ULTRASOUND-GUIDED TRANSVERSE ABDOMINIS PLANE BLOCK WITH ROPIVACAINE OR ROPIVACAINE WITH DEXAMETHASONE FOR POSTOPERATIVE ANALGESIA IN PATIENTS UNDERGOING LOWER SEGMENT CAESAREAN SECTION
Main Article Content
Keywords
Dexamethasone, lower segment caesarian section, postoperative analgesia;, ropivacaine, TAP block, ultrasound
Abstract
BACKGROUND AND AIM: LSCS is the most commonly performed surgery all over the world. [1] Multimodal analgesia in the form of parenteral NSAIDs, patient-controlled analgesia with opioids, epidural analgesia, wound infiltration and peripheral nerve blocks have been tried over several decades. [2] More recently, ultrasound-guided TAP block has been described with promises of better localization and deposition of the local anaesthetic with improved accuracy. Thus, in the current study, we assess the efficacy of 0.2% ropivacaine with or without dexamethasone used as an adjuvant in USG-guided TAP block in providing postoperative analgesia in LSCS patients.
METHOD: A prospective, randomised, double-blinded study was conducted in our tertiary care hospital on sixty pregnant patients of ASA-2 posted for LSCS under spinal anaesthesia. The study population was divided into 2 groups of 30 patients each. They received a USG-guided TAP block; Group A with 20 ml of 0.2% ropivacaine alone and Group B with 20 ml of 0.2% ropivacaine with dexamethasone 4mg on each side at the end of the surgery. Tramadol 100 mg was administered intravenously in case of NRS > 3 and the time to first rescue analgesia was noted. Patient satisfaction scores and complications like intravascular injection, local anaesthesia systemic toxicity, haematoma at the injection site, paresthesia, nausea, vomiting, hypotension and bradycardia were also recorded if any.
RESULTS: The time to first rescue analgesia in group A was 15.21 5.26hrs and in group B was 22.82 4.75hrs which was statistically significant. No block-related complications were noted.
CONCLUSION: We conclude that the addition of dexamethasone to ropivacaine in the TAP block for LSCS significantly prolongs the duration of postoperative analgesia.
References
2. McDonnell NJ, Keating ML, Muchatuta NA, et al. Analgesia after caesarean delivery. Anaesth Intensive Care 2009;37:539-51.
3. Laviola S, Kirvelä M, Spoto MR, Tschuor S, et al. Pneumocephalus with intense headache and unilateral pupillary dilatation after accidental dural puncture during epidural anesthesia for cesarean section. Anesth Analg. 1999;88:582–3.
4. Hebbard P, Fujiwara Y, Shibata Y, et al. Ultrasound- guided transversus Abdominis plane (TAP) block. Anaesthesia and Intensive Care 2007;35:616-7.
5. Anie Gupta, Alok Gupta, Neeraj Yadav. Effect of dexamethasone as an adjuvant to ropivacaine on duration and quality of analgesia in ultrasound-guided transversus abdominis plane block in patients undergoing lower segment cesarean section - A prospective, randomised, single-blinded study. Indian journal of anaesthesia 2019; 63(6):469-474.
6. Liu SS, Wu CL. Effect of postoperative analgesia on major postoperative complications: a systematic update of the evidence. Anesth Analg 2007;104(3):689–702.
7. D. Belavy, P. J. Cowlishaw, M. Howes and F. Phillips, Ultrasound-guided transversus abdominis plane block for analgesia after Caesarean delivery. British Journal of Anaesthesia 2009;103(5): 726–30.
8. Carney J, McDonnell JG, Ochana A, et al. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy. Anaesth Analg 2008;107(6):2056-60.
9. Niraj G, Searle A, Mathews M, et al. The analgesic efficacy of ultrasound guided transversus abdominis plane (TAP) block in patients undergoing open appendicectomy. Br J Anaesth 2009;103(4):601-05.
10. Paul D, Kulkarni SN, Gupta N, et al. Comparison of postoperative analgesic effect of transversus abdominis plane block versus direct wound infiltration with local anesthetic for lower segment cesarean section. J Mar Med Soc 0;0:0
11. Das N, Shukla U, Singh D, et al. Comparison of analgesic efficacy between TAP block and local site infiltration post operatively in caesarean section. Int J Res Med Sci 2018;6:1407- 13.
12. Kiran LV, Sivashanmugam T, Kumar VR, et al. Relative efficacy of ultrasound-guided ilioinguinal-iliohypogastric nerve block versus transverse abdominis plane block for postoperative analgesia following lower segment cesarean section: A prospective, randomized observer-blinded trial. Anesth Essays Res 2017;11:713-7.
13. Rafi A. N. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia. 2001;56(10):1024–1026.
14. Tran TMN, Ivanusic JJ, Hebbard P, et al. Determination of spread of injectate after ultrasound-guided transversus abdominis plane block: A cadaveric study. Br J Anaesth 2009;102:123-27.
15. Parmar R, Bhut C, Trivedi L, et al. Clinical evaluation of efficacy and safety of transversus abdominis plane block with bupivacaine and ropivacaine for post-operative analgesia following lower segment caesarean section: A prospective, randomized, controlled, double blind study. Indian J Clin Anaesth 2019;6(2):189-93.
16. McDonnell JG, Curley G, Carney J, et al. The analgesic efficacy of transversus abdominis plane block after cesarean delivery: a randomized controlled trial. Anesth Analg. 2008;106(1):186-91.
17. Jadon A, Jain P, Chakraborty S, et al. 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 Anesthesiol. 2018;18(1):53.
18. Akkaya A, Yildiz I, Tekelioglu UY, et al. Dexamethasone added to levobupivacaine in ultrasound-guided tranversus abdominis plain block increased the duration of postoperative analgesia after caesarean section: a randomized, double blind, controlled trial. Eur Rev Med Pharmacol Sci. 2014;18(5):717-22.
19. Raghukumar M, Majigoudar S S, A randomized clinical comparative trial to study the efficacy of adding Clonidine or Dexamethasone to Bupivacaine(0.5%) in prolonging the duration of post operative analgesia with ultrasound guided TA. Indian J Clin Anaesth 2017;4(2):198-201.
20. Naveen S, Singh RK, Sharma PB, et al. Evaluation of transversus abdominis plane block for postoperative analgesia after lower segment cesarean section. Karnataka Anaesth J 2017;3:41-4.
21. Abdalla W. Ultrasound-guided transversus abdominis plane block for radical cystectomy with and without dexamethasone: a prospective, double-blinded controlled trial. Ain-Shams J Anaesthesiol 2014;7:539-44.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Reshma B.M
Postal Address: Dr. B. R Ambedkar Medical College & Hospital, K.G Halli, Bangalore, Karnataka- 560045, Phone: 8892019120
Dr. Sahana S
Senior Resident, Department of Anaesthesiology, Sri Balaji Medical College Hospital & Research, Tirupati, Andhra Pradesh
Dr. Ravindra S Padial
Consultant, Department of Anaesthesia, Community Health Center, Yadrami, Gulbarga, Karnataka.
Dr. Harsoor S S
Professor and HOD, Department of Anaesthesiology, Dr. B.R. Ambedkar Medical College& Hospital, Bangalore, Karnataka
Dr. Vinod B. N
Post Graduate, Department of Otorhinolaryngology, Akash Institute of Medical Sciences & Research Institute, Bangalore, Karnataka.