Evaluation of postoperative analgesic efficacy and perioperative hemodynamic changes with low dose intravenous dexmedetomidine infusion in patients undergoing laparoscopic cholecystectomy – A randomised, double-blinded, placebo-controlled trial

Abstract

Background and Aims:Recently, low-dose intravenous (IV) dexmedetomidine has been evaluated for obtunding the pneumoperitoneum-induced haemodynamic changes and its analgesic efficacy in laparoscopic cholecystectomy. The aim was to determine the postoperative analgesic efficacy of low-dose bolus of 0.5 μg/kg dexmedetomidine via IV and intraperitoneal (IP) route in laparoscopic cholecystectomy.Methods:Seventy-five patients, aged 18–60 years of ASA physical status I and II, undergoing laparoscopic cholecystectomy under general anaesthesia were included. Patients in Group C received IP bupivacaine. Patients in Group IV received 0.5 μg/kg dexmedetomidine infusion IV after removal of gall bladder along with IP bupivacaine and Group IP received 0.5 μg/kg dexmedetomidine in 40 mL of 0.25% bupivacaine IP. The primary outcome was 'time to first request of analgesia' and the secondary outcomes were 'total consumption of tramadol in 24 hours,' visual analogue scale (VAS) pain score.Results:In total, 75 patients with 25 in each group were included. Time to first request of analgesia was found to be significantly lower in IV (59.68 ± 71.05 min, P = 0.00) and IP group (90.80 ± 80.46 min, P = 0.001) compared tp Group C (59.68 ± 71.05 min). Mean tramadol consumption in 24 hours (152.40 ± 60.958 vs 137.64 ± 52.40 mg) and mean VAS pain score were comparable in both IV and IP groups in the initial 12 h.Conclusion:Low bolus dose of IP dexmedetomidine is as efficacious as IV dexmedetomidine (0.5 μg/kg) along with IP bupivacaine in laparoscopic cholecystectomy.

Effects of dexmedetomidine on intraoperative hemodynamics, recovery profile and postoperative pain in patients undergoing laparoscopic cholecystectomy: a randomized controlled trial

“…Continuous infusion of dexmedetomidine during surgery further affected postoperative recovery time and extubation time compared with preoperative bolus infusion. In the previous study, it was found that patients with continuous intravenous infusion of dexmedetomidine 0.5μg/kg/h were still under deep sedation 15 min after entering PACU [ 22 ]. This is also the reason for using slow bolus infusion (10 min) rather than continuous infusion during surgery in this study.…”

Analgesic Efficacy of Bupivacaine or Bupivacaine-Dexmedetomidine After Intraperitoneal Administration in Cats: A Randomized, Blinded, Clinical Trial

“…Thus, decreases in pain scores over time were also likely to mask differences between groups. Based on the pharmacological profile of agonists of α 2 -adrenergic receptors, it is possible that the BDG could produce better analgesia than BG at later time points (e.g., 16 h) considering the ability of these drugs to produce local vasoconstriction and prolong the anesthetic effect of local anesthetics as demonstrated in humans (14–18). Hence, the lack of difference between groups at 24 h should be interpreted with caution because the administration of meloxicam might have confounded these results.…”

Intraperitoneal administration of lidocaine or tramadol alone or in combination on postoperative pain after ovariohysterectomy in dogs

“…For pain control, topical anaesthetics and opioid analgesics are utilized (Carpenter et al, 2004;Yazbek and Fantoni, 2005;Campagnol et al, 2012;Morgaz et al, 2013). Lambertini et al, 2018;Chilkot et al, 2019). Furthermore, intraperitoneal administration has been employed to control abdominal postoperative pain in human and veterinary medicine.…”

“…Furthermore, intraperitoneal administration has been employed to control abdominal postoperative pain in human and veterinary medicine. For intraperitonael administration, a local anaesthetic or analgesic is applied to the surgical site and the viscera before suturing the abdominal wall (Carpenter et al, 2004;Ng et al, 2002;Golubovic et al, 2009;Campagnol et al, 2012;Guerrero et al, 2016;Lambertini et al, 2018;Chilkot et al, 2019). Today, intraperitoneal administration of topical anaesthetics is a valuable and approved method for controlling postoperative pain (Chilkot et al, 2019).…”

“…For intraperitonael administration, a local anaesthetic or analgesic is applied to the surgical site and the viscera before suturing the abdominal wall (Carpenter et al, 2004;Ng et al, 2002;Golubovic et al, 2009;Campagnol et al, 2012;Guerrero et al, 2016;Lambertini et al, 2018;Chilkot et al, 2019). Today, intraperitoneal administration of topical anaesthetics is a valuable and approved method for controlling postoperative pain (Chilkot et al, 2019). Several studies have shown that the intraperitoneal administration of lidocaine or bupivacaine is sufficient for pain control after surgery in dogs (Campagnol et al, 2012;Carpenter et al, 2004;Chilkot et al, 2019;Guerrero et al, 2016;Lambertini et al, 2018).…”