ĐÁNH GIÁ HIỆU QUẢ GIẢM ĐAU PHỐI HỢP LIDOCAIN, KETAMIN VÀ MAGIE SULFATE TĨNH MẠCH THAY THẾ OPIOID TRONG GÂY MÊ TOÀN THÂN PHẪU THUẬT CẮT TUYẾN GIÁP

Abstract

Objective: Evaluate the analgesic effectiveness and unwanted effects of a combination of lidocaine, ketamine and intravenous magnesium sulfate during and after thyroidectomy surgery. Research subjects and methods: Randomized clinical trial design comparing 64 thyroidectomy patients divided into two groups: Group 1 (OA- Opioid Anesthesia group): anesthesia using intravenous fentanyl, Group 2 (OA group): OFA-Opioid-Free Anesthesia group): anesthesia using intravenous lidocaine, magnesium sulfate and ketamine. During surgery, patients were monitored through ANI (Analgesia Nociception Index). After surgery, patients were monitored for 24 hours, from the time the endotracheal tube was removed and fully awake. Results: The total time of ANI < 50 during surgery was higher in group 1 than in group 2 (15.63 ± 4.86 minutes versus 11.47 ± 5.68 minutes; p < 0.05). The average VAS score in the first hour after surgery when resting, when moving the neck and when coughing in group 1 was significantly higher than in group 2 (3.09 ± 0.8; 3.35 ± 0.89; 3, 51 ± 1.02 vs. 1.85 ± 0.53, 2.79 ± 1.13; 2.19 ± 1.08; p < 0,05), the amount of ketorolac used for rescue within 24 hours after surgery in Group 1 was statistically significantly higher than group 2 (420mg vs 210mg). The rate of postoperative nausea and vomiting in group 1 was statistically significantly higher than that in group 2 (34.47% vs. 9.37%; p < 0.05). The proportion of patients with postoperative irritation in group 1 and group 2 is 31.25% and 12.5%, respectively, the difference is statistically significant (p < 0,05). Conclusion: Combining lidocaine, ketamine and magnesium sulfate provides better pain relief both during and after surgery, and the unwanted side effects are also lower than anesthesia using opioids alone.