Comparison of Bupivacaine and Dexmedetomidine versus Bupivacaine Alone in Transversus Abdominis Plane Block for Post-Operative Analgesia
Objective: To study the effects of adding dexmedetomidine to bupivacaine in transverses abdominis plane block in comparison with using bupivacaine alone.
Materials and Methods: This was a prospective comparative study that was conducted in the Anaesthesia Department, CMH, Lahore over a period of six months from 1st June 2020 to 30th November 2020. Fifty patients of the American Society of Anesthesiologist Class I and II with an age range between 40 to 60 years were divided into two groups. Group B received 20ml of 0.25% bupivacaine with 2ml of normal saline on each side in the transversus abdominis plane block while group BD was given 20ml of 0.25% bupivacaine with dexmedetomidine 0.5mcg/kg on each side (in a volume of 2ml). Post-operative pain was assessed with a visual analogue scale. Rescue analgesia was given when a score of greater than 3 was observed using this scale. Time to first rescue analgesia was noted. Total opioid consumption in the first 24 hours was also recorded. Patients were observed for postoperative hypotension and bradycardia.
Results: The mean-time for the first dose of analgesia for group B and BD was 302.92 ± 24.01 and 419.28 ± 31.97 minutes respectively with a p-value of 0.001. The mean of the total consumption of opioids in 24 hours post-operatively for group B and BD was 14.20±2.36 and 10.40±1.38 mg respectively with a p-value of 0.001. Hypotension was not seen in any patient in either group. Only one patient developed bradycardia and he belonged to group BD. P-value was 0.327.
Conclusion: The addition of dexmedetomidine to bupivacaine for transversus abdominis plane block for postoperative analgesia significantly prolongs the duration of analgesia and reduces the postoperative opioid requirements.
2. Thompson C, French DG, Costache I. Pain management within an enhanced recovery program after thoracic surgery. Journal of Thoracic Disease. 2018;10(Suppl 32):S3773-S3780. DOI: 10.21037/jtd.2018.09.112
3. Hedderson M, Lee D, Hunt E, Lee K, Xu F, Mustille A, et al. Enhanced Recovery After Surgery to Change Process Measures and Reduce Opioid Use After Cesarean Delivery: A Quality Improvement Initiative. Obstetrics and Gynecology. 2019;134(3):511-519. DOI: 10.1097/AOG.0000000000003406.
4. Carney J, McDonnell JG, Ochana A, Bhinder R, Laffey JG. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy. Anesth Analg. 2008;107(6):2056-2060. DOI: 10.1213/ane.0b013e3181871313
5. Dai C, Zhang K, Huang J. The Efficacy of Transversus Abdominis Plane Block for Abdominal Hysterectomy Post-operative Analgesia. Cureus. 2018;10(8):e3131. DOI: 10.7759/cureus.3131
6. Chin KJ, McDonnell JG, Carvalho B, Sharkey A, Pawa A, Gadsden J. Essentials of Our Current Understanding: Abdominal Wall Blocks. Regional Anesthessia & Pain Medicine. 2017;42(2):133-183. DOI: 10.1097/AAP.0000000000000545
7. Shelly R, Kumar VR, Jai S, Kumar CH, Ankita C. Magnesium sulphate as an adjuvant to bupivacaine in ultrasound-guided transversus abdominis plane block in patients scheduled for total abdominal hysterectomy under subarachnoid block. Indian Journal of Anaesthesia. 2016;60(3):174-179
8. 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 Journal of Anaesthesia. 2014;8(2):161-166. DOI: 10.4103/1658-354X.130683. PMID: 24843325
9. Gertler R, Brown HC, Mitchell DH, Silvius EN. Dexmedetomidine: a novel sedative-analgesic agent. Baylor University Medical Center Proceedings. 2001;14(1):13-21. DOI: 10.1080/08998280.2001.11927725
10. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: A flexible sta-tistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods. 2007;39(1)175-191
11. Rafi AN. Abdominal field block: A new approach via the lumbar triangle. Anaesthesia. 2001;56(10):1024-1026. DOI: 10.1111/j.1365-2044.2001.2279-40.x
12. Hebbard P, Fujiwara Y, Shibata Y, Royse C. Ultrasound-guided transversus abdominis plane (TAP) block. Anaesth Intensive Care. 2007;35(4):616-617
13. Elhamamy N. Ultrasound-guided Transversus Abdominis plane block by using Bupivacaine alone or when mixed with Dexmedetomidine or Dexamethazone for pain relief among abdominal hysterectomy patients. Journal of Gynecology and Women’s Health. 2020;18(1):555979. DOI: 10.19080/jgwh.2020.18.555979
14. Sarvesh B, Shivaramu BT, Sharma K, Agarwal A. Addition of Dexmedetomidine to Ropivacaine in Subcostal Transversus Abdominis Plane Block Potentiates Postoperative Analgesia among Laparoscopic Cholecystectomy Patients: A Prospective Randomized Controlled Trial. Anesthesia Essays and Researches. 2018;12(4):809–813. https://doi.org/10.4103/aer.AER_141_18
15. Mishra M, Mishra SP, Singh SP. Ultrasound-guided transversus abdominis plane block: What are the benefits of adding dexmedetomidine to ropivacaine?. Saudi Journal of Anaesthesia. 2017;11(1):58–61. https://doi.org/10.4103/1658-354X.197348
16. Chen Q, Liu X, Zhong X, Yang B. Addition of dexmedetomidine or fentanyl to ropivacaine for transversus abdominis plane block: evaluation of effect on postoperative pain and quality of recovery in gynecological surgery. Journal of pain research. 2018;11(1):2897–2903. https://doi.org/10.2147/JPR.S178516
17. Sun Q, Liu S, Wu H, Ma H, Liu W, Fang M et al. Dexmedetomidine as an Adjuvant to Local Anesthetics in Transversus Abdominis Plane Block: A Systematic Review and Meta-analysis. The Clinical journal of pain. 2019;35(4):375–384. https://doi.org/10.1097/AJP.0000000000000671
18. Ding W, Li W, Zeng X, Li J, Jiang J, Guo C et al. Effect of adding Dexmedetomidine to Ropivacaine on ultrasound-guided dual Transversus Abdominis plane block after gastrectomy. Journal of Gastrointestinal Surgery. 2017;21(6):936-946. DOI: 10.1007/s11605-017-3402-5.
Copyright (c) 2021 Aftab Hussain, Akhtar Hussain, Rehana Feroze, Muhammad Akram, Muhammad Asif Saleem, Ahsan Ali
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
All research articles published in the Journal of Rawalpindi Medical College (JRMC) are fully open access: immediately freely available to read, download, and share. Copyrights of all articles published in JRMC are retained by the authors. First publication rights are granted to JRMC. The journal/publisher is not responsible for subsequent uses of the work.
All articles are published under the Creative Commons Attribution (CC BY-SA 4.0) license.