Incidence of chronic postoperative surgical pain after laparoscopic cholecystectomy: A comparison between dexmedetomidine-fentanyl and propofol-fentanyl based total intravenous anesthesia

Pradeep Kumar Das; Katika Surya Gowthami; Jaya Chandra Tentu

doi:10.53730/ijhs.v6nS4.9705

Authors

Pradeep Kumar Das Associate Professor, Department of Anesthesia, Great Eastern Medical School and Hospital, Ragolu, Srikakulam, Andhra Pradesh, India, Pin code: 532484
Katika Surya Gowthami Assistant Professor, Department of Anesthesia, Great Eastern Medical School and Hospital, Ragolu, Srikakulam, Andhra Pradesh, India, Pin code: 532484
Jaya Chandra Tentu Assistant Professor, Department of Anesthesia, Great Eastern Medical School and Hospital, Ragolu, Srikakulam, Andhra Pradesh, India, Pin code: 532484

Keywords:

post-operative surgical pain, anaesthesia, propofol

Abstract

Background: The combination of fentanyl to dexmedetomidine or propofol provides complete and balanced anesthesia and has advantages such as high potency, lower dosages, and fewer side effects. The research studies to describe the effect of type of anesthesia on CPSP after laparoscopic cholecystectomy are sparse. Objective: The present study was undertaken to compare the incidence of CPSP after two different types of TIVA using propofol-fentanyl and dexmedetomidine-fentanyl-based anesthesia. Materials and methods: After IEC clearance, 100 patients of ASA I&II undergoing elective laparoscopic cholecystectomy were recruited into the study. They were randomly allocated to group Propofol-fentanyl (P-F) and Group Dexmedetomidine-fentanyl(D-F) where anaesthesia was induced and maintained with propofol (induced with 1.5mg/kg IV and maintained with 3-12mg/kg/h) and dexmedetomidine (induced with 1mcg/kg slow IV over 10 minutes and maintained with 0.3-1mcg/kg). At the end of surgery, time to eye-opening, time to achieve limb lift on command was noted. Modified Aldrete score was assessed every hourly in PACU until score >9. A fixed post-operative analgesic regimen was standardized in the PACU. After discharge from the hospital each patient was interviewed. over telephone at 1st, 2nd, 3rd, month after the surgery.

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References

Hendolin HI, Pääkönen ME, Alhava EM, Tarvainen R, Kemppinen T, LahtinenP.Laparoscopic or open cholecystectomy: a prospective randomised trial to compare postoperative pain, pulmonary function, and stress response. Eur J Surg. 2000;166:394-9.

Stiff G, Rhodes M, Kelly A, Telford K, Armstrong CP ,Rees BI. Long-term pain: Less common after laparoscopic than open cholecystectomy. Br J Surg. 1994;81:1368-70.

Luman W, Adams W H, Nixon S N, Mcintyre I M, Hamerhodges, Wilson G. Incidence of persistent symptoms after laparoscopic cholecystectomy: a prospective study. Gut. 1996,39:863-66.

Macrae WA. Chronic post-surgical pain: 10 years on.Br J Anaesth. 2008;101:77-86.

Buchh V, Saleem B, Reshi F, Hashia A, Gurcoo S, Shora A et al. A Comparison of total intravenous anaesthesia (TIVA) to conventional general anaesthesia for day care surgery. The Internet Journal of Anesthesiology. 2008 ;22:1.

Gupta A, Kullander M, Ekberg K, Lennmarken C. Assessment of recovery following day-case arthroscopy. A comparison between propofol and isoflurane-based anaesthesia. Anaesthesia. 1995;50:937-42.

Wammen S, Guldager H, Rasmussen AM, Højsted J. [Total intravenous anesthesia with propofol-fentanyl. Is it necessary to supply nitrous oxide?]. Ugeskr Laeger.1990;152:2415-7.

Grounds RM, Twigley AJ, Carli F, Whitwam JG, Morgan M. The haemodynamic effects of intravenous induction. Comparison of the effects of thiopentone and propofol. Anaesthesia. 1985;40:735-40.

Weir PM, Munro HM, Reynolds PI, Lewis IH, Wilton NC. Propofol infusion and the incidence of emesis in pediatric outpatient strabismus surgery. Anesth Analg.1993;76:760-4.

De Kock M. Expanding our horizons: transition of acute postoperative pain to persistent pain and establishment of chronic postsurgical pain services.Anesthesiology. 2009;111:461-3.

Peters ML, Sommer M, de Rijke JM, Kessels F, Heineman E, Patijn J et al. Somatic and psychologic predictors of long-term unfavorable outcome after surgical intervention. Ann Surg. 2007;245:487-94.

Katz J, Poleshuck EL, Andrus CH, Hogan LA, Jung BF, Kulick DI et al. Risk factors for acute pain and its persistence following breast cancer surgery.Pain. 2005;119:16- 25.

Katz J, Jackson M, Kavanagh BP, Sandler AN. Acute pain after thoracic surgery predicts long-term post-thoracotomy pain. Clin J Pain. 1996;12:50-5.

Jess P, Jess T, Beck H, Bech P. Neuroticism in relation to recovery and persisting pain after laparoscopic cholecystectomy. Scand J Gastroenterol. 1998;33:550-3.

Nicholl JP, Brazier JE, Milner PC, Westlake L, Kohler B, Williams BT et al. Randomised controlled trial of cost-effectiveness of lithotripsy and open cholecystectomy as treatments for gallbladder stones.Lancet. 1992;340:801-7.