Evaluation of Dexamethasone and Ondansetron as Intraperitoneal Adjuvants to Bupivacaine for Analgesia in Laparoscopic Cholecystectomy

Abstract

Postoperative pain remains a significant concern following laparoscopic cholecystectomy (LC), necessitating a multimodal analgesic approach due to its multifactorial origins. Intraperitoneal instillation of local anesthetics over the diaphragmatic surface and gallbladder bed has emerged as an effective strategy to reduce visceral pain. While several adjuvants have been explored for enhancing analgesic efficacy, there is limited comparative evidence on their effectiveness when administered intraperitoneally with local anesthetics. This study aimed to compare the analgesic efficacy of dexamethasone versus ondansetron as adjuvants to 0.25% bupivacaine in patients undergoing elective LC. Ninety patients were randomly assigned into three groups to receive 2 ml of either dexamethasone, ondansetron, or normal saline, along with 30 ml of 0.25% bupivacaine, instilled intraperitoneally over the gallbladder bed. Postoperative pain was assessed using the Numeric Rating Scale (NRS) at 0, 1, 2, 4, 6, 12, and 24 hours, along with the time to first rescue analgesic and total number of rescue doses required within 24 hours. Incidence and severity of postoperative nausea and vomiting (PONV) were also evaluated using a 4-point scale. Results showed that the dexamethasone group had significantly lower NRS pain scores and reduced need for rescue analgesics compared to the ondansetron and control groups (p<0.001 and p<0.05, respectively). Additionally, patients in the dexamethasone group experienced significantly lower rates of PONV within the first 12 hours postoperatively (p<0.05). In conclusion, intraperitoneal dexamethasone as an adjuvant to bupivacaine provides superior analgesia and antiemetic effects compared to ondansetron in patients undergoing elective laparoscopic cholecystectomy, likely due to its potent local anti-inflammatory properties.