Transversus Abdominis Plane Block Using Dexmedetomidine and Bupivacaine
Status:
Completed
Trial end date:
2018-08-31
Target enrollment:
Participant gender:
Summary
Pediatric laparoscopy has been first described in 1923 by Kelling but its use has increased
since last decade. A laparoscopic approach offers several advantages over an open procedures;
potentially reduces the surgical stress and fluid shifts that may accompany it; in addition
there is less need for postoperative analgesia, reduction of postoperative respiratory and
wound complications; shortens postoperative convalescence, including an intensive care unit
stay; rapid return to normal diet and decreased overall hospital stay.
Despite the minimally invasive nature, pain can be moderate to severe in the immediate
postoperative period.
Inadequate control of post-operative pain leads to several unwanted adverse events ranging
from patients' discomfort and prolonged immobilization to thromboembolic phenomenon and
pulmonary complications.
Analgesic multimodalities were recommended to relieve the post-operative pain. Opioids
although provide satisfactory analgesia, they are associated with unwanted side-effects.
Transversus abdominis plane (TAP) block is a type of peripheral nerve block that involves
innervations of the anterolateral abdominal wall. It provides adequate post-operative pain
relieve following various abdominal surgeries.
With the aid of ultrasound or anatomical landmark guidance, local anesthetic (LA) is injected
into the transversus abdominis fascial plane, where the nerves from T6 to L1 are located.
Ultrasound TAP block is also accompanied by a good pain relief and reduced intraoperative and
postoperative opioids requirements after laparoscopic surgery. In this case a bilateral TAP
block is necessary because the abdominal skin incisions for the ports of laparoscopic
procedure are performed on both sides.
Unfortunately, TAP block duration is limited to the effect of administered LA. Recently,
adjuvant medications were added to LA to prolong the effect of TAP block. Dexmedetomidine is
a selective alpha 2 (α2) adrenergic agonist with both analgesic and sedative properties. Its
use with bupivacaine either epidurally or intrathecally is associated with prolongation of
the LA effect.