Background: Postoperative pain remains a primary clinical hurdle following laparoscopic

cholecystectomy (LC), driven by port-site trauma, visceral manipulation, and carbon dioxide (CO2) pneumoperitoneum. Systemic regimens using opioids and non-steroidal anti-inflammatory drugs (NSAIDs) are standard but carry dose-dependent adverse effects like

respiratory depression, sedation, and gastrointestinal issues. Intraperitoneal (IP) local

anesthetic instillation targets visceral nociception directly at its origin, and the addition of α2-adrenergic agonists can optimize this localized pathway.

Objectives: To compare the postoperative analgesic efficacy and safety profiles of intraperitoneal administration of bupivacaine combined with dexmedetomidine against conventional systemic intravenous (IV) analgesics in patients undergoing elective laparoscopic cholecystectomy.

Methods: A prospective, comparative, cross-sectional observational study was conducted at the KH Patil Institute of Medical Sciences (KHPIMS), Gadag, over 18 months. Sixty adult patients aged 18–60 years, with American Society of Anesthesiologists (ASA) physical status I or II, undergoing elective LC were randomly allocated to two equal groups (n = 30 each). Group BD received an intraperitoneal instillation of 50 mL of 0.25% bupivacaine combined with dexmedetomidine (1 μg/kg in 5 mL normal saline) before trocar removal in the Trendelenburg position. Group C received conventional systemic analgesics via IV tramadol (1 mg/kg twice daily) or IV paracetamol (15 mg/kg twice daily) for cases with tramadol hypersensitivity.

Postoperative pain intensity was monitored using the Visual Analogue Scale (VAS) at 0.5, 1, 2, 4, 6, 12, and 24 hours. The time to first rescue analgesia, cumulative 24-hour rescue analgesic dose, and occurrence of adverse events were evaluated.

Results: Baseline demographics, anthropometric values, and operative durations were highly comparable between the two cohorts (p > 0.05). Patients in Group BD demonstrated significantly better pain control, maintaining lower VAS scores across all postoperative intervals up to 24 hours (p < 0.05). The mean time to first rescue analgesia request was significantly prolonged in Group BD compared to Group C (405.3 ± 62.1 minutes vs. 139.3 ± 38.2 minutes; p < 0.001). Total rescue analgesic consumption over the initial 24 hours was significantly lower in the intraperitoneal group (74.3 ± 14.5 mg vs. 211.2 ± 39.8 mg; p < 0.001). Adverse events, including hypotension (60.0%), nausea (60.0%), and vomiting (46.7%), were observed exclusively in Group C (p < 0.001), while Group BD patients experienced no recorded side effects. No cases of bradycardia occurred in either arm.

Conclusion: Intraperitoneal administration of bupivacaine combined with dexmedetomidine provides superior, long-lasting postoperative pain relief, establishes a pronounced systemic opioid-sparing effect, and features a superior safety profile compared to conventional intravenous analgesia strategies after elective laparoscopic cholecystectomy.