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

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.

Dexmedetomidine in perioperative acute pain management: a non-opioid adjuvant analgesic

“…41 Some scholars reported that 0.5 μg/kg dexmedetomidine with 0.25% bupivacaine for transversus abdominis plane block in 50 patients undergoing abdominal hysterectomy led to better local anesthesia and better pain control postoperatively without any major side effects. 42 In a double-blinded study, 60 adults undergoing thyroid surgeries received bilateral superficial cervical plexus block with the addition of 0.5 μg/kg dexmedetomidine to 0.5% ropivacaine, and exhibited a significantly prolonged and better quality of postoperative analgesia and patient satisfaction. 43 …”

Effects of adding dexmedetomidine to local infiltration of bupivacaine on postoperative pain in pediatric herniorrhaphy: a randomized clinical trial

“…Dexmedetomidine (DEX) is a highly selective α 2 -adrenergic agonist with a receptor affinity greater than clonidine, which acts through various mechanisms, such as increased hyperpolarization of action potential, causing hypnotic and analgesic effects [10]. Adding DEX as an adjuvant to bupivacaine has proven effectiveness for postoperative pain relief in various procedures such as cesarean section [11], abdominal hysterectomy [12], and knee arthroplasty [13]. Even a combination of DEX with bupivacaine has been proposed to be superior to bupivacaine alone or with tramadol in cholecystectomy procedures [14].…”

Magnesium sulphate as an adjuvant to bupivacaine in ultrasound-guided transversus abdominis plane block in patients scheduled for total abdominal hysterectomy under subarachnoid block

“…Regarding the number of rescue analgesics in TAP block,[ 8 ] maximum number of demand boluses were observed between 4 and 24 h with plain bupivacaine, while our study shows maximum demands between 6 and 12 h. One reason for initial discrepancy can be the difference in anaesthesia technique that is general anaesthesia versus SAB (present study). The bupivacaine group required rescue analgesic from 4 to 12 h and magnesium group demanded rescue analgesic after 12 h postoperatively indicating shorter pain-free period and more requirement of analgesia in the bupivacaine group.…”