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Ehab H Shaker,1 Mahmoud S Soliman,2 Ayman Hanafy,3 Walaa Y Elsabeeny1 1Department of Anesthesia, Intensive Care and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt; 2Department of Anesthesia, Surgical ICU and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt; 3Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, EgyptCorrespondence: Walaa Y Elsabeeny, Department of Anesthesia and Pain management, National Cancer Institute, Kasr Al Eini Street, Fom El Khalig, Cairo, Egypt, Tel +20 1007798466, Email walaa.elsabeeny@nci.cu.edu.egObjective: Several modalities for analgesia after laparoscopic procedures have been used. This study aimed to investigate the efficacy of early versus late bupivacaine/tramadol combination and bupivacaine/dexmedetomidine combination in analgesia for laparoscopic cancer surgeries.Methods: A total of 100 patients of both genders scheduled for elective laparoscopic cancer surgeries were included. Patients were randomly assigned to one of four groups each comprises 25 patients. Group 1: early bupivacaine/tramadol, Group 2: late bupivacaine/tramadol, Group 3: early bupivacaine/dexmedetomidine, and Group 4: late bupivacaine/dexmedetomidine. Early groups received the intraperitoneal instillation before start of surgery and late groups received the instillation after completion of surgery. Perioperative heart rate (HR) and mean arterial blood pressure (MAP) were recorded. The degree of postoperative pain was measured at rest and with cough using Visual analogue scale (VAS) score at 2, 4, 6, 12, 18 and 24 h after surgery. In addition, the total intraoperative fentanyl and postoperative morphine doses were calculated.Results: Both late bupivacaine/tramadol, bupivacaine/dexmedetomidine groups had longer time to receive first analgesic requirement (13.4± 3.9, 11.3± 3.9 h) respectively as compared to early bupivacaine/tramadol, bupivacaine/dexmedetomidine groups (9.8± 3.6, 8.4± 2.8 h), respectively. Between each early and late group, intraoperative fentanyl consumption was higher for the late groups (75± 22.8, 73± 21.55μg) versus (32.7± 10.9, 37.5± 13.3 μg), respectively. As regards to rescue analgesic requirements, both early bupivacaine/tramadol and bupivacaine/dexmedetomidine groups consumed more analgesics (5.2± 2.0 and 6.1± 1.8 mg) as compared to the late groups (3.2± 0.8 and 4.3± 1.5 mg), respectively. The four groups were comparable for their perioperative HR and MAP values.Conclusion: Intraperitoneal instillation of bupivacaine/tramadol and bupivacaine/dexmedetomidine could be considered an effective route for analgesic administration during laparoscopic cancer surgeries. Early instillation reduced the intraoperative opioid consumption and late instillation resulted in reduced postoperative opioid consumption.Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT04813016.Keywords: intraperitoneal analgesia, tramadol, dexmedetomidine, bupivacaine, laparoscopic surgeries |
