Efficacy of systemic lidocaine infusion compared with systemic ketorolac infusion in improvement of recovery after laparoscopic bariatric surgery

Background Obese patients are at a high risk for both aspiration and acute airway obstruction after tracheal extubation. Thus, rapid recovery is desirable to ensure early efficient coughing and to decrease the rate of postoperative respiratory complications. Patients and methods Sixty patients who were assigned for elective laparoscopic bariatric surgery were divided into three equal groups. Lidocaine group, in which the patients received intravenous (i.v.) lidocaine (1.5 mg/kg bolus, followed by a 2 mg/kg/h infusion until the end of surgery); ketorolac group, in which the patients received i.v. ketorolac (30 mg i.v. as a bolus over 15–30 s, followed by a continuous i.v. infusion of ketorolac 0.5 mg/kg/h until the end of surgery); and the control group, in which participants received an i.v. infusion (normal saline) of the same volume as the drug groups. Immediate recovery from anesthesia was assessed on the basis of the time to eye opening, extubation, and orientation from the time of discontinuation of inhalation agents and reversal of neuromuscular block. Postoperative pain was assessed using a pain numeric scale, and postoperative nausea and vomiting were documented. Results No significant difference was found between the groups studied in terms of patient characteristics, type, and duration surgery, but there was a significant decrease in the intraoperative bispectral index value of the control group compared with the lidocaine and ketorolac groups (61.35 ± 4.54 vs. 63.35 ± 4.0 and 66.60 ± 7.19, respectively). The lidocaine group had a better postoperative mobility score, less nausea and vomiting, good incentive spirometry, greater patient satisfaction, low total fentanyl dose, and low postoperative pain at all the time points studied. The difference was statistically significant. Conclusion Lidocaine i.v. infusion was found to be an effective and safe adjuvant for the rapid recovery of obese patients following bariatric surgery. Ketorolac led to better outcome than that in the control group, but was less effective compared with lidocaine.