Comparative Evaluation of 0.5% Levobupivacaine with Dexamethasone Versus Fentanyl in Bilateral Ultrasound-Guided Transversus Abdominis Plane Block for Total Abdominal Hysterectomy

Background: Effective postoperative pain control after total abdominal hysterectomy (TAH) is essential for early mobilization and reduced opioid use. This study compared dexamethasone and fentanyl as adjuvants to 0.5% levobupivacaine in bilateral ultrasound-guided transversus abdominis plane (TAP) block. Methods: In this prospective, randomized, double-blind study, 100 ASA I-II patients undergoing elective TAH were allocated into two groups (n=50 each). Group D received 15 mL 0.5% levobupivacaine with dexamethasone 8 mg per side, while Group F received 15 mL 0.5% levobupivacaine with fentanyl 1 µg/kg per side. Primary outcome was duration of analgesia. Secondary outcomes included Visual Analogue Scale (VAS) scores, rescue tramadol consumption, hemodynamic parameters, and adverse effects over 24 hours. Results: Duration of analgesia was significantly longer in Group D (9.70 ± 1.07 h) compared to Group F (5.10 ± 0.63 h) (p<0.001). VAS scores were significantly lower in Group D at 4, 6, and 12 hours (p<0.001). Total tramadol consumption was reduced in Group D (52.0 ± 15.8 mg) versus Group F (74.4 ± 18.2 mg) (p<0.001). Hemodynamic parameters were more stable in Group D. No significant adverse effects were observed. Conclusion: Dexamethasone is a superior adjuvant to fentanyl in TAP block for TAH, providing prolonged analgesia and reduced opioid requirements without added complications.