Post-operative Analgesia with Intraperitoneal Bupivacaine Alone and with Dexmedetomidine Following Laparoscopic Cholecystectomy

Abstract

Background: Laparoscopic cholecystectomy (LC) is a customary treatment for patients with symptomatic cholelithiasis. This study aimed to compare the mean duration of analgesia (DOA) of intraperitoneal bupivacaine (BPV) with dexmedetomidine (DEX) to intraperitoneal BPV alone in patients undergoing LC.

Methods: This randomized controlled trial was done at the Department of Anesthesiology, Bahawalpur Victoria Hospital, Bahawalpur, Pakistan, from October 2023 to March 2024. A simple random sampling technique was adopted. A total of 68 cases undergoing LC were enrolled and randomly allocated to either Group-B (n=34) who received intraperitoneal BPV 50 ml 0.25%+5 ml normal saline and Group-BD (n=34) who were served intraperitoneal BPV 50 ml 0.25%+ DEX 1 μg/kg with normal saline 5 ml. The postoperative pain intensity for both groups was recorded and compared using a 10-point visual analogue score (VAS) at 0, 30 minutes, 1 hour, 2, 4, 6, 8, 12, and 24 hours. Independent sample t-test and chi-square test were used to compare data between groups taking p<0.05 as significant.

Results: The mean DOA in the patients in group B was 4.42±3.95 hours, and in group BD, it was 7.63±2.65 hours (p=0.0002). It was noted that pain scores were significantly low in Group BD at 1 hour (2.63±0.53 vs. 2.26±0.64, p=0.0116), 2 hours (2.81±0.56 vs. 2.43±0.73, p=0.0188), 4-hours (3.70±0.73 vs. 3.32±0.52, p=0.0160), and 6-hours (3.93±0.48 vs. 3.50±0.46, p=0.0003). BD group offered a significantly longer DOA (p=0.0002), an extended spell for rescue analgesia (p=0.0001), and a lesser dose of diclofenac (p=0.0137).

Conclusion: Intraperitoneal instillation of DEX 1 μg/kg with local anesthetic 0.25% BPV 50 ml at the end of surgery in patients undergoing LC significantly reduced the postoperative pain, especially up to six hours postoperatively.