Dexamethasone added to local anesthetics in ultrasound-guided transversus abdominis plain (TAP) block for analgesia after abdominal surgery: A systematic review and meta-analysis of randomized controlled trials

Abstract

ObjectiveTo evaluate the analgesic efficacy of dexamethasone added to local anesthetics in ultrasound-guided transversus abdominis plane (TAP) block for the patients after abdominal surgery.MethodsPubMed, CENTRAL, EMBASE, Web of science were searched to identify eligible randomized controlled trials (RCTs) that compared dexamethasone added to local anesthetics in ultrasound-guided TAP block with control for postoperative analgesia in adult patients undergoing abdominal surgery. Primary outcomes included postoperative pain intensity, the time to the first request for additional analgesics, and opioid consumption over 24 h after surgery. Secondary outcome was the incidence of postoperative nausea and vomiting. Analysis was performed by RevMan 5.3 software and the quality of evidence was rated using GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach.ResultsNine RCTs involving 575 patients were included. Compared to the control, dexamethasone added to local anesthetics in ultrasound-guided TAP block significantly decreased visual analogue scale (VAS) scores at rest at 4h (mean difference [MD] = -1.01; 95% confidence intervals [CI], -1.29 to -0.73; P<0.00001; moderate quality of evidence), 6h (MD = -1.21; 95% CI, -1.74 to -0.69; P<0.00001; low quality of evidence), and 12h after surgery (MD = -0.79; 95% CI, -0.97 to -0.60; P<0.00001; moderate quality of evidence). No difference was found at 2h (MD = -0.64; 95% CI, -1.35 to 0.08; P = 0.08; low quality of evidence) and 24 h (MD = -0.41; 95% CI, -0.91 to 0.09; P = 0.11; moderate quality of evidence) in VAS scores. The time to the first request for additional analgesics was prolonged in the dexamethasone group (MD = 3.08; 95% CI, 2.37 to 3.78; P<0.00001; moderate quality of evidence). Opioid consumption over 24 h after surgery was also reduced (MD = -5.42; 95% CI, -8.20 to -2.63; P = 0.0001; low quality of evidence). Meanwhile, the incidence of postoperative nausea and vomiting was significantly decreased in the dexamethasone group (risk ratios [RR] = 0.40; 95% CI, 0.28 to 0.58; P<0.00001; high quality of evidence). No complications were reported in all the included studies.ConclusionsDexamethasone added to local anesthetics in ultrasound-guided TAP block was a safe and effective strategy for postoperative analgesia in adult patients undergoing abdominal surgery.

A prospective randomized study to compare dexmedetomidine and dexamethasone as an adjunct to bupivacaine in transversus abdominis plane block for post-operative analgesia in caesarean delivery

“…A systematic review and meta-analysis of randomized controlled trials in 2015 by Zhang D and colleagues showed that addition of Dexamethasone to local anesthetics in ultrasound guided TAP block was a safe and effective strategy for postoperative analgesia in adult patients undergoing abdominal surgery. 10 A systematic review for randomized controlled trials by Fusco P et al, that assessed the efficacy of ultrasound (US) guided TAP block following cesarean delivery and concluded that controversy surrounds the utility of USguided TAP block in cesarean section, evidence suggests that when correctly executed as part of a multimodal analgesic regimen, TAP block may reduce postoperative opioid consumption and opioid-related side effects, improving postoperative pain control and patient satisfaction. 11 In our study we observed that duration of analgesia was significantly higher in patients who received bupivacaine along with dexmedetomidine in comparison to the patients who received bupivacaine alone or with dexamethasone.…”

“…A USG guided TAP block was given using linear probe (6)(7)(8)(9)(10)(11)(12)(13) in all groups with respective drug solutions. 23 G spinal needle was advanced by ultrasound guided in plane technique at the anterior axillary line between the 12 th rib and iliac crest with umbilicus at the center and exact location of the needle tip in a plane between internal oblique muscle, transverse abdominis muscle was identified with 1ml of normal saline.…”

A survey of patient satisfaction of obstetric anaesthesia service in Tuen Mun Hospital, Hong Kong

“…Systematic review had shown a single dose of intravenous dexamethasone could decrease postoperative pain with no increase in infection or delayed wound healing 11 and adding dexamethasone to local anaesthetics in trans versus abdomen is plane block could decrease opioid consumption and prolong the time to first request for additional analgesics. 12 It could also decrease the incidence of postoperative nausea and vomiting.…”

Adjuvants in pain medicine. Selection of the drug depending on the desired effect – so which drug to choose?

“…Цікаво також, що периневральне введення зменшує частоту післяопераційної нудоти та блювоти. Недавній метааналіз дев'яти рандомізованих клінічних випробувань за участю 575 пацієнтів з дексаметазоном, які використовувались при TAP-блоку, показав зменшення післяопераційної нудоти і блювоти [73].…”