Effect of addition of buprenorphine or dexamethasone to levobupivacaine on postoperative analgesia in ultrasound guided transversus abdominis plane block in patients undergoing unilateral inguinal hernia repair: a prospective randomized double blind controlled trial.
BACKGROUND
The transversus abdominis plane (TAP) block is an effective technique to block the thoracolumbar nerves innervating the anterolateral abdominal wall. This study was conducted to evaluate the analgesic efficacy and opioid consumption with the use of perineural buprenorphine or dexamethasone in TAP blocks after unilateral inguinal hernioplasties.


METHODS
This prospective, randomized, double-blinded, placebo-controlled study enrolled 93 patients scheduled for unilateral inguinal hernioplasty, followed by an ultrasound-guided TAP block. The participants were randomized into 3 groups (31 patients each). Group L received 20 ml 0.25% levobupivacaine + 1 ml normal saline (NS); group LB, 20 ml 0.25% levobupivacaine + 0.3 mg (1 ml) buprenorphine; and group LD, 20 ml 0.25% levobupivacaine + 4 mg (1 ml) dexamethasone. The patients were observed postoperatively for 24 h for first rescue analgesic requirement, total rescue analgesic consumption, and pain scores on the numeric rating scale (NRS).


RESULTS
The time to first rescue analgesic requirement was significantly longer in Group LB than in groups LD and L (688.87 ± 36.11 min, 601.45 ± 39.85 min, and 383.06 ± 36.21 min, respectively; P < 0.001). The mean total tramadol consumption in the first 24 h was the lowest in group LB (P < 0.001, L vs. LB / LD). Groups LB and LD displayed significantly lower NRS scores than group L (P < 0.001 both).


CONCLUSIONS
Levobupivacaine with perineural buprenorphine in a TAP block after unilateral open inguinal hernioplasty facilitates prolonged analgesia and reduced requirement for rescue analgesics compared to perineural dexamethasone, without significant side effects.
['Seervi|Satya Narayan|SN|', 'Singariya|Geeta|G|', 'Kamal|Manoj|M|', 'Kumari|Kamlesh|K|', 'Siddeshwara|Ashwini|A|', 'Ujwal|Shobha|S|']
D034861:Abdominal Wall D000328:Adult D000368:Aged D000701:Analgesics, Opioid D000779:Anesthetics, Local D002047:Buprenorphine D003907:Dexamethasone D004311:Double-Blind Method D005260:Female D006552:Hernia, Inguinal D059685:Herniorrhaphy D006801:Humans D000077554:Levobupivacaine D008297:Male D008875:Middle Aged D009407:Nerve Block D010147:Pain Measurement D010149:Pain, Postoperative D011446:Prospective Studies D018084:Ultrasonography, Interventional
Buprenorphine Dexamethasone Levobupivacaine Transversus abdominis plane block Inguinal hernioplasty