Intraperitoneal Instillation of Dexmedetomidine vs Dexamethasone as Adjuvant to Bupivacaine for Postoperative Pain in Laparoscopic Cholecystectomy, a Randomized Clinical Trial
Background: Intraperitoneal instillation (IPI) of local anesthesia was reported to reduce postoperative pain after laparoscopic surgeries. We aim to evaluate the effectiveness of IPI of bupivacaine + dexmedetomidine versus bupivacaine + dexamethasone on postoperative pain in patients undergoing laparoscopic cholecystectomy (LC). Methods: This randomized clinical trial was carried out on one hundred patients who underwent LC under general anesthesia. Patients were randomly divided into: Group (Dexa): IPI of bupivacaine with dexamethasone and Group (Dexmed): IPI of bupivacaine with dexmedetomidine. Results: The first time to request analgesia was significantly delayed in the dexmed group (P value < 0.001). The total analgesic consumption in the 1st postoperative day significantly increased considerably when using IPI of dexmedetomidine as an adjuvant to Bupivacaine (P value < 0.001). VAS, HR, and MAP at 2 h postoperative were statistically but not clinically significantly higher in the dexamethasone group (P value < 0.001), while there were no significant differences at 1, 4, 8, 16, and 24 h postoperative. Conclusions: Intraperitoneal Bupivacaine + Dexmedetomidine provided longer pain-free postoperative duration lower pain score over time, and lesser analgesic consumption.
References
[1]
Shukla, U., Prabhakar, T., Malhotra, K., Srivastava, D. and Malhotra, K. (2015) Intraperitoneal Bupivacaine Alone or with Dexmedetomidine or Tramadol for Post-Operative Analgesia Following Laparoscopic Cholecystectomy: A Comparative Evaluation. IndianJournalofAnaesthesia, 59, 234-239. https://doi.org/10.4103/0019-5049.155001
[2]
Mazy, A., Gad, M. and Bedairy, M. (2018) Preperitoneal Postcesarean Section Bupivacaine Analgesia: Comparison between Dexamethasone and Dexmedetomidine as Adjuvants. SaudiJournalofAnaesthesia, 12, 183-189. https://doi.org/10.4103/sja.sja_450_17
[3]
Minagar, M., et al. (2019) The Efficacy of Addition of Dexmedetomidine to Intrathecal Bupivacaine in Lower Abdominal Surgery under Spinal Anesthesia. Caspian Journal of Internal Medicine, 10, 142-149.
[4]
Sun, C., He, Z., Feng, B., Huang, Y., Liu, D. and Sun, Z. (2024) Effect of Intraperitoneal Instillation of Dexmedetomidine with Local Anesthetics in Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis of Randomized Trials. SurgicalLaparoscopy, Endoscopy&PercutaneousTechniques, 34, 222-232. https://doi.org/10.1097/sle.0000000000001262
[5]
Kanazi, G.E., Aouad, M.T., Jabbour‐Khoury, S.I., Al Jazzar, M.D., Alameddine, M.M., Al‐Yaman, R., et al. (2006) Effect of Low‐Dose Dexmedetomidine or Clonidine on the Characteristics of Bupivacaine Spinal Block. ActaAnaesthesiologicaScandinavica, 50, 222-227. https://doi.org/10.1111/j.1399-6576.2006.00919.x
[6]
Vandana, P., Ananya, N., Muralikrishna, D., Ponduru, S., Renganathan, V. and Gopinath, R. (2023) Analgesic Efficacy of Intra-Peritoneal Instillation of Dexamethasone and Bupivacaine versus Bupivacaine Following Laparoscopic Cholecystectomy—A Randomised, Double-Blind Controlled Study. IndianJournalofAnaesthesia, 67, 999-1003. https://doi.org/10.4103/ija.ija_275_23
[7]
Chundrigar, T., Hedges, A.R., Morris, R. and Stamatakis, J.D. (1993) Intraperitoneal Bupivacaine for Effective Pain Relief after Laparoscopic Cholecystectomy. The Annals of the Royal College of Surgeons of England, 75, 437-439.
[8]
Hernández-Palazón, J., Tortosa, J.A., Nuño de la Rosa, V., Giménez-Viudes, J., Ramírez, G. and Robles, R. (2005) Intraperitoneal Application of Bupivacaine plus Morphine for Pain Relief after Laparoscopic Cholecystectomy. EuropeanJournalofAnaesthesiology, 20, 891-896. https://doi.org/10.1017/s0265021503001431
[9]
Shankar, S., Gupta, B.K., Singh, M.K., Pandey, A.R., Dwivedi, V. and Sachan, S. (2022) Intraperitoneal Bupivacaine Alone or with Dexmedetomidine for Post-Operative Analgesia Following Laparoscopic Cholecystectomy: A Prospective Randomized Comparative Study. Anaesthesia, Pain&IntensiveCare, 26, 347-351. https://doi.org/10.35975/apic.v26i3.1909
[10]
Oza, V., Parmar, V., Badheka, J., Nanavati, D., Taur, P. and Rajyaguru, A. (2016) Comparative Study of Postoperative Analgesic Effect of Intraperitoneal Instillation of Dexmedetomidine with Bupivacaine and Bupivacaine Alone after Laparoscopic Surgery. JournalofMinimalAccessSurgery, 12, 260-264. https://doi.org/10.4103/0972-9941.181370
[11]
Kumari Bairwa, R. and Shukla, C. (2020) Comparison of Administration of Intraperitoneal Bupivacaine and Intraperitoneal Bupivacaine with Dexmedetomidine in Post Laparoscopic Cholecystectomy Patients for Post Operative Pain Relief. IndianJournalofClinicalAnaesthesia, 5, 561-565. https://doi.org/10.18231/2394-4994.2018.0106
[12]
Nasr, Y.M., Waly, S.H. and Mokhtar, W.E.L. (2022) Intraperitoneal Bupivacaine with Dexamethasone versus Bupivacaine Alone for Pain Relief after Laparoscopic Bariatric Surgeries: A Randomized Controlled Trial. TheEgyptianJournalofHospitalMedicine, 88, 3185-3191. https://doi.org/10.21608/ejhm.2022.246927
[13]
Di Pace, M.R., Cimador, M., Catalano, P., Caruso, A., Sergio, M., Casuccio, A., et al. (2009) Efficacy of Periportal Infiltration and Intraperitoneal Instillation of Ropivacaine after Laparoscopic Surgery in Children. JournalofLaparoendoscopic&AdvancedSurgicalTechniques, 19, 821-825. https://doi.org/10.1089/lap.2008.0227
[14]
Srivastava, V.K., Shree, P., Agrawal, S., Pandey, A., Babbar, K. and Manju, K. (2022) Comparison of Intraperitoneal Dexamethasone, Dexmedetomidine, and Dexamethasone-Dexmedetomidine Combination on Postoperative Nausea, Vomiting, and Analgesics Requirement after Gynecological Laparoscopy. BaliJournalofAnesthesiology, 6, 225-230. https://doi.org/10.4103/bjoa.bjoa_202_22
[15]
Fares, K.M., Mohamed, S.A., Abd El-Rahman, A.M., Mohamed, A.A. and Amin, A.T. (2015) Efficacy and Safety of Intraperitoneal Dexmedetomidine with Bupivacaine in Laparoscopic Colorectal Cancer Surgery, a Randomized Trial. PainMedicine, 16, 1186-1194. https://doi.org/10.1111/pme.12687
[16]
Sharma, M., Kharbuja, K. and Sharma, N.R. (2016) Intraperitoneal Hydrocortisone plus Bupivacaine versus Bupivacaine Alone for Pain Relief after Laparoscopic Cholecystectomy. JournalofLumbiniMedicalCollege, 3, 41. https://doi.org/10.22502/jlmc.v3i2.71
[17]
Asgari, Z., Mozafar-Jalali, S., Faridi-Tazehkand, N. and Sabet, S. (2012) Intraperitoneal Dexamethasone as a New Method for Relieving Postoperative Shoulder Pain after Gynecologic Laparoscopy. International Journal of Fertility and Sterility, 6, 59-64.
[18]
Bhattacharjee, D., Nayek, S., Dawn, S., Bandopadhyay, G. and Gupta, K. (2010) Effects of Dexmedetomidine on Haemodynamics in Patients Undergoing Laparoscopic Cholecystectomy—A Comparative Study. JournalofAnaesthesiologyClinicalPharmacology, 26, 45.
[19]
Arain, S.R., Ruehlow, R.M., Uhrich, T.D. and Ebert, T.J. (2004) The Efficacy of Dexmedetomidine versus Morphine for Postoperative Analgesia after Major Inpatient Surgery. Anesthesia&Analgesia, 98, 153-158. https://doi.org/10.1213/01.ane.0000093225.39866.75
[20]
Brown, E.G., Anderson, J.E., Burgess, D., Bold, R.J. and Farmer, D.L. (2017) Pediatric Surgical Readmissions: Are They Truly Preventable? JournalofPediatricSurgery, 52, 161-165. https://doi.org/10.1016/j.jpedsurg.2016.10.037
