A comparative study of the efficacy of intravenous Paracetamol and Dexmedetomidine on peri-operative hemodynamics and post-operative analgesia for patients undergoing laparoscopic cholecystectomy (original) (raw)
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INDIAN JOURNAL OF APPLIED RESEARCH, 2023
Background: Unrelieved post-operative pain may result in the physical suffering as well as multiple physiological and the psychological consequences, which may adversely affect the peri-operative outcome and contribute to increase the length of stay in hospital. Objectives: We designed this study to evaluate the effect of IV Paracetamol and Dexmedetomidine as multimodal analgesic technique on post-operative analgesia and to reduce the consumption of the systemic opioid and its adverse effects in cases of laparoscopic cholecystectomy. Materials and Methods: Eighty consenting, American society of Anesthesiologist-physical status-I (ASA-PS-I), female patients, aged 19-60 year was randomly assigned to one of the following two groups: Group P (n = 40) received IV 1 g Paracetamol infusion over 10 min pre-operatively and 6 hourly thereafter and Group D (n = 40) received IV Dexmedetomidine 1 μg/kg bolus over 10 min pre-operatively and 0.2-0.4 μg/kg/h thereafter for 24 h. Peri-operative hemodynamic variables, post-operative pain scores, and the need for rescue analgesics were recorded and compared. Results: Profi les of intra-operative hemodynamic changes were similar in both groups in respect to heart rate (HR), diastolic blood pressure, mean arterial pressure except in the systolic blood pressure where Dexmedetomidine signifi cantly reduced it in compare to Paracetamol (P = 0.014). Post-operatively 4 th h and 24 th h changes in mean HR between two groups was a statistically signifi cant (P < 0.05). Visual analog scale scores were signifi cantly lower in the Group P compared with Group D at 8 th , 16 th , and 24 th h (P < 0.001). Sedation score were statistically higher in the Group D compared with the Group P at post-operative 4 th , 8 th , 16 th , and 24 th h (P < 0.006). Conclusion: Adjunctive use of both Paracetamol and Dexmedetomidine infusion reduced opioid use. However, Paracetamol peri-operatively provides adequate analgesia with the less sedation whereas Dexmedetomidine provides analgesia and cooperative sedation.
Indian Journal of Clinical Anaesthesia, 2016
Background: Acute pain in the perioperative setting is detrimental to post operative outcome and adequate analgesia leads to better outcome. Methods: Sixty ASA I/II patients between 18-65 years undergoing laparoscopic cholecystectomy and appendicectomy were included and randomly divided into 2 groups. ASA III/IV patients, previous opioid and alpha 2 agonist treatment and patients requiring extensive surgical dissection were excluded. Group D received IV Dexmedetomidine 1μg/kg over 10 min followed by 0.2-0.7 μg /kg/hr and Group P received IV Paracetamol 15 mg/kg prior to extubation. Patients were monitored for hemodynamics and VAS score was assessed after extubation till 24 hours. Rescue analgesia (IV tramadol 1 mg/kg) was given and the time interval till the requirement of first dose of rescue analgesia was recorded. Results: In group D, 12 patients required rescue analgesia as compared to 4 Patients in group P (40% vs13.3%; P=0.02). VAS scores were similar in both groups with group P showing trend towards low score. Median time at which the first dose of rescue analgesia was administered in group P was longer (134.42 + 12.67 vs 82.76 + 9.38 min; P=0.001). Incidence of bradycardia and hypotension was higher in group D (20% vs 3.3%; P=0.04). Conclusion: Paracetamol is a superior to Dexmedetomidine for analgesia in short surgical procedures and should form a part of multimodal analgesia.
International Journal of Clinical Practice, 2022
is randomized prospective clinical study aimed to investigate the effects of dexmedetomidine or ketamine administration to total intravenous anesthesia (TIVA) on postoperative analgesia in subjects undergoing elective laparoscopic cholecystectomy procedures. 90 adults, American Society of Anesthesiologists (ASA) physical status 1 and II patients, who underwent elective laparoscopic cholecystectomy procedures were included in the study and randomized into three groups equally. Remifentanil, propofol, and rocuronium infusions were used for TIVA guided by the bispectral index. In group KETA, 10 μg/kg/min ketamine was added to TIVA before surgery, and in group DEX, 0.5 μg/kg/h dexmedetomidine was added to TIVA before surgery. Normal saline infusions were infused in the control group. Postoperative analgesia was provided with intravenous patient-controlled analgesia (PCA) morphine (1 mg bolus morphine, 5 min lockout time). Hemodynamic parameters, scores of visual analogue scale (VAS) for pain, rescue morphine requirements, and side effects such as sedation, nausea, and vomiting were recorded for 48 hours after surgery. Postoperative first analgesic requirement time was longer in group KETA (P < 0.001), and it was longer in group DEX than in the control group (P < 0.001). Pain scores were lower in group KETA and group DEX than in the control group at all corresponding times throughout the 48 h period of observation. Intravenous PCA morphine consumptions were higher in the control group than in group KETA (P < 0.001 for all followed-up times), and they were higher in group DEX than in group KETA (P < 0.001 for all followed-up times). It is concluded that the use of dexmedetomidine or ketamine infusions can be suitable as an additive for TIVA in the intraoperative period. Furthermore, the addition of both drugs to the TIVA protocol may improve postoperative pain relief and decrease opioid consumption.
Indian Journal of Clinical Anaesthesia
Pre-emptive paracetamol has been shown to decrease postoperative analgesia requirement in many patient populations; however evidence supporting its role in laparoscopic cholecystectomy is lacking. Our aim was to determine the effect of Pre-emptive paracetamol on post-operative analgesia requirement in patients undergoing laparoscopic cholecystectomy. Ninety patients belonging to American Society of Anesthesiologists physical status I or II were randomly assigned to 3 groups. Group I received 1 gram of paracetamol intravenously 30 min prior to surgery; Group II received 1 gram of paracetamol intravenously intraoperatively at time of skin closure and Group III was the control group and did not receive any paracetamol. The postoperative pain scores by VAS and analgesia requirement was compared in the 3 groups’ upto 6 hours postoperatively. The postoperative pain scores remained comparable in the 3 groups for most of the duration of study. The post-operative fentanyl consumption was sig...
International Journal of Human and Health Sciences (IJHHS)
Background: Afferent blockade of nociceptive (pain) impulses by paracetamol can bein effect throughout intraoperative and postoperative period.Objective: To see the effect of preoperative intravenous paracetamol administration in laparoscopic cholecystectomy patients.Methods: This single blind, randomized, prospective, case-control studywas conducted in Department of Anesthesiology, Square Hospitals, Dhaka, Bangladesh, between July and December of 2014. A total of 60 adult patients scheduled for laparoscopic cholecystectomy under general anesthesiawere enrolled in this study. Patients were randomly allocated equally into two groups – A (cases) and B (controls), through a computerized random table, with 30 patients in each group. Patients of group A (cases) received intravenous paracetamol 10mg/kg (in 100ml of normal saline) 10 minutes before skin incision, while group B (controls) received only 100 ml of normal saline 10 minutes before skin incision. Postoperative pain score, durati...
Research Paper, 2016
Introduction: Perioperative procedures are stressful and lead to haemodynamic instability with potentially devastating consequences. Dexmedetomidine is found to have many of the desired characteristics that are required in perioperative period. Aim: To evaluate the ability of pre and intraoperative dexmedetomidine to attenuate stress induced haemodynamic responses, quantifying the anaesthetic agents sparing as well as its cost-effectiveness in patients undergoing laparoscopic cholecystectomy. Materials and Methods: The present single blind randomized study was conducted with 120 ASA I and II consented patients who underwent laparoscopic cholecystectomy. Patients were randomly divided into 2 groups (i.e., group D and group N). Prior to induction, group D received 1 μg/kg of Dexmedetomidine and group N received Normal saline infusion over 20 minutes. Group D also received maintenance Dexmedetomidine intraoperatively. Bispectral index and minimum alveolar concentration monitoring was done in both the groups. Haemodynamic parameters were noted till 100 minutes post laryngoscopy. Opioid and anaesthetic agent consumptions were also noted and cost analysis was done. Medcalc –Version 12.5.0.0 software was used for statistics and p <0.05 was considered significant. Results: Dexmedetomidine attenuated the stress induced haemodynamics responses and produced stable, relatively non fluctuating haemodynamics throughout. The MAC requirement and the consumptions of Fentanyl and Isoflurane were significantly less in the Dexmedetomidine group (p<0.0001). However, despite anaesthetic dose sparing effect the anaesthetic technique was not cost-effective. Conclusion: Dexmedetomidine is effective in attenuating haemodynamic responses in laparoscopic surgery and having dose sparing effect on Fentanyl, Propofol and Isoflurane. However, overall this technique is not cost-effective.
2017
Background and Aim: Anesthetic techniques are based on hemodynamic stability during anesthesia and surgery. Dexmedetomidine is centrally acting α2 agonist with sedative, sympatholytic and analgesic. Aim of this study was to compare effect of conventional dose with low dose infusion of dexmedetomidine on hemodynamic stress response, induction agent requirement & postoperative analgesia. Materials and methods: Single randomised prospective study done on 100 ASA Ι and ΙΙ patients aged 18-65 years scheduled for elective laparoscopy cholecystectomy under general anesthesia. Patients were divided in to two groups of 50 each, Group A: 1 μg/kg loading dose of Rolaniya SL, Dhawan S, Meera Kumari, Jain R, Pareek A, Sehtia S. Comparison of conventional dose and low dose infusion of dexmedetomidine on hemodynamic stress response, dose of induction agent and postoperative analgesia in patients undergoing laparoscopic cholecystectomy. IAIM, 2017; 4(7): 111-117. Page 112 dexmedetomidine I.V. start...
International Surgery Journal, 2019
Background: Post-operative adequate analgesia plays an important role in early mobilization, short hospital stay and patient satisfaction in laparoscopic cholecystectomy. The use of opioids for providing postoperative analgesia has been marked by side effects like vomiting, nausea, sedation, respiratory distress, etc. hence, alternate drugs like paracetamol (PCM) and diclofenac are commonly used. In this study, we have compared the analgesic efficacy and any associated side effects of the two commonly used non-opioid NSAIDS namely paracetamol and diclofenac. Methods: We compared 50 patients undergoing laparoscopic cholecystectomy in ASA I and II. They were randomly divided into two groups, Group A and Group B. Group A was administered intravenous PCM and Group B was administered injection diclofenac sodium. Postoperatively, these patients were assessed for pain, blood pressure, respiratory rate, and presence of any side effects like nausea, vomiting or any respiratory discomfort. Results: The mean DBP, MAP and VAS score was significantly (p-value <0.05) in Group A as compared to Group B patients at 4, 8, 12 and 24 hours postoperatively. There was no statistically significant difference in mean SBP and O 2 saturation in both groups. The mean pulse rate was lower in Group A as compared to Group B at 8, 12 and 24 hours. Conclusions: This study concluded that postoperative PCM infusion provided better analgesia for a prolonged period of time with minimal side effects.
Archives of anesthesiology, 2020
Background: Laparoscopic cholecystectomy has rapidly become the procedure of choice for routine gallbladder removal and is currently the most commonly performed major abdominal procedure in Western countries. Paracetamol is a medication used to treat pain and fever. It is typically used for mild to moderate pain relief. Also it is used for severe pain, such as cancer pain and pain after surgery, in combination with opioid pain medication. Objectives: The aim of the present study was to evaluate the effects of intravenous paracetamol treatment on early postoperative period analgesia after laparoscopic cholecystectomy. Subjects and Methods: Those patients were attending the general surgical unit in Sabratha Hospital. We conducted a case-control study of 20 patients underwent laparoscopic cholecystectomy as control group (aged 25 to 55 years; 13 males, 7 females) and their nearest-aged paracetamol group (aged 24 to 55 years; 14 males, 6 females). was used to assess severity of pain in all cases and controls. Pain evaluation was performed every 15 minutes after pain control was obtained. Results: There was a significant difference between cases and controls regarding all scores of Verbal Rating Scales. The verbal evaluation scores of the paracetamol group were significantly lower than the control group. Conclusion: It can be concluded that paracetamol is effective postoperative analgesia. It is the drug of choice in patients that cannot be treated with non-steroidal anti-inflammatory drugs. Pre-operative administration of paracetamol supports effective and faster recovery. Anticipatory guidance should be provided to encourage to use paracetamol as postoperative analgesia. Further studies are needed to clarify the postoperative recovery characteristics by Modified Aldrete's Scoring System.
Asian Journal of Medical Sciences
Background: Pain due to open cholecystectomy can result in delayed recovery and poor operative outcomes. Multimodal approaches to pain control cause functional improvement. We compared the efficacy of paracetamol 1 g, dexamethasone 8 mg, and magnesium sulfate 2 g with normal saline in control over perioperative hemodynamics and post-operative pain in patients undergoing open cholecystectomy under general anesthesia. Aims and Objectives: This study conducted to assess the effect of preemptive intravenous paracetamol, dexamethasone, and magnesium sulfate on perioperative hemodynamic variables (primary outcome) and post-operative nausea, vomiting, and pain (secondary outcome) in open cholecystectomy. Materials and Methods: Sixty patients of ASA Grade I/II were randomized into two groups to receive either normal saline 100 ml iv (Group C, n=30) or infusion containing inj. paracetamol 1 g, inj. dexamethasone 8 mg and inj. magnesium sulfate 2 g iv (group PDM, n=30), 20 min before inductio...