Effect of Intraoperative Lidocaine vs. Dexmedetomidine Infusion on Postoperative Opioid Use in Laparoscopic Cholecystectomy
DOI:
https://doi.org/10.36283/ziun-pjmd14-4/080Keywords:
KWAbstract
Background: Laparoscopic cholecystectomy is a commonly performed abdominal procedure associated with significant postoperative pain that is often treated with opioids, resulting in delayed recovery and adverse effects. The objective of this study was to compare the intraoperative intravenous lidocaine infusion versus dexmedetomidine infusion on postoperative opioid requirement in patients undergoing laparoscopic cholecystectomy under general anesthesia.
Methods: A total of 300 ASA class I-II adults aged 18-60 years, scheduled for elective laparoscopic cholecystectomy were randomized into two groups: Group L (lidocaine) received a 1.5 mg/kg bolus followed by 2 mg/kg/h infusion, and Group D (dexmedetomidine) received a 1 ug/kg loading followed by 0.5 ug/kg/h infusion. Statistical analysis was performed by t-test and chi-square using SPSS v26 with a p < 0.05 for significance level.
Results: Lidocaine significantly decreased 24-hour opioid consumption (12.6 ± 4.1 mg versus 15.8 ± 4.7 mg, p < 0.001). Pain scores were lower at 6 hours (3.2 ± 0.9 vs. 3.8 ± 1.0, p = 0.001) and 24 hours (2.5 ± 0.8 vs. 3.1 ± 0.9, p < 0.001). Extubation time was shorter with lidocaine (9.4 ± 2.1 vs. 11.2 ± 2.6 min, p < 0.001). The incidence of PONV, 23 (15.3%) vs. 41 (27.3%), p = 0.10, and post-anesthesia care unit (PACU) stay (42.5 ± 8.7 vs. 44.1 ± 9.2 min, p = 0.31) were not significantly different.
Conclusion: Intraoperative intravenous lidocaine infusion resulted in superior opioid-sparing and analgesic effects compared to dexmedetomidine, supporting its use as a valuable adjunct.
References
1. Duarte-Medrano G, Nuño-Lámbarri N, Dominguez-Franco A, Lopez-Rodriguez Y, Minutti-Palacios M, Palacios-Chavarria A, et al. Perioperative intravenous lidocaine infusion for postsurgical pain management in bariatric surgery patients. J Anesth Analg Crit Care. 2024 Oct 30;4(1):73. doi: 10.1186/s44158-024-00208-9.
2. Purohit A, Kumar M, Kumar N, Bindra A, Pathak S, Yadav A. Comparison between dexmedetomidine and lidocaine for attenuation of cough response during tracheal extubation: A systematic review and meta-analysis. Indian J Anaesth. 2024 May;68(5):415-425. doi: 10.4103/ija.ija_790_23.
3. Sarakatsianou C, Perivoliotis K, Baloyiannis I, Georgopoulou S, Tsiaka A, Tzovaras G. Efficacy of intraoperative intravenous lidocaine infusion on postoperative opioid consumption after laparoscopic cholecystectomy: a randomized controlled trial. Langenbecks Arch Surg. 2023 May 18;408(1):197. doi: 10.1007/s00423-023-02937-x.
4. Taiym D, Cowan M, Nakamura B, Azad H, Strohl A, Barber E. Effect of continuous post-operative lidocaine infusion in an enhanced recovery program on opioid use following gynecologic oncology surgery. J Gynecol Oncol. 2023 Sep;34(5):e61. doi: 10.3802/jgo.2023.34.e61.
5. Bukhari AA, Shaikh AR, Salman W, Bhatti FA, Malik W, Minhas M, et al. Pathophysiological role of nerve growth factor (NGF) in asthma: insights into airway inflammation, remodeling, and neural regulation in intensive care settings. Anaesth. pain intensive care. 2025;29(3):681-689. doi: 10.35975/apic.v29i3.2778
6. Kim M, Huh J, Choi H, Hwang W. Impact of Dexmedetomidine-Based Opioid-Sparing Anesthesia on Opioid Use After Minimally Invasive Repair of Pectus Excavatum: A Prospective Randomized Controlled Trial. J Clin Med. 2024 Nov 29;13(23):7264. doi: 10.3390/jcm13237264.
7. Awan B, Elsaigh M, Elkomos BE, Sohail A, Asqalan A, Baqar SOM, et al. The use of lidocaine infusion in laparoscopic cholecystectomy: An updated systematic review and meta-analysis. J Minim Access Surg. 2024 Jul 1;20(3):239-246. doi: 10.4103/jmas.jmas_265_23.
8. Chen R, Sun S, Li Y, Dou X, Dai M, Wu Y, et al. Efficacy and safety evaluation of dexmedetomidine for postoperative patient controlled intravenous analgesia: A systematic review and meta-analysis. Front Pharmacol. 2022 Dec 12;13:1028704. doi: 10.3389/fphar.2022.1028704.
9. Besnier E, Moussa MD, Thill C, Vallin F, Donnadieu N, Ruault S, et al. Opioid-free anaesthesia with dexmedetomidine and lidocaine versus remifentanil-based anaesthesia in cardiac surgery: study protocol of a French randomised, multicentre and single-blinded OFACS trial. BMJ Open. 2024 Jun 3;14(6):e079984. doi: 10.1136/bmjopen-2023-079984.
10. Urooj S, Javaid H, Andleeb S, Mughal A, Naz A, Shah SJ, et al. Comparison of dexmedetomidine, fentanyl, and lidocaine in attenuation of hemodynamic responses during intubation in patients undergoing laparoscopic cholecystectomy. APICARE. 2024 May 30;28(3):524–33. doi: 10.35975/APIC.V28I3.1737.
11. Xie D, Wang F, Wen W, Li H. Postoperative analgesic effect of intravenous coinjection of lidocaine and dexmedetomidine in gynaecological surgery: a systematic review and meta-analysis. BMJ Open. 2024 Dec 11;14(12):e091904. doi: 10.1136/bmjopen-2024-091904.
12. Zulfania Z, Hayat H, Mahmood R, Bukhari AA, Ihtesham Y, Rasool U. COMPARISON OF PLATELET INDICES IN HYPOPRODUCTIVE AND HYPERDESTRUCTIVE THROMBOCYTOPENIA. Pakistan Journal of Physiology. 2021 Jun 30;17(2):3-6. doi: 10.69656/pjp.v17i2.1283
13. Ullah I, Bukhari AA, Durrani M, Khan Z, Tauqir S, Farid B, et al. Risk factors for ventricular tachycardia in acute ST-elevated myocardial infarction patients of a tertiary care hospital of Peshawar. Journal of Rehman Medical Institute. 2020;6(4):12-5. doi: 10.52442/jrmi.v6i4.168
14. Zhang Y, Ilyas M, Yilin W, Su Y, Bukhari AA, Ahmad A. A Methodical Approach to Scrutinize the Role of Body Mass Index in Heart Rate Increment and Recovery. Journal of Gandhara Medical & Dental Sciences (JGMDS). 2022 Oct 2;9(4):31-6. doi: 10.37762/jgmds.9-4.335
15. Bhardwaj R, Agrawal U, Vashist P, Manna S. Determination of sample size for various study designs in medical research: A practical primer. J Family Med Prim Care. 2024 Jul;13(7):2555-2561. doi: 10.4103/jfmpc.jfmpc_1675_23.
16. El-Boghdadly K, Jack JM, Heaney A, Black ND, Englesakis MF, Kehlet H, et al. Role of regional anesthesia and analgesia in enhanced recovery after colorectal surgery: a systematic review of randomized controlled trials. Reg Anesth Pain Med. 2022 May;47(5):282-292. doi: 10.1136/rapm-2021-103256.
17. Dai Y, Jiang R, Su W, Wang M, Liu Y, Zuo Y. Impact of perioperative intravenous lidocaine infusion on postoperative pain and rapid recovery of patients undergoing gastrointestinal tumor surgery: a randomized, double-blind trial. J Gastrointest Oncol. 2020 Dec;11(6):1274-1282. doi: 10.21037/jgo-20-505.
18. Okcul İ, Oral SE. The effects of early mobilization on pain and quality of recovery in patients undergoing laparoscopic cholecystectomy surgery. IJTMCR. 2023;4(3):153-61. doi: 10.53811/ijtcmr.1342768.
19. Sin JCK, Tabah A, Campher MJJ, Laupland KB, Eley VA. The Effect of Dexmedetomidine on Postanesthesia Care Unit Discharge and Recovery: A Systematic Review and Meta-Analysis. Anesth Analg. 2022 Jun 1;134(6):1229-1244. doi: 10.1213/ANE.0000000000005843.
20. Liu X, Li Y, Kang L, Wang Q. Recent Advances in the Clinical Value and Potential of Dexmedetomidine. J Inflamm Res. 2021 Dec 30;14:7507-7527. doi: 10.2147/JIR.S346089.
21. Syrous NS, Sundstrøm T, Søfteland E, Jammer I. Effects of Intraoperative Dexmedetomidine Infusion on Postoperative Pain after Craniotomy: A Narrative Review. Brain Sci. 2021 Dec 11;11(12):1636. doi: 10.3390/brainsci11121636.
22. Kumari R, Bhalotra AR, Dhiman S. Effects of perioperative infusion of lidocaine versus dexmedetomidine on postoperative pain and recovery in patients undergoing laparoscopic cholecystectomy: A randomized trial. IJMA. 2020;3(2):70-5.
23. Reichert M, Willis F, Post S, Schneider M, Vilz T, Willis M, et al. Pharmacologic prevention and therapy of postoperative paralytic ileus after gastrointestinal cancer surgery: systematic review and meta-analysis. Int J Surg. 2024 Jul 1;110(7):4329-4341. doi: 10.1097/JS9.0000000000001393.
24. Zhang X, Liu G, Sun C, Zhong Y, Wang L, Huang Z, et al. Assessment of the effect of perineural dexmedetomidine on oxidative stress during peritoneal dialysis catheter insertion: a randomized, controlled trial. Int Urol Nephrol. 2022 Dec;54(12):3203-3210. doi: 10.1007/s11255-022-03268-4.
25. Rekatsina M, Theodosopoulou P, Staikou C. Perioperative Dexmedetomidine or Lidocaine Infusion for the Prevention of Chronic Postoperative and Neuropathic Pain After Gynecological Surgery: A Randomized, Placebo-Controlled, Double-Blind Study. Pain Ther. 2022 Jun;11(2):529-543. doi: 10.1007/s40122-022-00361-5.
26. Gao T, Liu X, Liu S, Liu F, Zhou Y, Wang S, et al. Antianxiety effects of dexmedetomidine: systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci. 2025 May 15. doi: 10.1007/s00406-025-02017-9.
27. Ghai B, Jafra A, Bhatia N, Chanana N, Bansal D, Mehta V. Opioid sparing strategies for perioperative pain management other than regional anaesthesia: A narrative review. J Anaesthesiol Clin Pharmacol. 2022 Jan-Mar;38(1):3-10. doi: 10.4103/joacp.JOACP_362_19.
28. Hyland SJ, Brockhaus KK, Vincent WR, Spence NZ, Lucki MM, Howkins MJ, et al. Perioperative Pain Management and Opioid Stewardship: A Practical Guide. Healthcare (Basel). 2021 Mar 16;9(3):333. doi: 10.3390/healthcare9030333.
29. Shah SS, Alam A, Shah Bukhari AA, Ahmed J, Haindongo J. Decoding prescriptions: A closer look at common errors in clinical practice across community pharmacies of Northern Cyprus. Pak J Pharm Sci. 2025 Jul-Aug;38(4):1195-1202. doi: 10.36721/PJPS.2025.38.4.REG.14103.1.
30. Kausar R, Batool A, Bukhari AA, Shaikh AR, Aleem A, Minhas M, et al. Crosslinking Salivary Diagnosis with Non-Invasive Insights to Oral Pathology: Novel Systematic Insights to Personalized Medicine in Disease Management. . Pak Armed Forces Med J 2025; 75(3): 611-616. doi: 10.51253/pafmj.v75i3.13199
31. Shah SS, Alam A, Bukhari AA, Ahmed J, Haindongo J. Decoding prescriptions: A closer look at common errors in clinical practice across community pharmacies of Northern Cyprus. Pak. J. Pharm. Sci. 2025 Jul;38(4):1195-202. doi: 10.36721/PJPS.2025.38.4.REG.14103.1
32. Farid B, Bukhari AA, Tauqir S, Bibi N, Majid B, Jan M. Vaccine hesitancy in COVID-19: a major matter of concern. J Rehman Med Inst. 2022 Oct 8;8(3):20-3. doi: 10.52442/jrmi.v8i3.484
33. Bukhari AA, Durrani M, Khan Z, Shafiq M, Tauqir S, ur Rehman A. Urinary excretion of electrolytes and their correlation with clinical parameters in chronic kidney disease. Journal of Rehman Medical Institute. 2020 Jul 10;6(2):08-11. doi: 10.52442/jrmi.v6i2.175
34. Tahira S, Bibi F, Niaz M, Bukhari AA, Butt AI, Khan E. Multi-organ pathophysiology of endometriosis: Evaluating neurotrophin linked multifaceted health risks assessments. Official Journal of Pakistan Medical Association, Rawalpindi–Islamabad Rawalpindi–Islamabad Branch Apr–Jun 2025 Volume 50 Number 2. 2025 Apr;50(2):377.
35. KHAFAGA R, SHAH SS, AHMAD NA, BUKHARI AA. Assessment and Management of Adult Asthmatic Patient in Community Pharmacies of Port Said, Egypt. Lat Am J Pharm. 2025;44(2):97-102.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Pakistan Journal of Medicine and Dentistry
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access article distributed under the terms of the CreativeCommons Attribution License (CC BY) 4.0 https://creativecommons.org/licenses/by/4.0/
Metrics
How to Cite
