الفهرس 
TAP BLOCKOnly 14 pages are availabe for public view
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Abstract
Analgesia is very important after cesarean section because it improves ambulation and enables the mother to give optimal care for the neonate in the immediate postoperative period. Opioids are widely used, but their side effects limit their application. Transversus abdominis plane (TAP) block has been proved to be a useful and safe alternative technique to provide analgesia following abdominal surgeries.
Transversus abdominis plane (TAP) block has been effectively used for anterior abdominal wall analgesia. Unfortunately, a single-injection TAP block could provide effective abdominal wall analgesia for only up to 8 hours which limits its use. Diverse adjuvants (dexmedetomidine, fentanyl, MgSO4, etc.) were added to local anesthetics to prolong the analgesic duration of TAP block.
The aim of the study was to compare the duration of analgesia produced by two drugs fentanyl and dexmedetomidine as adjuvants to bupivacaine in TAP block under ultrasound-guidance after cesarean section in a randomized controlled trial.
Fentanyl is an opioid that targets opioid receptors being selective on MU receptors, (mu selective agonist) but it also can act on other opioid receptors like kappa and delta. This interaction with the opioid receptors especially the Mu receptors produce its analgesic effect with subsequent increase of neurotransmitter dopamine in the brain reward centers.
Dexmedetomidine is an α2-adrenergic receptor (α2-AR) agonist which has been successfully used in several clinical settings in view of diverse actions which include sedation, analgesia, anxiolysis in the intensive care unit (ICU).
In our study, 40 patients were randomly divided into 2 equal groups. The control group received 50 mcg of fentanyl added to bupivacaine on each side. The study group received 50 mcg of dexmedetomidine added to bupivacaine on each side. All patients received equal volumes. Our study showed that addition of a 50 mcg of dexmedetomidine to bupivacaine in ultrasound-guided TAP block has statistically significant effect on the hemodynamic stability of the patients. In addition, dexmedetomidine prolonged the duration of analgesia significantly, as proved by the time of request of first rescue analgesia. Moreover, in dexmedetomidine group, postoperative analgesic requirements were greatly lesser than that of fentanyl group. This makes dexmedetomidine with bupivacaine more superior than the use of fentanyl with bupivacaine.
CONCLUSION
Dexmedetomidine delayed the time to first rescue analgesia when added to bupivacaine in TAP block using ultrasound-guided technique and improved patients’ outcome with decrease in the total pethidine consumption and more hemodynamic stability in comparison to the addition of fentanyl to bupivacaine.