The effect of dexmedetomidine infusion on the treatment of intraoperative shoulder pain in diagnostic laparoscopic gynecological procedures under spinal anesthesia

Abstract

In laparoscopic surgeries under spinal anesthesia, shoulder pain is common and causes restlessness and hemodynamic changes due to pain and patient dissatisfaction and failure of spinal anesthesia and its conversion to general anesthesia. Studies have shown that dexmedetomidine is suitable for use as an adjunctive analgesic in all postoperative phases. The purpose of this study is to investigate the effects of dexmedetomidine infusion to control pain in diagnostic laparoscopic surgeries of women under spinal anesthesia. Methods: This study was conducted as a prospective and randomized double-blind clinical trial on 66 women aged 18-60 who were candidates for diagnostic laparoscopic surgery for women in two groups of 33 people. In group A patients, before spinal anesthesia, intravenous bolus dexmedetomidine 1 μg/kg was injected within ten minutes, followed by infusion of dexmedetomidine 0.5 μg/kg/h, and in group B patients, infusion with the same volume and dose of 0.9% sodium chloride serum. It was started as a placebo by the anesthesiologist in charge of the procedure and continued until the patient was delivered to the PACU. Hemodynamic parameters, respiratory parameters, patient and surgeon satisfaction, pain intensity and complications during and after surgery were measured at consecutive time points and compared between two groups. Results: There was no significant difference between the two studied groups in terms of age, height, weight, duration of surgery and duration of anesthesia. In the comparison of hemodynamic parameters between two groups, MAP in the times after the bolus dose, before spinal anesthesia, minutes 5, 10, 35, 40 and 45, and HR in all times during and after surgery except baseline, in The dexmedetomidine group was significantly higher and lower than the placebo group respectively (P<0.05). In the study of SPO2 and RR variables, there was no significant difference between the two groups in all the stages measured during surgery and PACU (P>0.05). None of the complications during surgery were significantly different in the two groups. The frequency of midazolam drug use in the placebo group was significantly higher than in the dexmedetomidine group. Abdominal pain VAS score was significantly higher in the placebo group than in the dexmedetomidine group at all measured stages, but the shoulder pain VAS score was not significantly different. Among other complications after surgery in PACU, restlessness was significantly higher in the placebo group. The complication of sedation in the placebo group was significantly higher than the dexmedetomidine group at 30 minutes and 45 minutes in the PACU. Patient satisfaction was significantly higher in the dexmedetomidine group. Surgeons in both groups had similar complete satisfaction.