Effectiveness of perineural and intravenous dexamethasone added to bupivacaine for transversus abdominis plane block in post-cesarean delivery pain control: A prospective cohort study

ABSTRACT Background: Cesarean delivery (CD) has been one of the most frequently performed major surgical interventions and causes severe postoperative pain. Abdominal field blocks like TAP block are mostly preferred as postoperative analgesia for this operation. Using different adjuvants like dexamethasone by different routes increases the quality and duration of block and maximizes patient satisfaction. The objective of this study was to compare the effectiveness of perineural and intravenous dexamethasone for post-cesarean delivery pain control. Methodology: An institutional based prospective cohort study was conducted on 87 patients. Data collection methods include a preoperative chart review, intraoperative observation, and postoperative patient interview at 4 th, 6 th, 8 th, 12 th, and 24 th hours. Kruskal Wallis with post hoc analysis was used to compare postoperative severity of pain score and cumulative analgesic consumption. Time to first analgesic request was analyzed using Kaplan Meier survival analysis with log rank. Categorical variables were analyzed by chi-square. Result: Time to first analgesic request was significantly longer in TAP-IVD and TAP-PD compared to TAP alone (p < 0.05). The postoperative NRS score at rest and on coughing was significantly lowered in TAP-PD and TAP-IVD group compared to TAP alone group (p < 0.05). The total analgesic consumption in the first 24 h was significantly lower in TAP-IVD and TAP-PD group compared to TAP alone group (p < 0.05). Conclusion: Dexamethasone 8 mg both intravenously and perineurally is effective adjuvant to bupivacaine on bilateral TAP block with prolonged and potent analgesia and reduced analgesic consumption. Research registry: UIN = researchregistry5538. Highlights: