Efficacy of Dexamethasone Added to Bupivacaine in Ultrasound Guided Transversus Abdominis Plane Block for Postoperative Analgesia after Inguinal Herniorraphy

Abstract

Inguinal herniorrhaphy is frequently associated with persistent postoperative pain. A significant proportion of pain experienced by patients undergoing abdominal surgeries is related to somatic pain signals derived from the abdominal wall. Post-operative pain after inguinal hernia lead to the increased consumption of analgesics, delayed bowel function and increase the requirement for rescue analgesics. Appropriate pain treatment protocols to reduce postoperative morbidity, improve the results of the surgery and decrease hospital costs. Treatment for postoperative pain after abdominal surgical procedure (inguinal herniorrhaphy) based on conventional drugs with pain escape (consisting of maximal does of paracetamol, non-steroidal ant inflammatory drugs, and oral or intravenous opioid), is associated with adverse effects, such as nausea, sedation, hypotension, reduced hung capacity and increased cardiac load. All these effects impede rehabilitation and early discharge. The aim of the present work was to evaluate the effect of preemptive dexamethasone added to bupivacaine on postoperative pain in patients receiving transversus abdominis plain block (TAPB) guided with ultrasound for inguinal hernia repair as regard the time of the first request for additional analgesia. Pain scores, total analgesic consumption and analgesic efficacy. The present study was conducted on 30 adult male patients aged 20 to 60 years, American Society of Anesthesiologists (ASA) class I or II scheduled for elective primary unilateral open inguinal hernia repair All patients were informed with the procedure US guided TAP block and were trained to use the visual analogue scale (VAS). Patients were randomized, double blind controlled into two equal groups (15 male patients each). Group I: The patients were received 20 ml of 0.5% bupivacaine with 2 ml 0.9% NaCl which were administered in a TAP block performed with ultrasound guided at same side of the operation.