Amany Mohamed Abotaleb Wafaa Madhy Atia Abdelwahed Asmaa Fawzy Amer

Keywords: Analgesia, Dexmedetomidine, Laparoscopic Cholecystectomy, Erector Spinae Plane Block, Bupivacaine

Abstract

Background & Objective: laparoscopic cholecystectomy (LC) is routinely performed under general anesthesia, but relieving postoperative pain poses real challenge, with the current trends of avoiding narcotic analgesics, due to their serious side effects. Addition of regional nerve blocks offers a more flexible analgesic approach. We hypnotized that addition of dexmedetomidine to the local anesthetic solution will prolong the duration of the blocks. This study aimed to assess the effectiveness of erector spinae plane block (ESPB) using bupivacaine and dexmedetomidine (DEX) for pain controlling in LC.

Methods: This randomized, controlled, double-masked trial included 60 cases of 18 to 65 years, both genders, scheduled for LC. Cases were randomized equally into two groups: Group I received ESPB with 20 mL of bupivacaine 0.25% on each side, and Group II received ESPB with 18 mL of bupivacaine 0.25% plus 2 mL of DEX 0.5 µg/kg on each side. Blocks were performed before the induction of general anesthesia. Ultrasonography was used to guide the ESPB.

Results: The morphine consumption in 1st 24 hours postoperatively was reduced significantly in group II contrasted to group I (10.59 ± 3.51 vs. 16.41 ± 5.43 mg, P < 0.001). The time to first rescue analgesia was delayed significantly in group II than in Group I (16.97 ± 4.66 vs 9.63 ± 1.77 h, P < 0.001). Intraoperative fentanyl consumption was insignificantly different between both groups. Postoperative visual analog scale, heart rate, and mean blood pressure measurements at post-anesthesia care unit 1, 3, 6, 12, and 18 h were reduced significantly in Group II than in Group I (P < 0.001). The 4-point sedation scale was significantly better in Group II than Group I (P = 0.031).

Conclusion: DEX as an adjuvant to ESPB during LC improved analgesia by reducing the need for morphine postoperatively, as well as the pain level with relatively better hemodynamics.

Abbreviations: ESPB: erector spinae plane block, LC: Laparoscopic Cholecystectomy, VAS: visual analog scale,

Keywords: Analgesia; Dexmedetomidine; Laparoscopic Cholecystectomy; Erector Spinae Plane Block; Bupivacaine

Citation: Abotaleb AM, Abdelwahed WMA, Amer AF. Analgesic efficacy of adding dexmedetomidine to bupivacaine in ultrasound-guided erector spinae plane block for laparoscopic cholecystectomy: a randomized, controlled, double-blind trial. Anaesth. pain intensive care 2025;29(4):318-25. DOI: 10.35975/apic.v29i4.2816

Received: October 22, 2024; Revised: January 27, 2025; Accepted: February 03, 2025