Comparative Analgesic Effect of Dexamethasone and Ketamine as Adjuncts to Plain Bupivacaine Using TAP Block For Elective Post-Caesarean Pain Relief

Background: Transversus abdominis plane (TAP) block has been demonstrated to be an effective post-operative analgesic modality for caesarean section. However, various adjuncts have been used to prolong the analgesic effect of TAP block. The study aimed to evaluate the analgesic effect of dexamethasone and ketamine as adjuncts to plain bupivacaine for TAP following caesarean section. Subjects and Methods: Forty six eligible patients were randomized into two groups D and k (21 each) to receive TAP block. Group D received 40ml of 0.25% bupivacaine + 6mg dexamethasone and group K received 40ml of 0.25% bupivacaine +0.5mg/kg ketamine respectively. The duration of analgesia, pain scores, hemodynamic variables, and patient satisfaction using Likert- 5 scale were assessed and recorded. Data was collected and assessed using SPSS 21 for Windows. Numerical data was analyzed using unpaired Student t-test, while categorical data was analyzed using chi-square test. A p-value < 0.05 was considered significant. Result: The duration of analgesia was significantly (p<0.000) longer in dexamethasone group (1140.0±227.68) compared to ketamine group (846.0±211.37). The mean VAS score became significantly (p<0.000) lower in dexamethasone group (2.25±1.12) at 12hrs of the block compared to ketamine group (4.37±2.01). 95% of the patients (20) in group dexamethasone were satisfied with the procedure compared to 60% of patients (12) in ketamine group. This difference was statistically significant. Conclusion: The study concluded that 6mg dexamethasone when used as an adjuvant to plain bupivacaine via TAP block provided better analgesic profile after caesarean section compared to ketamine as an adjuvant.