Comparison of Efficacy of Intraperitoneally Admin I Stered Local Anaesthetics With Adjuvants for Post - Operative Analgesia After Laparoscopic Cholecystectomy

Abstract

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.