Addition of Dexmedetomidine to Ropivacaine in Subcostal Transversus Abdominis Plane Block Potentiates Postoperative Analgesia among Laparoscopic Cholecystectomy Patients: A Prospective Randomized Controlled Trial.

Abstract

Context:Laparoscopic cholecystectomy is associated with moderate intensity postoperative pain especially in the early postoperative period. Transversus abdominis plane (TAP) block has been shown to reduce pain scores and analgesic requirements after abdominal surgery.Aims:We hypothesized that a subcostal TAP block with ropivacaine and dexmedetomidine will prolong the duration of postoperative analgesia following laparoscopic cholecystectomy.Settings and Design:This prospective, randomized study was done in 60 patients undergoing laparoscopic cholecystectomy surgery done at a tertiary care institution.Subjects and Methods:Sixty patients undergoing laparoscopic cholecystectomy were randomized into two groups to receive either bilateral ultrasonography-guided subcostal TAP blocks with 18 mL 0.375% ropivacaine and 2 ml of normal saline (n = 30, Group R) or 18 ml. 375% ropivacaine with 0.5 μg/kg dexmedetomidine 2 mL (n = 30, Group RD). Numerical rating scale was measured postoperatively to primarily assess the pain severity and analgesic requirement for the first 24 h, hemodynamic parameters, and adverse effects were recorded.Statistical Analysis Used:Categorical data were analyzed using Chi-square test/Fisher's exact test and quantitative data were analyzed using Student's t-test and the Mann–Whitney U-test.Results:The study group (Group RD) had significantly prolonged postoperative analgesia (485.6 min) as compared to Group R (289.83 min). Moreover, consumption of morphine over 24-h period is significantly less in Group RD (14.5 mg) as compared to Group R (28.5 mg).Conclusions:Addition of dexmedetomidine to ropivacaine in TAP block prolongs postoperative analgesia and reduces opioid consumption without any major adverse effects.