Laparoscopic cholecystectomy is currently the most accepted surgical technique for cholelithiasis as compared to open cholecystectomy.¹ Laparoscopic procedures have many advantages over open procedures such as lesser haemorrhage, better cosmetic results, lesser postoperative pain and shorter recovery time leading to shorter hospital stay and less expenditure.² Laparoscopic cholecystectomy would appear to be an ideal operation for ambulatory surgery because of short duration, small surgical incisions, a low rate of immediate complications and  maintenance of gastrointestinal homeostasis.³

Pain in laparoscopic surgery results from stretching of the intraabdominal cavity,⁴ peritoneal inflammation, and diaphragmatic irritation caused by residual carbon‑dioxide in the peritoneal cavity.⁵ A single agent is unlikely to treat all three types of pain and a multimodal approach will be required to alleviate the pain. Hence many methods have been proposed to relieve postoperative pain following laparoscopic cholecystectomy.⁶

As a part of multimodal analgesic regimen, opioids have always remained as the preferred agent. However, the use of opioids can result in significant adverse effects including sedation, nausea, vomiting and respiratory depression thus delaying early ambulation of patients. Therefore, alternative approaches which reduce the requirement of strong opioids postoperatively are required. Drugs like paracetamol, diclofenac and COX-2 inhibitors, may not meet all requirements of post-surgical patients.

Intraperitoneal instillation of local anaesthetic agents has become an important method to control postoperative pain, nausea, vomiting and reduced hospital stay.^7,8 Intraperitoneal instillation of local anaesthetic agents alone⁶ or in combination with opioids,^9,10 ∝ 2 agonists such as clonidine¹¹,dexmedetomidine⁹ have been found to reduce post‑operative pain following laparoscopic cholecystectomy.

The local anaesthetic agents provide antinociception by affecting nerve membrane associated proteins and by inhibiting the release and action of prostaglandins which stimulates the nociceptors and cause inflammation.¹²

There are very few studies in literature which have examined the analgesic effects of α 2 agonists intraperitoneally. The antinociceptive effects of dexmedetomidine occur at dorsal root neuron level, where it blocks the release of substance P in the nociceptive pathway and through action on inhibitory G protein, which increases the conductance through potassium channels.¹³

Fentanyl is a potent, synthetic opioid pain medication with a rapid onset and short duration of action. It is a strong agonist at the μ-opioid receptors. Fentanyl is 50 to 100 times more potent than morphine. Despite being a more potent analgesic, fentanyl tends to induce less nausea, as well as less histamine-mediated itching, in relation to morphine.

Since there are a few studies which have compared the nociceptive effects of intraperitoneal fentanyl to intraperitoneal dexmedetomidine, we have proposed a study to compare the effects of combination of  intraperitoneal  dexmedetomidine and  bupivacaine to intraperitoneal fentanyl and bupivacaine and to intraperitoneal bupivacaine alone in patients undergoing ambulatory laparoscopic cholecystectomy.