Premedication with clonidine and dexmedetomidine as multimodal analgesia for overnight stay laparoscopic cholecystectomy: A randomized comparative study

Background: Pain due to pneumoperitoneum after laparoscopic cholecystectomy (LC) may contribute to prolong hospital stay, patient discomfort, and failure of the surgery as an ambulatory procedure. A balanced multimodal analgesia regimen consisting of premedication with selective alpha-2 agonists is gaining popularity for postoperative pain relief for multiple surgeries. Although both clonidine (CLO) and dexmedetomidine (DEX) belong to this group, DEX is seen to have more selective alpha 2 action and better sympatholytic properties. The present study aims to assess the coanalgesic effect of premedication with CLO and DEX for LC, done as an overnight stay procedure, and to compare their efficacy. Methodology: This was a prospective, randomized, single-blinded comparative study, conducted between July 2015 and July 2016. A total of 80 patients undergoing LC were randomly assigned to either CLO or DEX groups (n = 40). The patients were premedicated with low-dose (1 mu g/kg) bolus intravenous drugs before induction according to the allotted group. Effect of individual drugs on the postoperative visual analog scale (VAS) score was noted, hemodynamic status was monitored, and analgesic-sparing effect to a multimodal analgesic regimen comprising intraoperative fentanyl and postoperative tramadol was noted. Results: VAS scores at 15 min postextubation, the number of patients required rescue analgesia, and the number of injections required were all found significantly low with DEX. Systolic as well as diastolic blood pressure was significantly lower in the DEX group. Conclusions: Although both the drugs were effective for short hospital stay LC, early pain relief and better hemodynamic stability were seen with DEX. Thus, routine premedication with DEX for ambulatory LC may be recommended.