Comparitive Study Of Dexamethasone Vs Clonidine As An Adjuvant To Levobupivacaine In Transversus Abdominis Plane Block For Postoperative Pain In Patients Undergoing Total Abdominal Hystrectomy

Abstract

Introduction: Transversus abdominis plane (TAP) block is a regional anaesthetic technique in which a local anaesthetic agent is
deposited in the TAP to block the sensory nerves supplying the anterior abdominal wall.1 TAP block has been used successfully for
pain relief after Total Abdominal Hysterectomy (TAH),which in turn improved surgical outcome and decreases patient’s morbidity.
Aim: To compare the effect of 0.25% Levobupivacaine with 8mg Dexamethasaone (group LD) and 0.25% Levobupivacaine with 1.0
µg/kg bodyweight of Clonidine (group LC) on the duration of post-operative analgesia.
Method: A prospective randomized double-blinded comparative study was conducted, involving hundred ASA I and II, adult patients
posted for elective Total Abdominal Hysterectomy under general anaesthesia.The patients were randomly divided into two groups LD
and LC, each comprising of fifty patients Group LD received 0.25% Levobupivacaine with 8mg Dexamethasaone and Group LC
received 0.25% Levobupivacaine with 1.0 µg/kg bodyweight of Clonidine. USG guided TAP block was performed under all aseptic
precautions, in the lumbar triangle of Petit bilaterally once the surgery has ended before extubation. The block effects in the two groups
under study were compared in terms of postoperative Numeric Pain Rating scale (NPRS), duration of analgesia (time for first rescue
demand) in the postoperative period upto 24 hours, number of demands for rescue analgesics, haemodynamic parameters like HR, SBP
and DBP.
Results: The demographic profile of patient in both the groups was similar with regard to age, sex, weight, BMI and ASA grade. NPRS
was significanly lower in LD group at 1,2,4,6,8 and 12 hours postopertaively as compared to LC group. The time of first rescue
analgesia was longer in LD group (626.40±40.93 minutes) versus LC-Group (403.40±31.63 minutes). The haemodynamaic parameters
and arterial oxygen saturation of both the groups were comparable.
Conclusion: Dexamethasone as adjuvant to 0.25% levobupivacaine (LD) reduces postoperative pain scores, prolongs the duration of
analgesia and decreases demands for rescue analgesia in ultrasound guided transversus abdominis plane block in comparison to 0.25%
levobupivacaine with clonidine (LC) without any clinically significant adverse effects.