Dexamethasone and methylprednisolone as additives in transversus abdominis plane block for postoperative pain management after lower abdominal gynecological procedures: A randomized controlled trial

Context Adjuvants can be utilized to increase efficiency and prolong the duration of local anesthetics. Aims This work aimed to compare dexamethasone and methylprednisolone (MP) as additives in transversus abdominis plane (TAP) blocks for pain management after lower abdominal gynecological procedures. Settings and design This randomized double-blinded clinical trial was conducted at Cairo University Hospitals, Egypt. Patients and methods The study included 50 females aged 25 to 45 who underwent lower abdominal gynecological procedures under intrathecal anesthesia. Patients were divided equally into two groups. Patients received TAP block bilaterally at the end of surgery using 15 ml of 0.25% levobupivacaine plus 2 ml dexamethasone (8 mg) in group I and 2 ml MP (80 mg) in group II. Statistical analysis used Statistical analysis was conducted utilizing SPSS version 27. Results The time to first rescue analgesia was significantly delayed in group II than in group I ( P =0.018). The total dose of morphine consumption in the first 24 and 48 h was significantly lower in group II than in group I ( P <0.05). Visual analog scale, heart rate and mean arterial blood pressure were significantly lower at 12, 18, 24, 36, and 48 h in group II than in group I ( P <0.05). Bradycardia, hypotension, and postoperative nausea and vomiting were insignificantly different between both groups. Conclusions Adding MP to TAP block is more effective than dexamethasone in the management of pain during lower abdominal gynecological procedures. It prolongs the analgesia, and reduces the total opioid use, and pain with improved hemodynamics and comparable adverse events.