A Comparative Study of Intravenous Dexmedetomidine and Intravenous Clonidine in Assessing Hemodynamic Stability During Creation of Pneumoperitoneum and Postoperative Analgesia in Laparoscopic Surgery Under General Anesthesia: A Prospective Randomized Double-Blind Study

Abstract

Introduction - During laparoscopic surgery, CO2 insufflation may produce significant hemodynamic changes in heart rate, increase in arterial blood pressure, SVR and PVR due to increased intra-abdominal pressure and hypercarbia. α2 adrenergic receptor agonists, clonidine and dexmedetomidine can be used to blunt these  responses due to their sympatholytic and cardiovascular stabilizing actions.

Materials and methods – A randomized double blind comparative study in elective laparoscopic surgical patients of ASA grades I and II was conducted with 76 patients aged between 18-65 years, who were randomly divided into two groups. Patients were randomized by computer generated numbering. Group A patients received 2 μg/kg of clonidine and group B patients received 1μg/kg of dexmedetomidine both diluted in 10 ml of normal saline slow IV over 10 minutes before induction of general anesthesia. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP) and heart rate (HR) were monitored at baseline, at  induction, intubation, creation of pneumoperitoneum, then at regular intervals of every 15 minutes till desufflation and  extubation. Post operatively VAS  scores were recorded for all patients at the end of surgery, 15 minutes, 30 minutes, 45 minutes, 60 minutes and 90 minutes. Patients were observed in the post-operative room till VAS score of 5. Inj. diclofenac sodium 75mg IV was given as first line and  Inj.tramadol 2mg/kg IV was given as second line of rescue analgesia.

Results - The data was presented as Mean ± SD. Groups A and B were compared by independent unpaired student’s t test at each timepoint. P value of <0.05 was considered statistically significant. The SBP measured at 30 minutes of pneumoperitoneum for group A vs group B was 109.42± 8.62 vs 112.58±10.65, p=0.160, for DBP 69.45±7.45 vs 71.68±7.29, p=0.190; for MAP 73.26±12.21 vs 76.71±11.43, p=0.208; for HR 72.11±13.37 vs 77.76±12.68, p=0.062. Findings were also recorded for all other timepoints and there was no statistical significance. The mean VAS scores in Group A was higher in all timepoints compared to Group B. The scores at 30 minutes and 45 minutes were significantly higher in Group A with p values of 0.018, 0.001 respectively.

Conclusion - Hence it can be concluded that both the drugs were found to be equally effective in attenuating the hemodynamic response  to pneumoperitoneum. Also dexmedetomidine provided better post operative analgesia when compared to clonidine.