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ORIGINAL ARTICLE
Year : 2017  |  Volume : 30  |  Issue : 2  |  Page : 538-543

Ultrasound-guided transversus abdominis plane block for lower abdominal surgeries: bupivacaine alone or combined with fentanyl or epinephrine


Department of Anesthesiology, Faculty of Medicine, Menoufia University Hospital, Menoufia University, Shebin El-Kom, Egypt

Correspondence Address:
Walid A Abo-Omar
Department of Anesthesiology, Faculty of Medicine, Menoufia University Hospital, Menoufia University, Shebin El-Kom, Menoufia-32511
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.215478

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Objective The objective of this study was to evaluate the effects of adding fentanyl or epinephrine to bupivacaine in ultrasound-guided transversus abdominis plane(TAP) block for lower abdominal surgeries. These effects include quality and duration of the analgesia and opioid consumption. Background TAP block provides analgesia to the anterior abdominal wall. Many adjuvants were used to improve the quality and duration of analgesia in various nerve blocks. Patients and methods Fifty-six adult patients undergoing elective lower abdominal surgeries under general anesthesia received TAP block with 20ml of local anesthetic mixture bilaterally and were randomly allocated according to the local anesthetic mixture into three groups: groupB(bupivacaine), groupBE(bupivacaine+epinephrine), and groupBF(bupivacaine+fentanyl). The primary outcomes were postoperative pain(evaluated by time to first analgesia request and visual analog scale) and opioid consumption(intraoperative fentanyl and morphine in 24h postoperatively). The secondary outcomes were effect on hemodynamics, time of extubation, and side effects. Results Time to first analgesia request was longer in groupBF, postoperative visual analog scale was lower in groupBF after 4h, the use of intraoperative fentanyl was lower in groupBF, and morphine consumption 24h postoperatively was lower in groupBF. Time of extubation was shorter in groupBF, and intraoperative mean arterial pressure decreased at 30min in groupB and groupBF. Conclusion The addition of fentanyl to the local anesthetic in ultrasound-guided TAP block prolongs the analgesia, lowers postoperative pain, and decreases the opioid consumption. Adding epinephrine prevents reduction of mean arterial pressure without additional effects on the block characteristics.


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