Postoperative Analgesic Efficacy of Low Dose Intravenous Dexmedetomidine and Intraperitoneal Dexmedetomidine with Bupivacaine in Patients undergoing Laparoscopic Cholecystectomy: A Randomised Prospective Study

Abstract

Introduction: Providing a better analgesia in the postoperative period improves the overall outcome in any surgical procedure in terms of better patient satisfaction, early recovery and shorter hospital stay. Multimodal analgesia using α 2 agonists like clonidine and dexmedetomidine along with local anaesthetics via intraperitoneal route had been proved to provide better analgesia in laparoscopic cholecystectomy. Aim: To evaluate the postoperative analgesic efficacy of low dose 0.5 μg/kg dexmedetomidine via intravenous (i.v.) and intraperitoneal (IP) route in laparoscopic cholecystectomy. Materials and Methods: This was a randomised prospective study carried out at the Department of Anaesthesiology, BLDE (Deemed to be University) Shri BM Patil Medical College, Hospital, and Research Centre, Vijayapura, Karnataka, India from December 2020 to September 2022. The study comprised of 99 patients of either gender, with American Society of Anaesthesiologists (ASA) Grade-I or II, were randomly allocated into three groups using computer generated randomised slips with 33 in each group (Group IV, Group IP, Group C). Group C (Control) patients received 30 mL of Normal Saline (NS) i.v. and 40 mL of 0.25% bupivacaine IP, Group IV patients received 0.5 μg/kg dexmedetomidine infusion i.v. in 30 mL NS over 10 minutes and 40 mL of 0.25% bupivacaine, IP. Group IP patients received 30 mL NS IV and 0.5 μg/kg dexmedetomidine in 40 mL of 0.25% bupivacaine IP. The time of rescue analgesia, total consumption of diclofenac in 24 hours, Visual Analogue Scale (VAS) pain score at 0.5, 1, 2, 4, 6, 12, 24 hours was compared among the three groups. Side-effects of the study drugs especially hypotension and bradycardia were monitored. All the data was analysed using statistical tests (Independent t-test, Kruskal-Wallis test, Chi-square test). The p-value was found to be statistically significant (p<0.005). Results: The VAS score was found to be consistently high in control group at all given time intervals, and significantly low in both i.v. and IP groups which were comparable. The Group IV had the longest mean time for rescue analgesia (180.91±41.617 minutes), followed by the Group IP (106.06±8.269 minutes), and the Group C (55.00±6.960 minutes). The consumption of total rescue analgesic (diclofenac) was determined to be highest in the Group C (241.82±30.767 mg) and lowest in the Group IP (115.30± 30.896 mg). Conclusion: The total consumption of diclofenac and VAS score was less in intraperitoneal dexmedetomidine was found to be effective in producing postoperative analgesia and can be considered as an effective alternative.

Keywords

• adrenergic α-2 receptor agonists
• opioids
• visual analog scale