Transversus abdominis plane (TAP) block with levobupivacaine versus levobupivacaine with dexmedetomidine for postoperative analgesia following cesarean delivery

Varshney, Aman; Prabhu, Mukhyaprana; Periyadka, Bhavya; Nanjundegowda, Divyashri C; Rao, Amrut K

doi:10.4103/joacp.joacp_372_17

Cited by 12 publications

(6 citation statements)

References 11 publications

(12 reference statements)

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“…According to the results of a previous study [ 14 ] and our pre-experimental observations in six patients, we considered a clinically important reduction of the first request time for PCA to be 3 h. The study sample size was estimated at 28 patients in each group, which was calculated with an α-value of 5 and 80% power. Taking into account the potential for dropouts, 90 patients were estimated.…”

Section: Methodsmentioning

confidence: 99%

RETRACTED ARTICLE: Efficacy of dexmedetomidine as an adjunct to ropivacaine in bilateral dual-transversus abdominis plane blocks in patients with ovarian cancer who underwent cytoreductive surgery

Zhang

Chen

et al. 2022

BMC Anesthesiol

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Objective We sought to evaluate the postoperative control of pain and recovery in patients with ovarian cancer who underwent cytoreductive surgery by adding dexmedetomidine to ropivacaine in bilateral dual-transversus abdominis plane (Bd-TAP) blocks. Methods We enrolled 90 patients with an American Society of Anesthesiologists physical status I to III undergoing open abdominal cytoreductive surgery in this study. Patients were randomized and assigned into three groups (TAP-R, TAP-DR, or CON) of 30 participants each. All of the patients received standardized general anesthesia, and postoperative Bd-TAP blocks were performed. The TAP-R, TAP-DR, and CON groups received Bd-TAP blocks with 0.3% ropivacaine, 0.3% ropivacaine and 0.5 μg/kg of dexmedetomidine, and 0.9% normal saline, respectively. All of the patients received patient-controlled analgesia (PCA) (formula, 100 μg of sufentanil and 16 mg of ondansetron diluted with normal saline to 100 mL). Flurbiprofen axetil was used as a rescue drug if the visual analog scale (VAS) score was more than four points. The first request time for PCA bolus; the VAS scores at 0, 6, 12, 24, and 48 h after operation; and the cumulative sufentanil consumption within 24 and 48 h, respectively, were compared. Pulmonary function was evaluated preoperatively and at 24 h after the operation. The use of the rescue drug was recorded. Postoperative functional recovery, including time to stand, time to walk, time to return of bowel function, time to readiness for discharge, and postoperative complications, were recorded. Results Median values of the first request time for PCA of the TAP-R group was significantly prolonged compared to that of the CON group (median [interquartile range], 7.3 [6.5–8.0] hours vs. 3.0 [2.3–3.5] hours) (P < .001), while the TAP-DR group has the longest request time among the three groups (median [interquartile range], 13.5 [12.4–14.5] hours) (P < .001). The VAS scores at rest and upon coughing of the TAP-R group in the first 12 h were significantly lower than those of the CON group (P < 0.05), but showed no significant difference compared to those of the TAP-DR group. The VAS scores at rest and upon coughing were lower in the TAP-DR group at each time point compared to those of the CON group (P < .05). The cumulative sufentanil consumption in the TAP-DR group was significantly lower at 48 h (P = .04) after surgery than in the CON group, while there was no significant difference compared to that in the TAP-R group (P > .05). Less rescue analgesic was required by patients in the TAP-DR group than in the CON group (P < .05). Postoperative mean measured forced expiratory volume in 1 s (FEV1) and FEV1/forced vital capacity values in the TAP-DR group were significantly higher than those of the CON group (P = .009), while there was no significant difference compared to those of the TAP-R group (P = .10). There was no significantly difference in postoperative functional recovery between TAP-DR and CON group (P > 0.05). Conclusion TAP blocks can provide effective pain relief up to 12 h postoperatively without a significant improvement in postoperative pulmonary function. The addition of dexmedetomidine to ropivacaine for Bd-TAP block prolonged the first bolus time of PCA when compared to that in the TAP-R group and decreased sufentanil consumption and the need of rescue analgesia relative to in the CON group at 48 h postoperative. The procedure provided better postoperative analgesia and improved postoperative pulmonary function relative to the CON group. Our results indicate that dexmedetomidine as an adjuvant of Bd-TAP can provide effective pain relief up to 48 h.

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Section: Methodsmentioning

confidence: 99%

RETRACTED ARTICLE: Efficacy of dexmedetomidine as an adjunct to ropivacaine in bilateral dual-transversus abdominis plane blocks in patients with ovarian cancer who underwent cytoreductive surgery

Zhang

Chen

et al. 2022

BMC Anesthesiol

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“…Similarly, other authors also found prolonged TFA when dexamethasone and dexmedetomidine were used as an adjuvant to LA in their studies [18,20,21]. However, Varshney et al [13] and Parameswari et al [14] reported prolonged TFA (10 h and 14 h respectively) in parturients receiving dexmedetomidine as an adjuvant in TAP block than the present study (7.49±1.02 h). Gupta et al [15] also reported delayed TFA in parturients receiving dexmedetomidine as an adjuvant (19 h).…”

Section: Discussionsupporting

confidence: 58%

“…It acts locally on nociceptive C-fibers to increase the activity of inhibitory potassium channels [12]. The analgesic efficacy of dexmedetomidine and dexamethasone in different doses with different local anesthetics has been evaluated in various studies [13][14][15][16]. In the present study, all patients in three groups were comfortable (VAS<4) till 4 h postoperatively which may be due to the additive effect of SAB to TAP block.…”

Section: Discussionmentioning

confidence: 64%

“…At the end of surgery, USG-guided TAP block was given. After skin disinfection, the abdominal wall was scanned using a linear array transducer probe (6)(7)(8)(9)(10)(11)(12)(13) in the multi-beam mode, connected to a portable ultrasound unit (Seiman Medical Solution USA). The edge of the probe was covered by a sterile plastic transducer sheath (Tegaderm) and a sterile gel was applied to the skin.…”

Section: Partani Et Almentioning

confidence: 99%

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Comparison of Levobupivacaine With Two Different Adjuvants (Dexamethasone vs. Dexmedetomidine) in Ultrasonography-Guided Transversus Abdominis Plane Block for Unilateral Inguinal Herniorrhaphy: A Randomized Double-Blinded Control Trial

Partani,

Karia,

Sharma

et al. 2024

Asian J Pharm Clin Res

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Objectives: Ultrasonography (USG)-guided transversus abdominis plane (TAP) block is an effective technique for postoperative analgesia in patients undergoing intraabdominal surgery. This study was aimed to compare the post-operative analgesia, hemodynamic variables, sedation, and adverse effects of levobupivacaine with two different adjuvants (dexamethasone and dexmedetomidine) in USG-guided TAP block for patients undergoing unilateral inguinal herniorrhaphy under subarachnoid block. Methods: A double-blind randomized control study, conducted on 96 patients, allocated in three groups of 32 each. Patients in group C received 0.25% levobupivacaine (20 mL) with normal saline (2 mL), group D1 received 0.25% levobupivacaine (20 mL) added with 0.1 mg/kg dexamethasone (2 mL) and group D2 received 0.25% levobupivacaine added with 0.5 mcg/kg dexmedetomidine diluted in NS (2 mL). Pain was assessed using Visual Analog Scale (VAS). The time for request of first analgesia (TFA), total number and total dose of rescue analgesic in 24 h were recorded. Statistical analysis was done using unpaired Student’s t-test and ANOVA. Results: At 12 and 24 h >30% of patients had VAS ≥4 in control group while it was <10% in groups D1 and D2 (p<0.001). TFA was earliest in control group (6.10±0.96 h) as compared to group D1 (7.26±1.22 h) and group D2 (7.49±1.02 h) (p<0.001). The total number and total dose of analgesic given were higher in the control group than other two groups (p<0.001). However, it was comparable between groups D1 and D2 (p<0.05). Conclusion: Dexamethasone and dexmedetomidine when added as an adjuvant to levobupivacaine for TAP significantly prolonged the duration of post-operative analgesia as compared to levobupivacaine alone, however, it was found to be comparable between adjuvant groups.

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“…This result was consistent with Joseph et al 85 He discovered that 20 mL of 0.5% ropivacaine combined with 25 µg fentanyl or 25 µg dexmedetomidine effectively prolonged analgesia and reduced total analgesic consumption. Varshney et al 86 and others have also proved this point of view.…”

Section: Application Of Dexmedetomidine In Peripheral Nerve Blockmentioning

confidence: 71%

Dexmedetomidine as an Adjuvant in Peripheral Nerve Block

Chen¹,

Liu²,

Feng³

et al. 2023

DDDT

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Peripheral nerve block technology is important to balanced anesthesia technology. It can effectively reduce opioid usage. It is the key to enhance clinical rehabilitation as an important part of the multimodal analgesia scheme. The emergence of ultrasound technology has accelerated peripheral nerve block technology development. It can directly observe the nerve shape, surrounding tissue, and diffusion path of drugs. It can also reduce the dosage of local anesthetics by improving positioning accuracy while enhancing the block’s efficacy. Dexmedetomidine is a highly selective drug α 2 -adrenergic receptor agonist. Dexmedetomidine has the characteristics of sedation, analgesia, anti-anxiety, inhibition of sympathetic activity, mild respiratory inhibition, and stable hemodynamics. Numerous studies have revealed that dexmedetomidine in peripheral nerve blocks can shorten the onset time of anesthesia and prolong the time of sensory and motor nerve blocks. Although dexmedetomidine was approved by the European Drug Administration for sedation and analgesia in 2017, it has not yet been approved by the US Food and Drug Administration (FDA). It is used as a non-label drug as an adjuvant. Therefore, the risk-benefit ratio must be evaluated when using these drugs as adjuvants. This review explains the pharmacology and mechanism of dexmedetomidine, the effect of dexmedetomidine on various peripheral nerve block as an adjuvant, and compare it with other types of adjuvants. We summarized and reviewed the application progress of dexmedetomidine as an adjuvant in nerve block and look forward to its future research direction.

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Transversus abdominis plane (TAP) block with levobupivacaine versus levobupivacaine with dexmedetomidine for postoperative analgesia following cesarean delivery

Cited by 12 publications

References 11 publications

RETRACTED ARTICLE: Efficacy of dexmedetomidine as an adjunct to ropivacaine in bilateral dual-transversus abdominis plane blocks in patients with ovarian cancer who underwent cytoreductive surgery

RETRACTED ARTICLE: Efficacy of dexmedetomidine as an adjunct to ropivacaine in bilateral dual-transversus abdominis plane blocks in patients with ovarian cancer who underwent cytoreductive surgery

Comparison of Levobupivacaine With Two Different Adjuvants (Dexamethasone vs. Dexmedetomidine) in Ultrasonography-Guided Transversus Abdominis Plane Block for Unilateral Inguinal Herniorrhaphy: A Randomized Double-Blinded Control Trial

Dexmedetomidine as an Adjuvant in Peripheral Nerve Block

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