BackgroundLaparoscopic cholecystectomy is widely performed, and postoperative pain is an important factor in patient morbidity during recovery. Various modalities for postoperative pain relief have been proposed, with varying levels of success such as intravenous or intramuscular non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, infiltration at the incision site with local anesthetics, intraperitoneal infiltration of local anesthetics, intraperitoneal infiltration of local anesthetics with adjuvants, regional anesthesia techniques such as epidurals and nerve blocks. The study was aimed to evaluate the efficacy of intraperitoneal instillation of bupivacaine and normal saline on postoperative analgesia, postoperative nausea, and vomiting after laparoscopic cholecystectomy. MethodsThis prospective, controlled, and randomized study included 60 American Society of Anesthesiologists (ASA) I and ASA II patients, aged 18-50 years, who were scheduled for laparoscopic cholecystectomy under general anesthesia. The patients were classified randomly into two groups with an equal number of participants: Group B received intraperitoneal instillation of 30 ml of plain bupivacaine 0.5% and Group N received 30 ml of normal saline. Postoperative pain was recorded using the visual analog scale (VAS) for 24 hours after surgery. Postoperative shoulder pain, nausea, vomiting, and the time taken to request rescue analgesia were noted. ResultsPatients receiving intraperitoneal bupivacaine showed a significant reduction in postoperative pain for the first six hours postoperatively (P = 0.04); moreover, the time taken to request rescue analgesia requirement was prolonged (P = 0.04). Side effects, such as nausea and vomiting, were similar between the two groups (P = 0.1 and p = 0.09, respectively) while shoulder pain was significantly lower in the bupivacaine group (P = 0.04). ConclusionBupivacaine is effective in reducing postoperative pain, and it prolongs the requirement time for rescue analgesia. It also reduces the incidence of shoulder pain but does not decrease postoperative nausea and vomiting.

BackgroundSubarachnoid block (SAB) with hyperbaric bupivacaine is routinely administered for abdominal and lower limb surgeries. Various agents have been used intrathecally as adjuvants to local anesthetic to increase efficacy and prolong the duration of SAB, among which opioids and α2 agonists are most commonly used. Intravenously administered dexmedetomidine has also been shown to prolong the duration of sensory and motor blockade obtained with subarachnoid block. MethodsA total of 212 adult patients scheduled to undergo abdominal or lower limb surgeries were enrolled in this prospective, double-blind, randomized study. They were divided into two equal groups to receive either intravenous dexmedetomidine (group D) 1μg/kg loading followed by maintenance at 0.5μg/kg or intravenous normal saline (group C) after 15 mins of subarachnoid block; no other intraoperative sedatives were used. The onset of sensory block and motor block, and the highest level of sensory block attained were assessed. The time taken for sensory regression to L1, Modified Bromage scale 0, and rescue analgesia requirement were assessed. ResultsPatients receiving intravenous dexmedetomidine showed no significant change in terms of onset and level of sensory block (P-0.774) and the onset of motor block (P-0.738). The time taken for sensory regression to L1 was significantly prolonged (P-0.000). Also, the time taken to achieve Modified Bromage scale of 0 and time taken for rescue analgesia was significantly prolonged (P-0.000). ConclusionIntravenous dexmedetomidine prolonged the duration of sensory and motor block, and also appears to provide sedation with easy arousability and analgesia postoperatively while maintaining hemodynamic stability with no significant side effects.