Abstract
Introduction: Laparoscopic surgeries are commonly performed surgical procedures in day to day practice. These patients require a multimodal postoperative pain treatment regimen that provides high quality analgesia with minimal side effects. Opioids, such as morphine, delivered using a patient-controlled analgesia device, remain the mainstay of postoperative analgesic regimens for such patients. TAP block is a regional anaesthetic technique that has been applied as one segment of a multimodal pain regimen in abdominal surgeries. Addition of dexamethasone as adjuvant to bupivacaine in TAP block provides prolonged post-operative analgesia and better pain control than LA alone. The duration of LA was longer with decreased VAS scores and the time of request for rescue morphine doses was less in dexamethasone group. Objectives: Evaluate efficacy of TAP block in providing post-operative analgesia in laparoscopic surgeries. Evaluate pain severity using VAS. Evaluate need for rescue analgesia. Evaluate safety and adverse effects of TAP block. Group 1 - 15 ml 0.25% Bupivacaine with Dexamethasone 8mg on both sides if surgical incision involved both sides of rectus sheath. Group 2 - 15 ml 0.25% Bupivacaine with normal saline. Results: The duration of analgesia increased considerably in study group. The time for request of analgesia was increased (364.7 min) in study group when compared to control group (148.0 min). Conclusion: dexamethasone to TAP block produces immense post-operative analgesia along with reduced VAS score, increased the duration of analgesia and reduced rescue analgesic dose requirements. Keywords: TAP block, Dexamethasone, VAS score.
Highlights
Laparoscopic surgeries are commonly performed surgical procedures in day to day practice
In the study group 28 patients were belonging to ASA class I and rest were of class II, where as in the control group 31 patients belonged to ASA class I and 4 were in class II. (Table 2) Our study showed that, Transversus abdominis plane (TAP) block with dexamethasone or normal saline is not influenced by ASA class of the patient undergoing the Block/procedure
Statistical significance was not noted indicating that these parameters did not influence duration of post op analgesia with TAP block in both the groups. (Table 3)
Summary
Conclusion: dexamethasone to TAP block produces immense post-operative analgesia along with reduced VAS score, increased the duration of analgesia and reduced rescue analgesic dose requirements. Laparoscopic surgeries are commonly performed surgical procedures in day to day practice These patients require a multimodal postoperative pain treatment regimen that provides high quality analgesia with minimal side effects. Opioids, such as morphine, delivered using a patient-controlled analgesia (PCA) device, remain the mainstay of postoperative analgesic regimens for such patients. Use of intravenous NSAIDs, such as ketorolac, has been limited due to side effects including bleeding, gastric mucosal damage and renal toxicity.[5,6]
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