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Korean J Anesthesiol > Epub ahead of print
DOI: https://doi.org/10.4097/kja.d.18.00182    [Epub ahead of print]
Published online January 9, 2019.
Effect of addition of perineural 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
Satya Narayan Seervi1, Geeta Singariya1, Manoj Kamal2, Kamlesh Kumari1, Ashwini S1, Shobha Ujwal1
1Dr S N Medical College, Jodhpur
2All India Institute of Medical Sciences, Jodhpur
Corresponding author:  Geeta Singariya, Tel: +91 9414803554, 
Email: geetamanojkamal@gmail.com
Received: 28 June 2018   • Revised: 23 October 2018   • Accepted: 6 January 2019
Abstract
Background
The transversus abdominis plane (TAP) block is an effective technique to block thoracolumbar nerves supplying anterolateral abdominal wall. This study was conducted to evaluate the analgesic efficacy and opioid consumption with addition of perineural buprenorphine or dexamethasone in TAP block after unilateral inguinal hernioplasty
Methods
This prospective, randomized, double blinded, placebo controlled study, enrolled 93 patients, scheduled for unilateral inguinal hernioplasty, randomly divided into three groups (31 each), to received ultrasound guided TAP block after completion of surgery. Group L received 20 ml 0.25% levobupivacaine + 1 ml normal saline (NS), group LB received 20 ml 0.25% levobupivacaine + 0.3 mg (1ml) buprenorphine and group LD received 20 ml 0.25% levobupivacaine + 4 mg (1ml) dexamethasone. The patients were observed till 24 h post-operatively for first rescue analgesic requirement, total rescue analgesic consumption and numeric rating scale.
Results
The group LB had significantly longer time to demand for first rescue analgesia than group LD and group 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 first 24 h in group LB was lowest in comparison to group LD and group L (P <0.001 L vs. LB/LD). The patients in group LB and group LD had significantly lower NRS scores as compared to group L (P <0.05).
Conclusion
Levobupivacaine with perineural buprenorphine in TAP block provide prolonged analgesia and less need of rescue analgesia in unilateral open inguinal hernioplasty than perineural dexamethasone without significant side effects.
Key Words: Transversus abdominis plane block; Levobupivacaine; Buprenorphine; Dexamethasone; Inguinal hernioplasty


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