A COMPARATIVE STUDY BETWEEN INJECTION BUPRENORPHINE HYDROCHLORIDE VS INJECTION DEXMEDETOMIDINE WITH INJECTION 0.375% ROPIVACAINE IN TRANSVERSUS ABDOMINIS PLANE BLOCK FOR POST OPERATIVE ANALGESIA IN PATIENT UNDERGOING ELECTIVE GYNECOLOGICAL EXPLORATORY LAP

Abstract

BACKGROUND: The present study is a comparison of analgesic efficacy between injection buprenorphine hydrochloride versus injection dexmedetomidine as an adjunct to local anesthetic agent, injection ropivacaine hydrochloride 0.375% in the procedure of transversus abdominis plane block for postoperative analgesia in patients undergoing elective gynecological laparotomy surgeries in a randomized double blinded controlled study design.

AIMS AND OBJECTIVES:

Primary objective- comparison of duration of analgesia between three study groups (Group P, Q, R). Duration of analgesia is the time from TAP block administration till time of administration of first rescue analgesic.

Secondary objective- comparison of quality of analgesia based on VAS score and hemodynamic parameters, side-effects if any between the three study groups.  The study parameters will be measured in postoperative period at 1, 2,4,6, 8,12,18 and 24 hours respectively

MATERIAL AND METHODS: Sixty consented adult female patients of ASA I and ASA II grade undergoing elective gynecological laparotomy procedure were randomly allocated into three groups, group P, Q, R respectively, (n=20) in each group by computer generated randomization method. Each group received bilateral transversus abdominis plane block as follows: Group P received 20 ml of 0.375% ropivacaine hydrochloride + 0.5 ml 0.9% normal saline (control), Group Q received 20 ml of 0.375% ropivacaine hydrochloride+ injection dexmedetomidine 0.5 ml (50 mcg), Group R received 20 ml of 0.375% ropivacaine hydrochloride + injection buprenorphine 0.5ml (150 mcg).TAP block was performed using anatomical landmark technique immediately after completion of surgical procedure and before emergence from anesthesia as per random allocation described previously. All patient were taught to evaluate visual analog score during their pre-anesthetic checkup. Patient in all three groups were assessed for pain, sedation, hemodynamic status, side effects if any in postoperative period. Primary objective was - comparison of duration of analgesia between three study groups (Group P, Q, R). Secondary objective-comparison of quality of analgesia based on VAS score and hemodynamic parameters, side-effects if any between the three study groups.

RESULTS: The duration of analgesia comparison between the three study groups revealed that in Group R the mean duration of analgesia was (7.66±1.3) hours while in Group P and Group Q it was  (2.48±0.8) hours and ( 4.86±0.7) hours respectively. Thus duration of analgesia was found to be comparatively higher in Group R as compared to Group P and Q, p value<0.0001 considered statistically significant. The quality  of analgesia based on vas score was found superior in Group R in comparison to Group P and Q. Side effects were less in both Group P and Group R When compared with Group Q.  No serious side effects like respiratory depression, heavy sedation  were observed in any of the study groups.

CONCLUSION: The result of this randomized double blinded controlled study revealed that injection buprenorphine when used as an adjuvant to local anesthetic in transversus abdominis plane block yield better quality as well as prolonged duration of analgesia with lesser side effects as compared injection dexmedetomidine in transversus abdominis plane block procedure for postoperative analgesia.