Perbandingan Pemberian Lidokain Intravena Kontinu dengan Pemberian Fentanyl Berdasarkan Hasil Kortisol Serum Selama Operasi Laparotomi di RS Adam Malik Medan

Abstract

Background: Surgical procedures, such as laparotomy, induce significant stress responses characterized by activation of the hypothalamic-pituitary-adrenal (HPA) axis and increased serum cortisol levels. Attenuating this stress response is crucial for reducing perioperative morbidity. Intravenous lidocaine and fentanyl infusions have been studied as potential modulators of surgical stress. Objectives: This study aimed to compare the effects of continuous intravenous lidocaine infusion and continuous intravenous fentanyl infusion on serum cortisol levels in patients undergoing laparotomy. Methods: This was a randomized controlled study conducted at Adam Malik General Hospital, Medan. Consecutive patients aged 18–65 years with normal body mass index undergoing laparotomy were enrolled and randomly allocated into two groups. The lidocaine group received intravenous lidocaine infusion at 2 mg/kg/h after intubation, while the fentanyl group received intravenous fentanyl infusion at 1 mcg/kg/h. Serum cortisol levels were measured at 6 a.m. before surgery and at skin closure. Additional fentanyl was administered as rescue analgesia if hemodynamic parameters exceeded predetermined thresholds. Data were analyzed using appropriate statistical tests, and p<0.05 was considered significant. Results: A total of 44 patients were analyzed (lidocaine group: 20; fentanyl group: 24). Baseline serum cortisol levels were comparable between groups (p=0.200). Postoperatively, both groups showed significant increases in cortisol levels (p<0.05). However, the mean delta cortisol increase was significantly lower in the lidocaine group (4.37 ± 3.90) compared to the fentanyl group (7.55 ± 2.90; p=0.037). Rescue fentanyl requirements were higher in the lidocaine group (40%) than in the fentanyl group (12.5%). Side effects differed between groups: hypotension (40%) and bradycardia (25%) were more frequent with lidocaine, whereas nausea (58.3%) predominated with fentanyl. Conclusion: Continuous intravenous lidocaine infusion was more effective than fentanyl in attenuating cortisol elevation during laparotomy, suggesting a greater protective effect against surgical stress. However, lidocaine was associated with higher rescue analgesia requirements and hemodynamic side effects, highlighting the need for multimodal analgesia strategies.