Intraperitoneal bupivacaine alone or with dexmedetomidine or tramadol for post-operative analgesia following laparoscopic cholecystectomy: A comparative evaluation.
OBJECTIVE
Intraperitoneal instillation of local anaesthetics has been shown to minimise post-operative pain after laparoscopic surgeries. We compared the antinociceptive effects of intraperitoneal dexmedetomidine or tramadol combined with bupivacaine to intraperitoneal bupivacaine alone in patients undergoing laparoscopic cholecystectomy.


METHODS
A total of 120 patients were included in this prospective, double-blind, randomised study. Patients were randomly divided into three equal sized (n = 40) study groups. Patients received intraperitoneal bupivacaine 50 ml 0.25% +5 ml normal saline (NS) in Group B, bupivacaine 50 ml 0.25% + tramadol 1 mg/kg (diluted in 5 ml NS) in Group BT and bupivacaine 50 ml 0.25% + dexmedetomidine 1 μg/kg, (diluted in 5 ml NS) in Group BD before removal of trocar at the end of surgery. The quality of analgesia was assessed by visual analogue scale score (VAS). Time to the first request of analgesia, total dose of analgesic in the first 24 h and adverse effects were noted. Statistical analysis was performed using Microsoft (MS) Office Excel Software with the Student's t-test and Chi-square test (level of significance P = 0.05).


RESULTS
VAS at different time intervals, overall VAS in 24 h was significantly lower (1.80 ± 0.36, 3.01 ± 0.48, 4.5 ± 0.92), time to first request of analgesia (min) was longest (128 ± 20, 118 ± 22, 55 ± 18) and total analgesic consumption (mg) was lowest (45 ± 15, 85 ± 35, 175 ± 75) in Group BD than Group BT and Group B.


CONCLUSIONS
Intraperitoneal instillation of bupivacaine in combination with dexmedetomidine is superior to bupivacaine alone and may be better than bupivacaine with tramadol.
Department of Anaesthesiology and Critical Care, U. P. Rural Institute of Medical Sciences and Research, Saifai, Etawah, Uttar Pradesh, India.
Usha
U
Shukla
Department of Anaesthesiology and Critical Care, Era Medical College, Lucknow, Uttar Pradesh, India.
T
T
Prabhakar
Department of Anaesthesiology and Critical Care, U. P. Rural Institute of Medical Sciences and Research, Saifai, Etawah, Uttar Pradesh, India.
Kiran
K
Malhotra
Department of Community Medicine, U. P. Rural Institute of Medical Sciences and Research, Saifai, Etawah, Uttar Pradesh, India.
Dheeraj
D
Srivastava
Department of Pharmacology, Rama Medical College, Kanpur, Uttar Pradesh, India.
Kriti
K
Malhotra
Bupivacaine hydrochloride; dexmedetomidine hydrochloride; intraperitoneal injection; pain; post-operative; tramadol hydrochloride