INTRODUCTION: Laparoscopic cholecystectomy(LC) technically has evolved as a day case procedure even to a extent that ASA III patients are also not a exclusion. Pain is one of the cause for unexpected overnight hospital stay. The recent PROSPECT (PROcedure SPECific Postoperative Pain Management) working Group has recommended port site infiltration along with NSAIDS and paracetamol as the preferred mode of analgesia for laparoscopic cholecystectomy. Hence, we studied about efficacy of dexmedetomidine as an adjuvant for local anesthetic portsite wound infiltration with bupivacaine in patients undergoing laparoscopic cholecystectomy.
METHODS: 120 patients of ASA I–II scheduled for LC were randomly allotted to two groups. Group A received port site wound infiltration with 24 ml of 0.25% Bupivacaine and dexmedetomidine 2mcg/kg, while Group B received wound infiltration with 24ml of 0.25% bupivacaine divided equally for all the four laparoscopic port sites. A standard general anesthesia technique was used in all the patients. Pre-emptive analgesia with Inj. Paracetamol 1gm i.v given 30minutes before skin incision. Rescue analgesic with Inj. tramadol 1mg/kg and ketorolac 0.5 mg/kg intravenous infusion. Postoperative pain score, duration of effective analgesia, need for rescue analgesic, time of ambulation and hospital discharge.
RESULTS: Dexmedetomidine group has better pain score, longer duration of effective analgesia, lower percentage of patients requiring rescue analgesic, and earlier ambulation and hospital discharge.
DISCUSSION AND CONCLUSION: We conclude that dexmedetomidine 2μg/kg is an effective adjuvant to bupivacaine for port site wound infiltration in terms of quality and duration of postoperative analgesia following laparoscopic cholecystectomy.