COMPARISON OF DEXMEDETOMIDINE AND MAGNESIUM SULPHATE AS AN ADJUVANT TO BUPIVACAINE FOR TRANSVERSE ABDOMINIS PLANE BLOCK IN CAESAREAN DELIVERY FOR POSTOPERATIVE ANALGESIA

Abstract

Background: Effective postoperative analgesia is crucial in cesarean deliveries to enhance maternal comfort and facilitate early recovery. The Transverse Abdominis Plane (TAP) block, when combined with adjuvants, has shown promise in prolonging analgesic effects. This study compares the efficacy of dexmedetomidine and magnesium sulphate as adjuvants to bupivacaine in TAP block for post-cesarean analgesia.

Aim: To evaluate and compare the postoperative analgesic efficacy, hemodynamic stability, and incidence of adverse effects of dexmedetomidine versus magnesium sulphate when used as adjuvants to bupivacaine in TAP block.

Methods: A prospective, randomized study was conducted at GMC Jammu from 2023 to 2024, involving 90 patients undergoing cesarean delivery under spinal anesthesia. Patients were allocated into three groups:

Group B: 18 mL of 0.25% bupivacaine + 2 mL normal saline

Group BM: 18 mL of 0.25% bupivacaine + 150 mg (1.5 mL) magnesium sulfate + 0.5 mL normal saline

Group BD: 18 mL of 0.25% bupivacaine + 0.5 µg/kg dexmedetomidine in 2 mL normal saline .

The primary outcome was the duration of analgesia assessed by the time to the first rescue dose of Tramadol. Secondary outcomes included pain scores (VAS), hemodynamic stability, and adverse Results: The time to first rescue analgesia was significantly prolonged in Group BD (589.2 ± 52.5 min) compared to Group BM (455.3 ± 49.8 min) and Group B (308.5 ± 45.2 min) (p < 0.001). Total tramadol consumption over 24 hours was significantly lower in Group BD (76.2 ± 12.4 mg) compared to Group BM (105.6 ± 15.8 mg) and Group B (150.4 ± 18.2 mg) (p < 0.001). VAS scores at all time points were significantly lower in Group BD compared to the other groups (p < 0.001). Hemodynamic stability was maintained in all groups, with a transient decrease in heart rate in Group BD, which was not clinically significant. Adverse effects were minimal, with a higher but clinically insignificant incidence of sedation in Group BD (13.3%) (p = 0.04).

Conclusion: Dexmedetomidine as an adjuvant to bupivacaine in TAP block provides superior and prolonged postoperative analgesia compared to magnesium sulphate, with an acceptable safety profile. Its use can be considered for effective multimodal postoperative pain management in cesarean deliveries.