Comparison of Dexmedetomidine and Magnesium Sulphate as an adjuvant to Ropivacaine in TAP Block for postoperative analgesia for LSCS: A Prospective Randomised Controlled Study

BACKGROUND: The duration of local anaesthetics can be prolonged by adding many adjuvants like Dexmeditomidine, Magnesium sulphate and Fentanyl.  Ropivacaine is a long-acting amide local anaesthetic. In this study, we compared the efficacy of Dexmeditomidine and Magnesium sulphate as an adjuvant to Ropivacaine in Transversus abdominis plane (TAP) block for postoperative analgesia in patients undergoing Lower Segment Caesarean Section (LSCS) procedure. Duration of analgesia, hemodynamic parameters, dose and frequency of rescue analgesia, level of sedation-by-sedation score, patient satisfaction, incidence of complications for both were documented. METHODS: This is a Tertiary care multi hospital based Prospective, Double Blinded, Randomised Controlled Study conducted at Karpaga Vinayaga Institute of Medical Sciences & Research Centre and in Trichy SRM Medical College Hospital & Research Centre among patients undergoing elective LSCS through pfannenstiel incision under General Anaesthesia. At the end of surgery after skin closure Transversus abdominis plane (TAP) Block with above adjuvants were given to both groups. Patients who received Dexmeditomidine was labelled as Group RD and those who received Magnesium sulphate as RM group. This study was conducted over a period of one year from July 2022 to June 2023, after obtaining clearance from institutional ethics committee and written informed consent from the study participants. RESULTS: The mean duration of analgesia for group RD was 692.57± 26.73 min and for RM group 573.50±38.62 min and it was statistically significant. The total dose of Tramadol as rescue analgesic for 24hrs for Group RD 21.42±10.5mg and for RM group it was 42.6±12.44mg which was statistically significant. Mean sedation score was significantly higher in RD group than RM group from 30 min up to 12 hours of blockade. Patient satisfaction score was better in RD group. 10% of patients in RM group and 15% of RD group had Postoperative nausea and vomiting, 5% of RM group and 7.5% of RD group had hypotension and 20% of patients in RD group developed bradycardia. So, Dexmedetomidine added to Ropivacaine prolongs the duration of analgesia with minimal side effects when compared to Magnesium Sulphate. CONCLUSION: Dexmedetomidine as an adjuvant to Transversus abdominis plane (TAP) block in LSCS was more effective than Magnesium Sulphate in prolonging the duration of analgesia and it reduces the need for additional rescue analgesia with minimal side effects.