Chilkoti Geetanjali Tolia, Kumar Manish, Mohta Medha, Saxena Ashok Kumar, Sharma Naveen, Singh Jitender
Department of Anesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India.
Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India.
Indian J Anaesth. 2019 Feb;63(2):106-113. doi: 10.4103/ija.IJA_440_18.
Recently, low-dose intravenous (IV) dexmedetomidine has been evaluated for obtunding the pneumoperitoneum-induced haemodynamic changes and its analgesic efficacy in laparoscopic cholecystectomy. The aim was to determine the postoperative analgesic efficacy of low-dose bolus of 0.5 μg/kg dexmedetomidine via IV and intraperitoneal (IP) route in laparoscopic cholecystectomy.
Seventy-five patients, aged 18-60 years of ASA physical status I and II, undergoing laparoscopic cholecystectomy under general anaesthesia were included. Patients in Group C received IP bupivacaine. Patients in Group IV received 0.5 μg/kg dexmedetomidine infusion IV after removal of gall bladder along with IP bupivacaine and Group IP received 0.5 μg/kg dexmedetomidine in 40 mL of 0.25% bupivacaine IP. The primary outcome was 'time to first request of analgesia' and the secondary outcomes were 'total consumption of tramadol in 24 hours,' visual analogue scale (VAS) pain score.
In total, 75 patients with 25 in each group were included. Time to first request of analgesia was found to be significantly lower in IV (59.68 ± 71.05 min, = 0.00) and IP group (90.80 ± 80.46 min, = 0.001) compared tp Group C (59.68 ± 71.05 min). Mean tramadol consumption in 24 hours (152.40 ± 60.958 vs 137.64 ± 52.40 mg) and mean VAS pain score were comparable in both IV and IP groups in the initial 12 h.
Low bolus dose of IP dexmedetomidine is as efficacious as IV dexmedetomidine (0.5 μg/kg) along with IP bupivacaine in laparoscopic cholecystectomy.
最近，低剂量静脉注射右美托咪定已被评估用于减轻腹腔镜胆囊切除术中气腹引起的血流动力学变化及其镇痛效果。目的是确定在腹腔镜胆囊切除术中通过静脉和腹腔内（IP）途径给予0.5μg/kg低剂量推注右美托咪定的术后镇痛效果。
纳入75例年龄在18 - 60岁、美国麻醉医师协会（ASA）身体状况为I级和II级、在全身麻醉下接受腹腔镜胆囊切除术的患者。C组患者接受腹腔内布比卡因。IV组患者在胆囊切除后静脉输注0.5μg/kg右美托咪定以及腹腔内布比卡因，IP组患者在40mL 0.25%布比卡因中腹腔内给予0.5μg/kg右美托咪定。主要结局是“首次要求镇痛的时间”，次要结局是“24小时内曲马多的总消耗量”、视觉模拟评分（VAS）疼痛评分。
总共纳入75例患者，每组25例。发现IV组（59.68±71.05分钟，P = 0.00）和IP组（90.80±80.46分钟，P = 0.001）首次要求镇痛的时间明显低于C组（59.68±71.05分钟）。在最初12小时内，IV组和IP组24小时内曲马多的平均消耗量（152.40±60.958对137.64±52.40mg）和平均VAS疼痛评分相当。
在腹腔镜胆囊切除术中，低剂量推注腹腔内右美托咪定与静脉注射右美托咪定（0.5μg/kg）联合腹腔内布比卡因的效果相同。
