Evaluation of lignocaine, dexmedetomidine, lignocaine-dexmedetomidine infusion on pain and quality of recovery for robotic abdominal hysterectomy: a prospective randomized controlled trial

Abstract

Background: Acute postoperative pain is associated with poor quality of recovery after surgery. Perioperative use of intravenous lignocaine or dexmedetomidine have demonstrated better pain control, early return of bowel function, and effects on quality of recovery.

Methods: Ninety-six women planned for elective robotic abdominal hysterectomy were randomized into four groups. Groups received lignocaine infusion (1.5 mg.kg ⁻¹ loading, 2 mg.kg ⁻¹.h ⁻¹ infusion) (Group I), dexmedetomidine infusion (1 µg.kg ⁻¹ loading, 0.6 µg.kg ⁻¹.h ⁻¹ infusion) (Group 2), lidocaine (1.5 mg.kg ⁻¹ loading, 2 mg.kg ⁻¹.h ⁻¹ infusion), and dexmedetomidine infusions (1 µg.kg ⁻¹ loading, 0.5 µg.kg ⁻¹.h ⁻¹ infusion) (Group 3), and normal saline 10 mL loading, 1 mL.kg ⁻¹.h ⁻¹ infusion) (Group 4). Primary outcome was visual analogue pain scores at 1, 2, 4, 12, and 24 hours after surgery. Secondary outcomes included postoperative fentanyl requirement, time of return of bowel sounds and flatus, QoR15 score on day 1, 2, and discharge.

Results : The VAS was significantly lower in Groups 2 and 3 compared to Groups 1 and 4. Total postoperative fentanyl consumption in the first 24 hours was 256.25 ± 16.36 mcg (Group 1), 177.71 ± 16.81 mcg (Group 2), 114.17 ± 16.19 mcg (Group 3), and 304.42 ± 31.26 mcg (Group 4), respectively. Time to return of bowel sounds and passage of flatus was significantly shorter in Groups 2 and 3 ( p < 0.01). QoR15 scores after surgery were higher in Group 3 compared to Groups 1, 2, and 4, ( p < 0.01) respectively.

Conclusion : Combined infusion of lignocaine and dexmedetomidine significantly decreased postoperative pain, fentanyl consumption, and improved quality of recovery score after surgery in patients undergoing Robotic abdominal hysterectomy.