Sinha Jyoti, Pokhriyal Abhimanyu Singh, Asthana Veena, Nautiyal Ruchira
Department of Anesthesiology, Himalayan Institute of Medical Sciences, Jollygrant, Dehradun.
Department of Gynecology, Himalayan Institute of Medical Sciences, Jollygrant, Dehradun.
Anesth Pain Med. 2023 Dec 10;13(6):e142059. doi: 10.5812/aapm-142059. eCollection 2023 Dec.
In the postoperative period, open total abdominal hysterectomy (TAH) surgeries induce considerable pain. Multimodal strategies are being used to alleviate pain.
This study aimed to examine the efficacy and safety of dexamethasone and dexmedetomidine as an adjuvant to levobupivacaine in ultrasound-guided transversus abdominis plane (TAP) blocks for postoperative pain in TAH patients.
A total of 72 patients with ASA grade I and grade II were randomly and equally assigned to two groups. After the completion of surgery with a subarachnoid block (SAB), patients in group 1 received a mixture of 20 mL of 0.25% levobupivacaine and 4 mg of dexamethasone on each side of the TAP block. Patients in group 2 received a mixture of 20 mL of 0.25% levobupivacaine and dexmedetomidine, with a total dose of 1 µg/kg body weight evenly distributed bilaterally in the TAP block. Patients were evaluated for pain using the Visual Analog Scale (VAS), total tramadol consumption as rescue analgesia, time to first rescue analgesia, any adverse effects, and patient satisfaction.
When comparing VAS scores for pain assessment, we observed that the mean VAS score was initially comparable between the two groups for the first hour. However, at 6, 9, and 12 h, VAS scores were significantly lower in group 2. The mean total tramadol consumption was higher in group 1 than in group 2 (213.33 ± 44.08 vs 161.11 ± 37.93 mg, P-value 0.027). The time to the first rescue analgesia after the TAP block in the postoperative period was significantly longer in group 2 (47.5 ± 62.76 vs 77.22 ± 56.14 min, P-value 0.002). No significant side effects were noted, and a greater proportion of patients in group 2 expressed satisfaction with their overall pain treatment.
The addition of dexmedetomidine to levobupivacaine is superior to the addition of dexamethasone, as it prolongs the duration of the block in the dexmedetomidine group. However, the use of dexamethasone as an adjuvant is a good alternative option, particularly due to its lower cost and reduced incidence of adverse effects such as postoperative nausea and vomiting.
在术后阶段，开放性全腹子宫切除术会引发相当程度的疼痛。目前正在采用多模式策略来缓解疼痛。
本研究旨在探讨地塞米松和右美托咪定作为左旋布比卡因辅助剂在超声引导下腹横肌平面（TAP）阻滞用于全腹子宫切除术患者术后镇痛中的有效性和安全性。
总共72例美国麻醉医师协会（ASA）分级为I级和II级的患者被随机且平均分为两组。在蛛网膜下腔阻滞（SAB）完成手术后，第1组患者在TAP阻滞的每一侧接受20 mL 0.25%左旋布比卡因与4 mg地塞米松的混合液。第2组患者接受20 mL 0.25%左旋布比卡因与右美托咪定的混合液，总剂量为1 μg/kg体重，在TAP阻滞中双侧均匀分布。使用视觉模拟评分法（VAS）评估患者的疼痛情况、作为补救镇痛的曲马多总消耗量、首次补救镇痛的时间、任何不良反应以及患者满意度。
在比较用于疼痛评估的VAS评分时，我们观察到在最初的1小时内两组的平均VAS评分相当。然而，在6、9和12小时时，第2组的VAS评分显著更低。第1组的曲马多平均总消耗量高于第2组（213.33±44.08 vs 161.11±37.93 mg，P值0.027）。术后TAP阻滞至首次补救镇痛的时间在第2组显著更长（47.5±62.76 vs 77.22±56.14分钟，P值0.002）。未观察到显著的副作用，并且第2组中更大比例的患者对其总体疼痛治疗表示满意。
在左旋布比卡因中添加右美托咪定优于添加地塞米松，因为它延长了右美托咪定组的阻滞持续时间。然而，使用地塞米松作为辅助剂是一个很好的替代选择，特别是由于其成本较低且术后恶心和呕吐等不良反应的发生率较低。
