CONTEXT: Post-operative pain after laparoscopic cholecystectomy is less than open cholecystectomy, but many patients require strong analgesia postoperatively. Intraperitoneal administration of local anaesthetics alone or in combination with various adjuvants can control postoperative pain. AIM: To compare the analgesic effect of the intraperitoneal administration of Bupivacaine, Bupivacaine plus Tramadol and Bupivacaine plus Dexmedetomidine. SETTINGS AND DESIGN: 80 patients undergoing laparoscopic cholecystectomy were randomly allocated to one of four groups: Group C; Group B, Group T and Group D. METHODS AND MATERIAL: 80 patients undergoing laparoscopic cholecystectomy were randomly allocated to one of four groups: Group C received 20 ml of saline; Group B received 20 ml of 0.25% Bupivacaine. Group T received 20 ml of 0.25% Bupivacaine with 100 mg Tramadol and patients allocated to Group D received 20 ml of 0.25% Bupivacaine with 1μg/kg of Dexmedetomidine intraperitoneally post-operatively. Faces pain scale was recorded at 0.5, 1, 2, 4, 6 and 24 hours postoperatively. Time of requirement of rescue analgesia was calculated. Level of sedation postoperatively was assessed. Incidence of postoperative nausea and vomiting (PONV) was also recorded. STATISTICAL ANALYSIS: Data was analyzed by two-way analysis of variance, Student's t-test, Kruscal-Walis and Mann-Whitney U-test. RESULTS: Pain intensity, time of requirement of rescue analgesia, sedation score, as well as PONV were significantly lower in Group D, Group T and Group B than in Group C. Duration of post-operative analgesia was highest with Bupivacaine plus Dexmedetomidine. There were no differences between the three groups receiving Bupivacaine and Bupivacaine with Tramadol and Bupivacaine with Dexmedetomidine in FPS score, incidence of PONV and postoperative analgesic and antiemetic consumption. CONCLUSIONS: Bupivacaine with or without adjuvants provides significant pain relief when administered intraperitoneally after laparoscopic cholecystectomy. Bupivacaine with Dexmedetomidine is superior to plain Bupivacaine or Bupivacaine with Tramadol in providing analgesia for greater duration. No side effects were noticed with instillation of local anaesthetic with or without adjuvants. It significantly reduced the need for antiemetic medication.

BACKGROUNDPain during intra-operative and post-operative period of intracranial surgery causes severe fluctuations in haemodynamics, which can be detrimental for patients with compromised intracranial compliance. With scalp block, the sensory nerve fibres from the scalp and pericranial areas by using local anaesthetics and various adjuvants can reduce total anaesthetic requirement enabling early recovery and also reducing post-operative analgesic requirements.

BACKGROUND: Awake craniotomy for removal of intracranial tumors is most challenging procedure. The critical aspect of awake craniotomy is to maintain adequate analgesia and sedation, hemodynamic stability, airway safety, while keeping the patient immobile for duration of surgery, cooperative for neurological testing. AIM OF THE STUDY: Dexmedetomidine is good analgesic, sedative and has anaesthetic-sparing properties without causing significant respiratory depression. [1] We are reporting cases series of awake craniotomy under monitored anesthesia care using dexmedetomidine infusion as an adjuvant to scalp block, titrating the sedation level by BIS monitoring. MATERIALS AND METHODS: after careful patient selection and psychological preparation Monitored Anesthesia care(MAC) was provided by continuous infusion of Dexmedetomidine at a rate of 0.2-0.5 mcg/kg/min titrating sedation level to a BIS value of 70-90%. Bilateral scalp block was administered using 0.5% bupivacaine. For dura mater incision, a pad with 2% lidocaine was applied for 3 minutes. The tumor removal was complete with no neurological deficiency. All the patients were discharged on 5 th postoperative day without complications and with full patient satisfaction. CONCLUSION: We conclude that monitored anesthesia care with dexmedetomidine infusion and scalp block for awake craniotomy is a safe and efficacious. Absence of complications and high patient satisfaction score makes this technique close to an ideal technique for awake craniotomy.