Comparative Evaluation of Intraperitoneal Instillation of Bupivacaine With Magnesium Sulfate Versus Bupivacaine With Dexmedetomidine for Postoperative Relief After Laparoscopic Cholecystectomy

TL;DR

This study compares two pain relief methods after laparoscopic cholecystectomy, finding that bupivacaine with magnesium sulfate offers better early pain control than bupivacaine with dexmedetomidine.

Contribution

The novel contribution is demonstrating that magnesium sulfate is a more effective adjuvant than dexmedetomidine for early postoperative analgesia in laparoscopic cholecystectomy.

Findings

Group A (bupivacaine with magnesium sulfate) had significantly lower pain scores at 2, 4, and 6 hours post-surgery.

Both groups had similar analgesia duration and rescue analgesic use.

Magnesium sulfate is a cost-effective alternative to dexmedetomidine for postoperative pain management.

Abstract

Background: Laparoscopic cholecystectomy (LC) is the most common surgical treatment for cholelithiasis and offers advantages over open surgery. However, postoperative pain remains a significant concern, arising from both somatic and visceral components. Intraperitoneal instillation of local anesthetics with adjuvants has been explored as a simple and effective method of pain control.

Objective: This study compared intraperitoneal bupivacaine with magnesium sulfate versus bupivacaine with dexmedetomidine for postoperative pain relief in LC. Pain assessed using the Visual Analog Scale (VAS), analgesia duration, rescue analgesic use, and hemodynamic stability were evaluated.

Materials and methods: A prospective, randomized, double-blind clinical study was conducted on 116 American Society of Anesthesiologists I and II patients undergoing elective LC. Patients were divided into two groups: Group A received intraperitoneal bupivacaine with magnesium sulfate, and Group B received intraperitoneal bupivacaine with dexmedetomidine. Pain scores, analgesic duration, rescue analgesic requirement, and hemodynamic parameters were compared between the groups.

Results: Both groups were comparable with respect to demographic variables. Group A showed significantly lower VAS scores at two, four, and six hours postoperatively (p < 0.001), indicating better early pain control. The duration of analgesia and total rescue analgesic consumption were comparable between groups. Hemodynamic parameters were stable, though Group B exhibited lower heart rate and blood pressure at some time intervals, consistent with the sympatholytic effect of dexmedetomidine. Both regimens were well tolerated, with minimal side effects.

Conclusions: Intraperitoneal instillation of bupivacaine with magnesium sulfate provides superior early postoperative analgesia compared to bupivacaine with dexmedetomidine, while both combinations are safe and effective. Magnesium sulfate is a cost-effective, readily available adjuvant that may be considered a better alternative in multimodal analgesia for LC.

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