Comparison of dexamethasone and clonidine as an adjunct to bupivacaine in transversus abdominis plane block in patients undergoing lower segment caesarean section

Authors

  • Mitesh D. Falia Department of Anaesthesiology, MVJ Medical College and Research Hospital, Hoskote, Bangalore, Karnataka
  • Prasad Kulkarni Department of Anaesthesiology, MVJ Medical College and Research Hospital, Hoskote, Bangalore, Karnataka

DOI:

https://doi.org/10.18203/2320-6012.ijrms20163315

Keywords:

TAP block, Postoperative pain, Postoperative analgesia, VAS score

Abstract

Background: A lower segment caesarean section (LSCS) commonly induces moderate to severe postoperative pain for 48 hours. Aim of the study was to compare 0.25% bupivacaine with dexamethasone and 0.25% bupivacaine with clonidine for transversus abdominis plane (TAP) block as post-operative analgesia in patients undergoing lower segment caesarean section (LSCS).

Methods: A randomized prospective controlled clinical study was conducted in 104 patients undergoing LSCS. Participants were divided into two groups in which group TAP-D (n=54) received 0.25% Bupivacaine with Dexamethasone 4mg and those in group TAP-C (n=50) received 0.25% Bupivacaine with Clonidine 75mcg as TAP block at the end of surgery. The postoperative pain was evaluated by visual analog scale (VAS) for pain scoring at every 2 hours for 12 hours postoperatively. Subjective assessment of duration of analgesia was done.

Results: The average duration of analgesia with TAP bock for the overall study population was 316.15 minutes. The average VAS score in patients who received TAP with dexamethasone was 1.50 which is significantly lower than those who received clonidine (1.95) (P value-0.0001). Further the duration of analgesia was 151 minutes longer in the first group who received dexamethasone TAP. In majority of the patients (84%) who received clonidine TAP, the analgesia persisted for 2-4 hours. While in patients who received dexamethasone addition, the analgesia persisted for 6-8 hours in 37%.

Conclusions: TAP block is a safe and effective way of relieving postoperative pain in LSCS patients. Addition of dexamethasone to bupivacaine significantly enhances its effect in terms of block quality and analgesia duration as compared to clonidine addition.

References

Bonnet MP, Mignon A, Mazoit JX, Ozier Y, Marret E. Analgesic effect and adverse effects of epidural morphine compared to parenteral opioids after elective caesarean section: A systemic review. Eur J Pain. 2010;14:894-9.

Eisenach JC, Pan PH, Smiley R, Lavand’homme P, Landau R, Houle TT. Severity of Acute Pain After Childbirth, but not Type of Delivery, Predicts Persistent Pain and Postpartum Depression. Pain. 2008;140:87-94.

Wlody D. Complications of regional anesthesia in obstetrics. Clin Obstet Gynecol. 2003;46:667-8.

Confidential Enquiry into Maternal and Child Health. Why Mothers Die 2000–2002: The Sixth Report of the Confidential Enquiry into Maternal Death in the United Kingdom. London: RCOG Press. 2004.

Rafi A. Abdominal field block: A new approach via the lumbar triangle. Anaesthesia. 2001;56:1024-6.

McDonnell JG, Curley G, Carney J, Benton A, Costello J, Maharaj CH, et al. The analgesic efficacy of transversus abdominis plane block after caesarean delivery: A randomized controlled trial. Anesth Analg. 2008;106:186-91.

McDonnell JG, O’Donnell BD, Curley G, Hefferman A, Power C, Laffey JG. Analgesic efficacy of transversus abdominis plane (TAP) block after abdominal surgery: A prospective randomized controlled trial. Anesth Analg. 2007;104:193-7.

Young MJ, Gorlin AW, Modest VE, Quraishi SA. Clinical implications of the transversus abdominis plane block in adults. Anesthesiol Res Pract. 2012:731645.

Kehlet H. Surgical stress: the role of pain and analgesia. Br J Anaesth. 1989;63:189-95.

Capdevila X, Barthelet Y, Biboulet P, Ryckwaert Y, Rubenovitch J, d'Athis F. Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. Anesthesiology. 1999;91:8-15.

Kehlet H, Holte K. Effect of postoperative analgesia on surgical outcome. Br J Anaesth 2001;87:62-72.

Bonnet F, Marret E. Influence of anaesthetic and analgesic techniques on outcome after surgery. Br J Anaesth. 2005;95:52-8.

Mishriky BM, George RB, Habib AS. Transversus abdominis plane block for analgesia after Cesarean delivery: a systematic review and meta-analysis. Can J Anaesth. 2012;59(8):766-8.

Carney J, Finnerty O, Rauf J, Bergin D, Laffey JD, Mc Donnell JG. Studies on the spread of local anaesthetic solution in transverses abdominis plane blocks. Anaesthesia. 2011;66(11):1023-30.

Kanazi GE, Aouad MT, Jabbour-Khoury SI, Al Jazzar, Alameddine MM, Al-Yaman R et al. Effect of low-dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. Acta Anaesthesiol Scand. 2006;50:222-7.

Thomson IR, Peterson MD, Hudson RJ. A comparison of clonidine with conventional preanaesthetic medication in patients undergoing coronary artery bypass grafting. Anesth Analg. 1998;87:292-9.

Fehr SB, Zalunardo MP, Seifert B, Rentsch KM, Rohling RG, Pasch T, et al. Clonidine decreases propofol requirements during anaeathesia: effect on bispectral index. Br J Anaesth. 2001;86:627-32.

Ammar AS, Mahmoud KM. Effect of adding dexamethasone to bupivacaine on transversus abdominis plane block for abdominal hysterectomy: A prospective randomized controlled trial. Saudi J Anaesth. 2012;6(3):229-33.

Devor MD, Gorvin-Lippmann R, Raber P. Corticosteroids suppress ectopic neural discharge originating in experimental neuromas. Pain. 1985;22:127-37.

Taguchi H, Shingu K, Okuda H, Matsumoto H. Analgesia for pelvic and perineal cancer pain by intrathecal steroid injection. Acta Anaesthesiol Scand. 2002;46:190-3.

Pan PH. Post cesarean delivery pain management: multimodal approach. Int J Obstet Anesth. 2006;15:185-8.

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Published

2016-12-19

How to Cite

Falia, M. D., & Kulkarni, P. (2016). Comparison of dexamethasone and clonidine as an adjunct to bupivacaine in transversus abdominis plane block in patients undergoing lower segment caesarean section. International Journal of Research in Medical Sciences, 4(10), 4481–4486. https://doi.org/10.18203/2320-6012.ijrms20163315

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Original Research Articles