Key result
The addition of dexmedetomidine to ropivacaine for transversus abdominis plane block after cesarean section significantly prolonged the duration of analgesia compared to ropivacaine alone (282.6 vs 192.2 minutes, p<0.001).
Why the study?
Although TAP block provides effective multimodal postoperative analgesia after cesarean section, the comparative efficacy of adding dexmedetomidine to ropivacaine versus ropivacaine alone needed evaluation.
Does the addition of dexmedetomidine to ropivacaine in TAP block prolong post-operative analgesia in pregnant patients undergoing cesarean section?
RCT (n=100)
Double-blind
Computer generated program using random numbers
No
Does the addition of dexmedetomidine to ropivacaine in TAP block prolong post-operative analgesia in pregnant patients undergoing cesarean section?
Adding dexmedetomidine to ropivacaine for TAP block after cesarean section significantly prolongs analgesia and reduces opioid consumption without increasing side effects.
Supports dexmedetomidine addition to ropivacaine TAP blocks after cesarean delivery; extends RCT evidence for adjunctive regional analgesia.
Background: Studies have demonstrated the efficacy of Transverses abdomen plane (TAP) block as a component of multimodal postoperative analgesia after cesarean section. The aim of the present study was to compare the efficacy of combination of dexmedetomidine and ropivacaine to ropivacaine alone for Transversus abdominis plane (TAP) block as post-operative analgesic after lower segment cesarean section (LSCS). Subjects and Methods: A randomized double blind, prospective study was conducted on 100 ASA grade I and II pregnant patients undergoing LSCS under spinal anesthesia. They were randomly divided into two groups, group I (n=50) received 20 ml of ropivacaine 0.25% and 2 ml of normal saline while group II (n=50) received 0.5 mcg/kg dexmedetomidine dissolved in 2 ml of normal saline and 20 ml of ropivacaine 0.25% as bilateral TAP block at the end of surgery. The total duration of effective analgesia was recorded as primary outcome and secondary outcomes were pain score, total requirement of analgesics in the first 24hrs postoperatively and side effects. Results: The time for first analgesic dose was longer in group I than group II (282.58 vs 192.2 min, p<0.05) and total dose of Tramadol used in the first 24 hrs was less among patients in group II when compared with those in group I (72 vs. 98 mg, p<0.05). Pain was significantly reduced at all postoperative points for the first 6 hrs in group II compared with group I (p<0.05). Changes in systolic, diastolic and mean arterial pressure and heart rate were statistically insignificant in both groups. There was no statistically significant difference in the incidence of side effects in both groups. Conclusion: In conclusion, this study shows that addition of dexmedetomidine to ropivacaine for TAP block after cesarean section, achieves better analgesia and provides longer duration of pain control post-operatively without any major side-effects.
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Mall et al. (2019) conducted an RCT in Post-operative pain after cesarean section (n=100). Dexmedetomidine and ropivacaine vs. 20 ml of ropivacaine 0.25% + 2 ml normal saline was evaluated on Duration of effective analgesia (time to first analgesic request in minutes) (p=<0.001). The addition of dexmedetomidine to ropivacaine for transversus abdominis plane block after cesarean section significantly prolonged the duration of analgesia compared to ropivacaine alone (282.6 vs 192.2 minutes, p<0.001).
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