EFFICACY OF CLONIDINE VERSUS DEXMEDETOMIDINE AS ADJUVANTS TO 0.25% LEVOBUPIVACAINE IN ULTRASOUND GUIDED TRANSVERSALIS FASCIAL PLANE BLOCK FOR LOWER SEGMENT CAESAREAN SECTION.

Abstract

:  Lower segment caesarean section [LSCS] is associated with significant post-operative pain which may delay recovery and adversely affect maternal wellbeing. Ultrasound guided transversalis fascial plane block [TFPB] is an effective component of multimodal analgesia within enhanced recovery after surgery [ERAS] protocols.

Aim: To compare the efficacy of clonidine versus dexmedetomidine as adjuvants to 0.25% levobupivacaine in TFPB for postoperative analgesia following LSCS.

Methods: This prospective, randomized, double-blinded controlled clinical study included 60 parturients undergoing LSCS, allocated into two groups [n=30 each]. Group TFP-C received 0.5 mcg/kg clonidine and Group TFP-D received 0.5 mcg/kg dexmedetomidine as adjuvants to 0.25 % levobupivacaine ‘

Primary outcomes were time for first rescue analgesia and number of rescue analgesic doses. Secondary outcomes included Visual analogue scale [VAS] scores, Bruggeman comfort scale [B.C.S] scores, hemodynamic parameters and adverse effects.

Results: The dexmedetomidine   group [Group- TFP-D] significantly prolonged the time to first rescue analgesia [6.05 + 1.00 vs 4.10 + 0.85 hours; p< 0.001] and reduced the number of rescue analgesic doses [1.60 + 0.60 vs 2.30 + 0.70; p=0.001]. VAS scores were significantly lower and comfort scores were higher in the Group TFP-D  [p<0.05]. Hemodynamic parameters were better controlled  without significant increase in adverse effects.

Conclusion: Dexmedetomidine is a superior adjuvant to levobupivacaine compared to clonidine in TFPB for LSCS, providing prolonged analgesia, improved patient comfort, and stable hemodynamics with a comparable safety profile.