ANALGESIC EFFICACY OF LEVOBUPIVACAINE WITH BUPRENORPHINE VERSUS LEVOBUPIVACAINE WITH DEXMEDETOMIDINE IN ULTRASOUND-GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCK FOR LOWER ABDOMINAL SURGERIES

Background and Aims: Lower abdominal surgeries are often associated with significant postoperative pain requiring effective management. Ultrasound-guided Transversus Abdominis Plane (TAP) block using levobupivacaine provides effective analgesia but with limited duration. This study aimed to compare dexmedetomidine and buprenorphine as adjuvants to levobupivacaine in TAP blocks for enhanced analgesic efficacy and duration. This prospective, randomized study included 60 ASA I-II patients undergoing lower abdomina Methods: l surgeries under spinal anesthesia. Patients were randomized into two groups: Group LB received 20 ml of 0.25% levobupivacaine with 150 mcg buprenorphine, and Group LD received 20 ml of 0.25% levobupivacaine with 0.5 mcg/kg dexmedetomidine. Postoperative pain (VAS scores at rest and movement), time to first rescue analgesia, total fentanyl consumption, adverse effects, and patient satisfaction were assessed over 24 hours. Ethical approval and informed consent were obtained. Group LD demonstrated a significantly prolonged time to first rescue a Results: nalgesia (749.17 ± 68.55 min vs. 692.67 ± 45.02 min; p < 0.01) and consistently lower VAS scores compared to Group LB. Total fentanyl consumption was lower in Group LD (56.7 ± 17.29 µg vs. 65 ± 23.3 µg; p = 0.123). Adverse effects, including nausea (6.7% vs. 13.3%) and sedation (13.3% vs. 20%), were fewer in Group LD, which also had higher patient satisfaction (83.33% extremely satisfied vs. 66.7%). Dexmedetomidine as Conclusion: an adjuvant to levobupivacaine provides superior analgesia, prolonged pain relief, reduced opioid consumption, and fewer side effects, making it a preferable choice over buprenorphine for lower abdominal surgeries.