Postoperative Analgesic Efficacy of Instillation of 0.25% Bupivacaine with 50 mcg Clonidine Following Radical Cholecystectomy

Postoperative pain management remains a critical challenge in abdominal surgery, significantly influencing patient recovery trajectories and hospital resource utilization. This research aimed to evaluate the postoperative analgesic efficacy of intraperitoneal instillation of 0.25% bupivacaine combined with clonidine (50 mcg) compared with bupivacaine alone and normal saline following radical cholecystectomy. A prospective, randomized, double-blind controlled trial was conducted at a tertiary care hospital. Ninety patients (ASA I-II) undergoing elective radical cholecystectomy were randomly allocated to three groups (n = 30 each). Group A received 40 mL normal saline, Group B received 40 mL of 0.25% bupivacaine, and Group C received 40 mL of 0.25% bupivacaine with 50 mcg clonidine, administered intraperitoneally at the conclusion of the procedure. Visual analogue scale (VAS) scores, haemodynamic variables, time to first rescue analgesic, total analgesic consumption, and adverse effects were recorded over 24 hours postoperatively. Group C demonstrated significantly lower VAS scores at 2, 4, 6, 8, 12, and 24 hours compared to Groups A and B (p < 0.001). The mean time to first rescue analgesic was substantially prolonged in Group C (486.3 ± 42.8 min) compared to Group B (312.7 ± 38.4 min) and Group A (148.2 ± 31.6 min). Total tramadol consumption in 24 hours was lowest in Group C (98.4 ± 22.1 mg) versus Group B (162.3 ± 28.7 mg) and Group A (278.6 ± 34.2 mg). Haemodynamic parameters remained stable across all groups without clinically significant differences. Intraperitoneal instillation of 0.25% bupivacaine combined with 50 mcg clonidine provides superior and prolonged postoperative analgesia following radical cholecystectomy compared to bupivacaine alone or normal saline, significantly reducing rescue analgesic requirements without increasing adverse effects.