Add dexmedetomidine to levobupivacaine for transversus abdominis plane block in elderly patients undergoing inguinal hernia repair: Could it make a difference? A randomised trial.

Autor:	Abo Elfadl GM; Medical Physiology Department, Faculty of Medicine, Assiut University, Assiut, Egypt., Ali WN; Medical Physiology Department, Faculty of Medicine, Assiut University, Assiut, Egypt., Ahmed FN; Medical Physiology Department, Faculty of Medicine, Assiut University, Assiut, Egypt., Abd El-Rady NM; Medical Physiology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.; Medical Physiology Department, Sphinx University, New Assiut, Assiut, Egypt., Ali AM; Department of General Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt., Abdel Rady MM; Department of Anesthesia and Intensive Care, Faculty of Medicine, New Valley University, New Valley Governorate, Egypt.
Jazyk:	angličtina
Zdroj:	Journal of perioperative practice [J Perioper Pract] 2024 Nov; Vol. 34 (11), pp. 339-346. Date of Electronic Publication: 2023 Oct 09.
DOI:	10.1177/17504589231196653
Abstrakt:	Background: Transversus abdominis plane block is becoming more common as part of multimodal analgesia for post-abdominal operation pain relief. This study compared the analgesic effects of adding dexmedetomidine to levobupivacaine (transversus abdominis plane) block in elderly patients undergoing inguinal hernia surgery to adding fentanyl. Methods: Overall, 90 elderly patients with a simple inguinal hernia repair were randomly assigned to one of three groups. After spinal anaesthesia, an ultrasound-guided transversus abdominis plane block was performed. Transversus abdominis plane block was accomplished with 0.25% levobupivacaine + 0.9% normal saline in Group L (n = 30) (20mL). Transversus abdominis plane block was accomplished with 0.25% levobupivacaine + 1 µg/kg dexmedetomidine in Group D (n = 30) (20mL). Transversus abdominis plane block was obtained with 0.25% levobupivacaine + 1 µg/kg fentanyl in Group F (n = 30) (20mL). The primary outcome was the first analgesic request, and the secondary outcomes were the visual analog scale, postoperative analgesic requirements, sedation, hemodynamic stability, and related complications 24 hours postoperatively. 1gm paracetamol intravenously was provided as rescue analgesia. Results: The time to first analgesic request in the dexmedetomidine group was substantially more prolonged than in the fentanyl and control groups (516.5±27.8, 451.2±11.1, and 403.9±10.5min, respectively; p < 0.05). Postoperative analgesic requirements were significantly decreased in dexmedetomidine 1(1-2) than control 2(1-3) and fentanyl 1.5(1-2) respectively (P<0.01). VAS was significantly lower in Group D and Group F than in Group L postoperatively. No significant difference in side effects was noted between the groups. Conclusion: The transversus abdominis plane block is the best multimodal analgesia choice for inguinal hernia repair in older patients. Combining dexmedetomidine with levobupivacaine in the transversus abdominis plane block can improve the quality of postoperative analgesia while avoiding significant side effects.
Databáze:	MEDLINE
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