Dexamethasone and dexmedetomidine versus dexamethasone alone with bupivacaine in ultrasound-guided rectus sheath block in midline abdominal surgeries

Background Regional blocks for postoperative pain have the advantage of opioid sparing effect as well as avoiding the potential immobility and hypotension associated with thoracic epidurals. Aim To compare between adding dexamethasone with dexmedetomidine versus dexamethasone alone in ultrasound-guided rectus sheath (RS) block. Patients and methods Research was on 40 patients undergoing midline abdominal surgeries who were divided randomly to two equal groups receiving bilateral RS block with either 20 µg dexmedetomidine and 4 mg dexamethasone in group (1) or 4 mg dexamethasone in group (2). Results Comparing visual analogue scale (VAS) at rest between two groups, VAS was significantly higher in group 2 than group 1 at 12 h ( P= 0.001) and 18 h ( P= 0.009). Comparing VAS with movement, VAS was significantly higher in group 2 than group 1 at 12 h( P= 0.007) and at 18 h ( P= 0.020). The total amount of opioids (nalbuphine) needed throughout the postoperative period was significantly lower in group 1 when compared with group 2 where ( P <0.001). The duration of postoperative analgesia was significantly longer in group 1 than group 2 where ( P <0.001). Conclusion Combination of dexmedetomidine and dexamethasone in RS block provides a lower pain score at rest and with movement, less amount of opioids used as rescue analgesia, longer time to rescue analgesics needed, and longer duration of postoperative analgesia.