Analgesic effect of intravenous versus intraperitoneal dexmedetomidine as an adjuvant to intraperitoneal bupivacaine (0.125%) in laparoscopic cholecystectomy: a randomized, double blind, interventional study
Keywords:Bupivacaine, dexmedetomidine, laparoscopic cholecystectomy
Background and Aims: Laparoscopic cholecystectomy has emerged as a gold standard technique for gall bladder stones. The aim of the present study was to compare the analgesic effect of intravenous (IV) vs intraperitoneal (IP) dexmedetomidine as an adjuvant to intraperitoneal (IP) bupivacaine in laparoscopy. Methods: A prospective, randomized, double blind, interventional study was conducted on 100 patients undergoing laparoscopic cholecystectomy where they were divided into following 2 groups: Group A: Patients received IV 1µg/kg dexmedetomidine diluted to 30 ml with normal saline over 10 min and 40 ml of 0.125% bupivacaine IP after removal of gall bladder. Group B: Patients received IV 30 ml of normal saline and 1µg/kg IP dexmedetomidine in 40 ml of 0.125% IP bupivacaine after removal of gall bladder. The primacy outcome was noted as a difference in mean duration for need of first rescue analgesia. The total consumption of analgesic in first 24hours was recorded and compared between the two groups. Results: Both the groups were comparable in terms of demographic profile and intraoperative hemodynamic parameters with no statistical difference. Comparison of time to first analgesic requirement between the two groups showed statistically significant results with unpaired t test The time of first rescue analgesia in Group A was 151.80 min ± 76.624. and in Group B was 94.80min ± 21.499. The total analgesic requirement in 24 hours in Group A was 136.64 ± 31.251 and in Group B was 144.12 ± 21.49. Conclusion: In our study we concluded that intravenous dexmetomidine provided superior analgesia as compared to intraperitoneal dexmetomidine when used as an adjuvant with Bupivacaine intraperitoneally.
Tobias JD. Pain management following laparoscopy. Can we do better? Saudi J. Anesth., 7, 3-4 (2013)
Jabbour-Khoury SI, Dabbous AS, Gerges FJ, Azar MS, Ayoub CM, Khoury GS. Intraperitoneal and Intravenous routes for pain relief in laparoscopic cholecystectomy. Journal of the Society of Laparoscopic & Robotic Surgeons, 9, 316–21 (2005).
EI-Labban GM, Hokkam EN. EI-Labban MA, Morsy K, Saadl S, Heissam KS. Intraincisional vs intraperitoneal infiltration of local anesthetic for controlling early post-laproscopic cholecystectomy pain. J Minim Access Surg, 7,173-7 (2011).
Karol MD, Maze M. Pharmacokinetics and interaction pharmacodynamics of dexmedetomidine in humans. Best Pract Res Clin Anaesthesiol, 14(2), 261-9 (2000)
Fares KM, Mohamed SA, Abd EI Rahman AM, Mohamed AA, Amin AT. Efficacy and safety of intraperitoneal dexmedetomidine with bupivacaine in laparoscopic colorectal surgery, a randomized trial. Pain Med, 16, 1186 94 (2015)
Kaarthika T, Radhapuram SD, Samantaray A, Pasupuleti H, Hanumantha Rao M, Bharatram R. Comparison of effect of intraperitoneal instillation of additional dexmedetomidine or clonidine along with bupivacaine for post operative analgesia following laparoscopic cholecystectomy. Indian J Anaesth, 65, 533-8 (2021)
Shukla U, Prabhakar T, Malhotra K, Srivastav D. Intraperitoneal bupivacaine alone or with dexmedetomidine or tramadol for post operative analgesia following laparoscopic cholecystectomy: A comparative evaluation. Indian J Anaesth, 59, 234 8 (2015)
Srinivas R, Kumar K, Aasim SA. A comparative study on intraperitoneal bupivacaine alone or with dexmedetomidine for post-operative analgesia following laparoscopic cholecystectomy. International Archives of Integrated Medicine, 3(12), 33-40 (2016)
Chilkoti GT, Kumar M, Mohta M, Saxena AK, Sharma N, Singh J. Comparison of postoperative analgesic efficacy of low-dose bolus intravenous dexmedetomidine and intraperitoneal dexmedetomidine with bupivacaine in patients undergoing laparoscopic cholecystectomy: A randomised, controlled trial. Indian J Anaesth, 63(2), 106-113(2019).
Ye Q, Wang F, Xu H, Wu L, Gao X. Effects of dexmedetomidine on intraoperative hemodynamics, recovery profile and postoperative pain in patients undergoing laparoscopic cholecystectomy: a randomized controlled trial. BMC Anesthesiol., 21(1), 63 (2021).
Deshmukh P, Takalkar S, Chaudhari A, Chakole V. A prospective comparative study to assess-post operative analgesic effect of intraperitoneal instillation of bupivacaine with dexmedetomidine to bupivacaine with tramadol in patients undergoing laparoscopic cholecystectomy. Indian Journal of Forensic Medicine & Toxicology, 14 (4), 6546-6551 (2020)
Oza VP, Parmar V, Badheka J, Nanavati DS, Taur P, Rajyaguru AM. Comparative study of postoperative analgesic effect of intraperitoneal instillation of dexmedetomidine with bupivacaine and bupivacaine alone after laparoscopic surgery. J Minim Access Surg, 12 (3), 260-264 (2016)
Narasimham M and Rao BD. Comparison of intraperitoneal bupivacaine alone or with dexmedetomidine or tramadol for post-operative analgesia following laparoscopic cholecystectomy. Indian Journal of Clinical Anaesthesia, 4 (1), 143-146 (2017)
Beder El Baz MM, Farahat TEM. Intraperitoneal Levobupivacaine Alone or with Dexmedetomidine for Postoperative Analgesia after Laparoscopic Cholecystectomy. Anesth Essays Res, 12(2), 355-358 (2018).
Bielka K, Kuchyn I, Babych V, Martycshenko K, Inozemtsev O. Dexmedetomidine infusion as an analgesic adjuvant during laparoscopic сholecystectomy: a randomized controlled study. BMC Anesthesiol, 18(1), 44 (2018)
Thakur A, Sharma C, Bijender et al. Analgesic efficacy of intraperitoneal vs intravenous dexmedetomidine as adjuvant to levobupivacaine 0.25% in laparoscopic cholecystectomy under general anaesthesia. International Journal of Medical Anesthesiology , 3(1), 255-260 (2020)
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