Comparison of intravenous magnesium–lignocaine or magnesium–lignocaine–ketorolac versus normal saline for perioperative pain in laparoscopic cholecystectomy: A randomized controlled trial

Background and Aims: There is a need for research into opioid sparing analgesic options. The study aimed to compare postoperative pain scores at 24 h in patients receiving preoperative magnesium–lignocaine–ketorolac (MLK) or magnesium–lignocaine (ML) with control during laparoscopic cholecystectomy. Methods: The present randomized, controlled trial enrolled 120 patients, 18–60 years, American Society of Anesthesiologists I/II, scheduled for laparoscopic cholecystectomy. Patients were randomized preinduction to either Group MLK ( n = 40), magnesium 50 mg/kg + lignocaine 1.5 mg/kg + ketorolac 0.5 mg/kg in normal saline (NS), Group ML ( n = 40), magnesium 50 mg/kg + lignocaine1.5 mg/kg in NS, or group saline (S) ( n = 40) NS. All patients received a standard general anesthetic (GA) technique. In the postoperative period, if the Visual Analog Scale (VAS) ≥30, the patient received morphine boluses of 1 mg by intravenous (IV) PCA pump with a lockout interval of 10 min. Results: VAS at rest in group MLK was lower in group S, ( P = 0.001) at 12 h postoperatively. VAS on movement in group MLK and group ML was lower as compared to group S ( P < 0.001) at 24 h postoperatively. IV Morphine consumption in the first 24 h after surgery was lower in groups MLK and ML versus group S ( P < 0.001). The time to first rescue analgesia was early in Group S, delayed in Group MLK and Group ML ( P < 0.001). Conclusion: A preoperative IV MLK or ML resulted in lower VAS on movement score in patients undergoing laparoscopic cholecystectomy under GA at 24 h postoperatively.