Analgesic Efficacy of Dexamethasone and Dexmedetomidine as an Adjuvant to 2% Lignocaine Adrenaline and 0.5% Bupivacaine in Transversus Abdominis Plane Block after Caesarean Delivery
Published: June 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/54885.16541
V Rao Yarramsetti, Sai Sravanthi Thumpati, Hari Kiran Varma Nadimpalli, LV Simhachalam Kutikuppala
1. Assistant Professor, Department of Anaesthesiology, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India.
2. Assistant Professor, Department of Obstetrics and Gynaecology, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India.
3. Assistant Professor, Department of Anaesthesia, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India.
4. Junior Resident, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India.
Correspondence
Dr. V Rao Yarramsetti,
Flat No. 402, New Apartment, Near Channamalla Temple, Amalapuram, Andhra Pradesh, India.
E-mail: yarramsettyvraombbs@gmail.com
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 ultrasound-guided 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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