Introduction: Cesarean section (CS) is one of the most common surgical procedures in India. The abdominal wall incision and soft tissue dissection associated with this procedure may result in moderate to severe post-operative pain. Postoperative pain management is usually multimodal including oral or intravenous (IV) acetaminophen, nonsteroidal anti-inflammatory agents (NSAIDs) and opiates, epidural analgesia, and peripheral nerve blocks. The transversus abdominis plane (TAP) block is a regional technique for analgesia, which provides satisfactory post-operative pain relief and reduces certain side effects associated with the use of opioids or epidural block^(9,10). The objectives of this study was to evaluate the potential benefits of dexmedetomidine or fentanyl when added to ropivacaine in TAP block for postoperative pain management and patient recovery after Cesarean section (CS).

Material & Methodology: We conducted a comparative prospective randomized controlled double-blind study on 90 patients of ASA grade I and II, 18 to 35 years of age undergoing elective and emergency Caesarean section under spinal Anaesthesia in Department of anaesthesia, S. P. Medical college and A.G. of Hospitals, Bikaner after taking approval from Institutional Ethical committee and valid written informed consent from patient and their close relatives.

90 patients were randomised into 3 groups and 30 patients were included in each group randomly. Group A, B & C received 0.375% ropivacaine, 0.375% ropivacaine + 1 μg/kg dexmedetomidine, 0.375% ropivacaine  + 1 μg/kg fentanyl ( total volume 20 ml each side) respectively.

Results:  We observed that the group receiving combination of ropivacaine with dexmedetomidine (Group B) & Ropivacaine with Fentanyl (Group C) has significantly lower pain scores postoperatively compared to group receiving only ropivacaine (Group A). There was a significant difference in the terms of VAS over time (p = <0.001) & total Analgesic Consumption (mg) ( p = <0.001) between the three groups in twenty four hours.

Conclusion:  From our study we concluded that dexmedetomidine or fentanyl as adjuvant to ropivacaine in transversus abdominus plane block significantly decreases the Post-Operative pain after  caesarean section under spinal anaesthesia .

Keywords: Ropivacaine, Dexmedetomidine, Fentanyl.

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Dr Jinesh Baid

Department of anaesthesia, Sardar Patel Medical College & AGH, Bikaner, Rajasthan, India