Addition of dexmedetomidine to bupivacaine in transversus abdominis plane block potentiates post-operative pain relief among abdominal hysterectomy patients: A prospective randomized controlled trial

Waleed A Almarakbi, Abdullah M Kaki, Waleed A Almarakbi, Abdullah M Kaki

Abstract

Background: Dexmedetomidine is an alpha 2 adrenergic agonist, prolongs analgesia when used in neuraxial and peripheral nerve blocks. We studied the effect of addition of dexmedetomidine to bupivacaine to perform transversus abdominis plane (TAP) block.

Materials and methods: A total of 50 patients scheduled for abdominal hysterectomy were divided into two equal groups in a randomized double-blinded way. Group B patients (n = 25) received TAP block with 20 ml of 0.25% bupivacaine and 2 ml of normal saline while Group BD (n = 25) received 0.5 mcg/kg (2 ml) of dexmedetomidine and 20 ml of 0.25% bupivacaine bilaterally. Time for first analgesic administration, totally used doses of morphine, pain scores, hemodynamic data and side-effects were recorded.

Results: Demographic and operative characteristics were comparable between the two groups. The time for the first analgesic dose was longer in Group BD than Group B (470 vs. 280 min, P < 0.001) and the total doses of used morphine were less among Group BD patients in comparison to those in Group B (19 vs. 29 mg/24 h, P < 0.001). Visual analog scores were significantly lower in Group BD in the first 8 h post-operatively when compared with Group B, both at rest and on coughing (P < 0.001). In Group BD, lower heart rate was noticed 60 min from the induction time and continued for the first 4 h post-operatively (P < 0.001).

Conclusions: The addition of dexmedetomidine to bupivacaine in TAP block achieves better local anesthesia and provides better pain control post-operatively without any major side-effects.

Keywords: Bupivacaine; dexmedetomidine; pain; transversus abdominis plane block.

Conflict of interest statement

Conflict of Interest: None declared

Figures

Figure 1
Figure 1
Time to first analgesic (TFA) in both groups in minutes. Boxplot of TFA. Box represents interquartile range. Horizontal line across box represents the median. Error bars represent 5th and 95th percentiles
Figure 2
Figure 2
The cumulative doses of morphine consumed by the patient in 24-h. Box represent interquartile range. Horizontal line across box represents the median. Error bars represent 5th and 95th percentiles and markers lying beyond these limits represent outliers
Figure 3
Figure 3
The median values of patient controlled analgesia boluses used by patients in both groups. Error bars represent interquartile range
Figure 4a
Figure 4a
Median values of visual analog scores for pain assessment during the rest in both groups. Error bars represent interquartile range
Figure 4b
Figure 4b
Median values of visual analog scores for pain assessment on coughing in both groups. Error bars represent interquartile range

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