title: [Opioid-free total intravenous anesthesia with propofol, dexmedetomidine and lidocaine infusions for laparoscopic cholecystectomy: a prospective, randomized, double-blinded study].
abstract: OBJECTIVE
  Intraoperative use of opioids may be associated with postoperative hyperalgesia and increased analgesic consumption. Side effects due to perioperative use of opioids, such as postoperative nausea and vomiting may delay discharge. We hypothesized that total intravenous anesthesia consisting of lidocaine and dexmedetomidine as an opioid substitute may be an alternative technique for laparoscopic cholecystectomy and would be associated with lower fentanyl requirements in the postoperative period and less incidence of postoperative nausea and vomiting.
  
  
  METHODS
  80 Anesthesiologists I-II adults were scheduled for elective laparoscopic cholecystectomy. Patients were randomly allocated into two groups to have either opioid-free anesthesia with dexmedetomidine, lidocaine, and propofol infusions (Group DL) or opioid-based anesthesia with remifentanil, and propofol infusions (Group RF). All patients received a standard multimodal analgesia regimen. A patient controlled analgesia device was set to deliver IV fentanyl for 6h after surgery. The primary outcome variable was postoperative fentanyl consumption.
  
  
  RESULTS
  Fentanyl consumption at postoperative 2nd hour was statistically significantly less in Group DL, compared with Group RF, which were 75±59μg and 120±94μg respectively, while it was comparable at postoperative 6th hour. During anesthesia, there were more hypotensive events in Group RF, while there were more hypertensive events in Group DL, which were both statistically significant. Despite higher recovery times, Group DL had significantly lower pain scores, rescue analgesic and ondansetron need.
  
  
  CONCLUSIONS
  Opioid-free anesthesia with dexmedetomidine, lidocaine and propofol infusions may be an alternative technique for laparoscopic cholecystectomy especially in patients with high risk for postoperative nausea and vomiting.
authors.affiliation: Departamento de Anestesiologia e Reanimação, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turquia. Electronic address: mefkur@yahoo.com.
authors.forename: Mefkur
authors.initials: M
authors.lastname: Bakan
authors.affiliation: Departamento de Anestesiologia e Reanimação, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turquia.
authors.forename: Tarik
authors.initials: T
authors.lastname: Umutoglu
authors.affiliation: Departamento de Anestesiologia e Reanimação, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turquia.
authors.forename: Ufuk
authors.initials: U
authors.lastname: Topuz
authors.affiliation: Departamento de Anestesiologia e Reanimação, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turquia.
authors.forename: Harun
authors.initials: H
authors.lastname: Uysal
authors.affiliation: Departamento de Medicina Pulmonar, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turquia.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Bayram
authors.affiliation: Departamento de Cirurgia Geral, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turquia.
authors.forename: Huseyin
authors.initials: H
authors.lastname: Kadioglu
authors.affiliation: Departamento de Anestesiologia e Reanimação, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turquia.
authors.forename: Ziya
authors.initials: Z
authors.lastname: Salihoglu
keywords: Anestesia venosa total; Colecistectomia laparoscópica; Dexmedetomidina; Dexmedetomidine; Laparoscopic cholecystectomy; Lidocaine; Lidocaína; Propofol; Remifentanil; Total intravenous anesthesia