Intraperitoneal dexmedetomidine as an adjuvant to bupivacaine for postoperative pain management in children undergoing laparoscopic appendectomy: A prospective randomized trial

Elnabtity, Ali Mohamed Ali; Ibrahim, Mohamed

doi:10.4103/sja.sja_760_17

Cited by 14 publications

(31 citation statements)

References 28 publications

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“…The 17 included papers were published between 1996 and 2020, and virtually all mentioned different approaches to the treatment of POP in children with LA, i.e., lidocaine infusion, different analgesic approaches, ultrasound-guided transverse abdominis block (UGTAP), ultrasound-guided quadratus lumborum block (UGQLB), and comparison of open appendectomy (OA) with LA in relation to the treatment of POP in children [ 7 , 10 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ]. As shown in Table 1 , a total of 1754 samples were included in the study, of which 61.86% were male.…”

Section: Resultsmentioning

confidence: 99%

Postoperative Pain Management in Children Undergoing Laparoscopic Appendectomy: A Scoping Review

et al. 2023

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Laparoscopic appendectomy (LA) is one of the most commonly performed surgical procedures in children and is associated with extreme postoperative discomfort due to peritoneal inflammation and infection. The main objective of this study was to investigate the effects of postoperative pain (POP) in children after laparoscopic appendectomy. Articles describing or evaluating the control of POP in children with LA were considered eligible. All available literature such as randomized controls, prospective controls, retrospective as well as clinical studies were considered. A comprehensive search was performed in PubMed, Medline, Embase, Cochrane Library, Clinical trials.gov, and Google scholar. The initial search took place on 23 April 2021, and was updated on 24 August 2021. There were no language or date restrictions. Each of the included articles was evaluated separately by two independent reviewers. Additional papers were found by searching the reference lists of eligible studies. Eighteen papers were considered. All papers, and many of them used different methods to treat POP in children undergoing LA, such as lidocaine infusion, different analgesic approaches, ultrasound-guided transverse abdominis blockade (UGTAP), ultrasound-guided quadratus lumborum blockade (UGQLB), and comparison of open appendectomy (OA) with local anesthetics in relation to POP management in children. Laparoscopic appendectomy is the surgical procedure preferred by clinicians compared with open appendectomy in children. A multimodal analgesic approach is optimal and efficient surgical techniques such as UGBRSB, UGQLB, and UGTAP block might significantly impact POP in children except that there are contraindications. Dexmedetomidine proved to be an effective adjuvant that can enhance the effect of local anesthetics. The lack of a sufficient number of studies may be a factor affecting our confidence in the results of this study. Therefore, further evidence-based randomized control trials with a large sample size are needed to provide clarity.

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Section: Resultsmentioning

confidence: 99%

Postoperative Pain Management in Children Undergoing Laparoscopic Appendectomy: A Scoping Review

et al. 2023

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“…Several studies have evaluated dexmedetomidine as an adjuvant to IPLA in laparoscopic surgeries to improve postoperative pain scores and decrease post-operative analgesic consumption. 10,13,22 We defined the duration of analgesia as the time period from the administration of the drug to the requirement of rescue analgesia that is a VAS score of ≥4. The mean time to first request of analgesia in this study was found significantly more in the Group-IV (216.467±42.198 min) compared to the Group-IP (108.033±48.779 min).…”

Section: Discussionmentioning

confidence: 99%

“…• Time to first request of analgesia was noted, considering the time of administration of study drug as "Time 0" • The post-operative pain intensity was assessed using visual analogue score (VAS) 12 where 0=no pain and 10=worst pain imaginable • Level of sedation was assessed using the Ramsay sedation scale 11 (RSS) where (1) anxious and agitated or restless, or both, (2) cooperative and oriented, (3) responds to commands only, (4) brisk response to light glabellar tap or loud auditory stimulus, (5) sluggish response to light glabellar tap or loud auditory stimulus, and ( 6) no response • Patient's satisfaction was assessed using the 7-point Likert scale: 13 ( 1) Extremely dissatisfied, (2) dissatisfied, (3) somewhat dissatisfied, (4) undecided, (5) somewhat satisfied, (6) satisfied, and (7) extremely satisfied.…”

Section: Group-ipmentioning

confidence: 99%

Efficacy of intravenous dexmedetomidine versus intraperitoneal dexmedetomidine in laparoscopic cholecystectomy – A prospective randomized double-blinded study

et al. 2022

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Background: Dexmedetomidine now has become one of the frequently used drugs as part of a multimodal analgesic regimen to provide improved pain control at all perioperative stages for laparoscopic surgeries. Aims and Objectives: In this prospective, double-blind, randomized, and control trial, we compared the postoperative analgesic efficacy of intravenous (IV) dexmedetomidine and intraperitoneal (IP) dexmedetomidine in laparoscopic cholecystectomy. Materials and Methods: Sixty patients of the American Society of Anesthesiologists Grade I and II undergoing laparoscopic cholecystectomy were allocated into two groups. The patients in Group-IV had received 30 ml of 0.5 μg/kg Dexmedetomidine infusion intravenously plus 40 ml of Ropivacaine (30 mL of 0.5% Ropivacaine and 10 ml NS) intraperitoneally and in Group-IP received 30 ml NS intravenously and 40 ml of Ropivacaine plus Dexmedetomidine (30 mL of 0.5% Ropivacaine and 0.5 μg/kg Dexmedetomidine diluted in 10 ml NS) intraperitoneally after removal of the gallbladder. Patients were assessed during the first 24 h postoperatively for time to the first requirement of analgesia, total analgesic consumption, sedation, hemodynamics, side effects, and patient satisfaction. Results: Time to first request of analgesia (min) was longer (216.46±42.19 vs. 108.03±48.77) and total analgesic consumption (mg) was lower (92.50±32.26 vs 115.0±38.056) in Group-IV than in Group-IP. A significant difference was observed in visual analogue score in Group-IV at 1 h, 2 h, 4 h postoperatively and in the patient satisfaction score (P=0.024) in comparison to Group-IP. Conclusion: The postoperative analgesic effects and patient satisfaction, of low dose IV Dexmedetomidine plus IP instillation of Ropivacaine, are superior to low dose IP Dexmedetomidine added to Ropivacaine.

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“…Various additives could be used to prolong the duration of analgesia produced. [ 24 ] This should be studied further to see if there is an increased benefit to patients.…”

Section: Discussionmentioning

confidence: 99%

Intraperitoneal nebulization of ropivacaine for control of pain after laparoscopic cholecystectomy -A randomized control trial

Sandhya

Puthenveettil

Vinodan

2021

J Anaesthesiol Clin Pharmacol

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Background and Aims: Use of high dose opioids following laparoscopic surgery delays discharge from the hospital. Unlike intraperitoneal instillation, nebulization has been reported to provide a homogeneous spread of local anesthetics and provide better analgesia. In our study, we aimed to assess the efficacy of intraperitoneal nebulization of local anesthetic in alleviating postoperative pain in patients undergoing laparoscopic cholecystectomy. Material and Methods: This randomized control double-blinded study was conducted after obtaining approval from the hospital ethics committee and informed consent from patients undergoing laparoscopic cholecystectomy under general anesthesia. Patients recruited were divided into two equal groups of 20 each. Group B received intraperitoneal nebulization with 4 ml of 0.75% ropivacaine and Group C received intraperitoneal nebulization with 4ml of saline before surgical dissection. Postoperative pain score using a numeric rating scale was monitored until 24 h, the need for rescue analgesics and associated complications were noted. Chi-square test, Student's test, and Mann–Whitney U test were used for statistical analysis. Results: The pain score was significantly less in Group B during rest and deep breathing up to 24 h with a P value <0.05. The pain score on movement was also less in Group B and this difference was statistically significant at 6 and 24 h ( P = 0.004 and 0.005, respectively). Tramadol consumption was less in Group B and was statistically significant at 24 h with P value of 0.044. No adverse events were noted. Conclusion: Intraperitoneal nebulization of ropivacaine is effective and safe in providing postoperative analgesia in patients undergoing laparoscopic cholecystectomy.

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Intraperitoneal dexmedetomidine as an adjuvant to bupivacaine for postoperative pain management in children undergoing laparoscopic appendectomy: A prospective randomized trial

Cited by 14 publications

References 28 publications

Postoperative Pain Management in Children Undergoing Laparoscopic Appendectomy: A Scoping Review

Postoperative Pain Management in Children Undergoing Laparoscopic Appendectomy: A Scoping Review

Efficacy of intravenous dexmedetomidine versus intraperitoneal dexmedetomidine in laparoscopic cholecystectomy – A prospective randomized double-blinded study

Intraperitoneal nebulization of ropivacaine for control of pain after laparoscopic cholecystectomy -A randomized control trial

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