Fares, K.M., Mohamed, S.A., Abd El-Rahman, A.M., Mohamed, A.A., & Amin, A.T. (2015). Efficacy and safety of intraperitoneal dexmedetomidine with bupivacaine in laparoscopic colorectal cancer surgery, a randomized trial. Pain Medicine, 16, 1186–1194. 

To investigate the safety and efficacy of intraperitoneal bupivacaine and dexmedetomidine in patients undergoing laparascopic colorectal surgery for postoperative pain management

Patients were randomized to one of three groups: (a) control (intraperitoneal injection of saline), (b) bupivacaine only (125 mg, 0.25%) injection, and (c) combined dexmedetomidine and bupivacaine (bupivacaine 0.25% and 1 mcg/kg dexmedetomidine). After hemostasis was achieved in surgery, intraperitoneal instillation of study drugs was sprayed uniformly into the periotoneal cavity guided by camera. Pain was assessed at baseline and at 2, 3, 6, 8, 12, and 24 hours postoperatively. IV tramadol (100 mg) was given when pain was at least 3 or upon patient request.

• N = 45   
• MEAN AGE = 50 years 
• MALES: 53.3%, FEMALES: 45.6%
• CURRENT TREATMENT: Other
• KEY DISEASE CHARACTERISTICS: All had colorectal cancer and were undergoing laparascopic surgical procedures. Most were undergoing hemicolectomy. Others had anterior resections.
• OTHER KEY SAMPLE CHARACTERISTICS: No differences existed between groups in duration of surgery.

• SITE: Single site   
• SETTING TYPE: Inpatient    
• LOCATION: Egypt

• PHASE OF CARE: Active antitumor treatment

• Double-blind, placebo-controlled, three-group, randomized trial

• Visual analog scale (VAS) for pain severity
• Observer's Assessment of Alertness/Sedation Scale (OAA/S)

The group that received bupivacaine and dexmedetomidine had significantly lower pain at 2, 4, and 24 hours compared to the other study groups (p < 0.03) and needed rescue analgesic much later (p = 0.0002). No difference in time to analgesia existed between study groups 1 and 2. Average overall postoperative tramadol consumption was lower in the group receiving the combined intraperitoneal analgesia (p = 0.001).

Intraperitoneal administration of bupivacaine and dexmedetomidine improved the effectiveness and duration of postoperative analgesia compared to bupivacaine alone or placebo.

• Small sample (< 100)

Findings showed that loco-regional analgesic administration after laparoscopic colorectal surgery was effective for postoperative analgesia, and the addition of dexmedetomidine to bupivacaine improved efficacy and duration of analgesic effect.