Introduction
Laparoscopic surgery has many beneficial effects but the creation of pneumoperitoneum (PNP) may be associated with significant hemodynamic changes.
Aim of the work
Primary outcome: to compare opioids and nonopioids in controlling pressor response during laparoscopy. Secondary outcome: to compare the efficacy of dexmedetomidine (Dex) and esmolol in the same situation.
Patients and methods
Ninety patients undergoing laparoscopic cholecystectomy were randomly divided into three equal groups; group F: received fentanyl 1 μg/kg 10 min before induction and then 0.4 μg/kg/h throughout the PNP, group D: received Dex 1 μg/kg 10 min before induction and then 0.5 μg/kg/h throughout the PNP, group E: received esmolol 1 mg/kg 10 min before induction and then 0.5 mg/kg/h throughout the PNP. Hemodynamics mainly mean heart rate (MHR) and mean arterial pressure (MAP) were recorded at a specific time. Postoperative visual analog scale, time to first request of postoperative analgesia, number of patients who required postoperative analgesia, and postoperative analgesic consumption were recorded. Perioperative sedation score and blood glucose and postoperative complications, for example, bradycardia, hypotension, nausea, and vomiting were recorded. Time of discharge from the postanesthesia care unit (PACU) and hospital stay time were recorded.
Results
Group D showed better hemodynamic (MHR, MAP) stability and pain control than group E and much better than group F. Sedation score was higher in group D than other two groups after infusion of test drug only. The incidence of nausea and vomiting were higher in group F than group E and nausea was higher in group D than group E. Ondanosterone use was higher group F than other two groups. PACU stay time was longer in group D than other two groups.
Conclusion
Nonopioids (Dex and esmolol) were superior to fentanyl for attenuation of pressor response to intubation and PNP. Apart from nausea and longer PACU stay, Dex was superior to esmolol in controlling hemodynamics with better pain control.