Clinical Benefits of Ketamine and Lidocaïne in the Morphine Saving Strategy in Major Digestive Surgery in a Middle-income Country

Abstract

Introduction: The use of adjuvants in general anesthesia (GA) is experiencing renewed interest in digestive surgery [1,2]. Objective: To provide proof of the efficacy of Ketamine and Lidocaine in the morphine saving strategy in digestive surgery. Materials and Methods: This was a randomized, single-blind, controlled trial. The study took place over a period of 6 months, from July to December 2020 at the Essos hospital center. Patients over 18 years of age scheduled for digestive surgery were divided into 3 groups: Ketamine (GK), Lidocaine (GL), control (GT). At induction of anesthetic, the GK group received IV ketamine as a bolus dose of 0.5 mg / kg; then 0.125 mg / kg / h continuously intravenously with an electric syringe pump (IVSE). The GL group received Lidocaine as an IV bolus of 1.5 mg / kg at induction anesthetic, followed by 1 mg / kg / h IVSE. The GT group did not receive any adjuvant administration. Intra and postoperative opioid consumption, intensity of postoperative pain, area of peri-scarring hyperalgesia and incidence of postoperative nausea and vomiting (PONV) were listed. A probability P <0.05 was used as the significance level. Results: During the survey period 60 participants met the inclusion criteria: 27 for the GK group, 15 for the GL group and 18 for the GT group. The average age of the participants was 55 with extremes ranging from 18 to 65. The sex ratio was 2.5 in favor of men. The majority of the workforce was in the ASA 2 class (57.1%). The main indications for surgery were hemicolectomy (33.3%), bilio-digestive bypass (19%) and cholecystectomy (14.8%). Ketamine and Lidocaine reduced intraoperative fentanyl consumption by 67.7% and 42.85%, respectively (P <0.001). The postoperative morphine savings were remarkable with Ketamine and Lidocaine in the order of 14.8mg and 20mg respectively (P = 0.001). The numerical scale was significantly improved with Ketamine and Lidocaine in the first 24 hours postoperatively (P = 0.001). The area of pericicatricial hyperalgesia was limited to the operative site for all participants in the GK and GL groups (P <0.001). The incidence of PONV was reduced in the test groups in a comparable manner (p = 0.045). Conclusion: The use of ketamine and IV lidocaine in the morphine sparing strategy in digestive surgery has been shown to be effective. The benefit / risk balance argues in favor of the use of these molecules in countries with low per capita income.