Key result
Adding dexmedetomidine to bupivacaine in ultrasound-guided bilateral rectus sheath block significantly reduced postoperative pain scores at 24 hours (median VAS 5 vs 7, p<0.001) compared to bupivacaine alone.
Why the study?
Does adding dexmedetomidine to bupivacaine in ultrasound-guided BRSB improve postoperative pain and reduce morphine consumption in adult cancer patients undergoing midline laparotomy?
RCT (n=60)
Double-blind
Computer-generated random numbers
No
Does adding dexmedetomidine to bupivacaine in ultrasound-guided BRSB improve postoperative pain and reduce morphine consumption in adult cancer patients undergoing midline laparotomy?
Adding dexmedetomidine to bupivacaine in ultrasound-guided bilateral rectus sheath block significantly improves postoperative pain control and reduces morphine consumption in cancer patients undergoing midline laparotomy.
Supports dexmedetomidine adjunct in rectus sheath blocks for laparotomy; extends RCT evidence on adjunctive regional analgesia in cancer surgery.
Background: Extended midline laparotomy incision is accompanied by intense pain postoperatively which affects patients’ physiology; therefore, good control of postoperative pain is mandatory to decrease the adverse effects on the body. Ultrasound-guided Bilateral Rectus Sheath Block (BRSB) is one of the options to achieve this goal. Objective: The study aimed to assess the analgesic potency of adding dexmedetomidine to bupivacaine in ultrasound-guided BRSB in cancer patients with a midline laparotomy incision. Methods: Sixty adult cancer patients planned for laparotomies with extended midline incision were included. Ultrasound-guided BRSB was performed immediately after the induction of anesthesia. Patients were classified randomly into two groups; B group, where only bupivacaine was used for BRSB and BD group in whom a mixture of bupivacaine and dexmedetomidine was used. Results: A significant decrease in visual analogue scale scores, total morphine consumption, postoperative nausea and vomiting and postoperative cortisol levels was observed in group BD. Conclusion: Dexmedetomidine as an adjuvant to bupivacaine in US-guided rectus sheath block bilaterally proved to be effective for proper pain management postoperatively in cancer patients after extended midline abdominal incision.
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Salem et al. (2019) conducted an RCT in Abdominal cancer requiring midline laparotomy (n=60). Dexmedetomidine added to bupivacaine vs. 20 ml of 0.25% bupivacaine alone was evaluated on Intensity of postoperative pain measured by Visual Analogue Scale (VAS) score at 24 hours (p=< 0.001). Adding dexmedetomidine to bupivacaine in ultrasound-guided bilateral rectus sheath block significantly reduced postoperative pain scores at 24 hours (median VAS 5 vs 7, p<0.001) compared to bupivacaine alone.
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