Evaluation of the Efficacy of Intraperitoneal Instillation of Ropivacaine with Dexmedetomidine Versus Ropivacaine with Ketamine for Post Operative Pain Relief following Laparoscopic Cholecystectomy: A Randomized Controlled Study

Abstract

Background: Adjuvants are added to intraperitoneal local anesthetics to prolong analgesia however no study compares Dexmedetomiditine with Ketamine as adjuvant to Ropivacaine for laparoscopic cholecystectomy.
To compare efficacy of intraperitoneal instillation of Ropivacine with Dexmedetomidine versus Ropivacaine with Ketamine for postoperative pain relief following laparoscopic cholecystectomy.
Methods: Sixty patients ASA I and ASA II undergoing laparoscopic cholecystectomy were  randomly allocated in three groups and received Ropivacaine 0.2 % (group R), Ropivacaine 0.2 % alongwith Dexmedetomidine 0.7 micogrms/ kg (group RD) and Ropivacaine with Ketamine 0.5 mg/kg (group RK) to a total volume of 40ml.The primary outcome measured was time to request of rescue analgesia while secondary outcomes were post op numeric rating scale, total dose of rescue analgesia required in 24 hours and haemodynamic parameters in postoperative period.
Results: The median time to request of rescue analgesia was shortest in R group 55 [42.5-70] minutes followed by RK group 60 [50.50-72.50] and maximum in the group RD the time being 900 [86.25 -1440] minutes while haemodynamics remained stable in all the groups. Similar findings were seen for total demand of analgesia in 24 hours as well as NRS scale both static and dynamic which was measured periodically in the first 24 hours.
Conclusion: Dexmedetomiditine 0.7 micrograms per kg when used as adjuvant with Ropivacine is effective combination that prolongs duration than Ropivacaine alone or when used with Ketamine 0.5 mg per kg body weight  however total dose of rescue analgesia was significantly less in Ketamine  group compared to Ropivacine alone and least when Dexmedetomiditine is used as adjuvant.