The Postoperative Lidocaine and Ketamine Effects on Morphine Requirement in Bariatric Surgery

Abstract

Background Effective postoperative pain management in obese patients undergoing bariatric surgery is challenging due to the adverse effects associated with opioid use. Multimodal analgesic approaches during the intraoperative period have shown to effectively reduce postoperative opioid consumption This study evaluates the impact of prolonged postoperative lidocaine and ketamine infusion for 90 minutes on postoperative morphine consumption as a complementary multimodal analgesic approach. Methods This retrospective cohort study included 64 patients who underwent elective sleeve gastrectomy and gastric bypass. Thirty-two patients who received lidocaine and ketamine infusions postoperatively (Group A) were compared with 32 patients who received standard postoperative analgesia (Group B). The primary outcome measured was total morphine consumption within the first 48 hours post-surgery. Pain was assessed using the Visual Analog Scale (VAS) at 1, 2, 4, 24, and 48 hours post-surgery. Results Mean cumulative morphine consumption at 48 hours was 0.82 ± 1.55 mg in Group A versus 2.03 ± 2.61 mg in Group B (p = 0.0696). : In total, 62.5% of patients did not require morphine during the first 48 postoperative hours. VAS scores were significantly lower in Group A at the four postoperative hour (1.03 ± 1.36) vs Group B (2.16 ± 1.65), p-value 0.0024. Conclusion Postoperative morphine consumption and pain scores were low with the current multimodal analgesic approach. Prolonging lidocaine and ketamine infusion for 90 minutes postoperatively is not justified based on current results.