Glucose 5% / Lidocaine 1g/500ml (0.2%) infusion 500ml polyethylene bottles

The substantial adverse effects associated with opioid-based analgesia and its contribution to postoperative dependence have prompted a shift toward multimodal, opioid-sparing perioperative strategies. Non-opioid analgesics now form the cornerstone of contemporary perioperative management and Enhanced Recovery After Surgery (ERAS) pathways. This review synthesizes current evidence on the efficacy, safety, and clinical utility of major non-opioid analgesic classes, including nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, N-methyl-D-aspartate (NMDA) antagonists, intravenous lidocaine, gabapentinoids, α2-agonists, regional anesthesia techniques, and glucocorticoids, for postoperative pain management. Evidence from randomized controlled trials, systematic reviews, and meta-analyses was evaluated with emphasis on analgesic effectiveness, opioid-sparing capacity, recovery outcomes, and adverse effects. The efficacy of non-opioid multimodal analgesia (MMA) stems from the synergistic targeting of distinct pain pathways. Across drug classes, non-opioid agents demonstrate clinically meaningful opioid-sparing effects while providing analgesia that is comparable to opioid-based regimens. Acetaminophen and NSAIDs are cornerstones of MMA, supported by extensive high-quality evidence. NMDA antagonists such as ketamine show particular benefit in major surgical procedures for modulating central sensitization and preventing chronic pain, whereas intravenous lidocaine has unique advantages in accelerating gastrointestinal recovery and may reduce hospital length of stay. Gabapentinoids may serve as adjuncts but exhibit heterogeneous efficacy and a side-effect profile (e.g., sedation) that necessitates selective use. Preoperative α2-agonists consistently prolong analgesia and reduce perioperative opioid requirements. As a core component of MMA, regional anesthesia techniques demonstrate robust reductions in both prolonged postoperative opioid use and the incidence of chronic postsurgical pain, and perioperative glucocorticoids such as dexamethasone contribute potent dual analgesic and antiemetic effects. The collective evidence indicates that MMA, integrating agents with complementary mechanisms, provides superior pain control, enhanced functional recovery, and meaningful reductions in opioid exposure. Broader implementation of standardized, procedure-specific multimodal protocols may further decrease opioid-related harms and strengthen alignment with ERAS principles. Future research should prioritize long-term outcomes and optimization of multimodal combinations to advance the transition toward a post-opioid paradigm in surgical care.

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ObjectivesConventional antispasmodics used during endoscopic retrograde cholangiopancreatography (ERCP), such as hyoscine butylbromide and glucagon, are often contraindicated in elderly patients with comorbidities. This trial aimed to assess the efficacy of lidocaine for inhibiting duodenal peristalsis during ERCP.MethodsThis multicenter randomized controlled trial enrolled 40 elderly patients (aged 65-89 years) who were scheduled to undergo ERCP. Patients were randomly assigned to the lidocaine group or the control group using a computer-generated sequence with stratification by age and sex. The lidocaine group (n = 19) received 2% lidocaine jelly mixed with saline, while the control group (n = 21) received a placebo jelly mixed with saline. The primary endpoint was inhibition of duodenal peristalsis. Secondary endpoints included the required time from drug spraying to cessation of duodenal peristalsis, stop duration time (DT) from cessation of peristalsis until peristalsis recovery, and adverse events.ResultsEighteen patients from the lidocaine group and 19 patients from the control group were analyzed for the primary outcome. The inhibition rate of duodenal peristalsis was significantly higher in the lidocaine group (94.4%) than in the control group (52.6%) (p = 0.008). The required time was significantly shorter in the lidocaine group than in the control group (p p = 0.862); no adverse events occurred in either group.ConclusionsIn our limited cohort, lidocaine inhibited duodenal peristalsis during ERCP without adverse events, suggesting its potential as a safe and practical option (jRCT No. 031190059).

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BackgroundEsketamine, the S-enantiomer of ketamine, has sympathomimetic and analgesic properties. Intravenous lidocaine provides sedative and analgesic adjuvant effects and blunts airway reflexes during anesthesia induction. However, the role of their combination in elderly patients remains unclear. This study aimed to compare the efficacy and safety of esketamine-lidocaine-propofol induction with those of sufentanil-propofol induction in this population.MethodsIn this prospective, double-blind, randomized trial, 116 elderly patients undergoing elective surgery were assigned to receive esketamine (0.5 mg·kg-1), lidocaine (1.5 mg·kg-1), and propofol (Group E) or sufentanil (0.4 μg·kg-1) and propofol (Group S) for anesthesia induction. The primary outcomes were the incidence of hypotension and the absolute area under the curve (AUC) of mean arterial pressure (MAP) deviation, measured during anesthesia induction (from the initiation of anesthetic drug administration to 5 minutes after tracheal intubation).ResultsThe absolute AUC for Group E was smaller than that for Group S (93.83 [79.74-130.78] mmHg·min vs.147.50 [99.38-210.62] mmHg·min), with a median difference of -51.09 mmHg·min (95% confidence interval (CI), -84.53- -14.00; P = 0.005). The incidence of hypotension in the Group E was lower than Group S (62.1% vs 82.8%), with a relative risk of 0.750 (95% CI, 0.594-0.947; P = 0.013). The incidence of coughing (P P P ConclusionEsketamine-lidocaine-propofol improved hemodynamic stability and reduced adverse events compared with sufentanil-propofol, supporting its use for anesthesia induction in elderly patients.

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Background/aimsThe current study aimed to evaluate the effects of intravenous (IV) lidocaine on sedative requirements, duodenal peristalsis, and procedural outcomes in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) under deep sedation.Materials and methodsIn this prospective, randomized, double-blind, placebo controlled study, 120 patients with ASA I-III who were scheduled for elective ERCP were enrolled. Participants were randomized to 2 groups: the lidocaine group (n = 60) received a 1 mg/kg bolus followed by a 2 mg/kg/h infusion, whereas the control group (n = 60) received an equivalent volume of 0.9% saline. Sedation was maintained with propofol and titrated to a Bispectral Index of 60-80. Duodenal peristalsis was assessed using a predefined semiquantitative peristalsis scoring system.ResultsDemographic characteristics were similar between groups. Total propofol consumption was significantly lower in the lidocaine group (P ConclusionIV lidocaine may serve as a supportive anesthetic-sparing adjunct during ERCP, reducing propofol requirements and facilitating shorter recovery times. Although lidocaine was associated with greater inhibition of duodenal peristalsis and reduced use of rescue antispasmodic, major procedural outcomes were comparable between groups; therefore, these findings should be interpreted cautiously.

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Neuropathic pain remains a major challenge in pain management because of its complex mechanisms and suboptimal response to conventional treatments, which often provide incomplete relief and carry the risk of adverse effects. Injections of 5% glucose in water (D5W) delivered via intradermal, subcutaneous, fascial, or perineural glucopuncture have emerged as a minimally invasive and safe therapeutic option. Although the exact mechanism has not been fully elucidated, the proposed pathways include transient receptor potential vanilloid 1 modulation, suppression of neurogenic inflammation, and stabilization of C-fiber excitability. Clinical studies, ranging from case reports to randomized controlled trials, have suggested the efficacy of this approach in postherpetic neuralgia, entrapment neuropathies, chronic tendinopathies, and fascial pain, with minimal complications. Unlike prolotherapy, glucopuncture uses isotonic glucose (D5W), and primarily exerts neuromodulatory rather than regenerative effects. Current evidence, while limited, indicates meaningful and sustained pain relief in selected neuropathic conditions with a favorable safety profile and low procedural complexity. This review outlines key mechanisms, clinical outcomes, differences between related interventions, and clinical considerations.

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