Vol. 6, Issue 1, Part A (2024)

Introduction: Dexmedetomidine (alpha-2 adrenergic agonists) has become one of the frequently used drugs in anesthesia as it has been reported to provide analgesia, anxiolysis, and an anesthetic-sparing action with minimal respiratory depression plus its sedative effect that mimics natural sleep. Intraperitoneal instillation of dexmedetomidine with bupivacaine reduces the pain after elective laparoscopic cholecystectomy in adults as compared to that with bupivacaine alone or with tramadol. In addition, the postoperative requirement for rescue analgesia is reduced. 
Objective: To assess the evaluation of effect of intraperitoneal dexmedetomidine versus remifentanyl as adjuvant of ropivacaine infiltration for pain relief after laparoscopic appendectomy. 
Methods: After the Institutional Ethics Committee approval, written informed consent was obtained from all patients, who were included in the study. Totally 50 patients, with the American Society of Anesthesiologists (ASA) physical status I and II, of both sexes, aged between 18 and 60 years, of both genders, with a suspected acute appendicitis scheduled for laparoscopic appendectomy, were included in this study. Group A: Dexmedetomidine 0.5 mcg/kg diluted to 1 ml. + 0.2% ropivacaine with 1 ml of normal saline. Group B: Remifentanil 1μg/kg IV+ 0.2% ropivacaine with 1 ml of normal saline. Repeated measure ANOVA was performed to check the effect of haemodynamic parameters over a time period and to compare between three groups. A p-value < 0.05 was considered statistically significant. Statistical analysis was done by using SPSS software version 23 (IBM Corp., Armonk, NY). 
Results: There was no statistically significant difference with respect to age, sex, weight, BMI, ASA physical status of the patients and the duration of surgery. VAS at different time intervals were statistically significantly lower at all times in A group compared to B group. None of the patients from both groups complained of shoulder pain. Furthermore, overall VAS in 24 h was also significantly lower in the A group (1.68 ± 0.46) compared to B group (4.47 ± 0.94) [Table 4]. The time required for the first dose of rescue analgesia was longer in the A group (122.7 ± 24.5 min) than in B group (89.3 ± 13.2 min), indicating better and longer pain relief in the A group compared to that of B group. The difference was also statistically significant among the two groups. Total analgesic consumption was high in B group than in the A group. Total diclofenac consumption was also low in B group (95.3 ± 15.6 mg) than in A group (135.7 ± 75.1 mg). Incidence of nausea and vomiting was significantly lower in A group than in B group. There was no significant difference between both groups regarding other adverse effects. 
Conclusion: Ropivacaine combined with Dexmedetomidine versus Remifentanil significantly prolonged the duration of postoperative analgesia and sensory and motor block, and reduced consumption of infiltration for pain relief after laparoscopic appendectomy for analgesia and the incidence of postoperative nausea and vomiting, compared to ropivacaine alone, across an array of surgeries.