Comparison of Perineural and Intravenous Dexamethasone Added to Bupivacaine for Ultrasound Guided Transversus Abdominis Plane Block in Hysterectomy Patients for Post Operative Analgesia: A Prospective Study

Background: Abdominal wall incision is a major contributor to the pain experienced by patients after abdominal surgery. Various adjuvants have been used to improve the quality and increase the duration of the local anesthetic action in different peripheral nerves and regional block techniques. Aim: To compare the effectiveness between perineural and intravenous dexamethasone as an adjuvant in ultrasound guided bilateral transversus abdominis plane block for post hysterectomy pain control. Methods: Seventy-five adult patients undergoing elective abdominal hysterectomy under spinal anaesthesia were included in this observational study. The study was conducted in the Department of Anesthesiology and Critical Care, GMCH Kathua. Patients were randomly divided into three groups using chit method, with 25 patients in each group. Patients were grouped as TAP-alone (n =25), TAP-IVD (n =25), and TAP-PD (n=25). TAP-alone group were considered as a control group. The primary outcome was postoperative pain, as evaluated by visual analog scale (VAS) for pain scoring at 0,2,4,6,8,10,12,18 and24 h postoperatively, whereas the secondary outcomes were time to first analgesia (TFA), total number of analgesic doses in 24 hours following surgery and the occurrence of nausea, vomiting and shivering. Result:(VAS score of group III (TAP-PD) was lower than VAS score of group II ( TAP-IVD ) than group I (TAP alone).Time to first analgesic request was significantly longer (p<0.05) in group III(TAP-PD) than group II (TAP-IVD )than group I (TAP alone ).The total analgesic consumption in first 24 hours was significantly lower in group III(TAP-PD) than group II(TAP-IVD) than group I (TAP alone).There were no statically differences with regard to postoperative nausea, vomiting and shivering. Conclusion: Addition of dexamethasone perineurally to bupivacaine in bilateral TAP block is more effective than intravenous dexamethasone, it prolongs the duration and provides potent analgesia and reduces analgesic consumption with decreased incidence of nausea, vomiting and shivering.