INTRAPERITONEAL BUPIVACAINE ALONE WITH DEXMEDETOMIDINE OR TRAMADOL FOR POSTOPERATIVE ANALGESIA FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY- A COMPARATIVE EVALUATION
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2017, Vol 6, Issue 90
Abstract
BACKGROUND Post laparoscopic cholecystectomy patients complain more of visceral pain as a result of stretching of the intra-abdominal cavity, peritoneal inflammation and phrenic nerve irritation caused by residual carbon dioxide in the peritoneal cavity. Intraperitoneal instillation of local anaesthetic agents has become an important method to control postoperative pain, nausea, vomiting and reduced hospital stay. The purpose of this double-blinded randomised controlled trial was to compare the analgesic efficacy of intraperitoneal instillation of local anaesthetic agents alone or in combination with opioids, ∝-2 agonists such as clonidine and dexmedetomidine to reduce postoperative pain following laparoscopic cholecystectomy. MATERIALS AND METHODS 135 were equally divided into three, allocated to one of the groups by random allocation cards using computer generated random numbers. Group A (n= 45): Intraperitoneal bupivacaine 30 mL 0.25% + 5 mL normal saline (NS); Group B (n= 45): Intraperitoneal bupivacaine 30 mL 0.25% + tramadol 1 mg/kg (diluted in 5 mL NS); or Group C (n= 45): Intraperitoneal bupivacaine 30 mL 0.25% + dexmedetomidine 1 mcg/kg (diluted in 5 mL NS). RESULTS We found bupivacaine in combination with tramadol (Group B) has significantly lower VAS score at all points of time (P < 0.001) and overall VAS score and postoperative analgesia was statistically lower than with Group A. But bupivacaine + dexmedetomidine had even better VAS score underlying high efficacy of drug. Time to first request of analgesia in postoperative period was significantly delayed in Group C as compared to Group A (P= 0.86). CONCLUSION We conclude that intraperitoneal instillation of dexmedetomidine 1 mcg/kg in combination with bupivacaine 0.25% in elective laparoscopic cholecystectomy significantly reduces the postoperative pain and significantly reduces the analgesic requirement in postoperative period as compared to bupivacaine 0.25% alone and may be better than bupivacaine combined with tramadol.
Authors and Affiliations
Ummer Ali, Mohamad Ommid, Nazia Shafiya Alamgir, Sheeba Nazir, Reyaz Lone, Arshi Taj, Humera Manzoor, Farhana Bashir
Keywords
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- EP ID EP278255
- DOI 10.14260/jemds/2017/1386
- Views 74
- Downloads 0
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