Effect Of Addition Of Dexmedetomidine To Ropivacaine In Ultrasound Guided Transverse Abdominis Plexus Block On Postoperative Pain In Open Appendicectomy

INTRODUCTION Post operative pain is the most common complaint in post anaesthesia care units (PACU). Lower abdominal surgeries are associated with severe post-operative pain and inadequate post-operative analgesia leads to many complications. Multimodality approach is used to treat postoperative pain. Transversus abdominus plane (TAP) block is a peripheral nerve block of the trunk that provides analgesia between T10 to L1 dermatomes with a single injection which was first described by A.N. Rafi 1 in 2001 . TAP Block is indicated in any lower abdominal surgeries. Local anaesthetic is deposited in the fascial sheath between the internal oblique and transverse abdominis muscle using either the blind or the ultrasound guided technique. Adjuvants are frequently used in regional analgesia for rapid onset to improve the quality and prolong the duration of block. Alpha 2 agonist dexmedetomidine speeds the onset of block and prolongs duration of analgesia. Aim : To assess whether addition of dexmedetomidine to ropivacaine may bring some improvements to the analgesic efficacy and quality of TAP blocks in patients undergoing appendicectomy surgeries . MATERIALS AND METHODS 30 Patients belonging to ASA Class I or II scheduled for appendicectomy were selected for the study . The patients were randomized into two groups: Group R - receiving plain ropivacaine (2ml of normal saline and 20ml 0.2%ropivacaine) Group R+D - receiving ropivacaine with dexmedetomidine (0.5 mcg /kg of dexmedetomidine dissolved in 2ml of normal saline and 20ml 0.2%ropivacaine). At the end of surgery, USG guided transversus abdominus plane block was performed. Results Addition of dexmedetomidine to ropivacine in TAP block lower pain scores after 3hrs in postoperative period and the same trend of analgesia continued for the first 24 hours. It confers better post operative analgesia with less analgesic requirement and adverse effects. Conclusion: The addition of dexmedetomidine to ropivacaine in TAP block confers better pain control and decreases the total dose of analgesics post-operatively without any major side-effect

Safety and effectiveness of ultrasound guided peripheral nerve blocks: audit at a tertiary care hospital

Objective: To assess the safety and effectiveness of peripheral nerve blocks using ultrasound. Methods: All patients who received peripheral nerve blocks (PNB) as a part of their anaesthesia care, in two years were analysed retrospectively. The data included outcomes of PNB effectiveness, complications and limb conditions after block. PNB effectiveness was assessed by monitoring pain scores at rest and on movement and the requirement of co- analgesia. Complications like numbness, motor block, metallic taste, hypotension, respiratory depression were also assessed. Results: A total of 299 patients received ultrasound guided peripheral nerve blocks. Most common block performed was transversus abdominus plane block (TAP) block (46.5%) followed by supraclavicular block (16.7%). Most common complication observed in the recovery room after PNB was numbness 6.2%. Approximately 70% patients remained pain free; however 16% of the patients had moderate pain on movement at 12 hour post-operatively. Sedation score, sensory block and skin conditions were observed to be normal. Conclusion: This study shows that the complications associated with ultrasound guided regional anaesthesia (UGRA) are very few. With advancements in ultrasound guided technique, further studies are required to evaluate benefits and complications in comparison to conventional techniques. Keywords: Regional anesthesia, ultrasound guided blocks, peripheral nerve blocks Continuous....