A Comparative Clinical Study to Evaluate the Antinociceptive Efficacy of Intravenous versus Intraperitoneal Dexmedetomidine with Ropivacaine in Patients Undergoing Laparoscopic Cholecystectomy

Abstract

Intraperitoneal (IP) local anesthetic administration has become a routine in laparoscopic surgeries. An additive to local anesthetic like alpha-2 agonist such as dexmedetomidine may enhance the efficacy of local anesthetic. Our primary objective was to compare the duration of analgesia and our secondary objectives were to compare the total amount of rescue analgesics in 24 h, hemodynamic changes, and adverse effects after the use of dexmedetomidine intraperitoneally versus intravenously in addition to 0.25% ropivacaine instillation intraperitoneally. Eighty patients aged 18–60 years of American Society of Anesthesiologists physical status I and II, undergoing laparoscopic cholecystectomy, were randomly allocated into two groups – Group V (n = 40) received 100 ml normal saline (NS) with 0.7 µg/kg dexmedetomidine over 15 min followed by 30 ml 0.25% ropivacaine intraperitoneally and Group P (n = 40) received 100 ml NS over 15 min followed by 30 ml 0.25% ropivacaine with 0.7 µg/kg dexmedetomidine intraperitoneally soon after removal of gallbladder at the end of surgery. The duration of analgesia was significantly longer in Group V (246.45 ± 27.00 min) as compared to Group P (112.83 ± 11.61 min) (P < 0.0001). The total amount of rescue analgesic consumption in 24 h was significantly reduced in Group V (185.00 ± 73.55 mg) as compared to Group P (225.00 ± 77.63 mg) (P < 0.05). As compared to Group P, patients in Group V had a statistically significant Ramsay Sedation Score. The hemodynamic parameters and side effect profile were comparable in both the groups. IV dexmedetomidine 0.7μg/kg is more efficacious as compared to IP dexmedetomidine along with IP ropivacaine 0.25% in laparoscopic cholecystectomy in terms of prolonged duration of analgesia and decreased requirement of rescue analgesia in 24 h.