Overview
Opioids are widely used during anesthesia for pain control, but they cause many side effects-such as nausea, constipation, respiratory depression, dependence, and delayed recovery. They can also worsen low blood pressure in patients with unstable circulation. Because of these risks, multimodal analgesia is recommended to reduce opioid use.
Research on other non-opioid options is limited. Systemic lidocaine offers anti-inflammatory and opioid-sparing benefits and improves recovery in elective colorectal surgery, but its role in emergency laparotomy is still unclear and requires further study.
Description
preoperatively, 8 mg dexamethasone will be slowly administrated. Fluid responsiveness will be defined as a 10% increase in stroke volume after passive leg raising maneuver. If responder will be given 500-mL bolus of lactated ringer.
induction of anesthesia: 2 mg/kg propofol and 1 mg/kg succinyl choline. Anesthesia will be maintained by isoflurane in air/oxygen admixture. Atracurium will be administered after patient recovery from succinylcholine at a dose of 0.5 mg/Kg.
A 10-12 mL/kg/hr of lactated ringer will be infused during the procedure. If patients developed hypotension (mean arterial pressure (MAP) ≤ 70% of the baseline reading and/or \<65 mmHg), a fluid bolus of 4 mL/kg will be given and the change in the pulse pressure will be noted. If the pulse pressure increases by \>10 %, the fluid bolus will be given until the increase in pulse pressure is \<10%. If hypotension persists despite the adequate volume replacement a 5-10 mg bolus of ephedrine will be given. The bolus will be repeated if MAP was not restored within 2 min. Infusion of norepinephrine can be given if MAP persisted \<65 mmHg despite 5 boluses.
At the end of the procedure, all patients will receive 1 gm of paracetamol intravenously and local infiltration of the wound with 40 mL of 0.125% bupivacaine.
Postoperative management All patients will receive 1 gm/ 6h of paracetamol.
Eligibility
Inclusion Criteria:
- Adult patients (21-65 years), ASA I-III undergoing emergency laparotomy with midline incision
Exclusion Criteria:
- Severe cardiac morbidities (impaired contractility with ejection fraction \< 45%, heart block, arrhythmias, tight valvular lesions)
- Patients on vasopressor infusion, patients with high shock index (heart rate / systolic blood pressure \>1)
- Body mass index \<18 or \> 35 Kg/m2,
- Pregnant or lactating women,
- Allergy of any of the study drugs
- Severe liver cell failure and renal impairment by history and/or abnormal liver and kidney function tests.
