Comparison between Intraperitoneal Instillation of Bupivacaine Versus Dexmedetomidine for Post-Operative Analgesia after Laparscopic Cholecystectomy

Abstract
Background: Optimizing post-operative pain management can be challenging due to surgical factors and intrinsic patient responses to surgery and pain. Intraperitoneal instillation of local anesthetic drugs has become a popular practice for pain relief after laparoscopic surgery which limit the requirements for opioid analgesics and prevent common post-operative side effects such as ileus, nausea and vomiting, thus enables more patients to meet early discharge criteria.
Aim of Study: The aim is to compare between the efficacy of intraperitoneal instillation of Bupivavcine versus Dexme-detomedine for pain relief post-operatively after Laparoscopic Cholecystectomy.
Patient and Methods: This study was carried out on 75 patients, 18-59 years, ASA I or II scheduled for elective Laparoscopic Cholecystectomy. Patients were randomly as-signed to receive either Dexmedetomidine (DEX ), Bupivacaine (Bup), or normal saline (control group) for post laparoscopic cholecystectomy peritoneal instillation of local anesthetic. All patients were premedicated with IV fentanyl inj. (2μg/kg) 15min before induction of anesthesia. The induction was done with propofol 2mg/kg IV and to facilitate the endotracheal intubation, atracurium (0.5mg/kg) was given intravenously. Throughout the procedure controlled ventilation was main-tained with 100% O2, sevoflurane (1-2%) and atracurium. At the end of the surgery, the study solution was instillated intraperitoneally before removal of trocar in Trendelenberg's position, into the hepato-diaphragmatic space, on gall bladder bed and near and above hepatoduodenal ligament. The neuro-muscular blockade was antagonized with neostigmine 0.05 mg/kg and atropine 0.01mg/kg and trachea was extubated.
Recording the demographic data, duration of surgery, intensity of post-operative pain using VAS score, pattern of pain, analgesic requirement, time to the first request of anal-gesia, total dose of analgesia and side effects.
Results: VAS score was significantly lower in Group I (DEX) than Group II (Bup) and Group III (Control) at 30min, 1hr, 2 hr and 4hr after extubation (p-value <0.05). The onset of post-operative analgesia was significantly lower in Group II (Bup) and Group III (Control) than Group I (DEX) (p-value <0.05). Total dose of post-operative analgesia requirement was significantly lower in Group I (DEX) and Group II (Bup) than in Group III (Control) (p-value <0.05).
Conclusions: Intraperitoneal instillation of dexmedetomi-dine 1μ/kg in elective laparoscopic cholecystectomy signifi-cantly reduces the post-operative pain and significantly reduces the analgesic requirement in post-operative period as compared to bupivacaine 0.25% before removal of trocars at the end of surgery.