A comparative study of Ropivacaine and Ropivacaine with Dexamethasone in Transversus abdominis plane block for postoperative analgesia in patients undergoing lower abdominal surgeries.

Dr. Saya Raghavendra Prasad; Dr. D.V.Rama Siva Naik; Dr.C.Kailashnath Reddy; Dr. G. Sanjeev Kumar

Volume : VII, Issue : XI, November - 2017

A comparative study of Ropivacaine and Ropivacaine with Dexamethasone in Transversus abdominis plane block for postoperative analgesia in patients undergoing lower abdominal surgeries.

Dr. Saya Raghavendra Prasad, Dr. D. V. Rama Siva Naik, Dr. C. Kailashnath Reddy, Dr. G. Sanjeev Kumar

Abstract :

Background: The great majority of patients scheduled to undergo surgery suffer from emotional stress due to anxiety about the pain which is expected in the postoperative period¹. Opioids remain the mainstay of postoperative pain relief but can result in significant adverse effects. A transversus abdominis plane (TAP) block is the technique to block the sensory nerves of the anterior abdominal wall and the TAP block has been used to control the pain after abdominal surgery in many cases. Steroids are very potent anti inflamaytory and immunosuppressive agents.peri neural injection of steroid is influences the postoperative analgesia.

Aim: to compare time for first rescue analgesia, VAS score after surgery, total rescue analgesia, PONV in control group, Ropivacaine group and repivacaine with dexamethasone group.

Methods: Patients were randomly allocated into three groups using computer generated random numbers. GROUP I(N=30): Control group(without TAP block)GROUP II (N=30):TAP block Ropivacaine (1.5mg/kg of 0.375%) with 2ml normal salineGROUP III(N=30):TAPblock Ropivacaine(1.5mg/kgof0.375%)with 2ml(8mg) dexamethasone. The TAP block was performed after intubating the patient,before skin incision using double– pop technique¹⁴. A 21–gauge 1.5 inch blunted hypodermic needle was attached with flexible tubing to a syringe filled with the study solution. A loss–of resistance technique was used to locate the TAP.

Results: Significant reduction of VAS scores in group II and group III when compared with group I at all specified time intervals and also significant reduction of VAS scores when compared in between group II and group III. Mean time for first rescue analgesia after surgery in groupI was125 mins,in group II it was 416.9 mins, in group III it was 540.83 minutes. (p<0.0001). Total rescue analgesia (fentanyl in mcg) for 48hrs after surgery in groupI 299±23.09mcg, in groupII it 180.16±17.18mcg, in group III it was 59.66±4.188mcg. (p<0.0001). Postoperative nausea and vomiting for 48hrs in groupI 16 members,in groupII 14 members.in group III it was 5 members. (p<0.0001).

Conclusion: The addition of dexamethasone as an adjuvant to ropivacaine in TAP block prolongs the time for first rescue analgesia, decreases VAS scores, decreases requirement of total rescue analgesia for 48 hours post operatively, decreases incidence of postoperative nausea and vomiting.