Intravenous Dexmedetomidine effect on shoulder pain in Laparoscopic Cholecystectomy under Spinal Anesthesia

Abstract

Introduction:Laparoscopic cholecystectomy (LC) is the commonly used surgical technique in acute and chronic cholecystitis. Regional anesthesia is not extensively used in such surgeriesdue to some limitations, mainly shoulder pain with no ideal alleviating method till now.Dexmedetomidine is aα2-adrenoreceptor agonist agent which has a promising results in controlling shoulder pain.

Aim:Assessing the effectiveness of IV dexmedetomidine on managing shoulder pain in patients undergoing laparoscopic cholecystectomy and receiving spinal anesthesia.

Methods:Forty six ASA I, II patients whose age ranged from 18- 60 years oldundergoing elective LC were randomized into 2 groups, 23 patients in each group. All patients received spinal anesthesia. Dexmedetomidine group (D) received 1µg/kg loading dose of dexmedetomidine in 10 minutes followed by maintenance dose: 0.7 µg/kg/ hr. The control (C) group received similar doses of normal saline. For all patients, the highest degree of VAS was recorded, incidence of shoulder pain, rescue analgesic requirements, incidence of conversion to general anesthesia and intraoperative hypotensive, bradycardic and hypoxic episodes were recorded.

Results:IV dexmedetomidine significantly reduced shoulder pain in the D group than the C group. Incidence of shoulder tip pain in the D group was significantly lower (26.1 %) compared to (78.3%) in the C group. The incidence of patients required rescue analgesia in the D group (21.7%) was significantly lower than the C group (73.9%). Also the incidence of conversion to general anesthesia was significantly higher in the C group (52.2 %) than the C group (0.0%).The incidence of intraoperative hypotensive, bradycardic and hypoxic episodes were comparable in both groups.

Conclusion:Intravenous dexmedetomidine decreased the severity and the incidence of shoulder pain, rescue analgesic requirement and the incidence of conversion to general anesthesia in patients underwent laparoscopic cholecystectomy under spinal anesthesia.