Comparison of Effectiveness between Perineural and Intravenous Dexamethasone as an Adjuvant to Bupivacaine on Transversus Abdominis plane block for post Cesarean delivery pain control.
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Date
2019-06
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Addis Ababa University
Abstract
Back ground: Caesarean delivery (CD) has been one of the most frequently performed major surgical interventions, and causes severe postoperative pain. Abdominal field blocks like TAP block are mostly preferred as post-operative analgesia for this operation. Using different adjuvants like dexamethasone by different routes increases the quality and duration of block and maximizes patient satisfaction.
Objective: The objective of this study was to compare the analgesic effectiveness between perineural and intravenous dexamethasone as an adjuvant to bupivacaine on bilateral transversus abdominis plane block for post cesarean delivery pain control after SA.
Methodology: An institutional based prospective cohort study was conducted on 87 patients. Study participants were selected by systematic random sampling technique. Data collection methods include preoperative chart review, intraoperative observation and postoperative patient interview at 4th, 6th, 8th, 12th and 24th hours. Sociodemographic variable were analyzed by ANOVA and chi square test. Kruskal Wallis with post hoc analysis was used to compare post-operative severity of pain score and cumulative analgesic consumption. Time to first analgesic request was analyzed using Kaplan Meier survival analysis with log rank. Categorical variable were analyzed by chi square.
Result: Time to first analgesic request was significantly longer in TAP-IVD and TAP-PD compared to TAP alone (p < 0.05). The postoperative NRS score at rest and on coughing were significantly lowered in TAP-PD and TAP-IVD group compared to TAP alone group (p <0.05).The total analgesic consumption in the first 24h was significantly lower in TAP-IVD and TAP-PD group compared to TAP alone group (p < 0.05).
Conclusion and recommendation: dexamethasone 8mg both intravenously and perineurally is effective adjuvant to bupivacaine on bilateral TAP block with prolonged time to first analgesic request, reduced severity of pain and total analgesic consumption. Therefore, TAP-PD and TAP-IVD are a valuable alternative to each other for post cesarean delivery pain control and we recommend use of perineural or intravenous dexamethasone as an adjuvant to bupivacaine on bilateral transversus abdominis plane block.
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Keywords
TAP block, intravenous dexamethasone, perineural dexamethasone