Department of Anesthesia, Harar College of Health Science, Harar, Ethiopia.
Department of Anesthesia, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia.
BMC Anesthesiol. 2021 Nov 22;21(1):292. doi: 10.1186/s12871-021-01513-4.
During transverses abdominal plane block (TAP) procedure to provide analgesia in cesarean section (CS) operation, the use of perineural dexamethasone as an additive agent may improve pain relief and may cause a prolonged block duration. This study aims to investigate whether perineural dexamethasone, when added to bupivacaine local anesthetic agent during a TAP block, may provide adequate pain relief without adverse events.
This is a prospective cohort study of fifty-eight patients undergoing elective CS with spinal anesthesia. We hypothesized to perform bilateral TAP block using perineural dexamethasone as an additive agent. The patients were randomly divided into two groups using a systematic random sampling method. While one group of patients received perineural dexamethasone of 8 mg additive agent together with bupivacaine 0.25% 40 ml (Group TAPD), the other group received only bupivacaine 0.25% 40 ml in TAP block (Group TAPA). The primary outcomes are the period for the first request of postoperative pain relief medication and the numerical rating scale (NRS) pain intensity scores at 2, 6, 12, and 24 h after surgery. The secondary outcomes are comparing the 24-h tramadol and diclofenac analgesic requirements and the incidences of side effects on postoperative day one. A p-value of < 0.05 is statistically significant.
The time to first analgesic request was 8.5 h (8.39-9.79) in the TAPD group versus 5.3 h (5.23-5.59) in the TAPA group, respectively. (p < 0.001) The median NRS scores were significantly reduced in the TAPD group compared to the TAPA group at 6, 12, and 24 h after surgery (p-values < 0.001). The total analgesics consumption over 24 h postoperatively was lower in Group TAPD compared to Group TAPA (p < 0.05).
An additive agent of perineural dexamethasone at a dose of 8 mg during bilateral TAP block for elective CS operation under spinal anesthesia provided better pain relief on postoperative day 1.
在行剖宫产术（CS）时进行腹横肌平面阻滞（TAP）时，使用神经周围地塞米松作为附加剂可能会改善镇痛效果，并可能延长阻滞持续时间。本研究旨在探讨在 TAP 阻滞中，将神经周围地塞米松添加到布比卡因局麻药中是否可以在没有不良反应的情况下提供足够的镇痛效果。
这是一项前瞻性队列研究，共纳入 58 例行脊髓麻醉下择期 CS 的患者。我们假设使用神经周围地塞米松作为添加剂进行双侧 TAP 阻滞。患者采用系统随机抽样法随机分为两组。一组患者在 TAP 阻滞中接受 8mg 地塞米松添加剂与布比卡因 0.25%40ml（TAPD 组），另一组仅接受 TAP 阻滞中布比卡因 0.25%40ml（TAPA 组）。主要结局是术后首次要求使用止痛药的时间和术后 2、6、12 和 24 小时的数字评分量表（NRS）疼痛强度评分。次要结局是比较术后第 1 天 24 小时曲马多和双氯芬酸的镇痛需求以及不良反应的发生率。p 值 < 0.05 具有统计学意义。
TAPD 组首次镇痛请求时间为 8.5 小时（8.39-9.79），TAPA 组为 5.3 小时（5.23-5.59）。（p < 0.001）与 TAPA 组相比，TAPD 组术后 6、12 和 24 小时的 NRS 评分中位数显著降低（p 值均 < 0.001）。术后 24 小时内的总镇痛药物消耗量在 TAPD 组低于 TAPA 组（p < 0.05）。
在脊髓麻醉下进行双侧 TAP 阻滞时，神经周围地塞米松剂量为 8mg 作为附加剂，可在术后第 1 天提供更好的镇痛效果。
