An investigation of the effects of dexmedetomidine and fentanyl as an adjuvant to ropivacaine on pain scores and hemodynamic changes following laparoscopic cholecystectomy

Abstract

Postoperative pain control is recognized as a challenging surgical issue receiving high priority in the healthcare system, and opioids are routinely prescribed for anesthesia and pain relief. This study aimed to investigate the effects of ropivacaine administered intraperitoneally alone or combined with dexmedetomidine or fentanyl on postoperative pain control following laparoscopic cholecystectomy. This randomized double-blind clinical trial recruited three equal-size block-randomized groups of patients ( n = 138) scheduled for elective laparoscopic cholecystectomy at Valiasr Hospital, Arak, Iran, in 2019–2020 who received ropivacaine (40 mL/0.5%), ropivacaine (40 mL/0.5%) + dexmedetomidine (1 μg/kg), and ropivacaine (40 mL/0.5%) + fentanyl (1 μg/kg). No significant differences were observed among the three groups according to the vital signs (mean arterial pressure/heart-rate/oxygen saturation) in the study period and during surgery ( P > 0.05). Lower pain was revealed in the ropivacaine + dexmedetomidine group ( P = 0.001), with the lowest opioid dose in postoperative 24 hours ( P = 0.001). Moreover, no clinically significant differences were observed in complications among the three groups ( P = 0.483), and no patient developed ileus. Intraperitoneal ropivacaine administered with dexmedetomidine could relieve pain and reduce opioid use in postoperative 24 hours, without any complication and ileus. Therefore, intraperitoneal ropivacaine administered with dexmedetomidine is recommended for postoperative pain control in patients undergoing laparoscopic cholecystectomy. This study was approved by the Ethical Committee of Arak University of Medical Sciences (approval No. IR.ARAKMU.REC.1397.267) on December 30, 2018 and was registered in the Iranian Registry of Clinical Trials (No. IRCT 20141209020258N117) on July 13, 2019.

Effect of Intraperitoneal Instillation of Dexmedetomidine With Local Anesthetics in Laparoscopic Cholecystectomy: A Systematic Review and Meta-analysis of Randomized Trials

“…The details of the included studies are summarized in Table 1. Seven studies 6,7,12,15,17,18,20 included other comparators (anesthetic agents in combination with fentanyl, clonidine, tramadol, or magnesium sulfate). After the exclusion of these irrelevant comparators, 890 patients were included in our study.…”

“…The LA group comprised 446 patients, and the LA+DEX group comprised 444 patients. Two studies 13,17 used levobupivacaine, 8 6,7,12,14,16 used bupivacaine, and 1 15 used ropivacaine as the LA. Opioids were given as a rescue analgesic alone in 2 studies (fentanyl and tramadol).…”

“…Opioids were given as a rescue analgesic alone in 2 studies (fentanyl and tramadol). 14,15 Nonsteroidal anti-inflammatory drugs (paracetamol and diclofenac) were used in 8 studies (one of these studies did not provide sufficient details regarding the doses of paracetamol). 6,7,12,13,[16][17][18][19] Both paracetamol and fentanyl were used in one study.…”

“…All RCTs provided their inclusion and exclusion criteria, and 8 RCTs 6,[12][13][14][15]17,18,20 reported the use of computer-generated randomization. Eight articles 6,12,[14][15][16][17][18]20 indicated that allocation concealment was achieved using closed envelopes. Double-blinding was performed in 10 RCTs, 6,7,[12][13][14][15][16][17]19,20 and all trials had a low risk for attrition bias.…”

“…Eight articles 6,12,[14][15][16][17][18]20 indicated that allocation concealment was achieved using closed envelopes. Double-blinding was performed in 10 RCTs, 6,7,[12][13][14][15][16][17]19,20 and all trials had a low risk for attrition bias. Moreover, most of the trials 7,[12][13][14]16,[18][19][20] were assessed as having unclear risk of detection bias because of insufficient details regarding blinding outcome assessment.…”