Comparison of the Effect of Adding Dexmedetomidine Versus Dexamethasone to Bupivacaine in Transverse Abdominis Plane Block on Postoperative Pain Intensity in Patients Undergoing Laparoscopic Cholecystectomy

TL;DR

This study compares how adding dexmedetomidine or dexamethasone to bupivacaine in a nerve block affects post-surgery pain and recovery after gallbladder removal.

Contribution

The study introduces a direct comparison of two adjuvants, dexmedetomidine and dexamethasone, in enhancing bupivacaine's analgesic effects for postoperative pain management.

Findings

Dexmedetomidine added to bupivacaine significantly reduced postoperative pain and morphine use compared to dexamethasone and control groups.

Hospital stays were shorter in the dexmedetomidine group compared to the control group.

Both adjuvants prolonged sensory block duration compared to bupivacaine alone.

Abstract

Laparoscopic cholecystectomy, compared to open surgery, offers advantages such as lower pain levels and shorter hospitalization. However, postoperative pain remains a common challenge. Inadequate pain control may lead to discomfort, reduced mobility, and prolonged hospitalization. This study aimed to compare the effect of adding dexmedetomidine versus dexamethasone to bupivacaine in transverse abdominis plane (TAP) block on postoperative pain intensity in patients undergoing laparoscopic cholecystectomy.

The present study aimed to compare the efficacy of dexmedetomidine and dexamethasone as adjuvants to bupivacaine in ultrasound-guided TAP blocks for laparoscopic cholecystectomy. Primary outcomes included sensory block duration, postoperative pain scores, 24-hour morphine consumption, and time to rescue analgesia. Secondary outcomes included sedation levels, hemodynamic stability, and incidence of adverse events.

This randomized, double-blind, controlled clinical trial included 120 ASA I-II patients aged 18 - 65 years, allocated into three groups: Bupivacaine alone, dexamethasone + bupivacaine, and dexmedetomidine + bupivacaine. Pain intensity, morphine consumption, time to first analgesia, block characteristics, hospital stay, and complications were evaluated.

The addition of dexmedetomidine or dexamethasone to bupivacaine in ultrasound-guided TAP blocks significantly improved postoperative outcomes. Compared to the control group (bupivacaine alone), both adjuvants reduced pain intensity (VAS scores, P < 0.001) and 24-hour morphine consumption (P < 0.001), with dexmedetomidine demonstrating superior efficacy. Sensory block duration was prolonged in the dexmedetomidine (330 minutes) and dexamethasone (180 minutes) groups versus control (155 minutes; P < 0.001). Hospital stays were shortest in the dexmedetomidine group (1 day vs. 2.5 days control; P < 0.001).

Adding dexmedetomidine or dexamethasone to bupivacaine in TAP block enhances analgesia and shortens hospital stay following laparoscopic cholecystectomy.