Background and Aims Dexmedetomidine and dexamethasone have most consistently demonstrated prolongation of a transversus abdominis plane (TAP) blocks. Kulkarni et al. found ketamine to be a safe and effective adjuvant for stellate ganglion blocks when combined with LA solution. The objective of this study is to determine if the addition of Ketamine to ropivacaine can improve the analgesic effect of TAP blocks in C-section as compared to dexmedetomidine or dexamethasone.
Methods 112 eligible women undergoing cesarean section under spinal anesthesia were randomized to one of three groups and received ultrasound-guided (USG) bilateral TAP block with 40 ml of 3mg/kg ropivacaine along with 0.2mg/kg dexamethasone (Group A; n=37) or 1.5μg/kg dexmedetomidine (Group B; n=38) or 2mg/kg Ketamine Group C; n=37). The primary outcome was the time to initial self-reporting of post-operative pain. Secondary outcomes included safety assessment and satisfaction. A p value < 0.05 was considered as statistically significant.
Results The duration of analgesia in group C (698.0±121 min) was longer than that in group B (406±100 min) and group A (301.56±111 min) (p<0.001). Time to first rescue analgesic in group C (786.30±112 min) was longer than group B (425.42±123 min) and group A (370±131 min), (p<0.001). patient satisfaction was significantly better in group C as compared to group A and B. No significant difference was observed in the incidences of adverse effects between the three groups.
Conclusions Ketamine addition to ropivacaine as compared with dexamethasone or dexmedetomidine improves significantly the analgesic effect of a bilateral TAP block following caesarean section.
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