine reduced the total morphine consumption where it was 14±4, 18±4, and 29±5 mg in the dexmedetomidine, lidocaine, and control groups, respectively (P<0.0001). While dexmedetomidine reduced postoperative pain at all measured time points, lidocaine reduced only early pain. Both drugs displayed better quality of recovery score 40 measured at postoperative day 3; 186±2 for the dexmedetomidine group versus 176±6 for the lidocaine group versus 140±6 for the control group (P<0.0001).

Conclusions: Continuous infusion of either dexmedetomidine or xylocaine reduces postoperative opioid consumption, pain and improve the quality of recovery following laparoscopic sleeve gastrectomy.