Preemptive analgesia with wound infiltration using bupivacaine with dexmedetomidine and bupivacaine alone for postoperative analgesia in abdominal hysterectomy: A prospective randomized analytical study

Abstract

Background: The administration of local anesthetics into the wound before the incision (preemptive analgesia) has been demonstrated to reduce postoperative pain. Aims: The aim of this study was to determine the quality of postoperative analgesia in abdominal hysterectomy by visual analog scale (VAS) in the group of 0.125% bupivacaine 15 ml with dexmedetomidine 1 μg/kg and in the group of 0.125% bupivacaine 15 ml alone. Settings and Design: A prospective observational analytical study was conducted in a tertiary care government hospital including 80 patients undergoing hysterectomy divided into two groups of 40 each. Subjects and Methods: Group A included those patients who received 0.125% bupivacaine 15 ml with dexmedetomidine 1 μg/kg and Group B patients received bupivacaine 15 ml alone. The pain was assessed by VAS. Rescue analgesia was given with diclofenac sodium 75 mg intramuscular on demand or whenever the VAS score was ≥4. The level of sedation was assessed using the four-point Sedation Scale. Nausea and vomiting were assessed by four-point categorical scales. Statistical Analysis: Mean and standard deviation were used to depict quantitative data, and paired t-test was used to compare the groups. Results: The combination of bupivacaine with dexmedetomidine has a better and longer anesthetic effect than bupivacaine alone (P < 0.001). The total diclofenac consumption in Group A was less (95.63 [±33.92] mg) than in Group B (150 [±0.0] mg), P < 0.01. Group A rescue analgesia was required after 2 h in only one (2.5%) patient, whereas in Group B, rescue analgesia was required immediately at 0 h in six (15%) patients (P < 0.001). Conclusions: The duration of analgesia was longer, and number of doses of rescue analgesia during the first 24 h after operation was significantly less in the group who received bupivacaine with dexmedetomidine when compared with bupivacaine alone.