Comparison of the effects of perioperative dexmedetomidine and levobupivacaine infusion at wound on pain in abdominal gynecologic surgery.

In this study, we evaluated the effectiveness of dexmedetomidine and levobupivacaine in prevention of chronic pain and hyperalgesia due to use of fentanyl and surgery. After obtaining the approval of the ethical committee, 75 patients, ASA I, II risk group, age between 18-65 years,undergoing abdominal gynecological surgery were enrolled and patients were divided into 3 groups with randomization. Group D :Dexmedetomidine, group L: Local and group C: Control.All groups had standard general anesthesia with fentanyl, propofol, rocuronium, and sevoflurane. In Group D, before induction of anesthesia patients were administered 0.5 mcg / kg dexmedetomidine intravenously in 10 min followed with dexmedetomidine infusion at a rate of 0.4-0.6 mcg / kg / h. In Group L a catheter was placed to the incision area. Then, 10 ml / h levobupivacain infusion continued in the postoperative 48 h period. Before induction of anesthesia in Group C was given 10 ml of saline in 10 min.In all groups, pain threshold measurement of with digital pressure algometer was performed preoperatively, postoperatively 24 and 48th hours on front arm, on insizion, 2 cm above and 2 cm below of the insizion. Postoperatively, VAS, time to first analgesic request, analgesic consumption were recorded. After surgery: at 6 and 12th months developing of any chronic pain were recorded.Postoperatively, VAS values lower in Group D and group L compared to group C (at 24. h as 1,20±1,08, 1,10±1,07, 1,96±1,33 and at 48. h 0,48±0,85, 1,50±1,06, 0,58±0,83) (p?0,05). Group D and group L showed a decrease in analgesic consumption than group C (at postoperative 0-24 h as 97,62±26,55 ml, 93,62±31,82 ml and 127,94±35,76 ml) (p?0,05). In Group L, postoperative insizion pain threshould level is higher than group C (at 24 h as 873,330±398,410 g, 667±233,57 g and at 48 h 909,330±409,77 g, 667,79±233,57 g) (p?0,05). We determined postoperatively chronic pain development at 6. month in group D, group L and group C as 22%, 25%, 63% (p?0,05).We determined the decrease of the need for analgesics, increase of the quality of analgesia, preventing the development of chronic pain with dexmedetomidine and levobupivacaine infusion at wound. Levobupivacaine infusion at wound and dexmedetomidine infusion were concluded as effective in preventing the hyperalgesia.Key Words: Fentanyl, dexmedetomidine, levobupivacaine, hyperalgesia, chronic pain.