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

2016-10-14T06-24-23Z
Source: International Journal of Research in Medical Sciences
Anjum Naz, Hasibul Hasan Shirazee.
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.


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