A comparative study of intraperitoneal Bupivacaine with Dexmedetomidine versus intraperitoneal Bupivacaine with Fentanyl for post operative analgesia following laparoscopic cholecystectomy

Abstract

Abstract INTRODUCTION: Maximum open surgeries are being replaced with laparoscopic surgeries. Laparoscopic cholecystectomy is being more commonly practiced than open surgery. Many parenteral or oral medications are used to control post operative pain following laparoscopic cholecystectomy do have their own side effects. So, local instillation will be beneficial with lesser or negligible side effects. The present study was conducted to compare the effect of intraperitoneal instillation of 0.25% Bupivacaine with Dexmedetomidine and 0.25% Bupivacaine with Fentanyl to know which combination has better efficacy in patients of Laparoscopic Cholecystectomy. METHODOLOGY: The present comparative study was carried on patients posted for Laparoscopic Cholecystectomy in a tertiary care hospital during 2019 to 2022, The patients were divided in two equal groups of 40 each with Group D - Patients receiving 0.25% bupivacaine with Dexmedetomidine and were instilled with 30ml of 0.25% bupivacaine with 1 μg/kg Dexmedetomidine (diluted in 2 ml Normal Saline). Also, Group F - Patients receiving 0.25% bupivacaine with Fentanyl where patients were instilled with 30ml of 0.25% bupivacaine with 1 μg/kg Fentanyl (diluted with 2 ml Normal saline NS). Degree of postoperative pain was assessed using Visual Analogue Scale (VAS). RESULTS: Overall VAS in 24 hrs was significantly lower in the D group compared to F group. The time required for the first dose of rescue analgesia was longer in the D group than in F group, indicating better and longer pain relief in the D group compared to that of F group. The difference was also statistically significant among the two groups. Total analgesic consumption was high in F group than in the D group. CONCLUSION: We concluded that intraperitoneal instillation of dexmedetomidine 1 μg/kg in combination with 0.25% Bupivacaine in elective laparoscopic cholecystectomy significantly reduces the post operative pain and analgesic requirement in postoperative period.