Analgesic efficacy of dexamethasone versus dexmedetomidine as an adjuvant to ropivacaine in ultrasound-guided transversus abdominis plane block for post-operative pain relief in caesarean section: A prospective randomised controlled study

Nitika Singla, Kamakshi Garg, Richa Jain, Aaina Malhotra, Mirley Rupinder Singh, Anju Grewal, Nitika Singla, Kamakshi Garg, Richa Jain, Aaina Malhotra, Mirley Rupinder Singh, Anju Grewal

Abstract

Background and aims: Transversus abdominis plane (TAP) block is commonly used to treat post-operative pain after lower abdominal surgeries. The aim of this randomised controlled study was to assess the efficacy of addition of dexmedetomidine or dexamethasone to ropivacaine in TAP block and compare the two for post-operative pain relief in caesarean section.

Methods: A hundred parturients (18-45 years) undergoing caesarean section under spinal anaesthesia received ultrasound-guided (USG) bilateral TAP block with 50ml of 3mg/kg ropivacaine along with 0.1mg/kg dexamethasone (Group A) or 1μg/kg dexmedetomidine (Group B) in this prospective, randomised, double-blind study. Time to initial self-reporting of post-operative pain, time to first rescue analgesic demand, visual analogue scale (VAS) for pain haemodynamic parameters and adverse effects if any were noted, anda P value < 0.005 was considered as statistically significant.

Results: Time to initial self-reporting of post-operative pain (411.35 vs. 338.20 min, P < 0.005) and time to first rescue analgesic (474.30 vs. 407.30 min, P < 0.005) were significantly longer in group B as compared to group A. VAS score at the time of initial self-reporting of pain was significantly lower in group B. No significant haemodynamic changes or side-effects were noted.

Conclusion: Addition of dexmedetomidine to ropivacaine as compared with dexamethasone in bilateral TAP block following caesarean section prolongs the time to initial post-operative pain and time to first rescue analgesic consumption.

Keywords: Dexamethasone; dexmedetomidine; post-operative pain; transversus abdominis plane block.

Conflict of interest statement

There are no conflicts of interest.

Copyright: © 2021 Indian Journal of Anaesthesia.

Figures

Figure 1
Figure 1
CONSORT Flow diagram. n: number of parturients
Figure 2
Figure 2
Time of initial self-reporting of pain (in min) and first rescue analgesic consumption (in min)
Figure 3
Figure 3
Mean Visual Analogue Scale (VAS) at the time of initial self-reporting of pain
Figure 4
Figure 4
Trends in haemodynamic parameters

References

    1. 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;8:79–82.
    1. Mukhtar BYK. Transversus abdominis plane (TAP) block. Br J Anaesth. 2009;102(6):763–7.
    1. Krishna Prasad GV, Khanna S, Jaishree SV. Review of adjuvants to local anesthetics in peripheral nerve blocks: Current and future trends. Saudi J Anaesth. 2020;14:77–84.
    1. Diab DG, Roshdy H. Efficacy of transversus abdominis plane block with ketamine for inguinal hernioplasty: A controlled study. Ain-Shams J Anaesthesiol. 2014;7:346–9.
    1. Kartalov A, Jankulovski N, Kuzmanovska B, Zdravkovska M, Shosholcheva M, Spirovska T, et al. Effect of adding dexamethasone as a ropivacaine adjuvant in ultrasound-guided transversus abdominis plane block for inguinal hernia repair. Pril (MakedonAkadNaukUmet Odd Med Nauki) 2015;36:35–41.
    1. Storti E, Vaccari S, Bruno R, Ricchi A, Buffagni J, Neri I. Guidelines for management of analgesics after caesarean section: Cognitive survey. Int J Womens Health Wellness. 2018;4:075.
    1. Jadon A, Bagai R. Effective pain relief after caesarean section; Are we on the right path or still on thecrossroad. J Obstet Anaesth Crit Care. 2019;9:3–6.
    1. Salama ER. Post-operative bilateral continuous ultrasound-guided transversus abdominis plane block versus continuous local anaesthetic wound infusion in patients undergoing abdominoplasty. Indian J Anaesth. 2018;62:449–54.
    1. Hirabayashi Y, Saitoh K, Fukuda H, Shimizu R. Visceral pain during caesarean section: Effect of varying dose of spinal amethocaine. Br J Anaesth. 1995;75:266–8.
    1. 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.
    1. McCormack K. The spinal actions of nonsteroidal anti-inflammatory drugs and the dissociation between their anti-inflammatory and analgesic effects. Drugs. 1994;47:28–45.
    1. Ahlgren SC, Wang JF, Levine JD. C-fiber mechanical stimulus-response functions are different in inflammatory versus neuropathic hyperalgesia in the rat. Neuroscience. 1997;76:285–90.
    1. Williams BA, Butt MT, Zeller JR, Coffee S, Pippi MA. Multimodal perineural analgesia with combined bupivacaine-clonidine-buprenorphine-dexamethasone: Safe in vivo and chemically compatible in solution. Pain Med. 2015;16:186–98.
    1. An K, Elkassabany NM, Liu J. Dexamethasone as adjuvant to bupivacaine prolongs the duration of thermal antinociception and prevents bupivacaine-induced rebound hyperalgesia via regional mechanism in a mouse sciatic nerve block model. PLoS One. 2015;10:0123459.
    1. El Sharnouby NM, El Gendy HA. Ultrasound-guided single injection transversus abdominis plane block of isobaric bupivacaine with or without dexamethasone for bariatric patients undergoing laparoscopic vertical banded gastroplasty: A comparative study of different doses. Ain Shams J Anaesthesiol. 2015;8:194–9.
    1. Sivakumar RK, Pannerselvam S, Cheian, Rudingwa P, Menin J. Perineural vs.intravenous dexmedetomidine as an adjuvant to bupivacaine in ultrasound guided fascia iliaca compartment block for femur surgeries: A randomized control trial. Indian J Anaesth. 2018;62:851–7.
    1. Zhang P, Liu S, Zhu J, Rao Z, Liu C. Dexamethasone and dexmedetomidine as adjuvants to local anesthetic mixture in intercostal nerve block for thoracoscopic pneumonectomy: A prospective randomized study. Reg Anesth Pain Med. 2019 rapm-2018.
    1. Xue Y, Yuan H. Effects of dexmedetomidine as an adjuvant in transversus abdominis plane block during gynaecological laparoscopy. Exp Ther Med. 2018;16:1131–6.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren