Comparison of Dexmedetomidine and Dexamethasone for Prevention of Postoperative Nausea and Vomiting after Laparoscopic Cholecystectomy.

Abstract

Introduction: Effective perioperative analgesia and hemodynamic stability are crucial for surgical outcomes. This study aimed to compare the efficacy of dexmedetomidine and paracetamol in managing intraoperative hemodynamics, postoperative pain, sedation, and opioid consumption.
Methodology: A total of 160 surgical patients were randomly assigned to either the Paracetamol group (Group P, n=80) or Dexmedetomidine group (Group D, n=80). Demographic and clinical parameters were recorded. Hemodynamic variables (HR, SBP, DBP, MAP) were monitored intraoperatively and up to 24 hours postoperatively. Pain was assessed using the Visual Analogue Scale (VAS), sedation using the Sedation Scale (SS), and opioid consumption (fentanyl) was recorded. Statistical analysis was performed to compare outcomes between the groups.
Results: Baseline demographics were comparable between groups (p > 0.05). Intraoperatively, Group D showed significantly lower heart rate and blood pressure at all time points. Postoperatively, Group D maintained lower HR and MAP values up to 24 hours. VAS scores were significantly lower in Group D at 4h, 8h, 16h, and 24h (p < 0.001), indicating superior analgesia. Sedation scores were higher in Group D (p < 0.001). Fentanyl consumption was significantly reduced in Group D both intraoperatively (80.3 ± 12.5 vs. 120.5 ± 15.2 mcg) and postoperatively (50.7 ± 10.2 vs. 90.6 ± 14.8 mcg), with longer time to first rescue analgesia (78.9 ± 7.3 vs. 45.2 ± 5.8 min, p < 0.001). Group D also had lower incidence of postoperative nausea and vomiting (15% vs. 22%, p = 0.045) and shorter PACU stay (48.2 ± 6.5 vs. 55.6 ± 7.9 min, p = 0.032).
Conclusion: Dexmedetomidine provided better intraoperative hemodynamic control, enhanced postoperative analgesia and sedation, and reduced fentanyl requirements compared to paracetamol. It also improved recovery outcomes with less nausea and shorter PACU duration. Dexmedetomidine may be a more effective option for perioperative management in surgical patients.