Does dexmedetomidine reduce postoperative pain after laparoscopic cholecystectomy with multimodal analgesia?

Abstract

BackgroundPain after laparoscopy is multifactorial and different treatments have been proposed to provide pain relief. Multimodal analgesia is now recommended to prevent and treat post-laparoscopy pain. Dexmedetomidine, an α2 agonist, has well-known anesthetic and analgesic-sparing effects. We evaluated the analgesic effect of perioperative dexmedetomidine infusion during laparoscopic cholecystectomy with multimodal analgesia.MethodsForty-two patients aged 20 to 60 years old were allocated randomly into one of 2 groups (n = 21, in each). All patients underwent laparoscopic cholecystectomy under multimodal analgesia. The patients in group P received dexmedetomidine 1 µg/kg during 10 min before induction and then 0.5 µg/kg/h continuously until the removal of the gall bladder while the patients in the group C received saline by the same methods as group P. Total analgesic consumption and VAS score were recorded for the first 24 hr.ResultsThere were no significant differences in VAS scores between group P and group C during 24 hr after laparoscopic cholecystectomy. VAS scores of group P were lower than that of group C during the 1st hr after operation. The amount of ketorolac required during the 24 hr after the operation was significantly less in group P compared to group C.ConclusionsThe administration of dexmedetomidine during laparoscopic cholecystectomy with multimodal analgesia has minimal benefits on the reduction of the postoperative pain score. The amount of ketorolac requirements during 24 hr after the operation showed significant difference. Dexmedetomidine might be helpful for the postoperative pain after laparoscopic cholecystectomy with multimodal analgesia.

Multimodal versus Conventional Approach for Postoperative Pain Relief in Oral Cancer Patients

“…The dose of rescue analgesic for 24 hour postoperatively was lowest among the patients of Group C and highest in Group A. Similar findings were reported by Park et al, in which VAS scores of dexmedetomidine group were lower than that of placebo group during the 1 st hour after operation [14]. The 24 hours tramadol requirement after the operation was significantly lower in dexmedomidine group compared to placebo group.…”

The effect of low-dose dexmedetomidine on hemodynamics and anesthetic requirement during bis-spectral index-guided total intravenous anesthesia

“…Since dexmedetomidine has a long half-life in comparison to propofol and remifentanil, it may have postoperative analgesic or anti-emetic effects after laparoscopy [7,18,19]. However, we found no statistical differences in postoperative pain score and the incidences of nausea and vomiting between the groups since this study was not powered to detect such differences.…”

“…Considering there were no adverse outcomes in the control group as well as in the dexmedetomidine group despite more hemodynamic variation in the control group, additional dexmedetomidine infusion may not be cost-effective method in healthy patients undergoing a short surgery such as laparoscopic cholecystectomy under TIVA. However, since co-administration of dexmedetomidine during laparoscopy has been reported to many beneficial effects including anti-inflammatory responses [6], hemodynamic stability [18], and reduced postoperative pain [7,18] and postoperative nausea and vomiting [19], further studies in regard to the cost-effectiveness of dexmedetomidine seem to be needed.…”

“…In addition, during laparoscopic cholecystectomy, this dose of dexmedetomidine administration has been reported to have beneficial effects, including anti-inflammatory responses and reduced postoperative pain with multimodal analgesia [6,7]. However, co-administration of dexmedetomidine & Hyun Jeong Kwak hyun615@gilhospital.com during propofol anesthesia could result in prolonged recovery from anesthesia because of its sedative property and significantly long action duration [8,9].…”

Anestesia venosa total libre de opiáceos, con infusiones de propofol, dexmedetomidina y lidocaína para la colecistectomía laparoscópica: estudio prospectivo, aleatorizado y doble ciego

“…Se ha relatado que en pacientes sometidos a CL, la infusión intraoperatoria de lidocaína en combinación con dosis bajas de opiáceos estuvo asociada con el menor consumo de opiáceos en el intraoperatorio y el postoperatorio 18,19 . Park et al 25 relataron que las puntuaciones de dolor después de CL fueron menores en el período postoperatorio inmediato con la adición de dexmedetomidina al régimen analgésico multimodal. La dexmedetomidina posee propiedades analgésicas menos potentes que los opiáceos, y es usada como un sustituto de opiáceos en diversas intervenciones cirúrgicas 21,26---28 .…”