Comparative study of dexmedetomidine versus fentanyl as adjuvants to bupivacaine in ultrasound-guided transversus abdominis plane block in patients undergoing radical cystectomy: a prospective randomised study

Abstract

Background Transversus abdominis plane (TAP) block is beneficial for pain management after conducting abdominal surgery. Objective To compare the outcomes of dexmedetomidine and fentanyl, as adjuvants to bupivacaine, for ultrasound-guided TAP block analgesia among patients undergoing radical cystectomy for postoperative pain management. Methods This prospective, randomised, comparative study included a total of 60 patients, who underwent radical cystectomy. Participants were randomly divided into three categories with 20 subjects each; group B had patients who received a single shot US-guided TAP block on each side with 20 ml of 0.25% bupivacaine + 2 ml normal saline; group BF had patients who received a single shot US-guided TAP block on each side with 20 ml of 0.25% bupivacaine + 1 µg/kg fentanyl dissolved in 2 ml normal saline and group BD had patients who received a single shot US-guided TAP block on each side with 20 ml of 0.25% bupivacaine + 1 µg/kg dexmedetomidine dissolved in 2 ml normal saline.The researchers recorded the time taken for first rescue analgesia, total analgesic dose in the first 24 h after surgery, patient satisfaction, sedation score, and postoperative complications. Results The time taken for first rescue analgesia was significantly lengthier in group (BD) (8.90 ± 2.47) than (BF) (6.50 ± 1.43) and (B) (4.40 ± 1.05) groups. The total nalbuphine consumption, during the first 24 h, was significantly lower in (BD) (0.15 ± 0.00) group compared to (BF) (0.20 ± 0.07) and (B) (0.24 ± 0.08) groups. Conclusion In comparison with fentanyl, as an adjuvant to bupivacaine, dexmedetomidine was found to be associated with prolonged postoperative analgesia, less postoperative pain scores and low opioid consumption. Trial registration This study was registered at Clinical Trials.gov on 23 March 2020 (registration number: NCT04318158).

Dexmedetomidine as an Adjuvant to Nerve Block for Cancer Surgery: A Systematic Review and Meta-Analysis

“…This study selection process is summarized in the PRISMA flow chart ( Figure 1 ). According to Cochrane’s Risk of Bias 2 (RoB2) assessment, seventeen RCTs [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ] were considered to be low-risk and three RCTs [ 30 , 31 , 32 ] had some concerns. Moreover, the quality of the included studies is summarized in Supplementary Materials (Table S2) .…”

“…The meta-analysis of those studies concluded that sufentanil consumption was significantly lower in the dexmedetomidine group (SMD = −1.34 [95% CI −2.29 to −0.40], p = 0.005, I2 = 84%, random effects) ( Figure 2 ). Similar to the breast cancer and abdominal surgery, in thoracic cancer [ 28 ] and radical cystectomy [ 32 ], dexmedetomidine adjuvant use decreased the need for analgesic consumption.…”

Liposomal bupivacaine in transversus abdominis plane blocks for lower abdominal surgery

“…18 Adjuvants to bupivacaine such as steroids, alpha-2 agonists, and opioids have been used for TAP blocks to prolong the duration of analgesia with varying durations of clinical efficacy. [20][21][22][23][24][25][26] In a recent retrospective study investigating the use of TAP blocks for chronic abdominal pain, Abd-Elsayed et al identified that patients experienced prolongation of analgesia when steroids were mixed with bupivacaine. 24,26 Additionally, a meta-analysis including nine prospective trials identified that dexamethasone added to local anesthetics in TAP blocks was associated with decreased levels of pain intensity 12 h after surgery however these differences did not remain persistent 24 h following the surgical procedure.…”

“…Multimodal analgesic strategies are continuing to evolve; incorporating opioid sparing techniques and the use of TAP blocks with local anesthetics 18 . Adjuvants to bupivacaine such as steroids, alpha‐2 agonists, and opioids have been used for TAP blocks to prolong the duration of analgesia with varying durations of clinical efficacy 20–26 . In a recent retrospective study investigating the use of TAP blocks for chronic abdominal pain, Abd‐Elsayed et al.…”

Cardiovascular changes, laboratory findings and pain scores in calves undergoing ultrasonography-guided bilateral rectus sheath block before herniorrhaphy: a prospective randomized clinical trial

“…Effects on the cardiac dynamic in dairy calves were previously explored by Cagnardi et al [ 21 ], who demonstrated that injecting 5 µg/kg dexmedetomidine intravenously (IV) resulted in HR reduction. In our case, the authors chose to add 1 µg/mL as an adjuvant to the local anesthetic mixture to improve the overall analgesic effects as performed in other species [ 22 – 24 ]. Nevertheless, systemic absorption of this drug cannot be excluded entirely, as well as a systemic effect.…”