DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20163640

Effect of intravenous dexmedetomidine and small dose fentanyl on shoulder tip pain in gynecological laparoscopic surgeries under spinal anaesthesia

Anjum Naz, Hasibul Hasan Shirazee

Abstract


Background: Shoulder tip pain and discomfort due to peritoneal stretching is the major limiting factor of spinal anaesthesia in laparoscopic surgeries. Aim of the study was to evaluate the effect of intravenous dexmedetomidine along with small dose fentanyl in abolishing the shoulder tip pain during gynaecological laparoscopic surgery and to assess its respiratory and hemodynamic effects.

Methods: 50 ASA grade I and II, with age 18-50 yrs and weight 45-70 kgs, who were undergoing elective gynecological laparoscopic surgeries with estimated pneumoperitoneum time of one hour or less, were included in the study. Injection dexmedetomidine 1 mcg/kg was infused over a period of ten minutes before spinal anaesthesia with 3.5 ml of injection ropivacaine (0.75%) in lateral position. Injection fentanyl 0.5mcg/kg was given intravenously before intraperitoneal insufflation. Shoulder tip pain, peri-operative heart rate, noninvasive blood pressure, end tidal carbon dioxide, respiratory rate and sedation level using Ramsay sedation score were assessed at frequent intervals.

Results: 35 patients were comfortable with no complaints, 11 patients had mild and two patients had moderate shoulder tip pain which was relieved by reducing abdominal pressure or/and an additional dose of fentanyl (25 mcg). One patient had severe pain and had to be converted to general anaesthesia. Ready sedation score was 2 or 3 for all the patients except one who was deeply sedated and had to be intubated. The drug combination used reduced the shoulder tip pain in gynaecological laparoscopic surgeries performed under spinal anaesthesia while maintaining the stable intra-operative hemodynamics.

Conclusions: This study has provided the preliminary evidence of feasibility of use of dexmedetomidine along with low dose fentanyl to reduce the discomfort and shoulder tip pain during gyanaecological laparoscopic procedures of short duration under spinal anaesthesia in selected patients.


Keywords


Dexmedetomidine, Fentanyl, Gynaecological laparoscopic surgery, Shoulder tip pain, Spinal anaesthesia

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References


Chui PT, Gin T, Oh TE. Anesthesia for laparoscopic general surgery. Anaesth Intensive Care. 1993;21(2):163-71.

Gramatica L Jr, Brasesco OE, Mercado Luna A, Martinessi V, Panebianco G, Labaque F, et al. Laparoscopic cholecystectomy performed under regional anesthesia in patients with chronic obstructive pulmonary disease. Surg Endosc. 2002;16: 472-5.

Van Zundert AAJ, Stultiens G, Jakimowicz JJ, van den Borne BEEM, van der Ham WGJM, Wild smith JAW. Segmental spinal anaesthesia for cholecystectomy in a patient with severe lung disease. Br J Anaesth. 2006;96:464-6.

Alexander JI. Pain after laparoscopy. Br. J. Anaesth. 1997;79:369-78.

Ghodki PS, Sardesai SP, Thombre ST. Evaluation of the effect of intrathecal clonidine to decrease shoulder tip pain in laparoscopy under spinal anaesthesia. Indian J Anaesth. 2010;54(3):231-4

Sarli L, Costi R, Sansebastiano G, Trivelli M, Roncoroni L. Prospective randomized trial of low-pressure pneumoperitoneum for reduction of shoulder-tip pain following laparoscopy. Br J Surg. 2000;87:1161-5.

Cunniffe MG, Mc Anena OJ, Dar MA, Calleary J. A prospective randomised trial of intraoperative bupivacaine irrigation for management of shoulder tip pain following laparoscopy. Am J Surg. 1998;176:258-61.

Sinha R, Gurwara AK, Gupta SC. Laparoscopic surgery using spinal anesthesia. JSLS. 2008;12:133-8.

Ali Y, Elmasry MN, Negmi H, Ouffi HA, Fahad B, Rahman SA. The feasibility of spinal anesthesia with sedation for laparoscopic general abdominal procedures in moderate risk patients. M.E.J. Anesth. 2008;19(5):1027-39.

Pasupati RN, Sivasanmugam T, Ravishankar M. Respiratory changes during spinal anaesthesia for gynaecological laparoscopic surgery. J Anaesth Clin Pharmacol. 2010;26(4):475-9.

Warner DO, Warner MA, Ritman EC. Human chest wall function during epidural anesthesia. Anesthesiology. 1996;85:761-73.

Paris A, Tonner PH. Dexmedetomidine in anaesthesia. Curr Opin Anaesthesiol. 2005;18:412-8.

Gertler R, Brown HC, Mitchell DH. Dexmedetomidine: a novel sedative- analgesic agent. BUMC Proceedings. 2001;14:13-21.

Badwaik RT, Siddiqui RA, Borkar AS. Synergistic analgesic action of dexmedetomidine and fentanyl in rats. IJPMS.2012;3(2):19-23.