POSTOPERATIVE ANALGESIA WITH INTRAPERITONEAL ROPIVACAINE WITH AND WITHOUT DEXMEDETOMIDINE AFTER TOTAL LAPAROSCOPIC HYSTERECTOMY: A RANDOMIZED, DOUBLE-BLIND, CONTROLLED TRIAL
Objective: In this advanced era of surgery, laparoscopic hysterectomy operations are very commonly practiced by surgeons. It reduces trauma, morbidity, and health-care costs, ensuring early discharge. However, the early post-operative pain experienced by patients may sometimes negate all the advantages of a laparoscopic procedure. Intraperitoneal (IP) instillation of local anesthetics has been proposed to decrease post-operative pain after laparoscopic surgeries. Additives to local anesthetics like Î±-2 agonists such as clonidine and dexmedetomidine prolong the duration of analgesia. Therefore, this randomized, prospective, controlled study was conducted to compare the analgesic efficacy of IP ropivacaine with or without dexmedetomidine for postoperative analgesia after total laparoscopy hysterectomy.
Methods: At the end of laparoscopic hysterectomy, in a double-blind, randomized manner, one of the following injections was given intraperitoneally. The patients were allocated into the following two groups: The patients in ropivacaine group (R group) (N = 40) were given 38 ml of 0.2% ropivacaine plus 2 ml of normal saline (NS) and the patients in ropivacaine plus dexmedetomidine group (RD group) (N = 40) were given 38 ml of 0.2% ropivacaine combined with 0.5 Î¼g/kg dexmedetomidine (diluted in 2 ml NS) through trocars. All the patients were given diclofenac sodium when they had a pain score of 4 on visual analog scale (VAS).
Results: VAS score at different time intervals was significantly lower after the second postoperative hour, time to first request of analgesia (minutes) was longest (487.7Â±40.96 vs. 242.5Â±19.84), and the total analgesic consumption (mg) was lowest (61.88Â±37.55 vs. 183.75Â±44.78) in RD group than in R group.
Conclusion: The antinociceptive effects of the IP instillation of ropivacaine in combination with dexmedetomidine are superior to ropivacaine alone in laparoscopic hysterectomy cases.
Keywords: Dexmedetomidine, Ropivacaine, Laparoscopic Hysterectomy.
Lahmann B, Adrales GL, Mastrangelo MJ Jr, Schwartz RW. Laparoscopic cholecystectomy-technical considerations. Curr Surg 2002;59(1):55-8.
Zucker KA, Bailey RW, Flowers J. Laparoscopic management of acute and chronic cholecystitis. Surg Clin North Am 1992;72(5):1045-67.
Joris J, Thiry E, Paris P, Weerts J, Lamy M. Pain after laparoscopic cholecystectomy: Characteristics and effect of intraperitoneal bupivacaine. Anesth Analog 1995;81(2):479-84.
Cuschieri A. Laparoscopic cholecystectomy. J R Coll Surg Edinb 1999;44(3):187-92.
Alexander JI. Pain after laparoscopy. Br J Anaesth 1997;79:369-78.
Gupta R, Bogra J, Kothari N, Kohli M. Postoperative analgesia with intraperitoneal fentanyl and bupivacaine: A randomized control trial. Can J Med 2010;11-11.
Marks JL, Ata B, Tulandi T. Systematic review and metaanalysis of intraperitoneal instillation of local anesthetics for reduction of pain after gynecologic laparoscopy. J Minim Invasive Gynecol 2012;19(5):545-53.
Labaille T, Mazoit JX, Paqueron X, Franco D, Benhamou D. The clinical efficacy and pharmacokinetics of intraperitoneal ropivacaine for laparoscopic cholecystectomy. Anesth Analg 2002;94(1):100-5.
Kucuk C, Kadiogullari N, Canoler O, Savli S. A placebo-controlled comparison of bupivacaine and ropivacaine instillation for preventing postoperative pain after laparoscopic cholecystectomy. Surg Today 2007;37(5):396-400.
Kahokehr A, Sammour T, Soop M, Hill AG. Intraperitoneal local anaesthetic in abdominal surgery - A systematic review. ANZ J Surg 2011;81(4):237-45.
Liu SS, Hodgson PS. Local anaesthetics. In: Barash PG, Cullen BF, Stoelting RK, editors. Clinical Anaesthesia. 4th ed. Philadelphia, PA: Lippicott Williams & Wilkins; 2001. p. 449-69.
Kim TH, Kang H, Park JS, Chang IT, Park SG. Intraperitoneal ropivacaine instillation for post-operative pain relief after laparoscopic cholecystectomy. J Korean Surg Soc 2010;79:130-6.
MÃ¸iniche S, JÃ¸rgensen H, Wetterslev J, Dahl JB. Local anesthetic infiltration for postoperative pain relief after laparoscopy: A qualitative and quantitative systematic review of intraperitoneal, port-site infiltration and mesosalpinx block. Anesth Analg 2000;90(4):899-912.
Narchi P, Benhamou D, Fernandez H. Intraperitoneal local anaesthetic for shoulder pain after day-case laparoscopy. Lancet 1991;338(8782-8783):1569-70.
Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin Trials 1996;17(1):1-12.
Moller R, Covino BG. Cardiac electrophysiologic properties of bupivacaine and lidocaine compared with those of ropivacaine, a new amide local anesthetic. Anesthesiology 1990;72(2):322-9.
Gupta A. Local anaesthesia for pain relief after laparoscopic cholecystectomy â€“ A systematic review. Best Pract Res Clin Anaesthesiol 2005;19(2):275-92.
Goldstein A, Grimault P, Henique A, Keller M, Fortin A, Darai E. Preventing postoperative pain by local anaesthetic instillation after laparoscopic gynecologic surgery: A placebo controlled comparision of bupivacaine and ropivacaine. Anesth Analg 2000;91(2):403-7.
Pappas-Gogos G, Tsimogiannis KE, Zikos N, Nikas K, Manataki A, Tsimoyiannis EC. Preincisional and intraperitoneal ropivacaine plus normal saline infusion for postoperative pain relief after laparoscopic cholecystectomy: A randomized double-blind controlled trial. Surg Endosc 2008;22(9):2036-45.
Kamibayashi T, Maze M. Clinical uses of alpha2 - Adrenergic agonists. Anesthesiology 2000;93(5):1345-9.
Kanazi GE, Aouad MT, Jabbour-Khoury SI, Al Jazzar MD, Alameddine MM, Al-Yaman R, et al. Effect of low-dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. Acta Anaesthesiol Scand 2006;50(2):222-7.
Memis D, Turan A, Karamanlioglu B, TÃ¼kenmez B, PamukÃ§u Z. The effect of tramadol or clonidine added to intraperitoneal bupivacaine onpostoperative pain in total abdominal hysterectomy. J Opioid Manag 2005;1(2):77-82.
Ahmed B, Elmawgoud AA, Dosa R. Antinociceptive effect of (á¼€-2 adrenoceptor agonist) dexmedetomidine vs meperidine, topically, after laproscopic gynecologic surgery. J Med Sci 2008;8:400-4.
Shukla U, Prabhakar T, Malhotra K, Srivastava D, Malhotra K. Intraperitoneal bupivacaine alone or with dexmedetomidine or tramadol for post-operative analgesia following laparoscopic cholecystectomy: A comparative evaluation. Indian J Anaesth 2015;59(4):234-9.
Louizos AA, Hadzilia SJ, Leandros E, Kouroukli IK, Georgiou LG, Bramis JP. Postoperative pain relief after laparoscopic cholecystectomy: A placebo-controlled double-blind randomized trial of preincisional infiltration and intraperitoneal instillation of levobupivacaine 0.25%. Surg Endosc 2005;19(11):1503-6.
How to Cite
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.