Laparoscopic cholecystectomy (LC) has rapidly become the procedure of choice for routine gallbladder removal and is currently the most commonly performed major abdominal procedure. The patient complains more of visceral pain after laparoscopic cholecystectomy in contrast to the parietal pain experienced in open cholecystectomy. Dissection around the gallbladder bed and capno-peritoneum raises the intraperitoneal pressure, which results in peritoneal inflammation. This leads to visceral abdominal pain that gets aggravated by coughing, deep breathing, and movement.

Various multimodal approaches have been tried to ameliorate post-operative pain, which includes parenteral opioids, NSAIDs, analgesic patches, steroids, and local infiltration of local anaesthetics alone or with additives. Intraperitoneal instillation of local anaesthetics (LA) block the visceral afferent signals and modify visceral nociception. However, as LAs are short-acting, adding adjuvants will prolong the duration of anaesthesia and enhance the analgesic effect.

All parenteral medications have associated adverse effects like respiratory depression, drug dependence or abuse, nausea, vomiting, CNS side effects, etc. Local anesthetics have the added advantage that they cause fewer systemic side effects. Adding adjuvants increases the duration of the postoperative analgesic effect. Dexamethasone is a strong, long-acting glucocorticoid that is effective in relieving postoperative pain as well as postoperative nausea in laparoscopic surgeries.

Dexmedetomidine is an alpha-2 adrenergic agonist. Studies have shown that topical application of dexmedetomidine during nerve block can enhance the analgesic effect, reduce the dosage of local anaesthetic and improve the postoperative analgesic effect. There are very few studies comparing the efficacy of dexamethasone vs dexmedetomidine as adjuvants in intraperitoneal installation, and hence the following study is being undertaken.