Ultra-Sound Guided Quadratus Lamborum Block Using Dexamethasone and Bupivacaine versus Dexmedetomidine and Bupivacaine for Post-Operative Analgesia after Labaroscopic Cholecystectomy

Abstract

Abstract Background The goal of postoperative pain management is provision of comfort, early mobilization and improved respiratory function without causing inadequate sedation and respiratory compromise, which can be achieved through using regional anethesia. Transversus abdominis plane (TAP) block has been increasedly used for postoperative pain relief after lower abdominal surgeries. The main advantage of quadratus lumborum block (QLB) compared to TAP block is the extension of local anesthetic agent beyond the transversus abdominis plane to the thoracic paravertebral space. The wider spread of the local anesthetic agents may produce extensive analgesia and prolonged action of the injected local anesthetic solution. Objective To assess the analgesic effect of addition dexamethasone or Dexmedetomidine with bupivacaine in ultrasound-guided QLB to prolong it’s duration in patients undergoing laparscopic abdominal surgeries in the early postoperative period regarding pain relief, provision of comfort, and improved respiratory functions. Patients and Methods After approval of anesthesiology department scientific and ethical committees in Ain Shams University Hospitals, patients undergoing laparscopic abdominal surgeries were included in the study, and were divided into two groups (n = 10; each); group A and B . Where in group A patients(n = 10) received 20 ml bupivacaine 0.5% plus 100 μg Dexmedetomidine diluted in 5ml 0.9% NaCl (the total volume injected in all patients is 25 ml), and group B patients (n = 10) received 20 ml bupivacaine 0.25% plus 8 mg dexamethasone (2 ml) plus 3 ml 0.9% NaCl . Results The thesis proved that the addition of either Dexmedetomidine or dexamethasone to bupivacaine 0.25% in ultrasound guided QLB for laparscopic abdominal (cholecystectomy) surgeries hastened the onset, prolonged the duration of sensory block, increased post-operative analgesia and decreased rescue analgesia needed without increasing the risk of adverse effects, with Dexmedetomidine showing better results. Conclusion The addition of either 100 μg Dexmedetomidine diluted in 5 ml 0.9% NaCl or 8 mg dexamethasone to 20 ml bupivacaine 0.25% in ultrasound guided quadratus lumborum block for laparscopic abdominal surgery prolonged the duration of analgesia significantly and decreased the postoperative analgesic requirement. Hence, our study suggests that either Dexmedetomidine or dexamethasone may be a useful alternative as an adjuvant to long-acting local anesthetics for quadratus lumborum nerve block with Dexmedetomidine showing better results.