Intravenous Dexmedetomidine Infusion as an Adjunct to the ERAS Protocol in Abdomino-Pelvic Laparoscopic Surgeries: Effect on Stress Response and Haemodynamics

Background and Aims: Enhanced Recovery After Surgery (ERAS) protocols are designed to limit surgical stress and promote faster recovery. This study evaluated the effect of intraoperative dexmedetomidine infusion on stress response, measured by serum cortisol and Interleukin-6 levels in patients undergoing elective laparoscopic surgeries. Secondary outcomes included haemodynamic stability, postoperative pain, sedation, and analgesic requirement.
Methods: In this prospective, double-blinded, randomized controlled trial, 100 ASA I–II patients scheduled for laparoscopic surgery were enrolled and randomly allocated into two groups. Group A received dexmedetomidine (1 µg/kg loading dose followed by 0.5 µg/kg/h infusion), while Group B received volume-matched saline. Serum cortisol and IL-6 were measured at baseline, immediate postoperatively, and at 24 hours. Haemodynamic parameters, pain scores, sedation levels, and analgesic usage were also recorded.
Results: Cortisol and IL-6 levels were significantly lower in Group A at both postoperative time points (p < 0.0001), with no difference at baseline. Group A demonstrated better haemodynamic control and lower pain scores up to 30 minutes after surgery (p < 0.0001). Sedation scores were higher in Group A during the same period. Only 16% of patients in Group A required diclofenac, compared to 88% in Group B; 18% in Group B also needed tramadol or both drugs. Total analgesic use was significantly lower in the dexmedetomidine group (p < 0.0001).
Conclusion: Dexmedetomidine infusion as part of an ERAS strategy effectively blunts the surgical stress response, improves haemodynamic stability, reduces early postoperative pain, and minimizes analgesic requirement in laparoscopic surgeries.