Evaluating Intravenous Paracetamol And Dexmedetomidine For Peri-Operative Hemodynamic Stability, Post-Operative Delirium, And Pain In Laparoscopic Cholecystectomy

Original Article

Abstract

Objective: To compare the efficacy of intravenous paracetamol and dexmedetomidine in achieving peri-operative hemodynamic stability, minimizing post-operative delirium, and managing pain in patients undergoing laparoscopic cholecystectomy.

Study Design: A Cross sectional study

Place and Duration of the Study: National Hospital Lahore in 6 months period of time.from March to Sep 2024

Methodology: One hundred forty patients slated for elective laparoscopic cholecystectomy were randomly allocated to receive either Paracetamol (Group P) or Dexmedetomidine (Group D). Hemodynamic measures (heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure) were documented at intervals throughout the surgical procedure. Post-operative outcomes, such as the incidence of delirium, onset time, duration, pain scores on the Visual Analog Scale (VAS), and sedation levels, were evaluated at 4, 8, 16, and 24 hours post-operatively.

Result: Group D's lower heart rate and blood pressure were consistently observed at various time intervals, with an HR of 91.25 ± 19.8 bpm compared to 103.12 ± 14.3 bpm (p < 0.05) and lower systolic and diastolic pressures of 114.35 ± 19.1 mmHg against 122.58 ± 17.3 mmHg (p < 0.05). Group D demonstrated improved pain management as evidenced by reduced pain scores on the VAS scale at 4 hours (1.90 ± 1.10 vs. 2.50 ± 1.25, p < 0.05) and 24 hours (1.40 ± 0.48 vs. 1.50 ± 0.92, p < 0.05). Group D had more consistent sedation

levels, with lower levels at 4 hours (2.00 ± 0.60 vs. 2.20 ± 0.75) and 24 hours (1.80 ± 0.30 vs. 2.00 ± 0.45). Group D had a considerably lower rate of post-operative delirium (7% vs. 21%, p = 0.02), started later (15 ± 4 hours vs. 12 ± 3 hours, p = 0.04) and lasted shorter (4 ± 1 hours vs. 6 ± 2 hours, p = 0.01). In terms of post- operative pain management, sedation, and delirium reduction, Dexmedetomidine demonstrated superior efficacy, suggesting its potential benefits in this area of treatment.

Conclusion: Dexmedetomidine (Group D) demonstrates superior efficacy compared to Paracetamol (Group P) in regulating vital signs, alleviating pain, and achieving sedation in post-operative management following laparoscopic cholecystectomy.