ABSTRACT
Background: Laparoscopic appendectomy is preferred because of increasing popularity and certain benefits over open method. Laparoscopic surgeries are conventionally done under general anaesthesia with positive pressure ventilation to avoid shoulder pain, respiratory embarrassment and abdominal discomfort caused by pneumoperitoneum. The data regarding use of spinal anaesthesia for laparoscopic appendectomy is limited. This study was designed to evaluate laparoscopic appendectomy under spinal anaesthesia along with the use of intravenous injection ketamine and intravenous injection dexmedetomidine. Objectives of this study were to observe efficacy of both drugs in reducing shoulder pain, need of rescue analgesia, need of conversion to open method due patient discomfort, changes in hemodynamic parameters, postoperative nausea and vomiting. Methods: After approval of ethical committee of institute , 100 patients of age group between 18-60 years with ASA grade I or II undergoing laparoscopic appendectomy with written informed consent were included in this study .All patients were informed about standard spinal anaesthesia technique in detail and also about the risk of conversion to general anaesthesia.Spinal anaesthesia procedure was carried out with hyperbaric injection bupivacaine 0.5% . Patients were randomized in two groups. One is Group K (n=50) patients who received injection Ketamine and other is Group D (n=50) patients who received injection Dexmedetomidine intravenously.Intraoperative hemodynamic parameters,shoulder pain,abdominal discomfort,need of rescue analgesia ,postoperative recovery were monitored and recorded. Results: No patients during study required conversion to general anaesthesia or open method. VDS(verbal descriptive scale) score for referred shoulder pain was statistically lower in group K compared to group D.Group D was associated with statistically significant lower heart rate and blood pressure than Group K. Conclusion:Injection ketamine and injection dexmedetomidine, both drugs are efficacious for reduction of referred shoulder pain with more hemodynamic stability in ketamine group during laparoscopic appendectomy.