Analgesic Effect of Three Different Adjuvants to Bupivacaine in Transversus Abdominis Plane Block after Caesarean Section: A Randomized Controlled Trial.

• Background: A vital component of enhanced recovery programs is optimal pain management after cesarean section (CS). Transversus abdominis plane block (TAPB) is recommended to reduce post-CS pain. • Methods: The study evaluated three different adjuvants to bupivacaine in TAPB after CS. The primary endpoint was the time to first rescue analgesia. The secondary endpoints were the visual analog scale (VAS) for pain, the total opioid consumption, the post-operative vital signs, and patient satisfaction with analgesia. The patients were assigned to four groups regarding the additives to bupivacaine (dexamethasone, Dexmedetomidine (DEX), tramadol, and control groups). The study included 240 patients planned for elective lower-segment CS underneath spinal anesthesia. After surgery, a bilateral posterior ultrasound-guided TAPB was performed. • Results: The first request for analgesia in dexamethasone group was delayed significantly compared to control group (p-value = 0.041). Still, it was statistically insignificant compared to the DEX and Tramadol groups. The opioid analgesic requirement in the dexamethasone group was reduced substantially in comparison to control group (p-value = 0.006). However, it was statistically insignificant compared to the DEX and Tramadol groups. The dexamethasone group had significantly lower VAS ratings from 8 to 24 hours than the other additives. However, VAS scores between 30 minutes and 4 hours and patient satisfaction with analgesia were comparable among groups. • Conclusion: adding dexamethasone, dexmedetomidine, or tramadol to TAPB improved postoperative analgesia without inciting severe adverse effects after CS. The dexamethasone significantly reduced the opioid analgesic requirements and prolonged analgesia for up to 24 hours.