Volume: 9 Issue: 1
Year: 2021, Page: 64-68, Doi: https://doi.org/10.47799/pimr.0901.13
Received: Nov. 17, 2020 Accepted: April 26, 2021 Published: April 26, 2021
INTRODUCTION: Post operative pain is the most common complaint in post anaesthesia care units (PACU). Lower abdominal surgeries are associated with severe post-operative pain and inadequate post-operative analgesia leads to many complications. Multimodality approach is used to treat postoperative pain. Transversus abdominus plane (TAP) block is a peripheral nerve block of the trunk that provides analgesia between T10 to L1 dermatomes with a single injection which was first described by A.N. Rafi 1 in 2001 . TAP Block is indicated in any lower abdominal surgeries. Local anaesthetic is deposited in the fascial sheath between the internal oblique and transverse abdominis muscle using either the blind or the ultrasound guided technique. Adjuvants are frequently used in regional analgesia for rapid onset to improve the quality and prolong the duration of block. Alpha 2 agonist dexmedetomidine speeds the onset of block and prolongs duration of analgesia.
Aim: To assess whether addition of dexmedetomidine to ropivacaine may bring some improvements to the analgesic efficacy and quality of TAP blocks in patients undergoing appendicectomy surgeries .
MATERIALS AND METHODS: 30 Patients belonging to ASA Class I or II scheduled for appendicectomy were selected for the study.
The patients were randomized into two groups:
Group R - receiving plain ropivacaine (2ml of normal saline and 20ml 0.2%ropivacaine)
Group R+D - receiving ropivacaine with dexmedetomidine (0.5 mcg /kg of dexmedetomidine dissolved in 2ml of normal saline and 20ml 0.2%ropivacaine). At the end of surgery, USG guided transversus abdominus plane block was performed. Results Addition of dexmedetomidine to ropivacine in TAP block lower pain scores after 3hrs in postoperative period and the same trend of analgesia continued for the first 24 hours. It confers better post operative analgesia with less analgesic requirement and adverse effects.
Conclusion: The addition of dexmedetomidine to ropivacaine in TAP block confers better pain control and decreases the total dose of analgesics post-operatively without any major side-effects.
Keywords: Appendicectomy, Dexmededetomidine, Postoperative Analgesia, Ropivacaine, Transverse Abdominal plain block, Ultrasound Guided
1. Rafi AN. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia. 2001 Oct; 56(10):1024-6. doi: 10.1046/j.1365-2044.2001.02279-40.x. PMID: 11576144.
2. McDonnell, John G., MB, FCARCSI*†; O'Donnell, Brian, MB, FCARCSI†; Curley, Gerard, MB*; Heffernan, Anne, MB, FCARCSI†; Power, Camillus, MD, FCARCSI†; Laffey, John G., MD, MA, FCARCSI*‡ The Analgesic Efficacy of Transversus Abdominis Plane Block After Abdominal Surgery: A Prospective Randomized Controlled Trial, Anesthesia & Analgesia: January 2007 - Volume 104 - Issue 1 - p 193-197doi: 10.1213/01.ane.0000250223.49963.0f
3. Lissauer J, Mancuso K, Merritt C, Prabhakar A, Kaye AD, Urman RD. Evolution of the transversus abdominis plane block and its role in postoperative analgesia. Best Pract Res Clin Anaesthesiol. 2014 Jun;28(2):117-26. doi: 10.1016/j.bpa.2014.04.001. Epub 2014 May 9. PMID: 24993433.
4. Tsai, H. C., Yoshida, T., Chuang, T. Y., Yang, S. F., Chang, C. C., Yao, H. Y., Tai, Y. T., Lin, J. A., & Chen, K. Y. (2017). Transversus Abdominis Plane Block: An Updated Review of Anatomy and Techniques. BioMed research international, 2017, 8284363. https://doi.org/10.1155/ 2017/8284363
5. Sun, Q., Liu, S., Wu, H., Ma, H., Liu, W., Fang, M., Liu, K., & Pan, Z. (2019). Dexmedetomidine as an Adjuvant to Local Anesthetics in Transversus Abdominis Plane Block: A Systematic Review and Meta-analysis. The Clinical journal of pain, 35(4), 375–384. https://doi.org/10.1097/ AJP.0000000000000671
6. Jadon, A., Jain, P., Chakraborty, S., Motaka, M., Parida, S. S., Sinha, N., Agrawal, A., & Pati, A. K. (2018). Role of ultrasound guided transversus abdominis plane block as a component of multimodal analgesic regimen for lower segment caesarean section: a randomized double blind clinical study. BMC anesthesiology, 18(1), 53. https:// doi.org/10.1186/s12871-018-0512-x
7. Bansal, Prannal MD*; Garg, Shashank MD, MS† Effect of Adding Dexmedetomidine to Local Anesthetic Agents for Transversus Abdominis Plane Block, The Clinical Journal of Pain: October 2019 - Volume 35 - Issue 10 - p 844-854 doi: 10.1097/AJP.0000000000000742
8. Raof, R. A., El Metainy, S. A., Alia, D. A., & Wahab, M. A. (2017). Dexmedetomidine decreases the required amount of bupivacaine for ultrasound-guided transversus abdominis plane block in pediatrics patients: a randomized study. Journal of clinical anesthesia, 37, 55– 60. https://doi.org/10.1016/j.jclinane.2016.10.041
9. Almarakbi, W. A., & Kaki, A. M. (2014). 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, 8(2), 161–166. https://doi.org/10.4103/ 1658-354X.130683
10. Nandanwankar N,Abdullah M F. Evaluation of TransversusAbdominis Plane (Tap) Block with Inj.Bupivacaine 0.25% For Post-Operative Analgesia In Inguinal Hernia Repair Surgery.Perspectives in Medical Research 2019; 7(3): 30-37
Karampudi K,Waghray K. Effect Of Addition Of Dexmedetomidine To Ropivacaine In Ultrasound Guided Transverse Abdominis Plexus Block On Postoperative Pain In Open Appendicectomy Perspectives in Medical Research 2021; 9 (1):64-68 DOI:10.47799/pimr.0901.13