Effect of Adding Dexmedetomidine as Adjuvant to Different Regional Anesthetic Techniques after Inguinal Herniorrhaphy

Abstract

Background: Inguinal herniorrhaphy is one of the most commonly performed surgeries, often performed on a fast-track basis. However, inguinal herniorrhaphy is frequently associated with persistent postoperative discomfort and pain, which can lead to patient distress, delayed discharge, and subsequent complication. Objective: Aim of this work is to compare TAP block technique versus local infiltration with or without dexmedetomidine regarding analgesic effect and endogenous stress response. Patients and Methods: This randomized prospective study included 120 patients of both genders scheduled for non-complicated inguinal hernioplasty. Their age ranged between 18 and 60 years, with ASA physical status I and II, and body mass index ≤ 35 kg /m². The study was approved by the medical ethics committee of Al-Azhar University Hospital in Assiut and a written informed consent is obtained from all patients. Results: The major finding in this study was that the pain scores were statistically significantly lower when we added dexmedetomidine than when we did not add it and in the surgical site infiltration groups than TAP block groups at postoperative 2nd, 6th, and12th hours. 1st request for analgesia in this study among all groups was similar. Frequency of analgesic doses was statistically significant among all groups, and group T used the most frequent doses. In this study, local wound infiltration and TAP block with dexmedetomidine showed decrease number of analgesic doses and attenuated the stress response indicators (norepinephrine and glucose levels) without side effects. Conclusion: Dexmedetomidine added to bupivacaine in both local infiltration and TAP block had better visual analogue scale, decreased number of analgesic doses and attenuated postoperative stress response indicators. Norepinephrine is the most accurate stress response indicator while blood glucose is accurate and the cheapest one.