Effect of intraperitoneal instillation of dexmedetomidine or fentanyl as adjuvants to bupivacaine on fast tracking discharge criteria in patients undergoing ambulatory laparoscopic cholecystectomy: a randomised double-blind control trial

Abstract

Background Postoperative analgesia in laparoscopic cholecystectomy significantly affects the ambulation and discharge of the patient. This study compares fentanyl and dexmedetomidine as adjuvants to bupivacaine in intraperitoneal instillation after LC, in terms of their impact on ambulation, analgesic efficacy and recovery profile. Ninety patients were randomised into three groups with thirty patients in each group; group BF was administered 20 ml of 2 μg/kg fentanyl + 0.25% bupivacaine, group BD received 20 ml of 1μg/kg dexmedetomidine + 0.25% bupivacaine and group B received 20 ml of 0.25% bupivacaine only. After 8 h, Post-Anaesthesia Discharge Scoring System (PADS) scored for determining home readiness. Analgesic profile was assessed using Verbal Rating Scale and rescue analgesia requirement seen. Sedation was scored using Ramsay sedation scoring. Results Group B had significantly higher VRS and rescue analgesia requirements whilst groups BF and BD had a similar analgesic profile. Ramsay sedation scores were significantly higher in group BD when compared to groups BF and B. However, the PADS score remained comparable in all three groups ( P = 0.113). The trial was retrospectively registered with the clinical trial registry of India CTRI/2019/07/020466. Conclusion Intraperitoneal instillation of bupivacaine in combination with dexmedetomidine or fentanyl significantly reduces postoperative pain scores in comparison to bupivacaine alone, in patients undergoing ambulatory laparoscopic cholecystectomy. However, fentanyl may be preferred over dexmedetomidine, because it causes less sedation and achieves a better PADS score.