DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20222302
Published: 2022-08-29

Comparison of clonidine and dexmedetomidine as adjuvants for ropivacaine in ultrasound guided transversus abdominis plane block for post caesarean analgesia

Ovais Nazir, Asif Hussain Bhat, Hamid Yatoo, Amit Kumar

Abstract


Background: Transversus abdominis plane block is an important regional anaesthesia technique for postoperative analgesia after caesarean section. Addition of adjuvants to local anaesthetic in TAP block helps in improving the duration of analgesia. Objective of current study was to compare clonidine and dexmedetomidine as adjuvants to 0.2% ropivacaine in USG guided TAP block for duration of postoperative analgesia in caesarean section under spinal anaesthesia.

Methods: A total of 75 pregnant patients belonging to ASA I-II scheduled for caesarean section were included and divided into three groups; Group I-0.2% Ropivacaine plus normal saline, Group II-0.2% Ropivacaine plus 50 mcg clonidine and Group III-0.2% ropivacaine plus 50 mcg dexmedetomidine. The patients were compared for duration of analgesia, total       number and amount of rescue analgesia utilized in 24        hours.

Results: The mean duration of analgesia was found to be more (statistically significant p<0.05) and number as well as amount of rescue analgesic doses were reduced in group III as compared to group I and group II.

Conclusions: Dexmedetomidine is a better alternative to clonidine as adjuvant for 0.2% ropivacaine in USG guided TAP block to extend the duration of postoperative analgesia and decreased 24-hour analgesic requirement in caesarean section.


Keywords


Transversus abdominis plane, Caeserean section, Ropivacaine, Clonidine, Dexmedetomidine

Full Text:

PDF

References


Petersen PL, Mathiesen O, Torup H, Dahl JB. The transversus abdominis plane block: a valuable option for postoperative analgesia? A topical review. Acta Anaesthesiol Scand. 2010;54:529-35.

Rafi AN. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia 2001;56(10):1024-6.

Petersen PL, Stjernholm P, Kristiansen VB, Torup H, Hansen EG, Mitchell AU, et al. The beneficial effect of transversus abdominis plane block after laparoscopic cholecystectomy in day-case surgery: a randomized clinical trial. J Soc Ambulat Anesthesiol. 2012;115(3):527-33.

Scott BD, Alistair L, Denise F, Geoffrey MR, Bowler P, Bloomfield, Lundh R. Acute toxicity of ropivacaine compared with that of bupivacaine. Anesth Analg. 1989;5:563-9.

Landau R, Schiffer E, Morales M, Savoldelli G, Kern C. The dose-sparing effect of clonidine added to ropivacaine for labor epidural analgesia. Anesth Analg. 2002;95(3):728-34.

El Saied AH, Steyn MP, Ansermino JM. Clonidine prolongs the effect of ropivacaine for axillary brachial plexus blockade. Can J Anesth. 2000;47(10):962-7.

Scott-Warren VL. Dexmedetomidine: its use in intensive care medicine and anaesthesia. BJA Edu. 2016;16(7):242-6.

Kenan K, Kol IO, Duger C, Gursoy S, Ozturk H, Kayacan U, et al. Effects of adding dexmedetomidine to levobupivacaine in axillary brachial plexus block current. Curr Ther Res. 2012;73(3):103-11.

Pan PH, Coghill R, Houle TT, Seid MH, Lindel WM, Parker RL, et al. Multifactorial preoperative predictors for postcesarean section pain and analgesic requirement. Anesthesiol. 2006;104:417-25

Ismail S. Multimodal analgesia for cesarean section: Evolving role of transversus abdominis plane block. J Obstet Anaesth Crit Care. 2012;2:67-8.

Adeniji AO, Atanda OO. Randomized comparison of effectiveness of unimodal opioidn analgesia with multimodal analgesia in post-cesarean section pain management. J Pain Res. 2013;6:419-20.

Hebbard P, Fujiwara Y, Shibata Y, Royse C. Ultrasound-guided transversus abdominis plane (TAP) block. Anaesth Intensive Care. 2007;35:616.

Garcia-Quintero PE, Suraci NP, Mello JD. TAP blocks: a recent review of anesthetic combinations pain relief. Anestesiol. 2018;7(5):333.

Luan H, Zhang X, Feng J, Zhu P, Li J, Zhao Z. Effect of dexmedetomidine added to ropivacaine on ultrasound-guided transversus abdominis plane block for postoperative analgesia after abdominal hysterectomy surgery: A prospective randomized controlled trial. Minerva Anestesiol. 2016;82:981-7.

Mishra M, Mishra SP, Singh SP. Ultrasound-guided transversus abdominis plane block: What are the benefits of adding dexmedetomidine to ropivacaine?. Saudi J Anaesth. 2017;11:58-61.

Xu L, Hu Z, Shen J, McQuillan PM. Efficacy of ultrasound-guided transversus abdominis plane block and rectus sheath block with ropivacaine and dexmedetomidine in elderly high-risk patients undergoing emergency abdominal surgery. Minerva Anestesiol. 2018;84;18-24.

Manju BS, Sowmya GR, Jyothsna G. Transversus abdominis plane block: comparison of efficacy of varying doses of clonidine combined with levobupivacaine a double-blind randomized trail. Anesth Essays Res. 2019;13(1):179-83.

Kanazi GE, Aouad MT, Abdallah FW. The analgesic efficacy of subarchnoidmorphine in comparison with ultrasound guided tranversus abdominis plane block after cesarean delivery: A randomized controlled trial. Anesth Analg. 2010;111(2):475-81.

Tan TT, Teoh WH, Woo DC. Sia ATA randomised trial of the analgesic efficacy of ultrasound-guided transversus abdominis plane block after caesarean delivery under general anaesthesia. Eur J Anaesthesiol. 2012;29(2):88-94.

Waleed AA, Kaki AM. 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 J Anaesth. 2014;8(2):161-6.

Recep A, Patmanoa G, Cihangir B, Ertan E, Aliye E, Erciyes C. Efficiency of bupivacaine and association with dexmedetomidine in transversus abdominis planeblock ultrasound guided in postoperative pain of abdominal surgery. Rev Bras Anestesiol. 2018;68(1):49-56.