Comparison of analgesic efficacy of dexmedetomidine for opioid-sparing anesthesia with conventional opioid-based anesthesia for elective laparoscopic cholecystectomy: a prospective randomized controlled study.

Laparoscopic cholecystectomy is the minimally invasive gold standard procedure for the removal of gall bladder in conditions like cholelithiasis. Unfortunately, the incidence of postoperative nausea and vomiting is as high as 55.8%which delays recovery. Perioperative opioid use is considered to be one of the reasons for it. Opioid usage is also associated with itching, respiratory depression, paralytic ileus, urinary retention, constipation, dependency, and drowsiness. Opioid-sparing anaesthesia by minimizing the perioperative opioid usage may reduce the incidence of these adverse effects and enhance recovery. In this study, Dexmedetomidine is used for opioid-sparing anaesthesia. Dexmedetomidine is a highly selective pre-synaptic alpha-2  receptor agonist having sedative, anxiolytic, hypnotic, analgesic and sympatholytic properties.

Various studies have shown the analgesic efficacy of dexmedetomidine and its hemodynamic stability in varying doses and in conjunction with other opioid sparing techniques. Studies have established the effect of dexmedetomidine in reducing post-operative nausea and vomiting compared to opoid based anaesthesia. This study compares opioid sparing effect of dexmedetomidine in conjunction with ultrasound-guided right external oblique intercostal nerve block and bilateral rectus sheath block for elective laparoscopic cholecystectomy against conventional opioid based technique.

Objective of the study is to measure total rescue opioid requirement in intraoperatiev and post operative period in using dexmetomidine infusion compared to conventional opioid based anaesthesia. Incidence of any post operative nausea vomiting, and any complication is also compared. Time to extubation and post operative pain scores are also compared

This is a prospective open label randomised control study conducted in Aster CMI Hospital, Bangalore, in 78 patients between 18 to 65years undergoing elective Laparoscopic Cholecystectomy surgery belonging to ASA 1 and ASA2. Any patients having contraindication to study drugs is excluded from the study.

One group  of patients are given Dexmedetomidine infusion with loading dose 0.3mcg/kg for 10min at induction of anaesthesia, followed by 0.5mcg/kg/hr. Other group will be given Fentanyl 2mcg/kg at induction. Both groups will be premedicated with Midazolam, glycopyrolate, and general anaesthesia induced with titrated dose of Propofol and atracurium. Preincisional ultrasound guided right External oblique intercostal plane block and bilateral ultrasound guided rectus sheath block is also given. Inj Fentanyl 25mcg boluses will be given as rescue analgesic intraoperatively. Inj Paracetamol and Diclofenac is also used intraoperatively.

Perioperative vitals, total Fentanyl usage, post operative pain scores and any incidence of complication will be measured, analysed and compared