A comparative study between bupivacaine-dexmedetomidine mixture versus bupivacaine-magnesium mixture in Pre-incision skin infiltration for para-umbilical hernia repair regarding their intraoperative and postoperative analgesic effect

Abstract

Background Poorly controlled acute pain after abdominal surgery is related to somatic pain signals derived from the abdominal wall and is associated with a variety of unwanted post-operative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia, prolonged hospital stay, an increased likelihood of chronic pain, increased consumption of analgesics, delayed bowel function and increase the requirement for rescue analgesics. Appropriate pain treatment protocols to reduce postoperative morbidity, improve the results of the surgery and decrease hospital costs. Aim of the Work to compare skin infiltration with bupivacaine-dexmedetomidine mixture versus bupivacainemagnesium mixture for analgesia in patients undergoing para-umbilical hernia repair under general anesthesia. magnesium. Results This study demonstrated that the addition of dexmedetomidine to wound infiltration with local anesthetics improves postoperative pain and reduces the need for analgesics which can be explained by different mechanisms: inhibition of painconduction in C -fibers, decreased in the production of inflammatory cytokines, the vasoconstrictive effect of 2 on vascular smooth muscle prolongs the time of analgesia, inhibition of tetrodotoxin-sensitive Na+ channels, and the absorption of dexmedetomidine to systemic circulation resulting in supraspinal analgesia. Patients and Methods A prospective randomized clinical trial study was conducted in Ain Shams university hospital on 44 adult patients undergoing para umbilical hernia or infra umbilical incisional hernia repair. The patients were randomly divided into two groups using their computer-generated random numbers will be enrolled in group D for bupivacaine-dexmedetomidine and group M for bupivacaine- Conclusion Pre-skin incision wound infiltration with dexmedetomidine–bupivacaine mixture provides prolonged local anesthetic effect, decreases the need for rescue analgesics, and provides better sedation than bupivacaine–magnesium sulfate mixture or bupivacaine alone in patients undergoing surgeries for hernia repair.