A comparative study of intraperitoneal Bupivacaine with Dexmedetomidine versus intraperitoneal Bupivacaine with Fentanyl for post operative analgesia following laparoscopic cholecystectomy

Sheetal Pawar, S. Totawar, V. Kulkarni
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Abstract

Abstract INTRODUCTION: Maximum open surgeries are being replaced with laparoscopic surgeries. Laparoscopic cholecystectomy is being more commonly practiced than open surgery. Many parenteral or oral medications are used to control post operative pain following laparoscopic cholecystectomy do have their own side effects. So, local instillation will be beneficial with lesser or negligible side effects. The present study was conducted to compare the effect of intraperitoneal instillation of 0.25% Bupivacaine with Dexmedetomidine and 0.25% Bupivacaine with Fentanyl to know which combination has better efficacy in patients of Laparoscopic Cholecystectomy. METHODOLOGY: The present comparative study was carried on patients posted for Laparoscopic Cholecystectomy in a tertiary care hospital during 2019 to 2022, The patients were divided in two equal groups of 40 each with Group D - Patients receiving 0.25% bupivacaine with Dexmedetomidine and were instilled with 30ml of 0.25% bupivacaine with 1 μg/kg Dexmedetomidine (diluted in 2 ml Normal Saline). Also, Group F - Patients receiving 0.25% bupivacaine with Fentanyl where patients were instilled with 30ml of 0.25% bupivacaine with 1 μg/kg Fentanyl (diluted with 2 ml Normal saline NS). Degree of postoperative pain was assessed using Visual Analogue Scale (VAS). RESULTS: Overall VAS in 24 hrs was significantly lower in the D group compared to F group. The time required for the first dose of rescue analgesia was longer in the D group than in F group, indicating better and longer pain relief in the D group compared to that of F group. The difference was also statistically significant among the two groups. Total analgesic consumption was high in F group than in the D group. CONCLUSION: We concluded that intraperitoneal instillation of dexmedetomidine 1 μg/kg in combination with 0.25% Bupivacaine in elective laparoscopic cholecystectomy significantly reduces the post operative pain and analgesic requirement in postoperative period.
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布比卡因联合右美托咪定腹腔注射与布比卡因联合芬太尼腹腔注射用于腹腔镜胆囊切除术后镇痛的比较研究
摘要简介:腹腔镜手术正在取代最大限度的开放手术。腹腔镜胆囊切除术比开放手术更常见。许多用于控制腹腔镜胆囊切除术后疼痛的肠外或口服药物确实有其副作用。所以,局部注射是有益的副作用更小或可以忽略不计。本研究比较0.25%布比卡因联合右美托咪定腹腔内滴注与0.25%布比卡因联合芬太尼腹腔内滴注的效果,以了解哪种组合在腹腔镜胆囊切除术患者中效果更好。方法:选取2019 ~ 2022年在某三级医院行腹腔镜胆囊切除术的患者为研究对象,将患者分为两组,每组40例,D组患者接受0.25%布比卡因加右美托咪定治疗,输注0.25%布比卡因加1 μg/kg右美托咪定30ml(稀释于2 ml生理盐水中)。F组:0.25%布比卡因加芬太尼组,患者输注0.25%布比卡因加芬太尼1 μg/kg 30ml(用生理盐水NS 2 ml稀释)。采用视觉模拟评分法(VAS)评估术后疼痛程度。结果:D组患者24小时VAS总分明显低于F组。D组首次给药镇痛所需时间较F组长,说明D组疼痛缓解效果较F组好,缓解时间较F组长。两组之间的差异也具有统计学意义。F组总镇痛用量高于D组。结论:选择性腹腔镜胆囊切除术患者腹腔注射右美托咪定1 μg/kg联合0.25%布比卡因可明显减轻术后疼痛和术后镇痛需求。
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