A Randomized Controlled Double-Blind Comparative Study between Bupivacaine 0.25% Plus Fentanyl and Bupivacaine 0.25% Plus Dexmedetomidine for Caudal Epidural Postoperative Analgesia in Pediatric Lower Abdominal and Urogenital Surgeries in Indian Genotype

Abstract Objectives This study aimed to clinically evaluate and compare the efficacy of caudal epidural bupivacaine in prolonging the postoperative analgesia, with adjuvants like fentanyl or dexmedetomidine among children of Indian genotype. Materials and Methods A prospective double-blind randomized comparative study. The study population of 68 patients of Indian phenotype were randomly taken from a random number table and divided into two groups with 34 patients in each group. They received single shot caudal epidural blocks, with group A receiving 0.75 mL/kg of 0.25% bupivacaine + 1 mcg/kg fentanyl, group B receiving 0.75 mL/kg of 0.25% bupivacaine + 1 mcg/kg dexmedetomidine. Global Assessment of anesthesia, defined as the time from caudal injection to the first administration of rescue analgesia, will be recorded for both the groups. Results The addition of either fentanyl or dexmedetomidine as adjuvants in caudal block provided excellent postoperative analgesia, and sedation was significantly longer duration with dexmedetomidine (18.0 hours) than fentanyl (13.1 hours). We observed good hemodynamic stability in both the groups. Conclusion Addition of dexmedetomidine over fentanyl to bupivacaine for caudal epidural analgesia in pediatric age group has multiple advantages like better control of intraoperative and postoperative hemodynamics, significantly longer duration of postoperative analgesia, lesser bleeding during surgery, and achieving good surgical satisfaction. As the children are pain-free, calm, quiet, and sedated but arousable, the parents’ satisfaction is rewarding. The caudal epidural dose of 0.25% bupivacaine 0.75 mL/kg with adjuvants like dexmedetomidine or fentanyl is effective for postoperative analgesia in lower abdominal surgeries and is without side effects among the Indian population.

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Evaluation of the efficacy of 150 micrograms of intrathecal morphine with bupivacaine compared to 250 micrograms for postoperative analgesia following abdominal hysterectomy: a double blinded randomized control study

International Journal of Clinical Trials ◽

10.18203/2349-3259.ijct20190257 ◽

2019 ◽

Vol 6 (1) ◽

pp. 17

Author(s):

G. S. Sai Ram Prudhvi ◽

N. S. S. Naga Shyam ◽

Anand Acharya

Keyword(s):

Postoperative Analgesia ◽

Intrathecal Morphine ◽

Abdominal Hysterectomy ◽

Double Blind Study ◽

Hyperbaric Bupivacaine ◽

Double Blind ◽

Rescue Analgesia ◽

Group A ◽

Group B ◽

Preservative Free

Background: The synergistic action of local anesthetics and morphine is well known, morphine probably more superior for postoperative analgesia, when compared to other opioids. Preservative-free morphine is now available in India making intrathecal administration possible. The present randomized double blind study was designed to evaluate the effect of adding preservative free morphine to hyperbaric bupivacaine given intrathecally for abdominal hysterectomy.Methods: Following approval by the institutional review board and institutional research grant committee, eighty patients presenting for elective abdominal hysterectomy were included in this randomized, double blind study. All drugs used for spinal anesthesia were autoclaved as per the departmental protocol. 3.5 ml of hyperbaric bupivacaine 0.5% [heavy] was given in both groups along with preservative free morphine according to study group.Results: 27.5% (11/40) patients in group A, 17.5% (7/40) patients in group B received one dose of rescue analgesia (ketorolac 10 mg),during the 24 hours for pain relief while 29 patients is group A (72.5%) and 82.5% (33/40) patients in group B received 2 doses of rescue analgesia. 10% patients in Group A (4/40) and 10% patients in Group B (4/40) had a sedation score of 1 (drowsy and arousable).Conclusions: The mean duration of analgesia in patients who received 250 μgms of intrathecal morphine was 18.725±1.38 hours while in patients who received 150 μgms it is 16.075±1.23 hours. We conclude that 250 µgms of preservative-free intrathecal morphine provides longer duration of analgesia when compared to 150 µgms morphine, with hardly any additional adverse effects.

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Effectiveness of Intravenous Dexmedetomidine vs. Fentanyl for Attenuation of Haemodynamic Response to Pneumoperitoneum in Laparoscopic Cholecystectomy: A Randomised Double Blind Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2020/44939.14106 ◽

2020 ◽

Author(s):

Reema Meena ◽

Chandrakant Parashar ◽

Priyanka Jain ◽

Manoj Soni

Keyword(s):

Laparoscopic Cholecystectomy ◽

Postoperative Analgesia ◽

Minimal Invasive ◽

Double Blind Study ◽

Double Blind ◽

Rescue Analgesia ◽

Haemodynamic Changes ◽

Group A ◽

American Society ◽

Group B

Introduction: Laparoscopy is a widely performed minimal invasive surgical procedure, wherein various haemodynamic changes are faced by anaesthesiologists during Pneumoperitoneum (PNP). Aim: To compare the effectiveness of dexmedetomidine vs fentanyl for attenuating the haemodynamics response to PNP in Laparoscopic Cholecystectomy (LC). Materials and Methods: A total of 84 patients of 18-50 years age, American Society of Anaesthesiologists (ASA) Class I/II of either sex for elective LC were included. The patients were divided into two groups (A, B) of 42 patients each. Group A received dexmedetomidine and Group B received fentanyl. Both the drugs were given as loading dose of one μg/kg over ten min followed by maintenance 0.2 μg/kg/h throughout the surgery. Haemodynamic parameters were recorded at different time intervals throughout the surgery. In recovery room patients were observed for postoperative analgesia by using Visual Analogue Scale (VAS), sedation level using RAMSAY Sedation score at every 30 minutes till the time of giving first rescue analgesia and side effects, if any. Results: Intraoperatively, throughout the period of PNP, Group A showed statistically better attenuation of haemodynamic responses in comparison to Group B (p<0.05). After creating PNP, rise in Mean Arterial Pressure (MAP) was observed in both group A and group B, 99.38±6.32 and 103.43±9.81, respectively but this rise was more in group B which was statistically significant (p<0.05) throughout the surgery except 40 minutes after PNP creation. Time to first rescue analgesia or mean duration of postoperative analgesia (VAS>3) was significantly longer in dexmedetomidine group (102.14±32.50 minutes) than fentanyl group (42.86±15.03 minutes). There was better control of pain but more sedation in Group A than in Group B. Conclusion: This study concludes that intravenously administered dexmedetomidine shows better attenuation of haemodynamic responses to CO2 insufflation as compared to fentanyl. Dexmedetomidine also provides better sedation and has more analgesic sparing effect.

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COMPARATIVE STUDY BETWEEN EPIDURAL BUPIVACAINE WITH BUPRENORPHINE AND EPIDURAL BUPIVACAINE FOR POST-OPERATIVE ANALGESIA IN ABDOMINAL AND LOWER LIMB SURGERY

10.36106/3029748 ◽

2021 ◽

pp. 29-31

Author(s):

Anant Prakash ◽

Rahul Kumar ◽

Chandeshwar Choudhary ◽

Debarshi Jana

Keyword(s):

Comparative Study ◽

Lower Limb ◽

Heart Beat ◽

Epidural Administration ◽

Visual Analogue Pain ◽

Post Operative Period ◽

Epidural Bupivacaine ◽

Lower Limb Surgery ◽

Group A ◽

Group B

Background: Epidural administration of various analgesics gained increasing popularity following the discovery of opioid receptors in the spinal cord capable of producing potent analgesia. This effect seems to be greatest when epidural anaesthesia in continued in the post-operative period as epidural analgesia. It is now clear that epidural administration of opioids. Ours was a comparative study between epidural bupivacaine with buprenorphine and epidural bupivacaine for post-operative analgesia in abdominal and lower limb surgery. Methods: 60 patients undergoing lower abdominal and lower limb surgeries of either sex with ASA grade 1 and 2 aged between 20 and 60 years for divided into two groups. After completion of the surgery and when the effect of local anaesthetic wears of and the patients complains of pain the intended study drugs were given when visual analogue pain score touched 5 cm mark. Group – A: Patients received 8ml of 0.25% bupivacaine + 0.15mg of buprenorphine. Group – B: patients received 0.25% of bupivacaine alone. In the post-operative period the following parameters were studied, 1. Onset of analgesia, 2. Duration of analgesia, 3. Vital parameters such as heart beat, blood pressure, respiratory rate, sedation score and visual analogue score were recorded, 4. Side effects like nausea, vomiting, hypotension, respiratory depression, and pruritus allergic reaction were looked for. Results: It is observed that onset of analgesia in Group A (0.25% bupivacaine + 0.15mg buprenorphine) was 7.35 min. When compared to Group B which 15.5 min, which is statically signicant (P<0.05). Duration of analgesia in Group A is 17.23 hrs compared to Group B, which is 5.2 hrs, this is statically signicant (P<0.05). Visual analogue scale was reduced in Group A compared to Group B Conclusions: Addition of buprenorphine to bupivacaine by epidural injection for post-operative analgesia improves the onset, The duration and the quality of analgesia

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Intraoperative and Postoperative Analgesia Using Intravenous Opioid, Clonidine and Lignocaine

Anaesthesia and Intensive Care ◽

10.1177/0310057x9402200103 ◽

1994 ◽

Vol 22 (1) ◽

pp. 15-21 ◽

Cited By ~ 31

Author(s):

M. de Kock ◽

P. Lavandhomme ◽

J. L. Scholtes

Keyword(s):

Side Effects ◽

Postoperative Analgesia ◽

Randomised Trial ◽

Skin Incision ◽

Time Interval ◽

Colonic Surgery ◽

Double Blind ◽

Group A ◽

Group B ◽

Group D

The postoperative analgesia afforded after colonic surgery by IV opioid, clonidine and lignocaine given intra- and postoperatively was evaluated. In a double-blind randomised trial, 80 male patients scheduled for colonic resection under general anaesthesia received fentany 15 μg.kg−1 at induction and another 4 μg.kg−1 before skin incision (group A) or fentanyl (same dose) plus clonidine 4 μg.kg−1 in 20 min + 2 μg.kg−1.h−1 (group B, C) or fentanyl plus clonidine (same dosage) plus lignocaine 2 mg.kg−1 before skin incision, repeated before peritoneal incision and retractor placement (group D). In the four groups, intraoperative boluses of fentanyl 2 μg.kg−1 were given in response to the painful stimulation of the procedure. Postoperative pain was managed with PCA delivering 2 mg morphine per request in group A, 1.5 mg morphine in group B, 1.5 mg morphine + 15 μg clonidine in group C and 1.2 mg morphine + 15 μg clonidine + 23 mg lignocaine in group D. Postoperative analgesia was assessed by recording the analgesic demands (met and unmet) and the dose of morphine delivered at 6, 12, 18, 24, 36 hours. Side-effects, pain and sedation analogue scores were also recorded. A nalgesic demands and delivered morphine dose were reduced, at any time interval considered, in groups B, C, D, compared with A (P <0.001). No differences were noted between the groups B, C, D. Pain analogue scores were better in groups B, C, D compared with group A (P <0.001). Sedation and side-effects were not increased in groups B, C, D. Intraoperative clonidine was the major determinant of the reduction in analgesic demands and morphine delivered. Lignocaine, at the dose used, failed to afford any additional benefit.

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A comparative study of caudal anesthesia with bupivacaine v/s bupivacaine with dexmedetomidine in lower abdominal surgeries in pediatric age group

Pain medicine ◽

10.31636/pmjua.v6i3.3 ◽

2021 ◽

Vol 6 (3) ◽

pp. 25-29

Author(s):

Kishore Kumar N. ◽

Sandeep Kadam

Keyword(s):

Adverse Effect ◽

Postoperative Analgesia ◽

Rescue Analgesia ◽

Pediatric Age Group ◽

Respiratory Parameters ◽

Caudal Anaesthesia ◽

Significant Difference ◽

Blinded Study ◽

Group B ◽

Double Blinded

Background: caudal anaesthesia has shortterm effect. Alpha2 adenoreceptors when used as adjuvant to local anaesthetic in children prolongs analgesic duration. The study is aimed to assess the efficacy of addition of dexmedetomidine with Bupivacaine in caudal block for extending postoperative analgesia and its safety profile in pediatric infraumbilical surgeries.Method: the prospective interventional longitudinal double blinded study was conducted on 60 patients randomly divided into two groups by simple lottery method: group B who received (0.25 %) bupivacaine 1 ml/kg plus 1 ml normal saline (NS), and those in group BD who received (0.25 %) bupivacaine 1 ml/kg plus 0.5 μg/kg dexmedetomidine in 1 ml NS. Postsurgery, both groups were compared in R studio v1.2.5001. Association between the adverse effect and other variables (age, gender, type of surgery, groups) were assessed by Multiple linear regression.Results: in group BD, duration of analgesia prolonged significantly (P < 0.05). In group BD, FLACC score at initial four hours and at 12th hour was significantly less (P < 0.05). Group B was more likely to receive high number of rescue analgesia (P = 0.0005; OR = 11.769). No significant difference was observed concerning hemodynamics, respiratory parameters and adverse effect between both groups (P > 0.05). Conclusion: in children, dexmedetomidine when used along with bupivacaine prolongs postoperative analgesia duration, without any significant side effects.

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A COMPARATIVE STUDY OF CLONIDINE VERSUS NALBUPHINE AS INTRATHECAL ADJUVANTS TO 0.5% HYPERBARIC BUPIVACAINE DURING LOWER ABDOMINAL SURGERIES – A RANDOMIZED DOUBLE BLIND INTERVENTIONAL STUDY.

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i3.1004 ◽

2020 ◽

Vol 4 (3) ◽

Author(s):

Trishala Jain ◽

Jaipal .

Keyword(s):

Motor Block ◽

Sensory Block ◽

Double Blind Study ◽

Hyperbaric Bupivacaine ◽

Double Blind ◽

Rescue Analgesia ◽

Institutional Ethics ◽

Group A ◽

Group B ◽

Intrathecal Clonidine

Background: Regional anesthesia techniques for gynecological procedures are on increasing trends due to their advantage of postoperative analgesia owing to intrathecal adjuvants. The present study was aimed to comparatively evaluate the clinical efficacy of clonidine with nalbuphine when co-administered intrathecally with 0.5% hyperbaric bupivacaine for Lower abdominal surgeries in Gynecology. Methods: With institutional ethics committee clearance No. 193MC/EC/2018, randomized, double blind study was conducted. After obtaining informed written consent total of 84 patients scheduled for lower abdominal surgeries were randomly allocated into two groups: Group A (n=42) - Inj. 3.5 ml Bupivacaine 0.5% + 0.2 ml Clonidine(30µg) intrathecally. Group B (n=42) - Inj.3.5 ml Bupivacaine 0.5%+0.2 ml Nalbuphine(2mg) intrathecally. The characteristics of sensory and motor block, hemodynamic data, side effects were recorded. Results: The onset of sensory block was earlier in Group B than Group A (3.08±0.52 min vs 4.00±0.54 min, p<0.001 ). The onset of motor block was also earlier in Group B than Group A (7.78±0.80 min vs 8.80±0.95min, p<0.001). The time to first rescue analgesia in patients receiving intrathecal clonidine was significantly delayed than patients receiving intrathecal nalbuphine (284.95 ± 12.93 min vs 211.52 ± 15.92 min, p<0.001). Introperative hemodynamic changes were comparable and none of the patient suffered from respiratory depression except very little cases of shivering which are not significant. Conclusions: Intrathecal clonidine as adjuvant to bupivacaine provided was clinically more effective than nalbuphine for prolonging the duration of analgesia for gynecological procedures. Keywords: Bupivacaine, Clonidine, Lower abdominal surgeries in gynecology, Nalbuphine, Subarachnoid block.

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A COMPARISON BETWEEN INTRATHECAL NALBUPHINE VERSUS FENTANYL AS AN ADJUVANT WITH 0.5% HYPERBARIC BUPIVACAINE FOR POSTOPERATIVE ANALGESIA IN PATIENTS UNDERGOING LOWER SEGMENT CESAREAN SECTION

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i8.2081 ◽

2021 ◽

Vol 5 (8) ◽

Author(s):

Mukesh Choudhary ◽

Neeti Mahla

Keyword(s):

Cesarean Section ◽

Postoperative Analgesia ◽

Motor Block ◽

Sensory Block ◽

Hyperbaric Bupivacaine ◽

Double Blind ◽

Lower Segment Cesarean Section ◽

Group A ◽

The Mean ◽

Group B

Background: Subarachnoid block is the preferred anesthesia for cesarean section, being simple to perform and economical with rapid onset. This study aims to compare the postoperative analgesia of intrathecal nalbuphine and fentanyl as adjuvants to bupivacaine in cesarean section. Methods: A prospective, randomized, double?blind, and comparative study was conducted on 120 patients of American Society of Anesthesiologists (ASA) physical status I and II. These patients were randomized into three groups with fifty patients in each group. Group A received 2 ml of 0.5% hyperbaric bupivacaine (10 mg) plus 0.4 ml nalbuphine (0.8 mg), Group B received 2 ml of 0.5% hyperbaric bupivacaine (10 mg) plus 0.4 ml fentanyl (20 ?g), and Group B received 2 ml of 0.5% hyperbaric bupivacaine (10 mg) plus 0.4 ml of normal saline. Results: The mean duration of sensory block was 107.32 ± 5.36 min in Group A, 111.23 ± 4.23 min in Group B, and 85.69 ± 2.31 min in Group C. The mean duration of motor block (time required for motor block to return to Bromage’s Grade 1 from the time of onset of motor block) was 152.02 ± 3.12 min in Group A, 151.69± 2.36 min in Group B, and 122.12 ± 2.32 min in Group C. Conclusion: We concluded that intrathecal nalbuphine prolongs postoperative analgesia maximally and may be used as an alternative to intrathecal fentanyl in cesarean section. Keywords: Nalbuphine, Bupivacaine, Fentanyl.

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CAUDAL ANALGESIA IN CHILDREN;

The Professional Medical Journal ◽

10.29309/tpmj/2012.19.05.2401 ◽

2012 ◽

Vol 19 (05) ◽

pp. 715-718

Author(s):

MUHAMMAD AMER ◽

MUHAMMAD SAIF UL MALOOK ◽

MUHAMMAD SHER UZ ZAMAN

Keyword(s):

Postoperative Period ◽

Controlled Trial ◽

Analgesic Efficacy ◽

Nausea And Vomiting ◽

Single Shot ◽

Rescue Analgesia ◽

Caudal Analgesia ◽

Group A ◽

Analgesic Technique ◽

Group B

Background: Caudal analgesia with bupivacaine is used commonly for pain relief in children and extradural administration oftramadol seems to be a safe method of analgesia. The aim of the study was to compare the analgesic efficacy of caudal bupivacaine andbupivacaine and tramadol mixture for postoperative analgesia and to observe for the side effects. Setting: Department of Anesthesia andIntensive Care Unit, Bahawal Victoria Hospital, Bahawalpur. Period: 01-12-2010 to 30-11-2011. Methods: Eighty children, aged between 2 to12 years of age undergoing infra umbilical surgeries were selected for this randomized, controlled trial. They were randomly divided into twogroups A and B. Group A (n = 40) received 0.5 ml/kg of 0.25 % bupivacaine and Group B (n = 40) received 0.5 ml/kg of 0.25 % bupivacaine with 1mg/kg of tramadol as a single shot caudal block. In the postoperative period, duration of analgesia, pain score, nausea, vomiting and sideeffects were noted and analyzed. Results: Patients in both groups were comparable for age and weight. It was observed that the meanduration of analgesia in group A patients was 6.23+0.68 hours while in group B, it was 9.33+0.72 hours (p<0.05). Nausea and vomiting waspresent in 20% (n=8) patients in group A, while in group B, 27.5% (n=11) had nausea and vomiting in the post operative period (p<0.05). None ofthe patients in both the groups had complications like motor weakness, urinary retention in the postoperative period. Conclusions: Theaddition of tramadol to bupivacaine in the caudal analgesic technique provides longer analgesia and lesser need for rescue analgesia in thepostoperative period compared to bupivacaine alone.

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A Comparative Study on the Efficacy of Kantkari and Vasa Lozenges in Children with Kasa (Cough)-Study Protocol

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i31b31685 ◽

2021 ◽

pp. 25-33

Author(s):

Sabir Ali ◽

Renu Rathi ◽

Bharat Rathi

Keyword(s):

Comparative Study ◽

Controlled Study ◽

Control Group ◽

Double Blind ◽

Abnormal Sound ◽

Sequence Method ◽

Group A ◽

Objective Outcomes ◽

Group B

Background: Kasa is the outcome due to release of obstructed Vayu resulting in the production of abnormal sound, which may be productive or dry. Kasa is one of the primary diseases of Pranavaha srotas, and can cause disturbances in other body functions. Prevalence of cough in India is 5% to 10% while acute cases of cough is 39% and chronic cases of cough is 29% reported in Maharashtra. This research drug is taken to check its efficacy on both the types of cough, dry as well as productive with acute or chronic origin. It has a good palatability and liked by children as it appears as candy. Many studies have been carried out on Kasa with different formulations so far like vati, churna, ghrita but they have no fast and long lasting action with different level of efficacy. Many lozenges are also available in the market but no studies have been done. Objective: Comparative Study on the efficacy of Kantakari lozenges with Vasa lozenges in the clinical features of Kasa by subjective criteria such as Peenasa-(running nose), Kasa, Aruchi-(taste impliedness), kanthkandu(throat itching), kaphnishthivan (Sputum) and objective criteria as adventitious sound and AEC-absolute eosinophil count, TLC-total leucocytes count, and DLC-differential leucocyte count. Materials and Methods: The present study is designed as a Double Blind, Randomized Controlled Study in which total 60 patients will be enrolled. Patients will be randomly divided (by computer generated sequence method) in two with 30 patients in each group. In group A, Vasa lozenges and in group B Kantkari lozenges will be given for 7 days. Assessment of the patients will be done on 3rd and 7th day during study after intervention and post treatment follow up will be taken on 14th& 21st day from the enrolled date. Results: Efficacy of both the lozenges will be observed in subjective and objective outcomes. Conclusion: Kantkari lozenges (trial group) is expected to be more effective than Vasa lozenges (control group) in the management of Kasa as Vata, Kapha are more dominant in the pathology of Kasa in children and Kantakari is a good Vatakaphahar drug added with Pippali to act synergistically.

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COMPARISON OF EFFICACY OF LEVOBUPIVACAINE IN TRANSVERSE ABDOMINIS PLANE BLOCK FOR POSTOPERATIVE ANALGESIA IN PATIENTS UNDERGOING CAESAREAN SECTION: A DOUBLE BLINDED, RANDOMIZED STUDY

10.36106/gjra/1302492 ◽

2020 ◽

pp. 1-3

Author(s):

Praveen S ◽

Shashank M

Keyword(s):

Caesarean Section ◽

Postoperative Analgesia ◽

Randomized Study ◽

Local Anaesthetics ◽

Tap Block ◽

Rescue Analgesia ◽

Transverse Abdominis ◽

Group A ◽

Group B ◽

Double Blinded

Background: Dexamethasone has a long and efficient glucocorticoid structure and presents anti-inflammatory properties. When used as an adjuvant to local anaesthetics, it prolongs the duration of analgesia. The aim of this study was to determine the effect of dexamethasone as an adjuvant to levobupivacaine in TAP block given to patients who underwent caesarean section. Materials & Methods: 70 patients posted for caesarean section under spinal anaesthesia were included in the study and divided into two groups. Group A received bilateral 30 ml 0.25% levobupivacaine and 2 ml dexamethasone(8mg). Group B received bilateral 30 ml 0.25% levobupivacaine and 2 ml 0.9% NaCl in a TAP block performed with ultrasonography. The time needed for the first rescue analgesia in the postoperative period was recorded. 24hr tramadol consumption & VAS was recorded. Results: Time for first analgesic administration (tramadol) was prolonged significantly in Group A (mean ± SD- 12.24 ± 1.22hrs) as compared to Group B (mean ± SD ‑ 8.37± 1.07 hrs), P < 0.0001. Tramadol requirement for 24hrs in Group A was 115.71± 16.89 mg and for Group B was 198.57± 22.64 mg, which was statistically significant (P < 0.0001). VAS was noted at 2, 4, 6, 8, 12, 18 and 24 h. VAS was greatly reduced in group A for the first 8–10 h post‑operatively as compared to patients in group B. CONCLUSIONS: Dexamethasone when used as an adjuvant to levobupivacaine in TAP block, enhances the duration of block & decreases opioid consumption in the post- caesarean section patients.

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