Efficacy of adding dexmedetomidine versus ibuprofen as an adjuvant to intraperitoneal bupivacaine for pain control after laparoscopic gynecological procedures: a double-blind randomized comparative study

Abstract

Background & objective: We compared the efficacy of ibuprofen versus dexmedetomidine in combination with
bupivacaine or bupivacaine alone in intraperitoneal local anesthetic (IPLA) installation for postoperative pain control after total laparoscopic hysterectomy (TLH).
Methodology: One hundred eighty female patients scheduled for total laparoscopic hysterectomy were randomly assigned to one of three groups to receive intraperitoneal injections of either 50 mL of bupivacaine 0.25% (group B), 50 mL of bupivacaine 0.25% with dexmedetomidine 1 µg/kg (Group BD), or 50 mL of bupivacaine 0.25% with ibuprofen 400 mg (Group BI). In this randomised controlled trial, we evaluated the severity of postoperative pain using a visual analogue scale (VAS). Additionally, hemodynamic changes, total postoperative opioid consumption within the first 24 hours, incidence of postoperative nausea and vomiting, patient satisfaction, sedation score, time to the first request for analgesia, onset of ambulation, and side effects were recorded.

Results: Group BI demonstrated significantly lower pain scores at 6 and 12 hours, both at rest and during movement, compared with Groups BD and B. Group BD also showed lower pain scores than Group B at 6 hours at rest and during movement (P < 0.009 and P < 0.002, respectively). The time to first analgesic request was significantly longer in Group BI than in Groups BD and B (8.50 ± 2.3, 6.80 ± 2.9, and 6.73 ± 2.6 hours, respectively). Postoperative cumulative opioid consumption was lower in Group BI compared with Groups BD and B. Sedation scores were higher in Group BD only at 2 hours postoperatively.

Conclusion: Bupivacaine-ibuprofen was superior to bupivacaine-dexmedetomidine and bupivacaine alone. This was achieved with no significant negative consequences.

Keywords: Laparoscopy; Hysterectomy; Ibuprofen; Dexmedetomidine; Bupivacaine; Pain; Postoperative.

Citation: Algharabawy WS, Abdou K, Kamal M, Salem M. Efficacy of adding dexmedetomidine versus ibuprofen as an adjuvant to intraperitoneal bupivacaine for pain control after laparoscopic gynecological procedures: a double blind randomized comparative study. Anaesth. pain intensive care 2025;29(8):831-840. DOI:
10.35975/apic.v29i8.3004

Received: February 02, 2025; Revised: September 26, 2025; Accepted: September 28, 2025