433: Dexmedetomidine as adjuvant to Ropivacaine in US-guided Subcostal Transversus Abdominis Plane block.

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Acute postsurgical pain, Pharmacological treatments

Background and Aims: Ultrasound guided subcostal transversus abdominal plane (TAP) block has come up as one of the promising modality to take care of postoperative pain after Laparoscopic cholecystectomy. The duration of analgesia depends upon duration of local anaesthetic used for the block. Various adjuvants are added to prolong the duration of local anaesthesia. So, the aim of our study is to find the efficacy of using dexmedetomidine as adjuvant to ropivacaine in subcostal TAP block for control of postoperative pain.

Methods: This prospective, comparative study was done in 40, American Society of Anesthesiologists classes I and II patients undergoing laparoscopic cholecystectomy surgery under general anaesthesia from September 2019 to February 2020. Patients were randomized into two groups to receive either bilateral ultrasonography-guided subcostal TAP blocks with 19ml 0.25% ropivacaine and 1ml of normal saline (n =20,Group R) or 19ml 0.25% ropivacaine with 1µg/kg dexmedetomidine 1mL (n = 20,Group RD). The primary outcomes were the first request time for rescue analgesia and numerical rating scale (NRS) scores at rest and movement across the different time intervals for the first 24h.

Results: The first request time for rescue analgesia was significantly longer in the group RD(452.75 ±215.25min) compared to group R(321.25 ±118.61min). The NRS scores at rest and movement in postoperative period were significantly lower in group RD compared to group R at 10 min, 1, 6, 12 and 24 hour time intervals. The mean supplemental analgesic requirement was significantly higher in group R compared to group RD. The sedation score were significantly higher in group RD at 30min and 60min time interval at postoperative period. Hemodynamic parameters were comparable between the groups and no other adverse events were recorded.

Conclusions: The use of dexmedetomidine as adjuvant to ropivacaine in subcostal TAP block prolongs the duration of analgesia, decreases the requirement of supplemental analgesia and lowers the pain scores in the postoperative period.

References: 1. Hebbard P. Subcostal transversus abdominis plane block under ultrasound guidance. Anesth Analg. 2008;106:674–5.
2.Bhatia N, Arora S, Wig J, Kaur G. Comparison of posterior and subcostal approaches to ultrasound-guided transverse abdominis plane block for postoperative analgesia in laparoscopic cholecystectomy. J Clin Anesth. 2014;26(4):294-9.
3.EldEgwy MH, AlfikEy R. Ultrasound-guided TAP Block with or without Dexmedetomidine Versus Local infiltration of the Wound after Open Herniorrhaphy : A Randomized prospective Controlled Study. MEJ ANESTH. 2017;24(2):147–54.

Presenting Author: Yogesh Dhakal
Submitting Author: Yogesh Dhakal

Senior Author: Balkrishna Bhattarai

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Birendra Prasad Sah: MD - BP Koirala Institute of Health Sciences
• Balkrishna Bhattarai: MD - BP Koirala Institute of Health Sciences
• Asish Subedi: MD - BP Koirala Institute of Health Sciences