Intraperitoneal instillation of levobupivacaine plus dexmedetomidine versus ropivacaine plus dexmedetomidine for post-operative analgesia in patients undergoing laparoscopic cholecystectomy

Abstract

Introduction: Laparoscopic procedures have many advantages over open procedures, such as less haemorrhage, better cosmetic results, less post-operative pain and shorter recovery time, leading to a shorter hospital stay and less expenditure. Hence, the present study was undertaken for comparing the effect of intraperitoneal installation of levobupivacaine (L-B) plus dexmedetomidine versus ropivacaine plus dexmedetomidine for post-operative analgesia in patients undergoing laparoscopic cholecystectomy (LC). Materials and Methods: This was a prospective randomized study conducted in our hospital on 60 American Society of Anaesthesiologists grade I or II patients of either sex, aged 18–55 years, scheduled to undergo LC surgery under general anaesthesia. All patients were randomly divided into two groups of 30 each: Group 1: Patients were given 20 ml of 0.5% L-B plus 0.25-μg/kg dexmedetomidine intraperitoneally after gallbladder removal, and Group 2: Patients were given 20 ml of 0.5% ropivacaine plus 0.25-μg/kg dexmedetomidine intraperitoneally after gallbladder removal. Post-operatively, the patients were assessed for pain utilizing a visual analogue scale (VAS). VAS was graded on a scale of 0–10. VAS was recorded at 0, 1, 8, 12 and 24 h post-operatively and compared. Results: Mean time to first analgesic requirement among patients of Group 1 and Group 2 was 365.1 min and 297.2 min, respectively, which shows a statistically significant longer post-operative analgesic effect in Group 1 patients. While comparing VAS at different time intervals in between the two study groups, all the readings were comparable. The difference was found to be non-significant in the two groups (P > 0.05). Nausea and vomiting were seen in two patients in Group 1 and three patients in Group 2. Complications were noted in <10% of the patients in both groups. Conclusion: Intraperitoneal instillation of local anaesthetic solution in LC provides effective post-operative analgesia, and analgesia provided by L-B plus dexmedetomidine is better than ropivacaine plus dexmedetomidine.