| This prospective randomized double blinded case control study was done to evaluate the post-operative analgesic efficacy
of bupivacaine alone or in combination with clonidine in ultrasound guided TAP block at Sree Lakshmi Narayana
Institute of Medical Sciences, Pondicherry ,after obtaining Hospital Ethical Committee approval and informed consent
from all the patients. 60 patients who underwent lower segment cesarean section under subarachnoid block were enrolled
in this study. They were divided in to two groups of 30 each. Both groups received standard dose of 10mg 0.5%
Bupivacaine in subarachnoid block. After the surgery when block level receded to T10 sensory level, ultrasound guided
TAP block was performed bilaterally using posterior approach. The ultrasound was used to identify the correct position of
needle and also the spread of local anaesthetic solution in the neurofascial plane between internal oblique and transversus
abdominis muscle. Group BC received 20ml of 0.25% Bupivacaine with clonidine 0.5microgram/kg and Group B received
20ml of 0.25% Bupivacaine on either side. The hemodynamic parameters like pulse rate, blood pressure, respiratory rate,
oxygen saturation and sedation score by means of Ramsay score was monitored after the performance of block. The
analgesic efficacy was monitored by means of VAS score. The duration of analgesia was calculated from the time of
performance of TAP block until the VAS score of 4 was obtained. The primary end point of study was when VAS score ?4
was obtained. The average duration of analgesia was 516 minutes in bupivacaine and clonidine group compared to 277
minutes in plain bupivacaine group and this duration of analgesia was statistically significant in bupivacaine with clonidine
group when compared to bupivacaine group. The sedation score of 3 was obtained in about 86.7% of the patients in
bupivacaine and clonidine group compared to only 10% of patients in plain bupivacaine group. Thus the sedation score was
significantly higher in bupivacaine with clonidine group but it was an arousable sleep. The incidence of complications like
post operative nausea, vomiting hypotension and bradycardia was similar in both groups ,and it was not statistically
significant. Thus the addition of clonidine to bupivacine extended the duration of analgesia without any significant side
effects in ultrasound guided Transversus abdominis Plane Blockddd |
