Is Multimodal Anesthesia Effecting Postoperative Nausea and Vomiting in Laparoscopic Cholecystectomy?

Area of Science:

• Anesthesiology
• Pharmacology

Background:

• Multimodal anesthesia aims to improve analgesia and reduce opioid-related side effects like postoperative nausea and vomiting (PONV).
• PONV is a common complication following laparoscopic cholecystectomy, often exacerbated by intraoperative opioid use.
• Investigating adjuncts to intraoperative fentanyl can mitigate PONV and opioid consumption.

Purpose of the Study:

• To compare the incidence of PONV among patients receiving intraoperative lidocaine, ketamine, or magnesium sulfate combined with fentanyl.
• To assess additional nausea and vomiting episodes.
• To measure intraoperative fentanyl requirements across the three groups.

Main Methods:

• A randomized, prospective study involving 120 patients (aged 20-65, ASA 1-2) undergoing laparoscopic cholecystectomy.
• Patients were allocated to receive either lidocaine, ketamine, or magnesium sulfate intraoperatively, alongside fentanyl.
• Postoperative nausea and vomiting were monitored at 1, 4, 8, 12, and 24 hours, with metoclopramide administered for vomiting.

Main Results:

• The lidocaine group exhibited significantly lower PONV incidence and reduced intraoperative fentanyl requirements compared to ketamine and magnesium groups.
• The ketamine group reported more nausea, while the magnesium group showed a higher rate of vomiting.
• Although fentanyl doses varied, the differences between groups were not statistically significant.

Conclusions:

• Multimodal anesthesia, particularly with lidocaine, effectively reduces PONV 24 hours post-laparoscopic cholecystectomy.
• The use of lidocaine, ketamine, or magnesium sulfate intraoperatively can decrease the overall need for opioids during the procedure.