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

Abstract

Background: Pain 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.

Methods: Forty-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.

Results: There 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.

Conclusions: The 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.

Keywords: Dexmedetomidine; Laparoscopic cholecystectomy; Postoperative pain.

Fig. 1

Changes in BIS between groups during preoperative infusion of solution. The BIS values of group P decreased significantly compared to group C at 10 min after the infusion of the study solution. Group P: dexmedetomidine infusion during perioperative period, Group C: normal saline infusion during perioperative period. BIS: Bispectral index, T0, 5, 10: solution start time, 5 minutes after solution start, 10 min after solution start. ^*P < 0.05 compared with group C.

Fig. 2

Changes in systolic blood pressure between groups during preoperative infusion of solution. The systolic blood pressure of group P decreased gradually during the infusion of the study solution. Group P: dexmedetomidine infusion during perioperative period, Group C: normal saline infusion during perioperative period. T0, 5, 10: solution start time, 5 minutes after solution start, 10 minutes after solution start. ^*P < 0.05 compared with group C.

Fig. 3

Changes in heart rate between groups during preoperative infusion of solution. The heart rate of group P decreased gradually during the infusion of the study solution. Group P: dexmedetomidine infusion during perioperative period, Group C: normal saline infusion during perioperative period. T0, 5, 10: solution start time, 5 min after solution start, 10 min after solution start. ^*P < 0.05 compared with group C.

Fig. 4

Changes in postoperative pain between groups. Patients who received dexmedetomidine suffered less pain during 1 hour after laparoscopic cholecystectomy but, not after 1 h after the operation. Group P: dexmedetomidine infusion during perioperative period, Group C: normal saline infusion during perioperative period. VAS: Visual analogue scale. ^*P < 0.05 compared with group C.