Comparison of local wound infiltration with ropivacaine alone or ropivacaine plus dexmedetomidine for postoperative pain relief after lower segment cesarean section

Abstract

Context:Dexmedetomidine, α2-adrenergic agonist, when coadministered with local anesthetics, improves the speed of onset, duration of analgesia and decreases the dose of local anesthetic used.Aims:The aim of this study was to compare the efficacy of local subcutaneous wound infiltration of ropivacaine alone with ropivacaine plus dexmedetomidine for postoperative pain relief following lower segment cesarean section (LSCS).Subjects and Methods:The study was a prospective, randomized control, double-blind study. Sixty female patients belonging to physical status American Society of Anesthesiologists Grade I or II scheduled for LSCS under spinal anesthesia were randomly allocated into two groups of thirty patients each. Group A: local subcutaneous wound infiltration of 0.75% ropivacaine (3 mg/kg) diluted with normal saline to 40 ml. Group B: local subcutaneous wound infiltration of 0.75% ropivacaine (3 mg/kg) plus dexmedetomidine (1.5 μg/kg) of the body weight diluted with normal saline to 40 ml. Standard spinal anesthesia technique was used and LSCS was conducted. The allocated drug was administered by local subcutaneous wound infiltration before closure of the skin. In postoperative period, pain was assessed using visual analog scale (VAS) over a period of 24 h, time of giving first rescue analgesic consumption, mean analgesic consumption, patient satisfaction, and incidence of side effects in 24 h postoperative period was noted.Statistical Analysis Used:All observations were tabulated and statistically analyzed using Chi-square test and unpaired t-test.Results:A total number of patients requiring rescue analgesic, mean VAS each time rescue analgesic was given, and the mean analgesic required in 24 h postoperative period was lesser in Group B than in Group A.Conclusions:Dexmedetomidine added to ropivacaine for the surgical wound infiltration significantly reduces postoperative pain and rescue analgesic consumption in patients undergoing LSCS. No serious adverse effects were noted.

Efficacy of dexmedetomidine as an adjuvant to local wound infiltration anaesthesia in abdominal surgery: A meta‐analysis of randomised controlled trials

“…The search identified 251 studies, of which 198 were eliminated from further review because of not controlled trials or were duplications; after reviewing the abstracts, an additional 48 trials were excluded because they were not relevant to our study. Finally, the articles considered to be suitable for the meta‐analysis consisted of five RCTs, enrolling a total of 294 adult patients. The search process is shown in Figure .…”

“…Of the five studies, two studies were from India, two studies were from China, and one study was from Egypt. Four studies involved local wound infiltration at the end of the operation, and one study concerned local wound infiltration before the operation. Among them, local anaesthetics were ropivacaine in three studies, and bupivacaine in the other two studies .…”

“…Four studies involved local wound infiltration at the end of the operation, and one study concerned local wound infiltration before the operation. Among them, local anaesthetics were ropivacaine in three studies, and bupivacaine in the other two studies . The concentration range of ropivacaine was 0.3%‐0.75%; concentration of bupivacaine was 0.25%.…”

“…The dosage of DEX fluctuated between 0.5 μg/kg and about 1.5 μg/kg in all studies. Three studies evaluated the VAS scores at 6, 12, and 24 hours in the postoperative period, four studies described the total analgesic consumption within 24 hours after surgery and analysed the incidence of PONV. The detailed characteristics of all the included studies are shown in Table .…”

“…Does DEX provide a similar effect on local wound infiltration in abdominal operation? At present, some clinical randomised controlled trials (RCTs) have studied this problem . Therefore, we wanted to see whether DEX could improve analgesia when used in combination with local anaesthetics for wound infiltration after abdominal surgery.…”