Use of Dexmedetomidine as adjunct with Bupivacaine in TAP block for postoperative pain relief in patients undergoing laparoscopic cholecystectomy
DOI:
https://doi.org/10.51985/Keywords:
Dexmedetomidine, laparoscopic cholecystectomy, transverses abdominas plane blockAbstract
Objective: To analyze adjunct effect of Dexmedetomidine along with Bupivacain in TAP block for postoperative analgesia in laparoscopic cholecystectomy.
Study Design and Setting: Prospective interventional study was conducted 1st September 2022 to 31st January 2023 at Anesthesia department of PAF Hospital Islamabad, affiliated with Air University.
Methodology: A total of 60 patients undergoing elective laparoscopic cholecystectomy between age 18 to 60 years were included. Patients having hypertension, heart disease, diabetes were excluded. Group A patients were given TAP block using 10ml 0.25 % Bupivacaine on each side.Group B patients were given 10ml of 0.25% Bupivacaine with injection Dexmedetomidine 0.5 µg/kg in divided dose on each side under ultrasound guidance. Patients were followed for postoperative pain in first 24 hours.
Results: Data was analyzed on SPSS 25.Mean ± SD of pain score on VAS was 6.54 ± 1.98 versus 3.54 ± 1.87 at 4 hours ( p value =0.0001) , 5.51 ± 1.16 versus 2.89 ± 1.65 at 8 hours ( p value=0.0001) , 4.89 ± 1.11 versus 2.13 ± 1.25 at 12 hours ( p value=0.0001) ,4.47 ± 1.07 versus 1.63 ± 0.85 at 24 hours ( p value=0.0001) in group A and B respectively. Stratification was done with age, gender, ASA status and duration of surgery .Results of study were not affected by these factors.
Conclusion: Dexmedetomidine when added as an adjunct to Bupivacaine is better than Bupivacaine alone in TAP block for postoperative analgesia after laparoscopic cholecystectomy
References
1. Matam R, Chawla V, Trivedi S, Bhardwaj A, Singh S.
Ultrasound-Guided Transversus Abdominis Plane Block
Versus Intraperitoneal Instillation of Bupivacaine after
Laparoscopic Cholecystectomy–A Randomized Control Trial.
J Med Sci Health. 2023;9(2):169-176. Doi : 10.46347/jmsh.v
9i2.22.394
2. Malik MJ, Malik NJ. Surgical Strategies for Gallbladder
Disease in Cirrhotic Patients: A Comparison of Open versus
Laparoscopic Cholecystectomy. Sjrmu. 2024;28(1):103-5.
3. Soni G, Singh D, Sood A, Rathore YS, Ranjan P, Singh A,
Choudhary N, Chumber S. Pain Relief in Laparoscopic
Cholecystectomy: Pre-emptive Versus Post-operative Local
Anaesthetic Infiltration—A Randomized Control Trial. Indian
Journal of Surgery . 2024:1-7. doi.org/10.1007/s12262-024-
04127-5
4. Cho HY, Hwang IE, Lee M, Kwon W, Kim WH, Lee HJ.
Comparison of modified thoracoabdominal nerve block through
perichondral approach and subcostal transversus abdominis
plane block for pain management in laparoscopic
cholecystectomy: a randomized-controlled trial. Korean J
Pain. 2023 ;36(3):382-391. doi: 10.3344/kjp.23114.
5. Bourgeois C, Oyaert L, Van de Velde M, Pogatzki-Zahn E,
Freys SM, Sauter AR, Joshi GP, Dewinter G. Pain management
after laparoscopic cholecystectomy: A systematic review and
procedure-specific postoperative pain management
(PROSPECT) recommendations. Eur J Anaesthesiol. 2024
;41(11):841-55. doi: 10.1097/EJA.0000000000002047
6. El-misady MM, El-rahman AS, Shabayek IAE. Comparison
between ultrasound guided transversus abdominis plane (tap)
block and local anesthetic infiltration in patients undergoing
laparoscopic cholecystectomy. Al-Azhar medical journal.
2023 ; 52(4):1107-18. doi:10.21608/amj.2023.326881
7. Rodriguez JZ, Edgley C, Lee S, Leigh N, Wolfe R, Sanford
D, et al. Preoperative transversus abdominis plane block
decreases intraoperative opiate consumption during minimally
invasive cholecystectomy. Surg Endosc. 2023 ;37(3):2209-
2214. doi: 10.1007/s00464-022-09445-x
8. Dost B, Cassai AD, Balzani E, Geraldini F, Tulgar S,
Ahiskalioglu A, et al. Analgesic benefits of pre-operative
versus postoperative transversus abdominis plane block for
laparoscopic cholecystectomy: a frequentist network metaanalysis of randomized controlled trials. BMC Anesthesiol.
2023 ;23(1):408. doi: 10.1186/s12871-023-02369-6
9. Zikri ZHB, Volis M, Mazur A, Orlova T, Alon H, Bar Yehuda
S, et al. The Effect of Various Combinations of Peripheral
Nerve Blocks on Postoperative Pain in Laparoscopic
Cholecystectomy: A Comparative Prospective Study. Int J
Clin Pract. 2023 ;2023:8864012. doi: 10.1155/2023/8864012.
10. Korkutata Z, Tekeli AE, Kurt N. Intraoperative and
Postoperative Effects of Dexmedetomidine and Tramadol
Added as an Adjuvant to Bupivacaine in Transversus
Abdominis Plane Block. J Clin Med. 2023 ;12(22):7001. doi:
10.3390/jcm12227001.
11. Shukla U, Prabhakar T, Malhotra K, Srivastava D.
Intraperitoneal bupivacaine alone or with dexmedetomidine
or tramadol for post-operative analgesia following laparoscopic
cholecystectomy: A comparative evaluation. Indian J Anaesth.
2015; 59(4): 234-9. Doi[;v c v: 10.4103/0019-5049.155001
12. Morgan GE, Mikhail MS. Morgan & Mikhail's clinical
anesthesiology. McGraw-Hill Education. 2022; 18:477
13. Iaquinandi F, Mongelli F, Christoforidis D, Cianfarani A, Pini
R, Saporito A, et al. Laparoscopic vs. ultrasound-guided
transversus abdominis plane (TAP) block in colorectal surgery:
a systematic review and meta-analysis of randomized trials.
Surg Endosc. 2024;38(3):1119-30. doi: 10.1007/s00464-023-
10658-x.
14. Varagani S, Safwan M, Makutam V, Moparthi S, Vaishnavi
S, Kondru S, et al. A comparative study on assessment of
safety and efficacy of Diclofenac, Naproxen and Etoricoxib
in reducing pain in osteoarthritis patients-An observational
study. Int J Curr Res Med Sci. 2024;10(8):31-8. doi:10.22192
/ijcrms.2024.10.08.003
15. Khanum R, Anwar A, Faridi M, Gauhar TM, Ahmed HW,
Ahmed R, et al. Is TAP block better than bupivacaine spray
for relieving post-cholecystectomy pain?. J Rehman Med Inst.
2024 ;10(2):25-30. Doi: org/10.52442/jrmi.v10i2.839
16. Mowafi MM, Elsenity MA, Elbeialy MAK. Surgical
transversus abdominis plane block versus surgical rectus
sheath block for postoperative pain control in morbid obese
patients undergoing major gynaecological surgery: a
prospective, randomized, blinded study. Ain-Shams J
Anesthesiol . 2022;14(1):1-9. https://doi.org/10.1186/s42077-
022-00223-4
17. Aksu R, Patmano G, Biçer C, Emek E, Çoruh AE. Efficiency
of bupivacaine and association with dexmedetomidine in
transversus abdominis plane block ultrasound guided in
postoperative pain of abdominal surgery. Bras J Anestesiol
2018;68(1): 49-56. doi: 10.1016/j.bjan.2017.04.021
18. Brummett CM, Norat MA, Palmisano JM, et al. Perineural
administration of dexmedetomidine in combination with
bupivacaine enhances sensory and motor blockade in sciatic
nerve block without inducing neurotoxicity in rat.
Anesthesiology. 2008;109(3):502-51. doi: 10.1097/ALN.
0b013e318182c26b.
19. Ozalp G, Tuncel G, Savli S, Celik A, Doger C, Kaya M. The
analgesic efficacy of dexmedetomidine added to ropivacaine
patient controlled interscalene analgesia via the posterior
approach. J Anaesth. 2006;21: 409-12. DOI:10.1097/
00003643-200606001-00790
20. Roofthooft E, Joshi GP, Rawal N, Van de Velde M.
PROSPECT guideline for elective caesarean section: updated
systematic review and procedure-specific postoperative pain
management recommendations. Anaesthesia. 2021 ;76(5):665-
680. doi: 10.1111/anae.15339.
21. Chen Z, Liu Z, Feng C, Jin Y, Zhao X. Dexmedetomidine as
an Adjuvant in Peripheral Nerve Block. Drug Des Devel Ther.
2023;17:1463-1484. doi: 10.2147/DDDT.S405294.
22. Nag DS, Gehlot P, Sharma P, Kumar H, Kumar Singh U.
Comparative Study of Ropivacaine and Ropivacaine With
Dexmedetomidine in Transversus Abdominis Plane (TAP)
Block for Post-operative Analgesia in Patients Undergoing
Cesarean Sections. Cureus. 2024 ;16(7):e65588. doi: 10.7759/
cureus.65588.
23. Korkutata Z, Tekeli AE, Kurt N. Intraoperative and
postoperative effects of dexmedetomidine and tramadol added
as an adjuvant to bupivacaine in transversus abdominis plane
block. J Clin Med. 2023 ;12(22):7001. doi: 10.3390/ jcm1222
7001
24. Sinha J, Pokhriyal AS, Asthana V, Nautiyal R. Dexmedetomidine vs Dexamethasone as an Adjuvant to Levobupivacaine
in Ultrasound-Guided Transversus Abdominis Plane Block
for Postoperative Analgesia in Patients Undergoing Total
Abdominal Hysterectomies. Anesth Pain Med.
2023;13(6):e142059. doi: 10.5812/aapm-142059.
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