European Journal of Cardiovascular Medicine

Laparoscopic surgery has revolutionized minimally invasive techniques, offering faster recovery and shorter hospital stays. Anesthetic agents significantly impact postoperative outcomes such as pain, hemodynamic stability, cognitive recovery, and nausea/vomiting.

Dexmedetomidine, a selective α2-adrenergic agonist, provides sedation and analgesia without respiratory depression [1]. Propofol, a GABA receptor agonist, is favored for its rapid onset and recovery [2]. This study compares these two agents in patients undergoing elective laparoscopic cholecystectomy.

2.1 Study Design

This prospective, randomized controlled study was conducted at [Institution Name] from [Month Year] to [Month Year], following approval by the Institutional Ethics Committee (Ref: IEC/23/2023).

2.2 Participants

Inclusion criteria:

• Age 18–65 years
• ASA class I–II
• Scheduled for elective laparoscopic cholecystectomy

Exclusion criteria:

• Allergies to study drugs
• Chronic opioid/sedative use
• Hepatic/renal dysfunction
• Cognitive impairment

2.3 Randomization

Using a computer-generated randomization list, 100 patients were divided into:

• Group D (Dexmedetomidine): Loading dose 0.5 μg/kg over 10 min, then 0.4 μg/kg/h
• Group P (Propofol): TCI to maintain BIS 60–70

2.4 Outcome Measures

Primary outcomes:

• Pain intensity (VAS at 2, 4, 6, 12, 24 hours)
• Opioid requirement (μg fentanyl equivalent)

Secondary outcomes:

• Ramsay Sedation Score
• Time to orientation
• Incidence of PONV
• Length of stay

2.5 Statistical Analysis

Data analyzed using SPSS v26. Continuous variables: t-test or Mann–Whitney U test. Categorical variables: Chi-square or Fisher’s exact test. p < 0.05 was considered statistically significant.

3.1 Patient Demographics

Both groups were comparable in baseline characteristics (Table 1).

Table 1. Baseline Demographic and Surgical Characteristics

3.2 Pain Scores

VAS scores were significantly lower in Group D at all time points up to 12 hours (Figure 1, Table 2).

Figure 1. Comparison of VAS scores at different postoperative time points
(Line graph showing VAS scores: Group D consistently lower until 12 hours)

Table 2. Postoperative Pain Scores (VAS)

3.3 Sedation and Recovery

Group D had higher Ramsay scores at 0–2 hours postoperatively (Table 3), with longer time to orientation (mean 25.3 vs. 14.7 minutes; p < 0.01).

Table 3. Sedation and Recovery

3.4 PONV and Opioid Use

Group D had significantly lower PONV incidence (Table 4).

Table 4. PONV and Opioid Use

3.5 Hospital Stay

No statistically significant difference in hospital stay duration (Table 5).

Table 5. Length of Hospital Stay

This study evaluated the comparative effects of dexmedetomidine and propofol on postoperative recovery following laparoscopic cholecystectomy. The findings demonstrate that dexmedetomidine provides superior analgesia, lower opioid requirements, and a significantly reduced incidence of postoperative nausea and vomiting (PONV). However, it was also associated with prolonged sedation and delayed time to orientation compared to propofol.

The enhanced analgesic efficacy of dexmedetomidine in our study aligns with previous findings where dexmedetomidine has been shown to provide not only sedation but also effective analgesia through its α2-adrenergic receptor agonist action [1,3,5]. By acting on the locus coeruleus in the brainstem, dexmedetomidine inhibits norepinephrine release and reduces sympathetic tone, thus promoting analgesia and anxiolysis [4,6]. The resulting opioid-sparing effect is of significant clinical importance, as reduced opioid consumption lowers the risk of respiratory depression, ileus, and opioid-induced hyperalgesia [7].

In contrast, propofol, a commonly used hypnotic agent, acts on GABA-A receptors and is associated with rapid onset and recovery, making it ideal for day-care anesthesia [2,8]. However, it lacks intrinsic analgesic properties and often requires adjunctive opioids or local anesthesia for effective postoperative pain management [9]. In our study, patients receiving propofol had significantly higher Visual Analog Scale (VAS) pain scores at all time points within the first 12 hours postoperatively and required higher doses of fentanyl, reflecting the analgesic limitations of propofol.

The reduction in PONV with dexmedetomidine is another clinically valuable outcome. Opioids and volatile anesthetics are among the primary contributors to PONV, and by minimizing the need for postoperative opioids, dexmedetomidine indirectly reduces the incidence of this complication [10]. Moreover, dexmedetomidine may exert direct antiemetic effects through inhibition of the chemoreceptor trigger zone and suppression of sympathetic outflow, which further supports its utility in fast-track recovery protocols [11].

However, one of the key trade-offs observed in this study was the delayed emergence and prolonged sedation in patients receiving dexmedetomidine. Time to orientation was significantly longer in Group D compared to Group P. This delay can be attributed to the central sedative effects of dexmedetomidine, which, although not associated with respiratory depression, can prolong arousal when administered continuously intraoperatively [12]. In fast-track or ambulatory surgery settings where rapid recovery and early discharge are desirable, this may pose a limitation [13]. Careful dose titration or discontinuation of infusion earlier in the surgical process may help mitigate this effect.

Our study did not observe a significant difference in the total length of hospital stay, suggesting that the benefits of analgesia and reduced PONV in the dexmedetomidine group may balance the prolonged sedation in terms of overall recovery timeline. Nevertheless, the lack of difference in hospital stay could also be influenced by institutional discharge policies and non-anesthetic factors such as social support or patient comorbidities.

Another important consideration is hemodynamic stability. Although not a primary outcome in our study, bradycardia and hypotension are well-known side effects of dexmedetomidine, especially when administered as a bolus or at higher infusion rates [1,14]. We noted transient bradycardia in four patients in Group D, all of which were managed conservatively. No patient in either group required pharmacologic intervention or ICU transfer, indicating that with appropriate monitoring, dexmedetomidine can be safely administered.

The strengths of this study include its randomized controlled design, standardized anesthesia protocols, and comprehensive postoperative assessment using both subjective (VAS) and objective (opioid consumption, PONV) outcome measures. However, several limitations must be acknowledged. First, the study included only ASA I and II patients undergoing a specific laparoscopic procedure, which may limit generalizability to higher-risk populations or other surgeries. Second, longer-term recovery markers, such as return to normal activity or cognitive function beyond 24 hours, were not assessed. Finally, serum drug levels were not monitored, which could have provided a more detailed pharmacokinetic understanding of the recovery differences.

Future research could explore the role of dexmedetomidine in enhanced recovery after surgery (ERAS) protocols, particularly when used as part of multimodal analgesia strategies. Further dose-optimization studies may help identify regimens that maximize analgesic benefit while minimizing sedation time. Moreover, studies involving ambulatory surgery settings or elderly populations may provide further insight into safety and efficacy in varied clinical scenarios.

In summary, the results of this study suggest that dexmedetomidine, when compared to propofol, offers enhanced early postoperative pain control and reduced nausea and vomiting in laparoscopic surgery patients. These benefits may support its use as a primary or adjunctive anesthetic agent in ERAS protocols, with appropriate precautions for delayed arousal.

Dexmedetomidine is a valuable alternative to propofol in laparoscopic surgeries when postoperative analgesia and PONV reduction are prioritized, though clinicians must account for delayed cognitive recovery.

Acknowledgements

We acknowledge the contributions of the anesthesia and surgery departments, and all participating patients.

Conflict of Interest

None declared.

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