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

Authors

  • Jitender Thakur Department of Anesthesia, DRPGMC, Tanda (Kangra), Himachal Pradesh, India
  • Bharti Gupta Department of Anesthesia, DRPGMC, Tanda (Kangra), Himachal Pradesh, India
  • Amit Gupta Department Obstetrics and Gynecology, DRPGMC, Tanda (Kangra), Himachal Pradesh, India
  • Ravinder Kumar Verma Department of Anesthesia, DRPGMC, Tanda (Kangra), Himachal Pradesh, India
  • Anita Verma Department of Anesthesia, DRPGMC, Tanda (Kangra), Himachal Pradesh, India
  • Payal Shah Department Anesthesia, Zonal Hospital, Dharamsala (Kangra), Himachal Pradesh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20195342

Keywords:

Caesarean section, Dexmedetomidine, Dexamethasone, Postoperative pain, Transversus abdominis plane block

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.

References

Leung AY. Postoperative pain management in obstetric anesthesia - New challenges and solutions. J Clin Anesth. 2004;16:57-65.

Gadsden J, Hart S, Santos AC. Post-cesarean delivery analgesia. Anesth Analg. 2005;101(5 Suppl):S62-9.

Urbanczae L. Transverse abdominis plane block. Anesth Intensive Ther. 2009;35:137-41.

Sharkey A, Borglum J, Blanco R, McDonnell J. TAP block: Past, present, and future. Am Soc Reg Anesth Pain Med. 2014;12:15-7.

Singh R, Kumar N, Jain A, Joy S. Addition of clonidine to bupivacaine in transversus abdominis plane block prolongs postoperative analgesia after cesarean section. J Anaesthesiol Clin Pharmacol. 2016;32(4):501-4.

Petersen P, Mathiesen O, Torup H, Dahl J. The transversus abdominis plane block: a valuable option for postoperative analgesia? A topical review. Acta Anaesthesiol Scand. 2010;54(5):529-35.

Baaj JM, Alsatli RA, Majaj HA, Babay ZA, Thallaj AK. Efficacy of ultrasound guided transversus abdominis plane (TAP) block for postcesarean section delivery analgesia: a double-blind, placebo-controlled, randomized study. Middle East J Anaesthesiol. 2010;20(6):821-6.

Srivastava U, Verma S, Singh TK, Gupta A, Saxsena A, Jagar KD. Efficacy of trans abdominis plane block for post cesarean delivery analgesia: A double-blind, randomized trial. Saudi J Anesth. 2015;9(3):298-302.

Kim AJ, Yong RJ, Urman RD. The role of transversus abdominis plane blocks in enhanced recovery after surgery pathways for open and laparoscopic colorectal surgery. J Laparoendosc Adv Surg Tech. 2017;27(9):909-14.

Zhang D, Zhou C, Wei D, Ge L, Li Q. Dexamethasone added to local anesthetics in ultrasound-guided transversus abdominis plain (TAP) block for analgesia after abdominal surgery: A systematic review and meta-analysis of randomized controlled trials. PloS One. 2019;14(1):e0209646.

Fusco P, Scimia P, Paladini G, Fiorenzi M, Petrucci E, Pozone T, et al. Transversus abdominis plane block for analgesia after Cesarean delivery. A systematic review. Minerva Anestesiol. 2015;81(2):195-204.

Almarakbi WA, Kaki AM. Addition of dexmedetomidine to bupivacaine in transversus abdominis plane block potentiates post-operative pain relief among abdominal hysterectomy patients: A prospective randomized controlled trial. Saudi J Anaesth. 2014;8(2):161-6.

Bansal P, Sood D. Effect of dexmedetomidine as an adjuvant to ropivacaine in ultrasound-guided transversus abdominis plane block for post-operative pain relief in cesarean section. J Obstet Anaesth Crit Care. 2018;8(2):79.

Abdelaal W, Metry A, Refaat M, Ragaei M, Nakhla G. Comparative Study between levobupivacine versus levobupivacaine plus dexmedetomidine for transversus abdominis plane block “TAP” in post-operative pain management after abdominoplasty. Enliven J Anesth Crit Care Med. 2015;2(2):4.

Sharma UD, Prateek, Tak H. Effect of addition of dexamethasone to ropivacaine on post-operative analgesia in ultrasonography-guided transversus abdominis plane block for inguinal hernia repair: A prospective, double-blind, randomised controlled trial. Indian J Anaesth. 2018;62(5):371-5.

Fouad HA, Mohammed A, Ahmed S, Mohammed Y, Osman M, Mohammed G, et al. Efficacy of preemptive dexamethasone added to bupivacaine in ultrasound guided transversus abdominus plain block for postoperative analgesia after inguinal herniorraphy. Am J Res Commun. 2016;4(5):27-42.

Falia MD, Kulkarni P. Comparison of dexamethasone and clonidine as an adjunct to bupivacaine in transversus abdominis plane block in patients undergoing lower segment caesarean section. Int J Res Med Sci. 2016;4(10):4481-6.

Aksu R, Patmano G, Biçer C, Emek E, Çoruh AE. Efficiency of bupivacaine and association with dexmedetomidine in transversus abdominis plane block ultrasound guided in postoperative pain of abdominal surgery. Brazilian J Anesthesiol. 2018;68(1):49-56.

Mishra M, Mishra S, Singh S. Ultrasound-guided transversus abdominis plane block: What are the benefits of adding dexmedetomidine to ropivacaine? Saudi Anaesth. 2017;11(1):58.

Venn RM, Bryant A, Hall GM, Grounds RM. Effects of dexmedetomidine on adrenocortical function, and the cardiovascular, endocrine and inflammatory responses in post-operative patients needing sedation in the intensive care unit. Br J Anaesth. 2001;86(5):650-6.

Kaur M, Singh PM. Current role of dexmedetomidine in clinical anesthesia and intensive care. Anesth essays Res. 2011;5(2):128-33.

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Published

2019-11-26

Issue

Vol. 8 No. 12 (2019): December 2019

Section

Original Research Articles