Analgesic Effect of Perineural Dexamethasone on Transversus Abdominis Plane Block: A Randomised Controlled Trial at a Tertiary Hospital in Ghana

Authors: Daniel Akwanfo Yaw Sottie, Ebenezer Owusu Darkwa, George Aryee, Raymond Essuman, Grace-Imelda Obeng Adjei, Robert Djagbletey

DOI: 10.18231/j.ijca.11272.1759482477

Keywords: Caesarean Delivery, Post-operative analgesia, Bilateral TAP Block

Abstract: Background Caesarean delivery (CD) is associated with significant post-operative pain. The aim of this study was to determine the postoperative analgesic effect of perineural dexamethasone as an adjunct in ultrasound guided TAP block for CD under spinal anaesthesia. Methods This was a prospective, randomised, double blind study of 99 patients booked for elective CD under spinal anaesthesia. Participants were randomised into three groups of 33 each. Ultrasound guided bilateral TAP block was administered immediately after CD using either bupivacaine + dexamethasone (Group D), only bupivacaine (Group B) or only saline (Group S). Time to request for first analgesia, systemic opioid consumption, numerical rating scale (NRS) pain scores and patients’ satisfaction were recorded. Results Ninety-two (92) patients completed the study. The time to first analgesic request was significantly prolonged in group B compared to S (327.5 ± 98.69 minutes vs 256.5 ± 72.33 minutes; p-value = 0.023); addition of dexamethasone (D) resulted in further prolongation (485.2 ± 143.03 minutes; p-value < 0.001). There was a significantly lower consumption of systemic opioids in group B compared to group S within 24hours post CD (p-value < 0.001); addition of dexamethasone further lowering the systemic opioid requirements in group D (p-value < 0.001). Conclusion Addition of dexamethasone to bupivacaine for a TAP block has opioid sparing effect and provides better postoperative analgesia after Caesarean delivery compared to bupivacaine alone and control.