IMPACT OF PERINEURAL DEXAMETHASONE ADDED TO BUPIVACAINE FOR TRANSVERSUS ABDOMINIS PLANE BLOCK IN POST-CESAREAN DELIVERY PAIN CONTROL. A PROSPECTIVE, RANDOMIZED, DOUBLE- BLIND, CONTROLLED TRIAL
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Date
2022-10-18
Authors
Noor Jamal Ahmad Shaheen
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Abstract
Background: Acute pain after Cesarean delivery (CD) is one of the most important outcomes that an obstetric anesthesiologist can influence.
Aim: The major aim of the present study is to compare the efficacy of perineural dexamethasone as an adjuvant for bupivacaine versa bupivacaine alone on bilateral transverse abdominis plan block for pain control after cesarean section for patients undergoing spinal anesthesia.
Method: This prospective, randomized, double-blinded, placebo-controlled trial, 80 women ASA II scheduled for caesarean section, followed by TAP block. The participants were randomized into two groups, Group (1) received mixture of 1ml dexamethasone (4 mg) added to 20 ml bupivacaine 0.25% for each side. Group (2) received 1ml normal saline 0.9% added to 20 ml bupivacaine 0.25% for each side, then the patients were observed postoperatively for 24 h for first rescue analgesic requirement, total rescue analgesic consumption, pain scores on the visual analogue scale (VAS), and the incidence of other complications (nausea, vomiting and shivering).
Results: Data on demographics are comparable between the TABD and the TABA groupings. The first request analgesia mean in minutes in the TABA group (359.08 ± 12.86) is considerably lower than the first request analgesia mean in the TABD group (mean = 521.25), with a P-value of 0.001 for the test. When compared to the TABA group, the postoperative VAS score at rest was considerably lower in the TABD group. The findings indicate that, over the entire study period, the TABA group's mean VAS scale at rest (mean = 3.1) is substantially greater than the TABD group's mean VAS scale (mean = 2.2), P = 0.001. In addition, the TABA group's mean VAS score (mean = 3.19) when coughing is substantially greater than the TABD group's mean (mean = 2.39), with a P-value of 0.001 for the test.
Conclusion: In patients undergoing cesarean section under spinal anesthesia, perineural dexamethasone 8 mg given to bupivacaine (40 ml (20 ml each side), 0.25%) is an effective adjuvant to bupivacaine on bilateral TAP block with extended and powerful analgesia that delayed the time to the first analgesic request and decreased the intensity of postoperative pain without side effects.
Keywords: Cesarean Section; Dexamethasone; Pain; Transversus Abdominis Plane Block.