Postoperative Analgesia using Intraperitoneal Instillation of Ropivacaine and Dexmedetomidine or Ropivacaine Alone following Laparoscopic Cholecystectomy

Abstract

Introduction: Laparoscopic cholecystectomy, a minimally invasive surgery, is relatively less painful than open procedures. Intraperitoneal Dexmedetomidine combined with Ropivacaine has shown promising analgesic effects compared to Ropivacaine alone in various abdominal surgeries. This study compared their postoperative analgesic efficacy.

Methods: A randomized, double-blinded, parallel-group, prospective comparative study was done in a duration of 12 months, from January to December 2018, following approval from the Institutional Review Committee involving 124 patients aged 20 70 years, American Society of Anesthesiologists I–II, body mass Index ≤25, undergoing elective laparoscopic cholecystectomy. Patients were randomized into two groups: Group R received 0.25% Ropivacaine (50 mL) + 5 mL normal saline, and Group RD received 0.25% Ropivacaine (50 mL) + Dexmedetomidine (1 μg/kg in 5 mL normal saline). The study drug was administered intraperitoneally at the surgery’s end. Pain scores (visual analog scale), duration of analgesia, total analgesic consumption, and adverse effects were recorded. Data were entered into IBM SPSS Statistics version 16 for statistical analysis. Descriptive statistics and independent paired t-tests were used to compare demographic variables, VAS scores, and analgesia duration between groups.

Results: Both groups were comparable in demographic and surgical parameters. Group demonstrated significantly lower VAS scores and a prolonged time to first rescue analgesia (608.95±310.6 minutes vs. 480.81±218.92 minutes). Rescue analgesia frequency was also lower in Group RD (1.29±0.71 vs. 1.55±0.69). Adverse effects, including nausea, vomiting, and shoulder pain, were comparable and insignificant in both groups.
Conclusions: Dexmedetomidine as an adjuvant to Ropivacaine enhances postoperative analgesia during laparoscopic cholecystectomy, prolonging analgesic duration and reducing rescue analgesia requirements without significant side effects.