Kobelyatsky YuYu, Shkitak IA
COMPARATIVE EVALUATION OF VARIOUS OPTIONS FOR MULTIMODAL PERIOPERATIVE ANALGESIA IN TOTAL LARYNGECTOMY
Kobelyatsky Yuriy
Dnipro State Medical University
Head of the Department of Anaesthesiology and Intensive Care
Doctor of Medical Sciences, Professor
Е-mail: anest@dmu.edu.ua
Orchid ID: https://orcid.org/0000-0002-8504-6125
Shkitak Inna
Dnipro State Medical University
Postgraduate student of the Department of Anaesthesiology and Intensive Care
Е-mail: shkitak.inna@gmail.com
Orchid ID: https://orcid.org/0000-0002-2019-6173
Abstract
Adequate anesthesia management for total laryngectomy requires a reasonable balance between the appropriate use of opioids and the avoidance of harm associated with them.
Aim: comparative evaluation of various options for multimodal perioperative analgesia and search for optimal methods of anesthesia for total laryngectomy.
Materials and methods: The study was conducted with the involvement of 100 patients with T3-4N0-3M0 laryngeal cancer who underwent total laryngectomy: Group I (n=25) received classical anesthesia with standard doses of opioid analgesics; Group II (n=25) received an additional infusion of lidocaine; Group III (n=25) received an additional infusion of dexmedetomidine; Group IV (n=25) received an infusion of both lidocaine and dexmedetomidine. Parameters of the cardiovascular and respiratory systems, BIS and ANI data were recorded at 8 stages of surgery. Statistical analysis was carried out using the methods of descriptive and analytical statistics using the STATISTICA v.6.1 software product (Statsoft Inc., USA, license no. AGAR909E415822FA).
Results and discussion: When used as adjuvant components of anesthesia, lidocaine (Group II), dexmedetomidine (Group III), or their combination (Group IV), compared with standard analgesia (Group I), there was an acceleration of awakening, an increase in the time of postoperative analgesia, and a significant decrease in intraoperative analgesics (p<0.001). In group IV, a statistically significantly (p<0.05) better result was observed according to the BIS and ANI indices. Despite a certain tendency to hypotension and bradycardia, the use of lidocaine and dexmedetomidine maintained the stable state of systemic hemodynamics.
Conclusions: A comparative evaluation of various schemes of anesthesia for total laryngectomy showed the feasibility of multimodal anesthesia and opioid-limiting anesthesia with the combined use of lidocaine and dexmedetomidine.
Key words: laryngeal cancer, total laryngectomy, multimodal analgesia, low-opioid anesthesia.
References
- Beverly A, Kaye AD, Ljungqvist O, Urman RD. Essential Elements of Multimodal Analgesia in Enhanced Recovery After Surgery (ERAS) Guidelines. Anesthesiol Clin. 2017 Jun;35(2):e115-e143. doi: 10.1016/j.anclin.2017.01.018.
- De Cassai A, Geraldini F, Tulgar S, Ahiskalioglu A, Mariano ER, Dost B, et al. Opioid-free anesthesia in oncologic surgery: the rules of the game. J Anesth Analg Crit Care. 2022;2: doi.org/10.1186/s44158-022-00037-8.
- Du E, Farzal Z, Stephenson E, Tanner A, Adams K, Farquhar D, et al. Multimodal Analgesia Protocol after Head and Neck Surgery: Effect on Opioid Use and Pain Control. Otolaryngol Head Neck Surg. 2019 Sep;161(3):424-30. doi: 10.1177/0194599819841885.
- Ghimire A, Subedi A, Bhattarai B, Sah BP. The effect of intraoperative lidocaine infusion on opioid consumption and pain after totally extraperitoneal laparoscopic inguinal hernioplasty: a randomized controlled trial. BMC Anesthesiol. 2020 Jun 3;20(1):137. doi: 10.1186/s12871-020-01054-2.
- Guo H, Ao T, Wang J, Zhang X, Zheng J, Xiao Y, et al. Clinical Efficacy of Perioperative Intravenous Dexmedetomidine and Lidocaine Combined Infusion for Thyroidectomy: A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial. Clin J Pain. 2022 Feb 3;38(4):264-70. doi: 10.1097/AJP.0000000000001027.
- Hinther A, Abdel-Rahman O, Cheung WY, Quan ML, Dort JC. Chronic Postoperative Opioid Use: A Systematic Review. World J Surg. 2019 Sep;43(9):2164-74. doi: 10.1007/s00268-019-05016-9.
- Hinther A, Nakoneshny SC, Chandarana SP, Matthews TW, Hart R, Schrag C, et al. Efficacy of Multimodal Analgesia for Postoperative Pain Management in Head and Neck Cancer Patients. Cancers (Basel). 2021 Mar 12;13(6):1266. doi: 10.3390/cancers13061266.
- O’Neill A, Lirk P. Multimodal Analgesia. Anesthesiol Clin. 2022 Sep; 40(3):455-68. doi: 10.1016/j.anclin.2022.04.002.
- Rekatsina M, Theodosopoulou P, Staikou C. Effects of Intravenous Dexmedetomidine Versus Lidocaine on Postoperative Pain, Analgesic Consumption and Functional Recovery After Abdominal Gynecological Surgery: A Randomized Placebo-controlled Double Blind Study. Pain Physician. 2021 Nov;24(7):E997-E1006.
- Weibel S, Jelting Y, Pace NL, Helf A, Eberhart LH, Hahnenkamp K, et al. Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery in adults. Cochrane Database Syst Rev. 2018 Jun 4;6(6):CD009642. doi: 10.1002/14651858.CD009642.pub3.