Clinical Efficacy Of Perioperative Intravenous Dexmedetomidine And Lidocaine Combined Infusion For Thyroidectomy

Background:Thyroidectomy can lead to moderate postoperative pain,which may restrict movement,prolong rehabilitation,lower quality of recovery,and even caused mental and psychological changes such as anxiety and depression.Postoperative nausea and vomiting（PONV）is high risk in thyroidectomy,which may lead to some severe complication,such as the wound bleeding,hematoma formation and airway obstruction.Because postoperative opioids usage is a known risk factor for PONV.Therefore,routine postoperative analgesia based on opioid usage is not ideal for patients undergoing thyroidectomy.Consequently,developing a new anesthesia management,which can attenuate postoperative pain instead of using opioid,may improve the experience and outcome of patients with thyroidectomy.Objective:To evaluate the efficacy of perioperative dexmedetomidine（DEX）combined with lidocaine intravenous infusion on relieving postoperative pain and improving recovery for patients undergoing thyroidectomy.Methods:138 patients undergoing thyroidectomy with general anesthesia were randomly divided into four groups:lidocaine(1.5 mg/kg bolus followed by 2 mg kg^-1h^-1infusion)in group L,DEX（0.5μg/kg）in group D,lidocaine（same as group L）with DEX（0.5μg/kg）in group L+D,and placebo as normal saline in group C.The VAS score of patients at 1,4,8,12 and 24h following surgery,opioid requirement,propofol consumption,incidence of PONV,awaking time,hemodynamic variables and any adverse effects were assessed.Results:1.Compared with group C,the VAS scores of patients in group L+D were significantly lower at 1h,4h,8h after surgery（P<0.01,respectively）.The VAS scores of patients in group L were significantly decreased at 1h and 4h after surgery（P<0.01,respectively）,but there was no difference at 8h（P>0.05）when compared with group C.The VAS score of group D was significantly lower than that of group C at 1h after surgery（P<0.01）,but there was no significant difference at 4h and 8h after surgery（P>0.05）.There was no significant difference in VAS scores at 12h and 24h among the groups（P>0.05）.2.There was no significant difference in perioperative sufentanil consumption between four groups（P>0.05）.3.Compared with group C,propofol consumption was significantly decreased in groups L,group D and group L+D during the perioperative period（P<0.05,respectively）.Furthermore,compared with group L and group D,propofol dosage in group L+D was significant lower（P<0.05,respectively）.There was no significant difference in propofol total dose between group L and group D（P>0.05）.4.The incidence of hypotension was higher in group D and group L+D,however there was no statistic difference between all groups（P>0.05）.Compared with group C,the incidence of bradyarrhythmia were higher in group L+D and group D（P<0.05,respectively）,but the incidence in group L was no difference with group C（P>0.05）.There was no difference between group L+D and group D on the incidence of bradyarrhythmia（P>0.05）.Compared with other three groups,the incidences of PONV were lower in group L+D（6.5%）（P<0.05,respectively）.Compared with group C,the incidence of PONV in group L and group D were no difference（P>0.05）.No local anesthetic toxicity was observed in the study.5.Compared with group C,awaking time was significant shorter in group L+D and group L（P<0.05,respectively）.However,awaking time of patients in group D was significantly longer than that of group C（P<0.05）.Compared with group L,the time to awareness in group L+D was no difference（P>0.05）.6.There were no differences in MAP or HR between all patients at T1（P>0.05）. Compared with group C,MAP and HR of patients in groups L,D and L+D were significantly lower at T2,T3,and T4（P<0.05）.Compared with group L and group D,MAP and HR in group L+D were no differences at each time point（P>0.05）.Conclusion:This study demonstrates that dexmedetomidine combined with lidocaine infusion maybe a safe and effective anesthesia regimen for thyroidectomy,which can effectively prolong the postoperative analgesia,reduce the incidence of postoperative nausea and vomiting and improve postoperative awaking without any serious adverse events.