Intraperitoneal Versus Intravenous Dexmedetomidine for Postoperative Analgesia Following Laparoscopic Sleeve Gastrectomy Surgery: A prospective, Randomized Controlled trial

Background Postoperative pain control is a major challenge after laparoscopic sleeve gastrectomy. We conducted this study to evaluate the efficacy of dexmedetomidine either intraperitoneal (IP) or intravenous (IV) as an adjuvant to intraperitoneal bupivacaine in patients undergoing sleeve gastrectomy. Methods A total of 105 patients were randomized in this prospective, controlled study. All patients received 40 ml bupivacaine 0.25% IP. Control group (n = 35): received 50 ml normal saline IV. IV dexmedetomidine group (n = 35): received 50 ml normal saline plus dexmedetomidine 1 mu g/kg IV. IP dexmedetomidine group (n = 35): received IP dexmedetomidine 1 mu g/kg plus bupivacaine 0.25%, and 50 ml normal saline IV. Time to first rescue analgesia was the primary outcome. Whereas the total consumption of tramadol and visual analog scale (VAS) were the secondary outcomes. Results The first time of rescue analgesia was prolonged in IP dexmedetomidine compared to IV dexmedetomidine and control group (P < 0.0001). The total amount of rescue tramadol was lower in IP dexmedetomidine compared to IV dexmedetomidine and control group (P < 0.0001). VAS was comparable between the three groups at the recovery room, 2, 4, and 24 h postoperatively, while a statistically significant difference was found at 6, 12, and 18 h postoperatively. Extubation and recovery times were prolonged in IV dexmedetomidine group (P < 0.0001, 0.0001; respectively). Conclusions IP dexmedetomidine as an adjuvant to IP bupivacaine is as efficacious as IV dexmedetomidine compared to IP bupivacaine alone. However, the IP administration has the longest duration of analgesia and the lowest postoperative analgesic consumption.