Ketamine, Lidocaine and Combination for Postoperative Analgesia in Open Liver Resection
Condition: Hepatectomy
Study type: Interventional

Summary: 
      Lidocaine and ketamine both are being used for perioperative analgesia. Perioperative
      lidocaine infusion has been shown to reduce postoperative pain and opioid consumption.
      Perioperative low dose Ketamine has shown improved postoperative pain and reduced opioid
      usage. We therefore tested the hypothesis that the combination would provide better analgesia
      in the milieu of intrathecal morphine.
    

Detailed description: 
      All study participants were monitored according to American Society of Anesthesiologists
      guidelines. All received intrathecal morphine (300 to 400 mcg) at L3-4 interspace via 25 G
      Whitacre needle. Participants were then randomized (computer generated) into one of four
      groups.

      General anesthesia was induced and endotracheal intubation was done. Immediately, after
      intubation, Lidocaine group (L) received a Lidocaine infusion at 0.33 mg/kg/h.

      The Ketamine group (K) received a ketamine infusion at 70 mcg/Kg/h. The Lidocaine-Ketamine
      group (LK) received a Lidocaine infusion at 0.33 mg/kg/h plus a Ketamine infusion at 70
      mcg/Kg/h.

      The control group (P) received a normal saline infusion to keep the blind. The infusions were
      stopped approximately 30-45 minute before the completion of surgery.

      All participants received a hydromorphone patient-controlled analgesia (PCA) via a pump. All
      were given acetaminophen 650 mg every 6 hrs for 4 days.

      Postoperatively, participants were monitored for nausea, vomiting, sedation, respiratory
      depression, light-headedness, perioral numbness, pruritus, disturbed dreams and
      hallucinations.

      Postoperative Hydromorphone consumption for the first, second and third day was recorded from
      the chart maintained by acute pain service team who were blinded to the group assignment.

      After the operation, study participants were interviewed at regular intervals by a blinded
      investigator about their current pain level, as well as satisfaction with pain management.
      They were also be questioned regarding the presence and severity of opioid-related side
      effects (nausea, vomiting, sedation, respiratory depression and, pruritus) and
      light-headedness, perioral numbness, disturbed dreams and hallucinations. Hospital charts
      were reviewed and data collected to analyze time to request for additional analgesia and
      total consumption of opioids, non-opioid analgesics, anti-emetics, and antipruritics within
      the first 72 hours postoperatively.
    

Intervention name(s): Lidocaine; Ketamine; Lidocaine+ketamine; Saline
Intervention type(s): Drug; Drug; Drug; Drug
Intervention description(s): This group will receive lidocaine infusion; This group will receive Ketamine infusion; This group will receive mixture of ketamine and lidocaine infusion; This group will receive saline infusion
Other intervention name(s): Xylocaine; Lidocaine infusion; Ketamine infusion; Lidocaine infusion; Ketamine infusion; Xylocaine; Normal saline
Intervention MeSH terms: Lidocaine; Ketamine
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Lidocaine, ketamine, combination and placebo are being evaluated for treating postoperative pain in major liver resection
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Lidocaine; Ketamine; postoperative analgesia