Comparative Study between Levobupivacine versus Levobupivacaine Plus Dexmedetomidine for Transversus Abdominis Plane Block “TAP” in Post-Operative Pain Management after Abdominoplasty

Aim of the work Transversus abdominis plane “TAP’’ block has been reported to be effective for post-operative analgesia for patients undergoing surgery involving abdominal wall incision by blocking anterior branches of thoracolumbar nerves originating from T6 ? L1 , which innervates anterior abdominal wall. Dexmedetomidine has a well ? known benefit in the relief of postoperative pain. The objective of this study is to evaluate effect of adding dexmedetomidine to levobupivacaine for preemptive TAP block in the post-operative pain management after abdominoplasty surgery. Methods Sixty nine ASA I and II patients undergoing cosmetic abdominoplasty surgery under general anesthesia were randomly assigned in a double ? blinded study divided into 3 groups. One group received bilateral TAP block performed by landmark ? based technique with 20 ml 0.375% levobupivacaine plus 1 ml normal saline on each side “L group ‘’ and second dexmedetomidine group “M group ‘’received same volume of levobupivacaine plus 100?g dexmedetomidinein 1 ml, third control group” C group “received 21 ml normal saline on each side all patients received the block after induction of anesthesia and before surgical incision. Postoperative pain scores were recorded based on a visual analogue scale “VAS” using a 10 cm ruler where 0= no pain and 10 =worst possible pain just after full recovery and before administration of analgesics. Patients received meperidine 1mg/kg for every 4 h either on demand or if pain score ? 3. Total dose of mepridine consumption was recorded. Level of sedation, and side effects were also recorded. Results 23 patients of each group complete the study. Patients in M, L groups had significant lower pain score as compared to C group. Total postoperative 24 hours meperidine consumption in M, L group were significantly less than C group p < 0.001. Total postoperative 24 hours meperidine consumption in M group was less than in L group P < 0.01. There were a higher incidence of nausea, vomiting and use of anti-emetic in C group in comparison to L, M groups. Conclusion TAP block with 0.375 % levobupivacaine plus dexmedetomidine preemptively decrease pain score and postoperative narcotic consumption in patients undergoing cosmetic abdominoplasty surgery.