The analgesic efficacy of dexamethasone added to ropivacaine in transversus abdominis plane block for transabdominal hysterectomy under subarachnoid block

Deshpande, Jyoti; Ghodki, Poonam S; Sardesai, Shalini

doi:10.4103/aer.aer_22_17

Cited by 28 publications

(38 citation statements)

References 23 publications

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“…The literature search identified 354 studies, including 9 qualifing RCTs with a total of 575 patients that met the inclusion criteria ( Fig 1 ) [ 16 , 17 , 24 – 30 ]. The characteristics of patients and interventions are summarized in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…All 9 RCTs compared the TAP block using LA with dexamethasone versus LA alone. All studies used a long-acting LA for the TAP block, including bupivacaine in 3 studies [ 26 , 28 , 29 ], ropivacaine in 5 studies [ 16 , 17 , 24 , 25 , 30 ], and levobupivacaine in 1 study [ 27 ].…”

Section: Resultsmentioning

confidence: 99%

“…The duration of the TAP block was reported in 7 of the 9 included studies, (n = 433 patients of which 234 received perineural dexamethasone), which was defined as the time to first analgesic request after surgery [ 16 , 25 – 30 ]. On average, dexamethasone prolonged the block duration by 2.98 h (95% CI: 2.19 to 3.78; I 2 = 95%; P<0.00001) from a baseline of 5.34 h without dexamethasone; however, there was a large degree of heterogeneity( Fig 3 ).…”

Section: Resultsmentioning

confidence: 99%

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Clinical analgesic efficacy of dexamethasone as a local anesthetic adjuvant for transversus abdominis plane (TAP) block: A meta-analysis

Chen

Zhou

et al. 2018

PLoS ONE

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BackgroundPerineural dexamethasone has been shown to prolong the duration of local anesthetic (LA) effect in regional anesthesia; however, the use of perineural dexamethasone as an adjuvant to to the transversus abdominis plane (TAP) block remains controversial. This meta-analysis sought to assess the efficacy of dexamethasone in prolonging the TAP block and enhancing recovery after abdominal surgery.MethodsWe identified and analyzed 9 RCTs published on or before September 30, 2017, regardless of the original language, after searching the following 6 bibliographic databases: PubMed, EMBASE, Medline, Springer, Ovid, and the Cochrane Library. databases. These studies compared the effects of perineural dexamethasone mixed with local anesthetic versus local anesthetic alone in the TAP block. The Cochrane Collaboration’s Risk of Bias Tool was used to evaluate the methodological quality of each RCT. The primary outcomes were the time until the first request for postoperative analgesics and the analog pain scores at 2, 6, 12, and 24 h after surgery. The secondary outcomes were the analgesic consumption and the incidence of nausea and vomiting on the first day after surgery. We used Trial Sequential Analysis (TSA) to control for random errors.ResultsPerineural dexamethasone prolonged the duration of LA effect in the TAP block [mean difference (MD): 2.98 h; 95% confidence interval (CI): 2.19 to 3.78] and reduced analog pain scores at 2 h [MD: -1.15; 95% CI: -2.14 to -0.16], 6 h [MD: -0.97; 95% CI: -1.51 to -0.44], and 12 h [MD: -0.93; 95% CI: -1.14 to -0.72] postoperatively. Furthermore, the use of perineural dexamethasone was associated with less analgesic consumption [standard mean difference: -1.29; 95% CI: -1.88 to -0.70] and a lower incidence of nausea and vomiting [odds ratio: 0.28; 95% CI: 0.16 to 0.49] on the first day after surgery.ConclusionDexamethasone prolongs the LA effect when used as an adjuvant in the TAP block and improves the analgesic effects of the block.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Clinical analgesic efficacy of dexamethasone as a local anesthetic adjuvant for transversus abdominis plane (TAP) block: A meta-analysis

Chen

Zhou

et al. 2018

PLoS ONE

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“…Post-operative VAS pain scores were significantly lower at 4, 6, and 12 h in Group Ropivacaine Dexamethasone (RD) as compared to Group Ropivacaine (R) alone (p<0.05). Significantly longer analgesia (13.2±7.6 vs. 7.1±4.6 h, p<0.001) with lesser tramadol requirement in first 24 h (50.2±34 vs. 94±35 mg, p<0.001) were observed in Group RD as compared to Group R. 23 Dexamethasone 300 µg/kg with ropivacaine intraarticular has a superior analgesic efficacy a much prolonged postoperative pain relief, minimal post-operative analgesia requirement and better patient compliance with negligible side effects. Liu et al did a prospective observational study and used a single shot of bilateral thoracic paravertebral block (TPVB) with 25 ml of 0.2% ropivacaine and 5 mg dexamethasone in combination for both sides at the 8 th thoracic transverse level (T8) performed on 201 participants who complained moderate to severe pain on arrival to postanesthesia care unit (PACU) after laparotomy.…”

Section: Perineural Dexamethasonementioning

confidence: 83%

Role of Dexamethasone in Peri-operative Anesthesia Management: A Review of Literature

Gupta¹

2017

Res Pract Anesthesiol Open J

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Dexamethasone has been used widely in clinical specialties including anesthesia. It is regarded as one of the ideal peri-operative agent being readily available, cheap, anti-inflammatory agent, prevents and treats post-operative nausea and vomiting (PONV), promotes appetite, suppress inflammation, a good analgesic agent both as intravenously or as an adjuvant to peripheral nerve blocks, it provides a sense of well-being and is considered to have a good quality of recovery and early discharge in patients from anesthesia. Controversial role of dexamethasone in causing post-operative surgical site infections have been solved and overall adverse effects of dexamethasone are rare and its benefits out-weighs the risks involved. The author did a literature search in Google Scholar and PubMed databases (latest articles related to the role of dexamethasone in peri-operative period over a period of two years 2015-17). KEY WORDS:Dexamethasone; Peri-operative agent; Anesthesia. KEY MESSAGES:Dexamethasone has a tremendous role in preventing post-operative nausea and vomiting, it has a fair analgesic action if given intravenously, epidurally or perineurally, patients receiving dexamethasone have enhanced recovery profiles after surgery and single dose would usually not increase the risk of surgical site infections. Overall adverse effects of dexamethasone are rare and its benefits out-weighs the risks involved.Dexamethasone has been used widely in clinical specialties including anesthesia. The biological half-life is about 3 hours, although the duration of action may be much longer. Dexamethasone is bound to plasma proteins in much lower-levels than other glucocorticoids. Hepatic metabolism (both glucuronidation and sulfation) occurs to produce inactive metabolites, with 65% of the dose of dexamethasone excreted in the urine within 24 hours, with less than 3% unchanged.

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“…14 Similarly, TAP block with Dex-R combination was associated with lower VAS score 12 hours after surgery, longer time to first tramadol use, and total tramadol use when compared with ropivacaine alone after abdominal hysterectomy. 15 However, another study showed that TAP block with Dex-R and ropivacaine did not differ in terms of postop pain score after inguinal hernia repair and spermatocelectomy. 16…”

Section: Discussionmentioning

confidence: 96%

Comparative study of ropivacaine versus dexmedetomidine-ropivacaine combination in transversus abdominis plane block for postoperative pain control in plastic surgery patients undergoing abdominoplasty

Jan¹,

Ahmad²,

Rashid³

2019

Int Surg J

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Background: Requirement of postoperative analgesic medication is decreased by the use of regional nerve blocks. Transversus abdominis plane (TAP) block is an effective way to provide postoperative analgesia in abdominal surgeries. TAP block using ropivacaine alone has not been consistently proven to be effective in alleviating pain after abdominal surgeries. The objective of the study was to compare the combination of dexmedetomidine and ropivacaine to ropivacaine alone in TAP block for abdominoplasty patients. Time to onset of post-operative pain and time interval for need of rescue analgesia were compared.Methods: Sixty ASA (American Society of Anesthesiology) grade I or II patients undergoing abdominoplasty were allocated to two groups with thirty patients in each group. In this randomized, controlled, double-blinded study, the test group received TAP block using 20 ml (100 mgs) 0.5 percent of ropivacaine mixed with 50 µg of dexmedetomidine while as Control group received TAP block with 20 ml (100 mgs) of 0.5 percent of ropivacaine alone. Patient demographics, time to initial reporting of post-operative pain, time to need of first rescue analgesia, quality of pain block and side effects were recorded.Results: Time to initial onset of pain and time to need of first rescue analgesia were significantly longer in the test group than control group. The two groups were similar in demographics and quality of pain block, with no significant difference in side effects.Conclusions: Addition of dexmedetomidine to ropivacaine for TAP block in abdominoplasty patients prolong the time to initial onset of pain and time to need for first rescue analgesia.

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The analgesic efficacy of dexamethasone added to ropivacaine in transversus abdominis plane block for transabdominal hysterectomy under subarachnoid block

Cited by 28 publications

References 23 publications

Clinical analgesic efficacy of dexamethasone as a local anesthetic adjuvant for transversus abdominis plane (TAP) block: A meta-analysis

Clinical analgesic efficacy of dexamethasone as a local anesthetic adjuvant for transversus abdominis plane (TAP) block: A meta-analysis

Role of Dexamethasone in Peri-operative Anesthesia Management: A Review of Literature

Comparative study of ropivacaine versus dexmedetomidine-ropivacaine combination in transversus abdominis plane block for postoperative pain control in plastic surgery patients undergoing abdominoplasty

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