INNOVATIVE APPROACHES TO ANAESTHESIA: EVALUATING MULTIMODAL TECHNIQUES FOR POSTOPERATIVE NAUSEA MANAGEMENT IN LAPAROSCOPIC CHOLECYSTECTOMY
Authors: Monazir Fahad , Raza Kasif , Ahmad Md Sohail 
Published: December 2024

Background : Multimodal anesthesia represents an innovative and strategic approach aimed at optimizing pain management while concurrently
minimizing the risk of opioid-related adverse effects, particularly postoperative nausea. By employing a diverse array of medications throughout
the surgical procedure, this technique significantly reduces dependence on opioids. Patients undergoing laparoscopic cholecystectomy are
especially vulnerable to postoperative nausea, a condition exacerbated by the administration of high doses of opioids.In our study, we sought to
meticulously examine the incidence of postoperative nausea across three distinct patient groups, each receiving a combination of lidocaine,
ketamine, or magnesium sulfate along with fentanyl during their surgical intervention. Additionally, we aimed to evaluate any subsequent
occurrences of nausea within these groups and to quantify the total amount of fentanyl administered throughout the procedure. Through this
comprehensive analysis, we aimed to illuminate the effectiveness of multimodal anesthesia in enhancing patient outcomes and reducing the burden
of postoperative nausea. Materials And Methods: In this randomized prospective study, 60 patients aged 15 to 65 years with American Society of
Anesthesiologists (ASA) physical status 1 and 2 were enrolled for laparoscopic cholecystectomy. Participants were randomly assigned to one of
three groups based on their analgesic regimen: Group 1 (Lidocaine Group, LG) received an intravenous bolus of lidocaine at 1 mg/kg during
induction, followed by a continuous infusion at 2 mg/kg/h post-intubation; Group 2 (Ketamine Group, KG) was administered ketamine at 0.5
mg/kg during induction; and Group 3 (Magnesium Group, MG) received a continuous infusion of magnesium sulfate at 1.5 g/h after intubation. All
groups also received bolus doses of fentanyl as part of standard care. The primary objective was to assess the incidence of postoperative nausea at 1,
4, 8, 12, and 24 hours postoperatively. In cases of vomiting, patients were treated with 10 mg of metoclopramide. The frequency and severity of
subsequent nausea and vomiting episodes were recorded as secondary endpoints. Additionally, the total fentanyl dosage administered during the
intraoperative period was quantified to evaluate the opioid-sparing effects of the interventions. This study aims to elucidate the comparative
efficacy of lidocaine, ketamine, and magnesium sulfate in reducing postoperative nausea, thereby enhancing postoperative recovery and patient
comfort. Results: Patients assigned to the Lidocaine Group exhibited a significantly lower incidence of postoperative nausea and required a
reduced total dosage of fentanyl compared to those in the Ketamine and Magnesium Groups. Conversely, the Ketamine Group demonstrated a
higher prevalence of nausea relative to the other groups, while the Magnesium Group experienced a greater incidence of vomiting and necessitated
a higher total fentanyl dosage during the surgical procedure.In terms of additional episodes of nausea and vomiting recorded across the five
monitoring intervals, two patients in the Lidocaine Group, one patient in the Ketamine Group, and two patients in the Magnesium Group reported
such occurrences. Quantitatively, the Magnesium Group received the highest average fentanyl dosage during the intraoperative period, calculated
at 319.50 ± 120.6 µg, followed by the Ketamine Group at 274.50 ± 70.5 µg, and the Lidocaine Group at 246.65 ± 70.6 µg. However, it is important
to note that the differences in fentanyl dosages among the three groups did not achieve statistical significance, indicating that while trends were
observed, they may not reflect clinically meaningful distinctions. Conclusion: Multimodal anesthesia effectively reduces postoperative nausea
within 24 hours following laparoscopic cholecystectomy while also decreasing intraoperative opioid requirements. By utilizing a combination of
analgesic agents, such as lidocaine, ketamine, and magnesium sulfate, this approach enhances pain management and promotes smoother recovery.
These findings highlight the advantages of multimodal strategies in optimizing anesthesia practices, leading to improved patient outcomes and
satisfaction. Further research is needed to refine these protocols and explore their applicability across a wider range of surgical procedures.