The effect of dexmedetomidine as an adjuvant to bupivacaine in ultrasound-guided quadratus lumborum block for postoperative analgesia in laparoscopic cholecystectomy: a randomized controlled trial

Abstract

Background Dexmedetomidine (DEX), an alpha-2 agonist, supplements local anesthetics in neuraxial and peripheral nerve blocks. This study examined the effects of adding DEX to bupivacaine in ultrasonography-guided quadratus lumborum block (USG-QLB) for postoperative analgesia in laparoscopic cholecystectomy (LC). Aim To evaluate the effect of adding DEX as an adjuvant to bupivacaine in USG-QLB for postoperative analgesia in LC. Patients and methods This prospective randomized controlled double-blinded study included 96 elective LC patients aged 21–65 of both sexes. Group I (bupivacaine group) received general anesthesia and bilateral USG-transmuscular QLB (TMQLB) with (20 ml bupivacaine 0.25%). Group II (bupivacaine+DEX group) received general anesthesia and bilateral USG-TMQLB with (20 ml bupivacaine 0.25%+DEX 1 μg/kg). Results Group II had significantly lower mean arterial blood pressure following surgery compared to group I, with no significant differences before or after skin incision (5, 15, or 30 min). Group II, lower heart rate changes after skin incision compared to group I. Group II had smaller change in the numerical rating scale at 6, 12, and 18 h compared to group I, but no significant difference immediately after discharge. In group II, intraoperative fentanyl and postoperative morphine were significantly lower than in group I. Conclusion DEX added to bupivacaine in USG-TMQLB for LC enhanced analgesia and hemodynamic stability by lowering mean arterial blood pressure, heart rate, and pain ratings, reducing opioid consumption, and delaying rescue analgesia.