Comparative evaluation of bupivacaine with magnesium sulphate and dexamethasone as adjuvants in ultrasound-guided transversus abdominis plane block for open unilateral inguinal hernia surgeries: A randomised controlled trial

T Shambhavi, Saswati Das, Laxman K Senapati, Pulak P Padhi, T Shambhavi, Saswati Das, Laxman K Senapati, Pulak P Padhi

Abstract

Background and aims: Inguinal hernia repair is associated with moderate to severe pain that is most extreme in the first 24 hours. The aim of this study was to compare the efficacy of dexamethasone versus magnesium sulphate (MgSO4) with bupivacaine in ultrasound-guided transversus abdominis plane (TAP) block for patients undergoing unilateral inguinal hernioplasty.

Methods: Eighty patients were randomly allocated to two groups to receive ultrasound-guided TAP block postoperatively with either 20 ml of 0.25% bupivacaine with 8 mg of dexamethasone (Group BD) or 20 ml of 0.25% bupivacaine with 250 mg of MgSO4 (Group BM). Patients were assessed for the first 24 hours after surgery for pain at rest and movement using a numerical rating scale (NRS). Two mg/kg of tramadol was administered as rescue analgesia. The time to first demand tramadol, total consumption of tramadol, patient satisfaction score and side effects were evaluated.

Results: The time to the first dose of rescue analgesia was significantly longer in BD group (596.13 ± 57.93 min) than in the BM group (422.50 ± 51.95 min). The NRS scores in the BD group were significantly lower compared to the BM group both at rest and on movement. The total requirement of tramadol was significantly less in the BD group (154.55 ± 59.11 mg) compared to the BM group (270.25 ± 105.72 mg). The incidence of side effects was lower and patient satisfaction was higher in BD group compared to BM group.

Conclusion: Bupivacaine with dexamethasone in TAP block after unilateral open inguinal hernioplasty provides increased duration of analgesia and decreased requirement for rescue analgesics compared to magnesium sulphate, with lesser side effects and better patient satisfaction.

Keywords: Analgesia; dexamethasone; inguinal hernia; magnesium; surgery; ultrasonography.

Conflict of interest statement

There are no conflicts of interest.

Copyright: © 2023 Indian Journal of Anaesthesia.

Figures

Figure 1
Figure 1
Consort flow chart
Figure 2
Figure 2
Kaplan–Meier survival analysis for time to first analgesic request
Figure 3
Figure 3
Comparison of mean numerical rating scale (NRS) scores at rest and on movement

References

    1. Morrison J. A case for open inguinal hernia repair. Int J Abdom Wall Hernia Surg. 2018;1:69–73.
    1. Seervi SN, Singariya G, Kamal M, Kumari K, Siddeshwara A, Ujwal S. Effect of addition of buprenorphine or dexamethasone to levobupivacaine on postoperative analgesia in ultrasound guided transversus abdominis plane block in patients undergoing unilateral inguinal hernia repair:A prospective randomized double blind controlled trial. Korean J Anesthesiol. 2019;72:245–52.
    1. Wegner R, Akwar D, Guzman-Reyes S, Pednekar G, Chaudhry R, Grewal N, et al. Evaluating the adjuvant effect of dexamethasone to ropivacaine in transversus abdominis plane block for inguinal hernia repair and spermatocelectomy:A randomized controlled trial. Pain Physician. 2017;20:413–8.
    1. Acharya R, Baksi R, Mohapatra P. Comparative analysis of duration of post-operative analgesia between levobupivacaine and levobupivacaine with clonidine after ultrasound-guided transversus abdominis plane block in patients undergoing lower segment cesarean section. Anesth Essays Res. 2018;12:943–8.
    1. Lee AR, Yi HW, Chung IS, Ko JS, Ahn HJ, Gwak MS, et al. Magnesium added to bupivacaine prolongs the duration of analgesia after interscalene nerve block. Can J Anaesth. 2012;59:21–7.
    1. Venkatraman R, Abhinaya RJ, Sakthivel A, Sivarajan G. Efficacy of ultrasound-guided transversus abdominis plane block for post-operative analgesia in patients undergoing inguinal hernia repair. Local Reg Anesth. 2016;9:7–12.
    1. Abd-Elsalam KA, Fares KM, Mohamed MA, Mohamed MF, El-Rahman AMA, Tohamy MM. Efficacy of magnesium sulfate added to local anesthetic in a transversus abdominis plane block for analgesia following total abdominal hysterectomy:A randomized trial. Pain Physician. 2017;20:641–7.
    1. Al-Refaey K, Usama EM, Al-Hefnawey E. Adding magnesium sulfate to bupivacaine in transversus abdominis plane block for laparoscopic cholecystectomy:A single blinded randomized controlled trial. Saudi J Anaesth. 2016;10:187–91.
    1. Yildiz I, Bayir H. Effect of dexamethasone added to levobupivacaine used for TAP block. Hippokratia. 2015;19:285.
    1. Ammar AS, Mahmoud KM, Kasemy ZA. Comparison between adenosine and magnesium sulphate as adjuvants for transversus abdominis plane block. A prospective randomized controlled trial. Minerva Anestesiol. 2017;84:304–10.
    1. Rana S, Verma RK, Singh J, Chaudhary SK, Chandel A. MgSO4 as an adjuvant to bupivacaine in ultrasound-guided transversus abdominis plane block in patients scheduled for total abdominal hysterectomy under subarachnoid block. Indian J Anaesth. 2016;60:174–9.
    1. Umalkar M, Londhe N. Evaluation of magnesium sulfate as an adjuvant to bupivacaine for postoperative analgesia in ultrasound-guided transversus abdominis plane block in patients scheduled for lower segment caesarean section under subarachnoid block –A prospective, randomized, double-blind study. Indian J Pain. 2020;34:189–92.
    1. Yousef M, Sayed-Ahmed A, Hassan A, Nasr Y. Effect of adding dexamethasone or magnesium sulphate as an adjuvant to bupivacaine in ultrasound guided supraclavicular brachial plexus block for upper limb surgeries;A comparative study. Zagazig Univ Med J. 2021;27:1038–46.
    1. Imani F, Rahimzadeh P, Faiz HR, Abdullahzadeh-Baghaei A. An evaluation of the adding magnesium sulfate to ropivacaine on ultrasound-guided transverse abdominis plane block after abdominal hysterectomy. Anesth Pain Med. 2018;8:e74124. doi:10.5812/aapm.74124.
    1. Verma V, Rana S, Chaudhary SK, Singh J, Verma RK, Sood S. A dose-finding randomised controlled trial of magnesium sulphate as an adjuvant in ultrasound-guided supraclavicular brachial plexus block. Indian J Anaesth. 2017;61:250–5.
    1. Thomas SM, Anjali A, Desai JB, Thakkar S. A comparitive study between magnesium sulphate versus dexamethasone as an adjuvant to bupivacaine in supraclavicular brachial plexus block. Indian J Forensic Med Toxicol. 2021;15:4099–104.
    1. Sharma N, Kausha S, Singh S, Mahajan S. Comparison of dexamethasone and magnesium sulphate with plain bupivacaine in pectoral nerve block for post operative analgesia:A randomised double blind controlled trial. Indian J Anesth Analg. 2020;7:774–9.
    1. Gad M, Nabil H, Elmetwally M, Elzahaby I. Ultrasound-guided transversus abdominis plane block for total abdominal hysterectomy:Comparison between magnesium sulfate and dexamethasone as adjuvants. Res Opin Anesth Intensive Care. 2019;6:243–8.
    1. Mahgoub AA. The addition of magnesium sulfate or dexamethasone to levobupivacaine for ultrasound-guided supraclavicular brachial plexus block for upper-limb surgery:A double-blinded comparative study. Res Opin Anesth Intensive Care. 2015;2:116–2.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅