Intraperitoneal bupivacaine alone or with dexmedetomidine or tramadol or fentanyl for post operative analgesia following laparoscopic cholecystectomy: A comparative evaluation

Abstract

Background: Local anaesthetics instilled intraperitoneally have been demonstrated to reduce postoperative discomfort after laparoscopic procedures. In patients having laparoscopic cholecystectomy, it is necessary to compare the antinociceptive effects of intraperitoneal dexmedetomidine, tramadol, or fentanyl coupled with bupivacaine to intraperitoneal bupivacaine alone. Aim: Comparative evaluation of Intraperitoneal bupivacaine alone or with dexmedetomidine or tramadol or fentanyl for post operative analgesia following laparoscopic cholecystectomy. Methods: This prospective, double-blind, randomised study involved a total of 200 patients. Patients were split into four study groups of equal size (n = 50). Before trocar removal, patients received intraperitoneal bupivacaine 50 ml 0.25 percent +5 ml normal saline (NS) in Group B, bupivacaine 50 ml 0.25 percent + tramadol 1 mg/kg (diluted in 5 ml NS) in Group BT, bupivacaine 50 ml 0.25 percent + fentanyl 1 mg/kg (diluted in 5 ml NS) in Group BF,and bupivacaine 50 ml 0.25% + dexmedetomidine 1 μg/kg, (diluted in 5 ml NS) in Group BD. A visual analogue scale score was used to assess the quality of analgesia (VAS). The time from the first request for analgesia, the total analgesic dose in the first 24 hours, and any adverse effects were all recorded. The Student's ttest and Chisquare test (level of significance P = 0.05) were used in the statistical analysis using Microsoft (MS) Office Excel Software. Results: At all occasions, the visual analogue scale in Group BD was statistically substantially lower than in Group BT and Group B. Furthermore, Group BD (2.80±0.36) had a considerably lower overall VAS in 24 hours than Groups BT (4.01±0.48), BF (4.31±0.48), and B (5.50±0.92). However, there was no discernible difference between Groups BT and BF. Group BD took the longest (138±20 minutes) to request analgesia, followed by BT (128±22 minutes), Group BF (129±22 minutes), and Group B (65±18 minutes). Group BD had the lowest total diclofenac intake (55±15 mg) compared to Group BT (95±35 mg), Group BF (97±35 mg), and Group B (185±75 mg). Overall, there were no statistically significant differences in adverse events across the four research groups (P = 5010). When comparing Group BF to Group BT, the incidence of adverse effects was lower in Group BF, and the difference was statistically significant. Conclusion: It was concluded that intraperitoneal instillation of bupivacaine in combination with dexmedetomidine is superior to bupivacaine alone and may be better than bupivacaine with tramadol and bupivacaine with fentanyl.