Review article
https://doi.org/10.26800/LV-144-supl3-8
The use of lidocaine and ketamine in the setting of abdominal surgery
Helena Ostović
; Klinika za anesteziologiju, reanimatologiju i intenzivnu medicinu, Klinička bolnica Dubrava, Zagreb, Medicinski fakultet Osijek, Sveučilište J. J. Strossmayera u Osijeku, Osijek
Brankica Šimac
; Klinički zavod za laboratorijsku dijagnostiku, Klinička bolnica Dubrava, Zagreb
Jasminka Peršec
; Klinika za anesteziologiju, reanimatologiju i intenzivnu medicinu, Klinička bolnica Dubrava, Stomatološki fakultet, Sveučilište u Zagrebu, Zagrebagreb,
Supplements: 08_ostovic.pdf
Abstract
Abdominal surgeries are among the most commonly performed surgical operations. They are accompanied by intestinal, intraperitoneal and an exaggerated systemic inflammatory response with acute postoperative pain and risk of postoperative ileus. The intensity of the inflammatory response, as a consequence of surgical stress, is proportional to the extent of surgical tissue injury, severity of postoperative pain and development of postoperative complications. Therefore, effective analgesia with reduced opioid use and early restoration of gastrointestinal function is necessary for the recovery of these patients. It has been shown that perioperative intravenous infusions of lidocaine and ketamine have a potential immunomodulatory effect on the surgical stress response, improve the quality of pain control, and influence gastrointestinal motility. Intravenous lidocaine has an anti-inflammatory effect with prokinetic, analgesic and antihyperalgesic properties. Its use reduces serum levels of interleukins (IL-6, IL-8), complement component C3a and interleukin-1 receptor antagonist (IL-1ra). The best effect of lidocaine has been shown in major colorectal surgeries, due to improved control of postoperative analgesia, decreased incidence of postoperative ileus and improvement of clinical outcomes of enhanced recovery after surgery (ERAS). Ketamine exerts an anti-inflammatory effect at subanesthetic doses, acting directly on the immune system and indirectly as an analgesic. Direct action is mediated through reduction of serum levels of C-reactive protein (CRP) and IL-6 and inhibiton of nuclear factor-κB (NF-κB) and activator protein 1 (AP-1), which regulate the transcription of genes responsible for production of proinflammatory mediators. Acting as an analgesic, ketamine causes potentiation of opioid analgesia with reduced opioid consumption. Standard treatment procedure in abdominal surgery involves the use of minimally invasive surgical technique and ERAS protocol with an emphasis on multimodal analgesia. Lidocaine and ketamine provide useful adjuvant therapy to opioids, and since they are cheap and long-established drugs in anesthesia practice, it is easy to implement them clinically.
Keywords
ABDOMEN; KETAMINE; LIDOCAINE; POSTOPERATIVE PAIN; SURGERY
Hrčak ID:
284187
URI
Publication date:
25.9.2022.
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