Comparative study between Bupivacaine with Magnesium sulphate v.s. Bupivacaine with Dexmedetomidine in ultrasound guided Transversus Abdominus Plane (TAP) block as postoperative analgesia for pain in Cesarean section

Abstract

Background: Most of anesthiologists use Magnesium sulfate and Dexmedetomidine as adjuvants to local anesthesia for improving the quality of regional anesthesia. Aim of the work: To compare the effects and side effects of Magnesium sulfate and Dexmedetomidine when added to Bupivacaine on the quality of trasversus abdominus plane block (TAPB). Patients and methods: The study was done at the department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt from November 2019 to October 2020. A total of 50 female patients undergoing elective Cesarean section using post operative transversus abdominus plane (TAP) block were randomly assigned into two groups; Ultrasound-guided transversus abdominus plane (TAP) block was performed using 20 ml 0.25% Bupivacaine. Magnesium sulfate 150 mg (1.5 ml) and dexmedetomidine 0.5 mcg/kg were added in the ( Magnesium sulfate + Bupivacaine ) group and ( Dexmedetomidine + Bupivacaine ) group, respectively. Time to first analgesic call, pain scores at 2/6/12/24/48 hours, hemodynamic data and side effects were recorded. Results: Dexmedetomidine group provided the longest duration of analgesia and the least consumption of postoperative rescue analgesia versus Magnesium sulfate group (P = 0.001). Dexmedetomidine group had higher incidences of post operative hypotension and bradycardia. Conclusion: Magnesium sulfate and Dexmedetomidine was a useful adjuvant to Bupivacaine for transversus abdominus plane (TAP) block in improving the duration of postoperative analgesia. Dexmedetomidine provided longer duration and quicker onset of analgesia with lesser consumption of postoperative rescue analgesia, but the incidence of postoperative hypotension and bradycardia was higher than Magnesium sulfate.