Key result
Intravenous paracetamol combined with dexmedetomidine significantly prolonged time to first rescue analgesia (9.06 h) versus dexmedetomidine (5.52 h) or paracetamol alone (4.35 h).
Why the study?
Laryngoscopy and peritoneal gas insufflation during laparoscopic cholecystectomy cause hemodynamic stress responses and pain, prompting evaluation of intravenous paracetamol and dexmedetomidine alone and in combination as multimodal analgesia.
Does the combination of intravenous paracetamol and dexmedetomidine improve perioperative hemodynamics and prolong post-operative analgesia in patients undergoing laparoscopic cholecystectomy?
RCT (n=105)
Double-blind
Close envelope method
No
Does the combination of intravenous paracetamol and dexmedetomidine improve perioperative hemodynamics and prolong post-operative analgesia in patients undergoing laparoscopic cholecystectomy?
Absolute Event Rate: 9.06% vs 4.35%
p-value: p=<0.0001
The combination of intravenous paracetamol and dexmedetomidine provides better hemodynamic stability and prolonged post-operative analgesia compared to either drug alone in patients undergoing laparoscopic cholecystectomy.
Combination may extend analgesia and stabilize hemodynamics; hypothesis-generating for multimodal regimens in laparoscopic cholecystectomy.
Background: With increase in incidence of gallbladder stone disease, the laparoscopic cholecystectomy is most preferred surgical technique. Laryngoscopy and peritoneal gas insufflation leads to hemodynamic stress response and pain during and after the procedure. Multimodal analgesia is recommended to reduce the stress response and prevent the post laparoscopic pain. Intravenous paracetamol and intravenous dexmedetomidine are both effective components in respect of multimodal analgesia. Aims and Objectives: The aim of this study was to compare and evaluate the effects of intravenous paracetamol and dexmedetomidine alone and in combination as part of multimodal analgesia on perioperative hemodynamics and post-operative analgesia. Materials and Methods: One hundred and five patients between the of age 18–60 years posted for laparoscopic cholecystectomy were randomly assigned to three groups (n=35). Before induction patients in Group D received dexmedetomidine 0.5 μg/kg/h and patients in Group P and Group P+D received 1 g paracetamol infusion over 15 min. Intraoperatively as continuous infusion patients in Group D and Group P+D received dexmedetomidine 0.2 μg/kg/h and Group P received 0.2 mL/kg NS until the removal of gallbladder. Perioperative hemodynamic variables, postoperatively, the need for rescue analgesia and any complications or side effects were recorded, compared, and analyzed. Results: Intraoperative hemodynamic variables were significantly higher in Group P compared to Group D and Group P+D (P<0.05). Prolonged rescue analgesia found in Group P+D (9.06±1.16 h) then Group D (5.52±1.22 h) and Group P (4.35±0.99 h), respectively, which was strongly significant among the groups (P<0.0001). Conclusion: Our study concluded that the combination of paracetamol and dexmedetomidine maintains the better hemodynamic stability and prolonged the duration of analgesia, with the benefit of high patient satisfaction. In addition, there was significantly less post-operative bradycardia and shivering.
No takes yet. Share an insight, caveat, or question.
Harshitha et al. (2023) conducted an RCT in Laparoscopic cholecystectomy (n=105). Intravenous paracetamol and dexmedetomidine combination vs. Intravenous paracetamol alone or dexmedetomidine alone was evaluated on Time for first rescue analgesia (hours) (p=<0.0001). Intravenous paracetamol combined with dexmedetomidine significantly prolonged time to first rescue analgesia (9.06 h) versus dexmedetomidine (5.52 h) or paracetamol alone (4.35 h).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: