Effect of Adding Dexamethasone as a Ropivacaine Adjuvant in Ultrasound-Guided Transversus Abdominis Plane Block for Inguinal Hernia Repair

Abstract

Background: The transverses abdominals plane block (TAP) is a regional anesthesia technique that provided analgesia to the parietal peritoneum, skin and muscles of the anterior abdominal wall. The aim of this randomized double-blind study was to evaluate postoperative analgesia on patients undergoing open inguinal hernia repair under general anesthesia (GA), (GA + TAP) block preformed with ropivacaine and (GA + TAP-D) block preformed with ropivacaine and 4 mg dexamethasone. Methods: 90 (ASA I-II) adult patients for unilateral open inguinal hernia repair were included in this study. In group I (n = 30) patents received only general anesthesia (GA). Patients in group II (n = 30) received GA and unilateral TAP block with 25 ml of 0.5% ropivacaine and the patients in group III (n = 30) received GA and unilateral TAP-D block with 25 ml of 0.5% ropivacaine + 4 mg Dexamethadsone. In this study we assessed the pain score -VAS at rest at 2, 4, 6, 12 and 24 hours after the operation and the total analgesic consumption of morphine over 24 hours. Results: There were statistically significant differences in the VAS scores between group I, group II and group III at all postoperative time points -2 hr , 4 hr , 6 hr , 12 hr and 24 hr. (p < 0.00001). The cumulative 24 hours morphine consumption after the operation was significantly lower in group III (5.53 1.21 mg) than in group II (6.16 2.41 mg) and group I (9.26 2.41 mg). This difference is statistically significant (p < 0.00001). Conclusion: Concerning the inguinal hernia repair we found better postoperative pain scores and 24 hours reduction of the morphine consumption in group III (GA and TAP-D block) compared with group I (GA) and group II (GA + TAP block).

Clinical analgesic efficacy of dexamethasone as a local anesthetic adjuvant for transversus abdominis plane (TAP) block: A meta-analysis

“…The literature search identified 354 studies, including 9 qualifing RCTs with a total of 575 patients that met the inclusion criteria ( Fig 1 ) [ 16 , 17 , 24 – 30 ]. The characteristics of patients and interventions are summarized in Table 1 .…”

“…All 9 RCTs compared the TAP block using LA with dexamethasone versus LA alone. All studies used a long-acting LA for the TAP block, including bupivacaine in 3 studies [ 26 , 28 , 29 ], ropivacaine in 5 studies [ 16 , 17 , 24 , 25 , 30 ], and levobupivacaine in 1 study [ 27 ].…”

Effect of addition of dexamethasone to ropivacaine on post-operative analgesia in ultrasonography-guided transversus abdominis plane block for inguinal hernia repair: A prospective, double-blind, randomised controlled trial

“…Duration of prolongation of analgesia with dexamethasone is highly variable with few studies suggesting analgesia up to 20–24 h while others suggest only up to 12–16 h as observed in this study. [ 8 15 16 ] Furthermore, it has also been found that dexamethasone at doses more than 0.1 mg/kg is an effective adjunct in multimodal strategies to reduce post-operative pain and opioid consumption after surgery. [ 17 18 ] Considering the fact that doses <0.1 mg/kg failed to produce any opioid-sparing effect when administered IV, combined with the result of the study conducted by Desmet et al .…”

Efficacy of Nalbuphine with Flurbiprofen on Multimodal Analgesia with Transverse Abdominis Plane Block in Elderly Patients Undergoing Open Gastrointestinal Surgery: A Randomized, Controlled, Double-Blinded Trial

“…Moreover, the transverse abdominis plane block (TAPB) is a relatively novel procedure for applying local anesthetics into the anatomic neurofascial space and provides analgesia to the skin, muscles of the anterior abdominal wall, and parietal peritoneum. Specifically, it offers a significantly prolonged duration of analgesia during the early postoperative stage [ 13 , 14 ], and reduces opioid consumption after abdominal surgery [ 15 ], suggesting the potential use for elderly patients undergoing open gastrointestinal surgery.…”