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

Abstract

BackgroundTransversus abdominis plane (TAP) block is reportedly a preferable technique for reducing postoperative pain in abdominal surgeries. The aim of this study was to compare the analgesic efficacy and recovery quality after gynecological surgery by adding dexmedetomidine or fentanyl into an ultrasound-guided TAP block.MethodsWe randomly assigned 100 elective gynecological patients into four groups (TAP, TAP-DEX, TAP-FEN, and control, n=25 in each). TAP blocks were performed postoperatively. The control group received patient-controlled intravenous analgesia (PCIA), the TAP group received TAP blocks with 0.375% ropivacaine, the TAP-DEX group received 0.375% ropivacaine with dexmedetomidine 1 µg/kg, and the TAP-FEN group received 0.375% ropivacaine with fentanyl 1 µg/kg. The primary outcomes were the first request time for PCIA bolus and quality of postoperative recovery assessed using the QoR-40 questionnaire 2 days after surgery. The secondary outcomes were the visual analog scale (VAS) scores at rest across the different time intervals, the total number of PCIA boluses required in 24 and 48 hours postoperatively, and associated complications.ResultsThe first request time for PCIA was significantly longer in the TAP-DEX than in the TAP, TAP-FEN, and control groups (9.86±0.77, 7.86±0.56, 8.79±0.55, and 1.56±0.65 hours, respectively; P<0.01). The QoR-40 scores were highest in the TAP-DEX group (P<0.05). The mean PCIA bolus consumption in the first 24–48 hours was lowest in TAP-DEX group. VAS showed significant differences between TAP-DEX and TAP-FEN groups only at 6 hours (P<0.01).ConclusionThe use of dexmedetomidine as an adjuvant to TAP blocks could facilitate postoperative analgesia and improve the quality of recovery without increasing related complications.

Comparison of Bupivacaine and Dexmedetomidine versus Bupivacaine Alone in Transversus Abdominis Plane Block for Post-Operative Analgesia

“…Various other studies have shown that adding dexmedetomidine to local anesthetics can prolong the duration and provide better quality analgesia as compared to local anesthetics only. [14][15][16][17] In our study, no patient developed post-operative hypotension from either group but one patient developed postoperative bradycardia in group BD. Conflicting results were seen in a study conducted by Almarakbi WA et al 8 They observed significant bradycardia in group BD during the first four postoperative hours.…”

Perineural dexmedetomidine added to ropivacaine for ultrasound-guided erector spinae plane block prolongs analgesia duration and reduces postoperative opioid consumption after thoracotomy: a prospective, randomized study

“…Previous studies have demonstrated that perineural dexmedetomidine in interfascial nerve block can prolong the analgesia time of ropivacaine. 12,13 ESPB is a novel kind of interfascial nerve block that has gained popularity for providing effective analgesia for thoracic surgery. In the context of this knowledge, the following question can be raised: could dexmedetomidine prolong the analgesia time of ropivacaine in ESPB for open thoracotomy?…”

Comparison of Postoperative Analgesia amongst Subjects Receiving Ropivacaine and Clonidine versus Ropivacaine Alone: A Hospital Based Study

“…[18] Qi Chen et al (2018) compared the analgesic effectiveness and recovery time after gynecological surgery by addition of dexmedetomidine or fentanyl and found a significant difference in VAS scores amongst the groups. [19]…”