Comparison Of Dexamethasone And Magnesium Sulphate As Adjuvants To Bupivacaine For Ultrasound Guided Subcostal Transverse Abdominis Plane Block In Laparoscopic Cholecystectomy For Post Operative Analgesia

Authors: Aparna Rayala, SUSHMA Konduri, Sachidanand Rachamalla, Srinivas Upadhyayula

Keywords: Bupivacaine,dexamethasone,laparoscopic cholecystectomy,magnesium sulphate,subcostal transverse abdominis plane block

Abstract: Aim & Objective: to compare the efficacy of dexamethasone and magnesium sulphate (Mg SO4) as adjuvants to bupivacaine in ultrasound-guided (USG) bilateral subcostal transverse abdominis plane (SCTAP) blocks in laparoscopic cholecystectomy (LC) for postoperative analgesia. Background: Dexamethasone and Mg SO4 are the most effective adjuvants, their efficacy in prolonging SCTAP block in LC is not well established. Materials & Methods: Enrolled patients were grouped into two categories and received bupivacaine 0.25% (45mg) along with adjuvants (group 0, dexamethasone (8mg); Group 1 MgSO4 (200mg)) on each side by using USG guided SCTAP. After completion of surgery under general anesthesia and before extubation USG guided bilateral SCTAP block was performed using 10cm Braun Stimuplex and linear USG probe. Postoperative pain scores were assessed using Visual analog scale (VAS) at 10min, 30min, 2hrs, 4hrs, 8hrs, 12hrs and 16hrs. Rescue analgesics (intravenous (IV) fentanyl 25mcg and IV paracetamol 1g) were provided as needed. Results: Sixty-eight patients within ASA 1&2.,with 94.12% females were enrolled. Group I recorded lower pain scores than group 0, remained low throughout and was statistically significant except at 4 and 12 hours. Thirteen (19.11%) patients required rescue analgesia (group 0 vs group 1, 29.41% vs 8.82%). Total dose of rescue analgesics given was IVfentanyl (25g) and IV paracetamol (1g). There were no complications reported among the study population. Conclusion: MgSo4 as an adjuvant in TAP block in LC yields a better analgesic effect, with a longer post-operative pain-free period, lower VAS score, lesser requirement of rescue analgesic medication.