Intraperitoneal Ropivacaine with Dexmedetomidine or Fentanyl for Postoperative Analgesia Following Laparoscopic Cholecystectomy: A Comparative Randomized Trial

B Lakshmi Praveena, B Bharathi, V R Sahana, B Lakshmi Praveena, B Bharathi, V R Sahana

Abstract

Background: Intraperitoneal local anesthetic is an effective analgesic approach following laparoscopic cholecystectomy.

Aims: The aim of the present study was to compare the antinociceptive effects of intraperitoneal ropivacaine plus fentanyl with ropivacaine plus dexmedetomidine in patients undergoing laparoscopic cholecystectomy.

Settings and designs: This was randomized, prospective, double-blinded, observational clinical study.

Methods: A total of 80 patients, undergoing elective laparoscopic cholecystectomy under general anesthesia were randomly assigned to one of the two equal groups to receive either of the following: Group RF (n = 40) were given 30 mL of 0.2% ropivacaine combined with 1 μg/kg fentanyl (diluted in 2 mL normal saline) and Group RD (n = 40) were given 30 mL of 0.2% ropivacaine combined with 1 μg/kg dexmedetomidine (diluted in 2 mL normal saline) through trocars. The quality of analgesia was assessed using visual analog scale score (VAS). Time to the first request of analgesia, the total dose of analgesic in the first 24 h and adverse effects were noted.

Statistical analysis: The data were analyzed with the Students' t-test and Chi-square test.

Results: VAS score at different time intervals, overall VAS in 24 h was significantly lower (1.68 ± 0.46 vs. 4.47 ± 0.94), time to first request of analgesia (min) was longest (122.7 ± 24.5 vs. 89.3 ± 13.2) and total analgesic consumption (mg) was lowest (95.3 ± 15.6 vs. 135.7 ± 75.1) in RD group than in RF group.

Conclusion: The antinociceptive effect of the intraperitoneal instillation of ropivacaine in combination with dexmedetomidine is superior to ropivacaine combined with fentanyl.

Keywords: Dexmedetomidine; fentanyl; intraperitoneal instillation; postoperative pain; ropivacaine.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Consort diagram showing the number of patients included and analyzed

References

    1. Bisgaard T, Kehlet H, Rosenberg J. Pain and convalescence after laparoscopic cholecystectomy. Eur J Surg. 2001;167:84–96.
    1. Wills VL, Hunt DR. Pain after laparoscopic cholecystectomy. Br J Surg. 2000;87:273–84.
    1. Kehlet H. Acute pain control and accelerated postoperative surgical recovery. Surg Clin North Am. 1999;79:431–43.
    1. Abdulla S, Eckhardt R, Netter U, Abdulla W. A randomized, double-blind, controlled trial on non-opioid analgesics and opioid consumption for postoperative pain relief after laparoscopic cholecystectomy. Acta Anaesthesiol Belg. 2012;63:43–50.
    1. Kim TH, Kang HK, Park JS, Chang IT, Park SG. Intraperitoneal ropivacaine instillation for postoperative pain relief after laparoscopic cholecystectomy. J Korean Surg Soc. 2010;79:130–6.
    1. Shukla U, Prabhakar T, Malhotra K, Srivastava D, Malhotra K. Intraperitoneal bupivacaine alone or with dexmedetomidine or tramadol for post-operative analgesia following laparoscopic cholecystectomy: A comparative evaluation. Indian J Anaesth. 2015;59:234–9.
    1. Albanese AM, Albanese EF, Miño JH, Gómez E, Gómez M, Zandomeni M, et al. Peritoneal surface area: Measurements of 40 structures covered by peritoneum: Correlation between total peritoneal surface area and the surface calculated by formulas. Surg Radiol Anat. 2009;31:369–77.
    1. Esmat ME, Elsebae MM, Nasr MM, Elsebaie SB. Combined low pressure pneumoperitoneum and intraperitoneal infusion of normal saline for reducing shoulder tip pain following laparoscopic cholecystectomy. World J Surg. 2006;30:1969–73.
    1. El-Labban GM, Hokkam EN, El-Labban MA, Morsy K, Saadl S, Heissam KS, et al. Intraincisional vs. intraperitoneal infiltration of local anaesthetic for controlling early post-laparoscopic cholecystectomy pain. J Minim Access Surg. 2011;7:173–7.
    1. Joris J, Thiry E, Paris P, Weerts J, Lamy M. Pain after laparoscopic cholecystectomy: Characteristics and effect of intraperitoneal bupivacaine. Anesth Analg. 1995;81:379–84.
    1. Bisgaard T, Klarskov B, Kristiansen VB, Callesen T, Schulze S, Kehlet H, et al. Multi-regional local anesthetic infiltration during laparoscopic cholecystectomy in patients receiving prophylactic multi-modal analgesia: A randomized, double-blinded, placebo-controlled study. Anesth Analg. 1999;89:1017–24.
    1. Ure BM, Troidl H, Spangenberger W, Dietrich A, Lefering R, Neugebauer E, et al. Pain after laparoscopic cholecystectomy. Intensity and localization of pain and analysis of predictors in preoperative symptoms and intraoperative events. Surg Endosc. 1994;8:90–6.
    1. Goldstein A, Grimault P, Henique A, Keller M, Fortin A, Darai E, et al. Preventing postoperative pain by local anesthetic instillation after laparoscopic gynecologic surgery: A placebo-controlled comparison of bupivacaine and ropivacaine. Anesth Analg. 2000;91:403–7.
    1. Callesen T, Hjort D, Mogensen T, Schouenborg L, Nielsen D, Reventlid H, et al. Combined field block and i.p. Instillation of ropivacaine for pain management after laparoscopic sterilization. Br J Anaesth. 1999;82:586–90.
    1. Saadalla AE, Khalifa OY. Influence of addition of dexmedetomidine or fentanyl to bupivacaine lumber spinal subarachnoid anesthesia for inguinal hernioplasty. Anesth Essays Res. 2017;11:554–7.
    1. Kiran S, Jinjil K, Tandon U, Kar S. Evaluation of dexmedetomidine and fentanyl as additives to ropivacaine for epidural anesthesia and postoperative analgesia. J Anaesthesiol Clin Pharmacol. 2018;34:41–5.
    1. Ahmed B, Elmawgoud AA, Dosa R. Antinociceptive effect of (ἀ2 adrenoceptor agonist) dexmedetomidine versus meperidine, topically, after laproscopic gynecologic surgery. J Med Sci. 2008;8:400–4.

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