Effect of Dexmedetomidine as an Adjuvant to 0.25% Bupivacaine for Local Infiltration of Port Site in Laparoscopic Cholecystectomy in Terms of Quality and Duration of Post-op Analgesia

Objective: 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 unex- pected 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 2 μg kg -1 while Group B received wound infiltration with 24 mL 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 paracetamol 1 g IV given 30 minutes before skin incision. Tramadol 1 mg kg -1 and ketorolac 0.5 mg kg -1 IV infusion was administered as rescue analgesic. Postoperative pain score, duration of effective analgesia, need for rescue analgesic, time of ambulation and hospital discharge was recorded. 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. Conclusion: We conclude that dexmedetomidine 2 μg kg -1 is an effective adjuvant to bupivacaine for port site wound infiltration in terms of quality and duration of postoperative analgesia follow- ing laparoscopic cholecystectomy.

Laparoskopik Kolesistektomide Port Sahasına %0.25 Bupivakain İnfiltrasyonuna Adjuvan Olarak Eklenen Deksmedetomidinin Postoperatif Analjezi Kalitesi ve Süresine Etkisi

Amaç: Laparoskopik kolesistektomi (LK), teknik açıdan, ASA III hastaların bile dışlanmadığı günü- birlik bir işlem haline gelmiştir. Ağrı, beklenmedik gece hastanede yatış nedenlerinden biridir. PROSPECT (PROcedure SPECific Postoperative Pain Management) çalışma grubu, NSAİİ’lar ve parasetamol ile port sahası infiltrasyonunu laparoskopik kolesistektomi için tercih edilen analjezi şekli olarak önermektedir. Buradan yola çıkarak, laparoskopik kolesistektomi yapılan hastalarda, port sahasına yara yeri infiltrasyonunda bupivakaine adjuvan olarak eklenen deksmedetomidinin etkinliğini çalıştık. Yöntem: LK planlanan 120 ASA I-II hasta rastgele iki gruba ayrıldı. Grup A’ya 24 mL %0.25 bupi- vakain ve 2 mcg kg -1 deksmedetomidin ile, Grup B’ye 24 mL % 0.25 bupivakain ile yara infiltras- yonu dört laparoskopik port bölgesi için eşit olarak bölünmüş dozda uygulandı. Tüm hastalarda standart bir genel anestezi tekniği kullanıldı. Cilt insizyonundan 30 dk önce parasetamol 1 g iv ile pre-emptif analjezi uygulandı. Tramadol 1 mg kg -1 ve ketorolak 0.5 mg kg -1 iv ile kurtarıcı analjezi sağlandı. Postoperatif ağrı skoru, etkili analjezi süresi, kurtarıcı analjezik ihtiyacı, ile mobilizasyon ve taburculuk zamanları kaydedildi. Bulgular: Deksmedetomidin grubunda, ağrı skoru daha iyi, etkili analjezi süresi daha uzun, kurta- rıcı analjezik gerektiren hasta oranı daha düşük ve mobilizasyon ve taburculuk daha erkendi. Sonuç: 2 μg kg -1 deksmedetomidinin, laparoskopik kolesistektomiyi takiben postoperatif analjezi kalitesi ve süresi açısından port sahası yara infiltrasyonu için etkili bir bupivakain adjuvanı olduğu sonucuna vardık.

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