This study aimed to assess the efficiency of dexmedetomidine against magnesium sulfate as adjuvants to intraperitoneal bupivacaine for postoperative analgesia in individuals having elective laparoscopic cholecystectomy.
Pain after laparoscopy is less intense than after laparotomy, but laparoscopy is not pain free and analgesia after this type of surgery is inadequately studied. Intraperitoneal (IP) instillation/nebulization of local anesthetics has been used as a method for reducing postoperative pain and opioid use following laparoscopy through acting on visceral nociceptors of the peritoneum. Bupivacaine is indicated for local infiltration, peripheral nerve block, sympathetic nerve block, and epidural and caudal blocks. It is available mixed with a small amount of epinephrine to increase the duration of its action. It typically begins working within 15 minutes and lasts for 2 to 8 hours. Dexmedetomidine is a selective alpha-2 (α2) adrenergic agonist known to have analgesic and sedative characteristics that can augment the duration of action of local anesthetics. Magnesium is an N-methyl-D-aspartate receptor antagonist in addition to its effects on calcium influx. The anti-inflammatory and opioid-sparing effects make it a popular component of opioid free anaesthesia. It is extensively used for perioperative analgesia in a dose of 30- to 50-mg/kg intravascular bolus followed by a 10- to 15-mg/kg/h infusion.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
75
Patients received intraperitoneal bupivacaine only at the end of the operations.
Patients received intraperitoneal bupivacaine plus dexmedetomidine at the end of the operations.
Patients received intraperitoneal bupivacaine plus magnesium sulfate at the end of the operations.
Tanta University
Tanta, El-Gharbia, Egypt
Degree of pain
Degree of pain was assessed using the numerical rating score (NRS) (from 0 = no pain, to 10 = the most severe pain).NRS was assessed at 1, 2, 4, 8, 16, and 24 hours postoperative.
Time frame: 24 hours postoperatively
Time to the first rescue analgesia request
Time to the first rescue analgesia request (time from the end of surgery till first dose of morphine administrated)
Time frame: 24 hours postoperatively
Total morphine consumption
If Numerical rating score (NRS)-S \>4, IV 3 mg morphine was given as a rescue analgesia.
Time frame: 24 hours postoperatively
Level of sedation
Level of sedation using Ramsey scale at 1, 2, 4, 8, 16, and 24 hours postoperative from 1 to 6: 1. Patient is anxious and agitated. 2. Patient is co-operative and oriented. 3. Patient responds to commands only. 4. Patient exhibits brisk response to light glabellar tap or loud auditory stimulus. 5. Patient exhibits sluggish response to light glabellar tap or loud auditory stimulus. 6. Patient exhibits no response.
Time frame: 24 hours postoperatively
Lenght of hospital stay
Length of hospital stay was recorded from admission till discharge from hospital.
Time frame: 1 week postoperatively
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