Comparison of postoperative analgesia and sedation responses of intravenous dexmedetomidine and esmolol during laparoscopic cholecystectomy

Background: Although, the concept of laparoscopic surgeries has revolutionised the surgical practice and has markedly reduced the incidence of complications especially postoperative pain. However, the menace of postoperative pain still remains challenge, especially in first 24 hours. The present study was conducted to comparatively analyse the postoperative pain and sedation using intravenous dexmedetomidine and intravenous esmolol during laparoscopic cholecystectomy.Methods: Study was conducted on 90 adult patients aged 18-60 years of ASA grade I or II of both genders, scheduled for laparoscopic cholecystectomy under general anaesthesia. Patients were randomized into three groups of 30 patients each. Patients of group A received esmolol infusion (loading: 1 mg/kg and maintenance: 5-15 µg/kg/min), patients of group B received dexmedetomidine infusion (loading: 0.7 µg/kg and maintenance: 0.4 µg/kg/hour) and group C (control group) received normal saline infusion. During the post-operative period of 24 hours, patient were monitored for sedation using Ramsay sedation score like pain, using visual analogue score (VAS), incidence of post-operative nausea and vomiting and use of any drug for pain, vomiting and any other side effect.Results: Frequency of pain was highest in group C at all post periods, followed by group A and was least in group B. The mean sedation score of group B was comparatively higher as compared to both group C and group A.Conclusions: The inference authors drew was that dexmedetomidine is better analgesic with aurousable sedation.

Comparative Evaluation Of Clinical Efficacy Of Intraperitoneal Ropivacaine With And Without Fentanyl For Post-Operative Analgesia After Laparoscopic Cholecystectomy

Background: The improved understanding of origin of abdominal and shoulder pain after laparoscopic procedures led to the use of intra peritoneal and port site instillation of local anaesthetic to reduce post-operative pain. Combinations of intraperitoneal local anaesthetics with many opioids have been studied in past and it was proved that they provide additional analgesic benefits. Material and methods: 106 ASA grade I and II patients of age 20 to 60 years of either sex weighing 40 to 70 kg undergoing laparascopic cholecystectomy under general anaesthesia were enrolled for the present study after written informed consent and institutional ethical committee cleareance. Patients were randomized into two groups , Group I (n=53): Patients received 30ml of 0.5% ropivacaine with 2ml Normal Saline. Group II (n=53): Patients received 30ml of 0.5% ropivacaine with fentanyl 100 mcg (2 ml). General anaesthesia was standardized. VAS, VRS scores, hemodynamics, total amount of rescue analgesic and side effects were noted at regular intervals. Results: VAS and VRS score were significantly lower in ropivacaine plus fentanyl group in comparisons to ropivacaine alone group at most of the time intervals. Hemodynamics was comparable between the two groups. Total Rescue analgesic were also significantly ow in ropivacaine plus fentanyl group side effects were comparable between two group. Conclusion: Intraperitoneal instillation of ropivacaine with fentanyl reduces not only the intensity of visceral, parietal and shoulder pain but also the total rescue analgesic dose consumption.