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A prospective randomized study to compare dexmedetomidine and dexamethasone as an adjunct to bupivacaine in transversus abdominis plane block for post-operative analgesia in caesarean delivery

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Background: Caesarean section is most frequently performed surgery worldwide. Patients experience moderate to severe pain in the first 48 hours post-operatively. Aim of this study was to evaluate the efficacy of dexmedetomidine and dexamethasone as an adjunct to bupivacaine in ultrasound guided TAP block for postoperative analgesia in patients of caesarean section.Methods: A total 120 ASA I and II patients undergoing elective and emergency caesarean section under subarachnoid block were randomly divided into three groups B, BDM, BDX to receive bupivacaine alone or dexmedetomidine or dexamethasone as an adjunct to bupivacaine in ultrasound guided TAP block. Postoperatively, the patients were evaluated for pain level at rest and on movement with a 10 cm visual analog scale (VAS) pain score (0 = no pain and 10 = worst pain), time to demand of first analgesic request, number of analgesic requirements, nausea or vomiting, sedation and patient satisfaction at 0 hours and at 2, 4, 6, 12, 18, and 24 hours.Results: VAS score was significantly higher in group B in comparison to BDM and BDX, and higher in BDX in comparison to group BDM. Mean duration of analgesia was significantly higher in group BDM in comparison to group B and BDX. Total number of rescue analgesic demands were significantly lower in group BDM in comparison to group B and BDX. Sedation score and satisfaction score was higher in group BDM as compared to group B and BDX.Conclusions: Addition of dexmedetomidine and dexamethasone as an adjunct to bupivacaine reduces postoperative pain, prolongs analgesia, decreases demand for additional analgesics and provides better maternal satisfaction as compared to plain bupivacaine group in TAP block in patients undergoing caesarean section under subarachnoid block. Among dexmedetomidine and dexamethasone, dexmedetomidine had prolonged analgesia as compared to dexamethasone group.
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December 2019 · Volume 8 · Issue 12 Page 4903
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Thakur J et al. Int J Reprod Contracept Obstet Gynecol. 2019 Dec;8(12):4903-4908
www.ijrcog.org
pISSN 2320-1770 | eISSN 2320-1789
Original Research Article
A prospective randomized study to compare dexmedetomidine and
dexamethasone as an adjunct to bupivacaine in transversus
abdominis plane block for post-operative analgesia in
caesarean delivery
Jitender Thakur1, Bharti Gupta1*, Amit Gupta2, Ravinder Kumar Verma1,
Anita Verma1, Payal Shah3
DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20195342
ABSTRACT
Background: Caesarean section is most frequently performed surgery worldwide. Patients experience moderate to
severe pain in the first 48 hours post-operatively. Aim of this study was to evaluate the efficacy of dexmedetomidine
and dexamethasone as an adjunct to bupivacaine in ultrasound guided TAP block for postoperative analgesia in
patients of caesarean section.
Methods: A total 120 ASA I and II patients undergoing elective and emergency caesarean section under
subarachnoid block were randomly divided into three groups B, BDM, BDX to receive bupivacaine alone or
dexmedetomidine or dexamethasone as an adjunct to bupivacaine in ultrasound guided TAP block. Postoperatively,
the patients were evaluated for pain level at rest and on movement with a 10 cm visual analog scale (VAS) pain score
(0 = no pain and 10 = worst pain), time to demand of first analgesic request, number of analgesic requirements,
nausea or vomiting, sedation and patient satisfaction at 0 hours and at 2, 4, 6, 12, 18, and 24 hours.
Results: VAS score was significantly higher in group B in comparison to BDM and BDX, and higher in BDX in
comparison to group BDM. Mean duration of analgesia was significantly higher in group BDM in comparison to
group B and BDX. Total number of rescue analgesic demands were significantly lower in group BDM in comparison
to group B and BDX. Sedation score and satisfaction score was higher in group BDM as compared to group B and
BDX.
Conclusions: Addition of dexmedetomidine and dexamethasone as an adjunct to bupivacaine reduces postoperative
pain, prolongs analgesia, decreases demand for additional analgesics and provides better maternal satisfaction as
compared to plain bupivacaine group in TAP block in patients undergoing caesarean section under subarachnoid
block. Among dexmedetomidine and dexamethasone, dexmedetomidine had prolonged analgesia as compared to
dexamethasone group.
Keywords: Caesarean section, Dexmedetomidine, Dexamethasone, Postoperative pain, Transversus abdominis plane
block
1Department of Anesthesia, DRPGMC, Tanda (Kangra), Himachal Pradesh, India
2Department Obstetrics and Gynecology, DRPGMC, Tanda (Kangra), Himachal Pradesh, India
3Department Anesthesia, Zonal Hospital, Dharamsala (Kangra), Himachal Pradesh, India
Received: 23 August 2019
Revised: 08 November 2019
Accepted: 13 November 2019
*Correspondence:
Dr. Bharti Gupta,
E-mail: drbharti203@gmail.com
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
Thakur J et al. Int J Reprod Contracept Obstet Gynecol. 2019 Dec;8(12):4903-4908
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 8 · Issue 12 Page 4904
INTRODUCTION
Caesarean section is often associated with severe pain,
which may result in patient dissatisfaction, impaired
patient rehabilitation and prolonged hospitalization.1,2
Therefore, a well-planned analgesia regimen is required
to ensure adequate maternal satisfaction, early initiation
of breast feeding and early mobilization to prevent risk of
thrombo-embolism as a result of immobility due to pain.
Pain after caesarean section is mainly contributed to
somatic component of pain (Abdominal wall incision)
and less because of visceral pain (uterus). Thereby
requiring a multimodal approach for postoperative pain
management in the form of NSAIDS, opioids, local
infiltration by LA and neuraxial blocks in the form of
epidurals.3
Transversus abdominis plane block is used to provide
analgesia to the anterior and lateral abdominal wall. A
local anaesthetic solution (Bupivacaine) is injected into
facial plane between the internal oblique and transversus
abdominis muscle under ultrasound guidance. The
procedural simplicity of this block, along with the
reliable level of analgesia (T6-L1) and longer duration
and quality of analgesia makes TAP block a good option
for lower abdominal gynaecological surgeries, as also
been reported by American society of regional
anaesthesia (ASRA).4
Some of the adjuncts which have been used so far in
literature in TAP block are dexamethasone, magnesium
and α2 agonists. Out of these agonists, α2 agonist drugs
and Dexamethasone are most commonly used drugs,
owing to their analgesic potential and safety profile.5
A comparative study between dexmedetomidine versus
dexamethasone as an adjuvant to bupivacaine in
ultrasound guided TAP block for postoperative analgesia
in patients undergoing caesarean section under
subarachnoid block was planned. Our primary aim was to
compare the dexmedetomidine and dexamethasone as an
adjunct to bupivacaine post-operatively up to 24 hours for
duration of analgesia and demand of additional
analgesics. Secondary aims were to assess sedation,
nausea, vomiting, haemodynamic stability and maternal
satisfaction in relation with the early start of breast
feeding and early ambulation.
METHODS
The study was approved by institutional ethical
committee and was carried over a period of one year from
March 2018 to February 2019. 120 ASA I-II patients,
scheduled for emergency and elective caesarean section
under subarachnoid block were included in the study and
one patient was excluded due to block failure. Patient’s
refusal for block, local infection at the site of TAP block
and allergy to study drugs were the exclusion criteria.
It was a prospective, double blind randomized control
study. The patients were allocated to one of the three
groups by random number chart. Random number was
enclosed in a sealed opaque envelope and opened by one
of the investigators to know the study drug to be
administered. The operating surgeon and observer
anesthesiologist who collected the postoperative data
were blinded to the study drug. The study drug solution
was prepared and given to the investigator by a
nonparticipant staff.
The group B received 38 ml of 0.25% bupivacaine and 2
ml of 0.9% NS to make total volume of 40 ml, group
BDM-38 ml of 0.25% bupivacaine and 2 ml of 1 μg/kg
dexmedetomidine and group BDX-38 ml of 0.25%
bupivacaine and 2 ml of 0.1 mg/kg dexamethasone.
All patients undergoing caesarean section were given
subarachnoid block in lateral position and surgery was
started after confirmation of T6 level. Postoperatively,
after regression of sensory block to T10 dermatome.
A USG guided TAP block was given using linear probe
(6-13 MHz) in all groups with respective drug solutions.
23 G spinal needle was advanced by ultrasound guided in
plane technique at the anterior axillary line between the
12th rib and iliac crest with umbilicus at the center and
exact location of the needle tip in a plane between
internal oblique muscle, transverse abdominis muscle
was identified with 1ml of normal saline.6,7
After confirmation of hypo echoic area on USG imaging,
the injection of 20 ml of drug solution was given. The
amount of 20 ml was also injected on the opposite side
using the identical technique). Postoperatively, the
patients were evaluated in post-anaesthesia care unit
(time 0 hours) and at 2, 4, 6, 12, 18, and 24 hours by an
investigator blinded to group assignment. Pain level
(somatic and visceral) at rest and on movement (knee
flexion) was quantified with a 10 cm visual analog scale
(VAS) pain score (0 = no pain and 10 = worst pain), time
to demand of first tramadol request, number of
supplemental analgesics. For the first 24 hours, the
protocol for postoperative analgesia in our institute
consisted of injection diclofenac intramuscular 8 hourly
and injection tramadol 50 mg intravenous on demand if
pain scores remain high (VAS > 4).
Nausea and vomiting were assessed on a four-point scale
(None- 1, Mild -2, Moderate- 3, Severe- 4). Injection
Ondansetron 4 mg IV was given if score was more than
2.
Level of sedation was assessed as a sedation score of 0-3,
where 0 = awake and alert, 1 = quietly awake, 2 = asleep
but easily arousable, 3 = deep sleep, responding to
painful stimulus. Patients were labeled to be sedated if
score was > 2.
Thakur J et al. Int J Reprod Contracept Obstet Gynecol. 2019 Dec;8(12):4903-4908
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 8 · Issue 12 Page 4905
The patients were also interviewed after 24 hours of
surgery regarding satisfaction with their pain
management and comfort in view of early ambulation and
early start of breast feeding on a 3-point scale (highly
satisfied-1, satisfied-2, dissatisfied-3). In addition,
haemodynamic monitoring (systolic blood pressure,
diastolic blood pressure and heart rate) was also done at
similar study points.
Statistical analysis
Data was presented as frequency, mean, and standard
deviation whenever applicable. Categorical variables
between 2 groups were compared using Chi square test of
Fischer exact test. One-way ANOVA followed by post-
hoc analysis (Bonferroni) was used to compare
quantitative variables between 3 groups. P value <0.05
was considered significant. Statistical analysis was
performed using SPSS v21.
RESULTS
A total of 119 patients were enrolled into the study and
randomized into 3 groups - group B, BDM, and BDX.
Patient characteristics like age, weight and ASA status
were comparable in all three groups (Table 1).
Table 1: Comparison between three groups according to demographic variables.
Parameter
Group BDM, N = 40
Group BDX, N = 40
P value
Age (years)
27.62±3.50
27.50±3.42
0.324#
Weight (kg)
63.97±7.33
64.72±7.73
0.893#
Data presented as mean±SD; #One-way ANOVA.
Figure 1: Comparison of VAS scores.
The VAS for pain was comparable in group B, BDM and
BDX at 0 hour but at 4-hour, VAS score was
significantly lower in group BDM in comparison to group
B (P = 0.037) and group BDX (0.040). At 6 and 12 hours.
VAS of the patients was comparable in group B, BDM,
and BDX. Again at 18-hour, VAS of the patients was
significantly higher in group B in comparison to group
BDM (P = 0.0003) and group BDX (P = 0.039). At 24-
hour, VAS of the patients in group B was significantly
higher than VAS of the patients in group BDM (P <
0.0001) and BDX (P < 0.0001). So, VAS score was
significantly higher in group B at 2-hour, 4-hour, 18-
hour, and 24-hour in comparison to BDM and BDX and
higher in BDX in comparison to group BDM (Figure 1).
Mean duration of analgesia (time to first rescue
analgesia) was significantly higher in group BDM
(407.99±4.60) minutes in comparison to group B
(178.99±5.00) and group BDX (325.88±5.51) (Figure 2).
Figure 2: Comparison of mean duration of
analgesia (minutes).
Figure 3: Total number of analgesic demands.
0
2
4
6
8
10
0 hour 2 hour 4 hour 6 hour 12 hour 18 hour 24 hour
VAS Score
B (n=39) BDM (n=40) BDX (n=40)
0
100
200
300
400
500
B (n=39) BDM (n=40) BDX (n=40)
Mean duration of analgesia
0
1
2
3
4
B (n=39) BDM (n=40) BDX (n=40)
Total number of analgesic demands in 24 hours
Total number of demands in 24 hours
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Figure 4: Comparison of sedation score.
Total number of rescue analgesic demand in 24 hours
was significantly lower in group BDM (2.02±0.16) in
comparison to group B (2.90±0.31) and group BDX
(2.82±0.50) (Figure 3).
The PONV scores were similar in all groups. Sedation
score and satisfaction score was marginally higher in
group BDM which was not significant (Figure 4).
Heart rate was comparable between group B, group
BDM, and group BDX at all study points except at 2
hours when it was lower in group BDM (Table 2).
Table 2: Comparison of heart rate among different groups.
Heart rate
B (n = 39)
BDM (n = 40)
BDX (n = 40)
ANOVA Statistic
Post-hoc analysis
0-hour
86.97±10.27
87.00±10.15
87.35±7.47
0.980
-
2-hour
83.49±9.80
76.35±6.76
83.25±9.87
< 0.001
B versus BDM = 0.0002; B
versus BDX = 1.000; BDM
versus BDX = 0.002
4-hour
77.38±7.46
77.30±7.38
79.45±5.99
0.300
-
6-hour
79.49±8.44
79.75±8.34
81.10±6.47
0.681
-
12-hour
78.61±8.13
78.75±8.07
79.40±5.98
0.882
-
18-hour
79.84±8.29
79.60±8.33
81.95±7.12
0.351
-
24-hour
80.26±8.84
80.20±8.73
81.50±5.95
0.712
-
Data presented as mean±SD; One-way ANOVA followed by Bonferroni Post-hoc.
Table 3: Comparison of diastolic blood pressure in different groups.
Diastolic BP
B (n = 39)
BDM (n = 40)
BDX (n = 40)
ANOVA statistics
Post-hoc analysis
0-hour
73.69±5.16
71.05±5.06
68.95±5.32
< 0.0001
B versus BDM = 0.076; B versus BDX =
< 0.0001; BDM versus BDX = 0.218
2-hour
74.26±5.15
70.65±4.56
70.55±4.75
0.001
B versus BDM = 0.004; B versus BDX =
0.003; BDM versus BDX = 1.000
4-hour
75.18±5.59
69.65±5.41
71.00±4.73
< 0.0001
B versus BDM < 0.0001; B versus BDX
= 0.002; BDM versus BDX = 0.759
6-hour
73.23±7.06
71.05±4.96
69.90±5.74
0.046
B versus BDM = 0.323; B versus BDX =
0.044; BDM versus BDX = 1.000
12-hour
76.82±4.44
70.80±5.18
70.65±5.84
< 0.0001
B versus BDM < 0.0001; B versus BDX
< 0.0001; BDM versus BDX = 1.000
18-hour
76.46±4.93
70.10±5.45
68.10±12.13
< 0.0001
B versus BDM = 0.002; B versus BDX <
0.0001; BDM versus BDX = 0.835
24-hour
75.95±5.51
71.60±4.46
70.45±5.39
< 0.0001
B versus BDM = 0.001; B versus BDX <
0.0001; BDM versus BDX = 0.958
Data presented as mean±SD; # (B vs. BDM); One-way ANOVA followed by Bonferroni Post-hoc.
Diastolic BP was significantly higher in group B in
comparison to group BDX and group BDM up to 24
hours (Table 3).
DISCUSSION
The ideal analgesic regime should be efficacious without
impacting the ability of mother to take care of the neonate
and with minimal drug transfer through breast milk.
Limited availability of drugs, equipment cost and non-
availability of trained staff for monitoring are the major
issues in providing adequate post caesarian section
analgesia by epidurals.
The TAP block gives good analgesia, is cost affective,
requires less expertise, and reduces consumption of
opioids in post- operative period.
1
2
B (n=39) BDM (n=40) BDX (n=40)
Sedation score
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International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 8 · Issue 12 Page 4907
This was observed by Srivastava U et al in their study
which concluded that TAP block was effective in
providing analgesia with a substantial reduction in
tramadol use during 48h after cesarean section when used
as an adjunct to standard analgesia.8
For abdominal surgeries, TAP blocks have been
demonstrated to decrease the use of postoperative opioids
and their side effects such as sedation and PONV,
increase the time to first request for further analgesia,
provide more effective pain relief, earlier mobilization
and faster recovery.9
Different local anaesthetics alone and addition of
adjuvant to local anaesthesia may prolong the block's
duration. A systematic review and meta-analysis of
randomized controlled trials in 2015 by Zhang D and
colleagues showed that addition of Dexamethasone to
local anesthetics in ultrasound guided TAP block was a
safe and effective strategy for postoperative analgesia in
adult patients undergoing abdominal surgery.10
A systematic review for randomized controlled trials by
Fusco P et al, that assessed the efficacy of ultrasound
(US) guided TAP block following cesarean delivery and
concluded that controversy surrounds the utility of US-
guided TAP block in cesarean section, evidence suggests
that when correctly executed as part of a multimodal
analgesic regimen, TAP block may reduce postoperative
opioid consumption and opioid-related side effects,
improving postoperative pain control and patient
satisfaction.11
In our study we observed that duration of analgesia was
significantly higher in patients who received bupivacaine
along with dexmedetomidine in comparison to the
patients who received bupivacaine alone or with
dexamethasone. Similar results were observed by
Almarkbi and Kaki, who studied the effect of addition of
dexmedetomidine to bupivacaine to perform TAP
block.12,13 They concluded that the addition of
dexmedetomidine to bupivacaine in TAP block achieves
better local anesthesia and provides better pain control
post-operatively with lower heart rate from 60 min from
block to 4 hours postoperatively. Similarly, analgesia
period was significantly higher in the patients who
received bupivacaine and dexamethasone as an adjunct in
comparison to the patients who received bupivacaine
alone. Similar results have been reported by Abdeelal and
colleagues.14 Among these two adjuncts
dexmedetomidine provided longer analgesia and there
was no previous research for similar comparison.
Because of prolonged pain free period total number of
rescue analgesic demands in 24 hours were significantly
lower in group BDM in comparison to group B and group
BDX.
Sharma et al, determined the effect of the addition of
dexamethasone to 0.5% ropivacaine on post-operative
analgesia in USG guided TAP block for inguinal hernia
repair and concluded that addition of dexamaethasone to
ropivacaine in USG guided TAP block significantly
reduces post-operative analgesia and reduces analgesic
consumption.15-17 Our study observed that addition of
dexmedetomidine to bupivacaine provided more
sedation; however, the difference was not significant. Our
results also match with Aksu et al and Mishra et al who
observed that sedation was non-significantly higher in the
patients who received dexmedetomidine in addition to
bupivacaine.18,19 We found that the patients satisfaction
was non significantly higher in the patients who received
dexmedetomidine in addition to bupivacaine in
comparison to other groups. Such findings have also been
reported previously by Aksu et al and Mishra et al.18,19
We observed that heart rate, systolic and diastolic BP was
better maintained in BDX except decrease in heart rate at
2 hours was for very short time, and it can be explained
by bradycardia causing property of alpha 2 agonist.
Bradycardia is one of reported endocrine effects of
dexmedetomidine. Bradycardia may occur with ongoing
therapy mediated by central α2A adrenergic receptors,
causing decreased release of nor adrenaline from the
sympathetic nervous system.20,21 Systolic BP was
comparable in all the groups up to 24 hour while diastolic
BP was significantly lower in group BDX in comparison
to group B and BDM at all time points up to 24 hour
which can be explained by effect of alpha 2 agonist for
BDM group and comparatively higher pain scores in
group B and group BDM. Incidence of post-operative
nausea vomiting was equivalent in all groups. We found
no significant difference in age, weight, ASA class and
duration of surgery.
CONCLUSION
Dexmedetomidine and dexamethasone as an adjunct to
bupivacaine in post-operative pain scores, prolongs the
duration of analgesia, decreases demands for rescue
analgesia, and provides better patient satisfaction with
improved quality of block.
The analgesia is maximally prolonged with
dexmedetomidine without any significant adverse effects.
ACKNOWLEDGMENTS
Authors would like to thank all the patients who
participated in study.
Funding: No funding sources
Conflict of interest: None declared
Ethical approval: The study was approved by the
Institutional Ethics Committee
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Cite this article as: Thakur J, Gupta B, Gupta A,
Verma RK, Verma A, Shah P. A prospective
randomized study to compare dexmedetomidine and
dexamethasone as an adjunct to bupivacaine in
transversus abdominis plane block for post-operative
analgesia in caesarean delivery. Int J Reprod
Contracept Obstet Gynecol 2019;8:4903-8.
... During the eligibility assessment, a significant number of reports were excluded due to various reasons: 88 were in vitro studies, 65 were literature reviews, 38 were case reports, and 43 were thesis articles. Consequently, these exclusions left eight trials [20][21][22][23][24][25][26][27] that were deemed suitable for inclusion in the review. ...
... An overview of the demographic parameters of the eight selected papers [20][21][22][23][24][25][26][27] are shown through Table 2, with a total of 644 participants across diverse geographical locations, predominantly in India and also in China and Egypt. [20][21][22][23][24][25][26][27] An overall trend observed in these studies was the evaluation of the efficacy of DMD in combination with different local anesthetics, such as ropivacaine, bupivacaine, and levobupivacaine in different clinical settings. ...
... An overview of the demographic parameters of the eight selected papers [20][21][22][23][24][25][26][27] are shown through Table 2, with a total of 644 participants across diverse geographical locations, predominantly in India and also in China and Egypt. [20][21][22][23][24][25][26][27] An overall trend observed in these studies was the evaluation of the efficacy of DMD in combination with different local anesthetics, such as ropivacaine, bupivacaine, and levobupivacaine in different clinical settings. In most studies, the addition of DMD to the local anaesthetic was associated with a prolonged time to initial onset of pain and time to first rescue analgesia. ...
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Postoperative pain management is a key component of care for women undergoing cesarean section. Although the use of dexmedetomidine (DMD) as an adjuvant to local anesthetics in transverse abdominal plane (TAP) blocks has been investigated, its conclusive evidence on its efficacy and safety remains unclear. A standardized data extraction form, under the guidance of the PRISMA protocol, was devised for selecting relevant studies across eight databases, without restrictions on the publication period. In most of the eight studies reviewed, the group receiving DMD demonstrated a significant extension of the duration of analgesia compared to the control group [mean difference (MD) = -3.37 hours, 95% confidence interval (CI) = -6.10 to -0.65 hours, Z = 2.43, P = 0.02]. The DMD group also showed a significant decrease in Visual Analogue Scale pain scores (MD = -1.38, 95% CI = -2.52 to -0.24, Z = 2.37, P = 0.02) in comparison to the control group. Nevertheless, significant heterogeneity was observed across the studies, potentially due to differences in study design, patient demographics, and dosing protocols, among other factors. The results of this meta-analysis indicate that DMD could be an effective adjuvant to local anesthetics in TAP blocks, potentially improving postoperative pain management and decreasing the need for additional analgesia. Nevertheless, the considerable heterogeneity among the studies warrants cautious interpretation of these results.
... A cetamina pode ser eficaz na redução da dor aguda, mas sua eficácia em comparação com a dexmedetomidina varia conforme o contexto clínico. A dexmedetomidina, por sua vez, não apenas proporciona analgesia, mas também atua como um sedativo eficaz, permitindo uma recuperação mais tranquila para os pacientes(Thakur et al., 2019). A eficácia analgésica da cetamina e da dexmedetomidina, a última demonstrou um perfil de analgesia mais favorável, especialmente em procedimentos cirúrgicos que exigem sedação profunda(Thakur et al., 2019).Além disso, a dexmedetomidina tem sido utilizada em combinação com outros agentes, como a metadona, para potencializar seus efeitos analgésicos.A metadona, um opióide, quando associada à dexmedetomidina, tem mostrado resultados promissores na redução da dor pós-operatória, permitindo uma diminuição significativa na dose de opioides necessária(De Souza, 2023). ...
... A dexmedetomidina, por sua vez, não apenas proporciona analgesia, mas também atua como um sedativo eficaz, permitindo uma recuperação mais tranquila para os pacientes(Thakur et al., 2019). A eficácia analgésica da cetamina e da dexmedetomidina, a última demonstrou um perfil de analgesia mais favorável, especialmente em procedimentos cirúrgicos que exigem sedação profunda(Thakur et al., 2019).Além disso, a dexmedetomidina tem sido utilizada em combinação com outros agentes, como a metadona, para potencializar seus efeitos analgésicos.A metadona, um opióide, quando associada à dexmedetomidina, tem mostrado resultados promissores na redução da dor pós-operatória, permitindo uma diminuição significativa na dose de opioides necessária(De Souza, 2023). Essa combinação é especialmente relevante em pacientes que apresentam resistência a opioides ou que têm um histórico de dependência, onde a utilização de adjuvantes não opióides é preferível. ...
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Introdução: A dexmedetomidina tem emergido como um adjuvante eficaz no controle da dor pós-operatória, apresentando benefícios significativos em comparação com outros agentes. Objetivo: Avaliar a eficácia da dexmedetomidina na analgesia pós-operatória, focando na redução do uso de opioides e na melhoria dos desfechos clínicos. Metodologia: Trata-se de uma revisão narrativa com dados coletados da plataforma PubMed, empregando a busca “Dexmedetomidine AND Anesthesia AND Postoperative Pain AND Opioids”. Foram aplicados filtros para incluir apenas ensaios clínicos, revisões e metanálises publicadas entre 2019 e 2025, em inglês, espanhol ou português, com acesso gratuito. Após a triagem inicial de 96 artigos, a seleção final foi realizada com base na leitura de títulos, resumos e textos completos, resultando em 29 estudos incluídos na revisão. Resultados: A dexmedetomidina demonstrou reduzir a necessidade de opioides em até 30%, prolongar a duração da analgesia em 25% e diminuir a incidência de náuseas e vômitos em 15%. Além disso, a análise econômica indicou que, apesar do custo inicial elevado, a dexmedetomidina pode resultar em uma redução de 20% nos custos totais de tratamento devido à diminuição da duração da internação. Conclusão: A dexmedetomidina se apresenta como uma opção segura e eficaz para o manejo da dor pós-operatória, com implicações positivas para a prática clínica e a satisfação do paciente, sugerindo a necessidade de sua inclusão em protocolos anestésicos.
... Poorly controlled pain is associated with a variety of detrimental acute as well as chronic effects. 4 The attenuation of perioperative pathophysiology that occurs during surgery through reduction of nociceptive input to the CNS and optimization of perioperative analgesia may decrease complications and facilitate recovery during immediate post operative period and after discharge from the hospital. Post-operative consequences of pain include, distress, confusion, post operative development of hypercoagulability, neuroendocrine stress response leading to development of cardiac complications, paralytic ileus, inadequate cough and pulmonary complications all of which result in prolonged hospital stay and increase morbidity and mortality. ...
... Post-operative consequences of pain include, distress, confusion, post operative development of hypercoagulability, neuroendocrine stress response leading to development of cardiac complications, paralytic ileus, inadequate cough and pulmonary complications all of which result in prolonged hospital stay and increase morbidity and mortality. 4 Provision of effective perioperative analgesia is of key importance in patients. With adequate peri-operative analgesia, the magnitude of the neuro-endocrine stress response, postoperative pulmonary complications and the incidence of myocardial ischemia can be decreased. ...
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Background: The relief of pain and suffering is, and always has been, one of the primary concerns of mankind and one of the prime factors that has influenced the course of history of medicine. Transversus abdominis plane (TAP) block is a regional anaesthetic technique which blocks the abdominal neural afferents by introducing local anaesthetic into the neuro-fascial plane between the internal oblique and the transversus abdominis muscle. Aim: To compare the efficacy of Dexmedetomidine and dexamethasone as an adjuvant to 0.2%ropivacaine in ultrasound guided transverses abdominis plane block in infra umbilical surgeries in terms of, 1. Time to initial postoperative pain. 2. Time to initial rescue analgesia. 3. Quality of block.. 4. Total postop analgesic consumption. 5. Patient satisfaction with regard to pain relief. 6. Post-operative nausea and vomiting. Materials And Methods: We included 80 patients of age between 18-60 years of American Society of Anesthesiologists status (ASA)I and II scheduled for elective infraumbilical surgeries in our study. We randomly allotted these patients into two groups namely Group A and Group B of each. Patients in Group APatients who received transversus abdominis plane block with - 18ml Ropivacaine 0.2%+ 2 ml Dexamethasone 8mg. Patients in Group B received transversus abdominis plane block with-18ml Ropivacaine 0.2%+ 2 ml Dexmedetomidine .This TAP block was given soon after the surgery is completed. The duration of block and regression of sensory block, time for rescue analgesia, degree of sedation, hemodynamic parameters, post operative analgesia and adverse effects were noted. Result: The two groups were comparable on the basis of duration of surgery, site of surgery, ASA and BMI. Heart rates and mean arterial pressure were compared and it was found to be significantly lower in group B compared to group A until initial 5 hours. In our study we found that the visual analogue score at rest and on coughing between groups A and B was statistically insignificant. However, the time to first rescue analgesia (330 mins vs 240 mins) and total analgsic consumption in the 24 hours period post operatively was significantly lesser for group A compared to group B. Ramsey sedation score was significantly higher in group B compared to group A until 8 hourspost operatively. Nausea and vomiting in 3 cases of group A , and 2 cases in group B. No other significant side effects were noted. Conclusion: USG-guided TAP block is an effective and safe adjunct for postoperative analgesia in infra umblical surgeries. Addition of dexamethasone as an adjuvant prolongs the duration and reduces post-operative analgesic requirement in patients significantly more than dexmedetomidine whereas dexamethasone provides better control of the heart rate and mean arterial pressure.
... A study was conducted using isobaric bupivacaine with 2 different adjuvants (dexmedetomidine or dexamethasone) in TAP block for postoperative analgesia in cesarean delivery. It was observed that the VAS pain score interpreted from patients decreased in the bupivacaine plus dexmedetomidine group (15). ...
... However, when comparing both groups, we observed more instances of sedation in the dexmedetomidine group. Similarly, a study conducted by Thakur J et al. showed that the sedation score and patient satisfaction were higher in the group receiving bupivacaine with dexmedetomidine compared to the groups receiving bupivacaine alone and bupivacaine with dexamethasone (15). In our study, we used levobupivacaine instead of bupivacaine because it has a similar duration of action to bupivacaine but with fewer adverse effects (6). ...
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Background In the postoperative period, open total abdominal hysterectomy (TAH) surgeries induce considerable pain. Multimodal strategies are being used to alleviate pain. Objectives This study aimed to examine the efficacy and safety of dexamethasone and dexmedetomidine as an adjuvant to levobupivacaine in ultrasound-guided transversus abdominis plane (TAP) blocks for postoperative pain in TAH patients. Methods A total of 72 patients with ASA grade I and grade II were randomly and equally assigned to two groups. After the completion of surgery with a subarachnoid block (SAB), patients in group 1 received a mixture of 20 mL of 0.25% levobupivacaine and 4 mg of dexamethasone on each side of the TAP block. Patients in group 2 received a mixture of 20 mL of 0.25% levobupivacaine and dexmedetomidine, with a total dose of 1 µg/kg body weight evenly distributed bilaterally in the TAP block. Patients were evaluated for pain using the Visual Analog Scale (VAS), total tramadol consumption as rescue analgesia, time to first rescue analgesia, any adverse effects, and patient satisfaction. Results When comparing VAS scores for pain assessment, we observed that the mean VAS score was initially comparable between the two groups for the first hour. However, at 6, 9, and 12 h, VAS scores were significantly lower in group 2. The mean total tramadol consumption was higher in group 1 than in group 2 (213.33 ± 44.08 vs 161.11 ± 37.93 mg, P-value 0.027). The time to the first rescue analgesia after the TAP block in the postoperative period was significantly longer in group 2 (47.5 ± 62.76 vs 77.22 ± 56.14 min, P-value 0.002). No significant side effects were noted, and a greater proportion of patients in group 2 expressed satisfaction with their overall pain treatment. Conclusions The addition of dexmedetomidine to levobupivacaine is superior to the addition of dexamethasone, as it prolongs the duration of the block in the dexmedetomidine group. However, the use of dexamethasone as an adjuvant is a good alternative option, particularly due to its lower cost and reduced incidence of adverse effects such as postoperative nausea and vomiting.
... In the study by Thakur et al., where dexmedetomidine and dexamethasone were added to bupivacaine in TAP block during cesarean sections, similar to our findings, higher pain levels and analgesic requirements were observed in the dexamethasone group during the initial hours [31]. In another study by Sinha et al., where dexamethasone and bupivacaine were added to levobupivacaine in the TAP block during hysterectomies, similar to our study, higher VASs and shorter time to the first rescue analgesia were observed in the dexamethasone group within the first hour. ...
Article
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Background: The transversus abdominis plane (TAP) block is providing effective postoperative analgesia in patients undergoing cesarean section (CS). This study aims to evaluate and compare the effects on pain levels of bupivacaine alone versus bupivacaine combined with dexmedetomidine and bupivacaine combined with dexamethasone in ultrasound-guided TAP block for postoperative pain after CS. Material and Method: In this randomized controlled trial, 120 patients with American Society of Anesthesiologists (ASA) physical status I and II scheduled for elective cesarean section under spinal anesthesia were randomly divided into three groups. At the end of the surgery, an ultrasound-guided TAP block was performed on all patients: bupivacaine 0.5% (Group B), bupivacaine 0.5% + dexmedetomidine (1 µg/kg) (Group BD), and bupivacaine 0.5% + dexamethasone (4 mg) (Group BDx). Postoperatively, all patients were evaluated at 0, 1, 4, 8, 16, and 24 h for visual analog scores VASs, tramadol consumption, complications, and patient satisfaction. A p value of < 0.05 is statistically significant. Results: At 0 h, VASs in the sitting and supine positions were significantly higher in the BDx group (0.85 ± 1.61 and 0.85 ± 1.36, respectively) compared to the B group (0.05 ± 0.32 in both positions) and the BD group (0.15 ± 0.48 in both positions) (p = 0.005 and p = 0.001, respectively). At the 24th hour, VASs in the sitting and supine positions were significantly lower in the BDx group (1.7 ± 1.2 and 1.43 ± 1.05) compared to the B group (2.3 ± 0.68 and 2.2 ± 0.72) and the BD group (2.57 ± 1.01 and 2.28 ± 0.78) (p = 0.005 and p = 0.001, respectively). At 0 h, the tramadol requirement was highest in the BDx group at 12.5%, while it was not required in the B and BD groups (p = 0.005). At 0 h, the rate of nausea and vomiting was highest in the BDx group at 17.5%, compared to 2.5% in the BD group and 0% in the B group (p = 0.003). Patient satisfaction scores were higher in the dexamethasone group compared to the other groups. This was significant between Group B and Group BDx (p = 0.009 < 0.05). Conclusions: Adding dexmedetomidine or dexamethasone to bupivacaine in ultrasound-guided TAP blocks reduces postoperative pain and increases patient satisfaction after cesarean sections. Dexamethasone, due to its delayed onset but extended duration, achieves lower pain scores and higher satisfaction. Further research is necessary to confirm these findings.
... The sample size was calculated using openepi.com ( Figure 1) by using means and standard deviation of diastolic blood pressures between the groups according to the study done by Thakur et al. [15]. The sample size required to obtain a statistical significance between both groups was 24. ...
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Background Opioids, which have well-known adverse effects such as drowsiness paralytic ileus and respiratory depression, were mostly utilised to treat postoperative pain in the past. The increased incidence of side effects has led to a rise in interest in pain management techniques that spare opioids. Persistent abdominal pain following surgery has a major detrimental effect on patients' quality of life. While epidural analgesia is widely regarded as the gold standard to combat the pain that is present post abdominal surgeries, it is not devoid of drawbacks. The transversus abdominis plane (TAP) block has developed as a potentially effective treatment for severe abdominal pain. The TAP block acts on the neuro-fascial plane between the internal oblique and transversus abdominis muscles, which is innervated by spinal nerves from T6 to L1. Studies reveal that the addition of corticosteroids to bupivacaine in TAP blocks provides pain relief and improves the quality of life of the patient. Aims and objectives In this study, the effects of bupivacaine and corticosteroids, particularly dexamethasone and methylprednisolone, on chronic abdominal pain following surgery are examined. Assessing the quality of pain relief is the primary objective. Methodology Thirty patients who had undergone abdominal surgery and had been having persistent abdominal pain for six to eight months thereafter and had attempted unsuccessfully to treat the pain with alternative pain relief methods participated in the study. They were divided into two groups at random. Dexamethasone and bupivacaine were given to patients in Group D while methylprednisolone and bupivacaine were given to patients in Group M for ultrasonography (USG)-guided bilateral TAP blocks. At various intervals up to 12 weeks after injection, the patient's pain levels were measured using the visual analogue score (VAS), and their quality of life was assessed using the quality-of-life score. Results Patients in Group M experienced significantly less pain than those in Group D at the fourth, sixth, and 12th weeks of treatment. Furthermore, in the fourth, sixth, and 12th weeks, patients in Group M reported a superior quality of life in comparison to those in Group D. Conclusion Patients with persistent postoperative abdominal pain receiving bupivacaine and methylprednisolone in an ultrasonography-guided TAP block experience more effective and long-lasting pain relief than those who receive bupivacaine and dexamethasone. The quality of life for patients may be enhanced by using corticosteroids to optimise postoperative pain management strategies and lessen the need for opioids, as this study highlights.
... They found in their study on 60 patients undergoing supraclavicular brachial plexus block that addition of dexmedetomidine 1 µg/kg to bupivacaine 0.25%clonidine 1µg/kg mixture significantly prolonged the duration of analgesia more than bupivacaine-clonidine mixture only. 13 Similar findings have been reported in a study comparing dexamethasone (0.1 mg/kg) and dexmedetomidine (1 µg/kg) as adjuvants to bupivacaine (0.25%) in USGguided TAP block in patients undergoing cesarean section under spinal anasthesia. The investigators concluded that addition of dexmedetomidine reduces postoperative pain, prolongs duration of analgesia and decreases demand for additional analgesic requirement as compared with dexamethasone added to bupivacaine. ...
Article
Background & objective: Transversus abdominis plane (TAP) block using local anesthetics is associated with relatively shorter duration of action, and thus additional analgesic drugs are required in the postoperative period. We compared the efficacy and duration of postoperative analgesia achieved with using dexmedetomidine or dexamethasone as adjuvants to bupivacaine in TAP block for lower abdominal surgeries. Methodology: We enrolled 45 adult patients aged from 20-60 y, and randomly divided them into three equal groups. Group A received ultrasound guided TAP block with 0.25% bupivacaine 20 ml plus 4 mg dexamethasone on each side. Group B received 0.25% bupivacaine 20 ml plus dexmedetomidine 0.5 µg/kg on each side, and Group C (control group) patients received only 0.25% bupivacaine 20 ml on each side. Postoperative pain was assessed with VAS on arrival in post-anesthesia care unit (PACU), at 2 h, 6 h, 12 h, 18 h, and at 24 h postoperatively. Duration of analgesia was the time from drug injection to the time of first rescue of analgesia was recorded. Results: Mean duration to first dose of rescue analgesia among patients of dexmedetomidine group (Group B) was significantly prolonged as compared to dexamethasone group and bupivacaine only group. Regarding postoperative pain scores there were no statistically significant difference between the three groups; except at 6 h between the A and B groups and the control group. Both dexamethasone group and dexmedetomidine group showed better pain control than bupivacaine only at 6 h interval. Conclusion: Dexmedetomidine added to bupivacaine in ultrasound-guided transversus abdominis plane block for postoperative pain relief in patients undergoing lower abdominal surgeries prolongs the time to initial postoperative pain presented by time to first rescue analgesic demand than dexamethasone added to bupivacaine; the shortest time to first rescue analgesic was observed in bupivacaine alone group. Abbreviations: TAP: Transversus abdominis plane block; LA: Local anesthetic; PACU: Post anesthesia care unit; VAS: Visual Analogue Scale; ASA: American Society of Anesthesiologists; SD: Standard deviation; IQR: Inter quartile range. Citation: Sobhy YS, Gadalla RR, Nofal WH, Saleh MAE, Abdou KM. A comparative study between the use of dexmedetomidine .vs dexamethasone as adjuvants to bupivacaine in ultrasound-guided transversus abdominis plane block for postoperative pain relief in patients undergoing lower abdominal surgeries. Anaesth. pain intensive care 2022;26(5):681–688; DOI: 10.35975/apic.v26i5.2031
... A combination of analgesics, including long-acting neuraxial opioids such as morphine and diamorphine, can reduce somatosensory pain at the incision site, which is a significant component of pain experienced by women after caesarean delivery [4,5]. However, women can still experience severe breakthrough pain and neuraxial opioids may be unsuitable for some women. ...
Article
( Anaesthesia . 2022;77:463–474. doi: 10.1111/anae.15645) With cesarean delivery (CD) rates on the rise globally, it is important to understand the most effective methods of managing postoperative pain, which can be moderate to severe. Effective analgesia following CS has the long-term benefits such as decreasing opioid consumption, postpartum depression, and the likelihood of chronic pain. While long-acting neuraxial opioids reduce opioid requirements, breakthrough pain is not uncommon and neuraxial interventions may be contraindicated for some women. Local anesthetic infiltration has been increasingly used to reduce pain without significant adverse effects and may add the benefit of visceral analgesia. With many approach sites for treatment (direct wound infiltration, ilio-inguinal nerve, transversus abdominis plane, erector spinae plane, transverse fascia plane, and quadratus lumborum plane), it has not yet been studied if certain sites offer greater benefit over others. This network meta-analysis compares and ranks injection sites for efficacy of pain relief following CD.
... Also, postoperative hemodynamics results in Thakur et al. (23) study were similar to our results. They observed that HR and DBP showed significant difference at 2h and at 0,2,4,12,18,24 h postoperative respectively. ...
Article
Background: Local anesthetic adjuvants prolong analgesia duration with single shot interfascial plane blocks. They potentiate the analgesic effect of the local anesthetics. These adjuvants include several groups and different mechanisms of action such as dexamethasone and dexmedetomidine. Objectives: This study was aimed at achievement of better analgesia for total abdominal hysterectomy patients via prolongation of sensory block duration and reducing opioid consumption. Patients and Methods: This study was carried out at Zagazig University Hospitals where 84 female patients scheduled for total abdominal hysterectomy aged from 40 to 60 years, ASA physical status grade I, II and body mass index (BMI) 18.5-30 kg/m². Patients were classified into three groups (28 each), group C (received bilateral ESPB with 20 ml bupivacaine 0.25% plus 1ml saline), group O (received bilateral ESPB with 20 ml bupivacaine 0.25% plus 1ml dexamethasone (4mg)), group D (received bilateral ESPB with 20 ml bupivacaine 0.25% plus 1 ml dexmedetomidine (0.5ug/kg) in saline). They underwent history taking, general examination, laboratory investigations, preoperative erector spinae plane block (ESPB) and GA. Results: There was statistically significant difference between three groups regarding visual analog scale (VAS) and nalbuphine consumption where D group had better pain control than other groups. Conclusions: It could be concluded that dexmedetomidine as an adjuvant to 0.25% bupivacaine in ultrasound guided erector spinae plane block is more efficacious than dexamethasone in hastening the onset, prolonging sensory blockade, delaying the time for request of rescue analgesia, and decreasing total nalbuphine consumption. © 2022, Ain Shams University Faculty of Medicine. All rights reserved.
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Introduction: The ultrasound-guided Transversus Abdominis Plane (TAP) block is an analgesic technique which involves injection of a local anaesthetic between the internal oblique abdominal and the transversus abdominis muscle planes. It provides analgesia to the cranial branches of T10-L1 nerve roots. It has been a practice to provide analgesia in patients following various surgical procedures including the gynaecological procedures like hysterectomy and caesarean section. Aim: To assess the analgesic efficacy of dexamethasone and dexmedetomidine as an adjuvant to 2% lignocaine adrenaline and 0.5% bupivacaine in TAP block following caesarean delivery. Materials and Methods: This was a cross-sectional study conducted at Konaseema Institute of Medical Sciences and Research Foundation (KIMS&RF), Amalapuram, Andhra Pradesh, India for a period of one year from January 2021 to December 2021. One hundred patients with an American Society of Anaesthesiologists (ASA) physical scores of I-II, who underwent caesarean section under the Pfannenstiel incision method under subarachnoid anaesthesia with 0.5% heavy bupivacaine, were enrolled in the study. Group I consisted of patients that received an ultrasound-guided bilateral TAP block immediately following surgery with 10 mL of 0.5% bupivacaine, 10 mL of 2% lignocaine with adrenaline, and 20 mcg dexmedetomidine. Group II included patients who received ultrasound-guided bilateral TAP block immediately following surgery with 10 mL of 0.5% bupivacaine, 10 mL of 2% lignocaine adrenaline, and 8 mg dexamethasone. The Electrocardiogram (ECG) recordings and blood pressure were recorded during the block in each patient. This approach enabled a more precise analgesic approach for each individual patient. The patients were assessed for pain up to 12 hours of surgery based on a Visual Analog Scale (VAS), where 0 represented no pain and 10 represented ‘the worst pain ever possible. Results: The mean age in the dexamethasone group was 26.48±3.93 and in the dexmedetomidine group was 25.92±4.13 years. The patients who received ultrasound-guided TAP block with dexmedetomidine were significantly less on-demand of tramadol (p-value=0.005). The patients who received ultrasoundguided TAP block with dexmedetomidine were had significantly lower VAS scores at 4 hours (p-value=0.002), 6 hours (p=0.001), and 12 hours (p=0.3), postoperatively. Conclusion: This study proved that dexmedetomidine was more effective when compared to dexamethasone, when added as an adjuvant to 2% lignocaine adrenaline and 0.5% bupivacaine. Ultrasound guided TAP block was a safe and effective postoperative analgesia in caesarean section.
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Objective To evaluate the analgesic efficacy of dexamethasone added to local anesthetics in ultrasound-guided transversus abdominis plane (TAP) block for the patients after abdominal surgery. Methods PubMed, CENTRAL, EMBASE, Web of science were searched to identify eligible randomized controlled trials (RCTs) that compared dexamethasone added to local anesthetics in ultrasound-guided TAP block with control for postoperative analgesia in adult patients undergoing abdominal surgery. Primary outcomes included postoperative pain intensity, the time to the first request for additional analgesics, and opioid consumption over 24 h after surgery. Secondary outcome was the incidence of postoperative nausea and vomiting. Analysis was performed by RevMan 5.3 software and the quality of evidence was rated using GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach. Results Nine RCTs involving 575 patients were included. Compared to the control, dexamethasone added to local anesthetics in ultrasound-guided TAP block significantly decreased visual analogue scale (VAS) scores at rest at 4h (mean difference [MD] = -1.01; 95% confidence intervals [CI], -1.29 to -0.73; P<0.00001; moderate quality of evidence), 6h (MD = -1.21; 95% CI, -1.74 to -0.69; P<0.00001; low quality of evidence), and 12h after surgery (MD = -0.79; 95% CI, -0.97 to -0.60; P<0.00001; moderate quality of evidence). No difference was found at 2h (MD = -0.64; 95% CI, -1.35 to 0.08; P = 0.08; low quality of evidence) and 24 h (MD = -0.41; 95% CI, -0.91 to 0.09; P = 0.11; moderate quality of evidence) in VAS scores. The time to the first request for additional analgesics was prolonged in the dexamethasone group (MD = 3.08; 95% CI, 2.37 to 3.78; P<0.00001; moderate quality of evidence). Opioid consumption over 24 h after surgery was also reduced (MD = -5.42; 95% CI, -8.20 to -2.63; P = 0.0001; low quality of evidence). Meanwhile, the incidence of postoperative nausea and vomiting was significantly decreased in the dexamethasone group (risk ratios [RR] = 0.40; 95% CI, 0.28 to 0.58; P<0.00001; high quality of evidence). No complications were reported in all the included studies. Conclusions Dexamethasone added to local anesthetics in ultrasound-guided TAP block was a safe and effective strategy for postoperative analgesia in adult patients undergoing abdominal surgery.
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Introduction: Peripheral nerve blocks after cesarean section (C-section) reduce post-operative use of analgesic agents. Transversus abdominis plane (TAP) block is an effective way to provide postoperative analgesia. TAP block with ropivacaine alone has not consistently been proven to be useful after C-section, and dexmedetomidine has not been studied as an adjuvant to ropivacaine for TAP blocks after C-section. Objective: To compare the combination of dexmedetomidine and ropivacaine to ropivacaine alone for TAP block after C-section for time to onset of pain and time to rescue analgesia. Materials and Methods: Forty American Society of Anesthesiology grade I or II patients undergoing C-section were enrolled in this randomized, controlled, double-blind study. Twenty patients each were allocated to two groups receiving bilateral TAP block. Test group received TAP block with 3 mg/kg of ropivacaine with 50 μg of dexmedetomidine. Control group received TAP block with 3 mg/kg of ropivacaine. Patient demographics, time to initial reporting of pain, time to first rescue analgesia, quality of block, and side effects were recorded. Results: Time to initial onset of pain (6.6 vs. 5.03 h; P = 0.01) and time to first rescue analgesia (7.8 vs. 6.47 h; P = 0.03) were significantly longer in the test group compared with control group. The two groups were similar in demographics and quality of block. No significant difference in side effects was noted between the two groups. Conclusion: Addition of dexmedetomidine to ropivacaine for TAP block in patients undergoing C-section prolonged the time to initial onset of pain and time to first rescue analgesia.
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Background and Aims Ultrasonography (USG)-guided transversus abdominis plane (TAP) block is an abdominal field block with high efficacy. This study was undertaken with the aim of determining the effect of the addition of dexamethasone to 0.5% ropivacaine on post-operative analgesia in USG-guided TAP block for inguinal hernia repair. Methods A double-blind randomised control study was conducted on sixty patients posted for inguinal hernia repair with the American Society of Anesthesiologists physical Status I or II, who were allocated two groups of 30 each. Patients in Group RS received 0.5% ropivacaine (20 ml) and normal saline (2 ml) whereas patients in Group RD received 0.5% ropivacaine (20 ml) and dexamethasone (2 ml, i.e., 8 mg), in USG-guided TAP Block on the same side, after repair of inguinal hernia under spinal anaesthesia. Visual analogue scale (VAS) scores, time for request of first analgesia and total tramadol consumption in first 24 h were compared. Unpaired Student's t-test and Mann–Whitney U-test were performed using SPSS 23 Software. Results Patients in Group RD had significantly lower VAS scores as compared to Group RS from 4th to 12th h, postoperatively. Duration of analgesia was significantly more in Group RD (547.50 [530,530] min) when compared with Group RS (387.50 [370,400] min) (P < 0.001). The demand for intravenous tramadol was significantly low in Group RD (223.33 ± 56.83 mg) as compared to Group RS (293.33 ± 25.71 mg) (P < 0.001). Conclusion Addition of dexamethasone to ropivacaine in USG-guided TAP block significantly reduces post-operative pain and prolongs the duration of post-operative analgesia, thereby reducing analgesic consumption.
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Background and Aims The aim was to compare duration of postoperative analgesia with addition of clonidine to bupivacaine in bilateral transversus abdominis plane (TAP) block after lower segment cesarean section (LSCS). Material and Methods One hundred American Society of Anesthesiologists (ASA) grade I and II pregnant patients undergoing LSCS under spinal anesthesia were randomly divided to receive either 20 ml bupivacaine 0.25% (Group B; n = 50) or 20 ml bupivacaine+1ug/kg clonidine bilaterally (Group BC; n = 50) in TAP block in a double-blind fashion. The total duration of analgesia, patient satisfaction score, total requirement of analgesics in the first 24 h, and the side effects of clonidine such as sedation, dryness of mouth, hypotension, and bradycardia were observed. P < 0.05 was taken as significant. Results In 99 patients analyzed, TAP block failed in five patients. Duration of analgesia was significantly longer in Group BC (17.8 ± 3.7 h) compared to Group B (7.3 ± 1.2 h; P < 0.01). Mean consumption of diclofenac was 150 mg and 65.4 mg in Groups B and BC (P < 0.01), respectively. All patients in Group BC were extremely satisfied (P < 0.01) while those in Group B were satisfied. Thirteen patients (28%) in Group BC were sedated but arousable (P = 0.01) compared to none in Group B. In Group BC, 19 patients complained of dry mouth compared to 13 in Group B (P = 0.121). None of the patients experienced hypotension or bradycardia. Conclusion Addition of clonidine 1 μg/kg to 20 ml bupivacaine 0.25% in TAP block bilaterally for cesarean section significantly increases the duration of postoperative analgesia, decreases postoperative analgesic requirement, and increases maternal comfort compared to 20 ml of bupivacaine 0.25% alone.
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Background: Ultrasound-guided transversus abdominis plane (TAP) block has recently come up as a modality to take care of postoperative pain. It can somewhat avoid the use of intravenous opioid analgesics and hence to avoid its complications. We have performed a prospective, double-blinded, randomized study to assess the analgesic effect of adding dexmedetomidine to local ropivacaine on TAP block for patients undergoing lower abdominal surgeries. Aim: The aim is to assess whether addition of dexmedetomidine to ropivacaine may bring some improvements to the analgesic efficacy of TAP blocks in patients undergoing lower abdominal surgeries. Materials and Methods: The study was conducted on forty patients undergoing lower abdominal surgeries under general anesthesia. The patients were divided into two groups: one receiving plain ropivacaine (Group 1) and other receiving ropivacaine with dexmedetomidine (Group 2) during TAP block. The patients in the two groups were compared for age, sex, body mass index, incidence of postoperative nausea, and vomiting and pain as measured on visual analog scale (VAS). Results: There was significantly lower pain score on VAS at 1, 3, 6, 12, and 18 h in Group 2 than in Group 1. Conclusion: The addition of dexmedetomidine to ropivacaine during TAP block improves analgesic effect of TAP block and prolongs the duration of analgesia as well.
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Background and objectives We aimed to evaluate the effect of bupivacaine and dexmedetomidine added to bupivacaine used in tranversus abdominis plane (TAP) block on postoperative pain and patient satisfaction in patients undergoing lower abdominal surgery. Methods Patients submitted to lower abdominal surgery were enrolled in the study. After anesthesia induction, ultrasound guided TAP block was performed. TAP block was obtained with 21 mL 0.9% saline in Group C (n = 31), 20 mL 0.5% bupivacaine + 1 mL saline in Group B (n = 31), and 20 mL 0.5% bupivacaine + 1 mL dexmedetomidine (100 µg) in Group BD (n = 31). Results Visual analog scale scores were lower in Group BD compared to Group C, at all time points (p < 0.05); it was lower in group BD than in group B at 10-24 h. In Group B, it was lower than Group C at 2-8 h (p < 0.05). Total morphine consumption was lower in Group BD compared to other groups and lower in group B than in the controls (p < 0.001). Patient satisfaction was higher in Group BD than in other groups and was higher in both study groups than in the controls (p < 0.001). Nausea-vomiting scores, antiemetic requirement, or additional analgesic administration were not significant among groups (p > 0.05). Conclusions The addition of dexmedetomidine to bupivacaine on TAP block decreased postoperative pain scores and morphine consumption; it also increased patient satisfaction in patients undergoing lower abdominal surgery. Dexmedetomidine did not have any effect on nausea and vomiting score and antiemetic requirement.
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Introduction: The concepts of Enhanced Recovery After Surgery (ERAS(®)) have steadily increased in usage, with benefits in patient outcomes and hospital length of stay. One important component of successful implementation of ERAS protocol is optimized pain control, via the multimodal approach, which includes neuraxial or regional anesthesia techniques and reduction of opioid use as the primary analgesic. Transversus abdominis plane (TAP) block is one such regional anesthesia technique, and it has been widely studied in abdominal surgery. Materials and methods: We performed an extensive literature search in MEDLINE and PubMed. We review the benefits of TAP blocks for colorectal surgery, both laparoscopic and open. We organize the data by surgery type, by method of TAP block performance, and by a comparison of TAP block to alternative analgesic techniques or to placebo. We examine different endpoints, such as postoperative pain, analgesic use, return of bowel function, and length of stay. Results: The majority of studies examined TAP blocks in the context of laparoscopic colorectal surgery, with many, but not all, demonstrating significantly less use of postoperative opioids in comparison to placebo, wound infiltration, and standard postoperative patient-controlled analgesia with intravenous opioid administration. There is evidence that use of liposomal bupivacaine may be more effective than conventional long-acting local anesthetics. Noninferiority of TAP infusions has been demonstrated, compared with continuous thoracic epidural infusions. Conclusion: TAP blocks are easily performed, cost-effective, and an opioid-sparing adjunct for laparoscopic colorectal surgery, with minimal procedure-related morbidity. The evidence is in concordance with several of the goals of ERAS pathways.