Analgesic Efficacy of Addition of Clonidine to Bupivacaine in Transversus Abdominis Plane Block(TAP) for Pot Operative Analgesia in Laparoscopic Appendicectomy

Abstract

Background: Pain is the commonest symptom encountered postoperatively and hence multimodal analgesia is tried to overcome it. Objectives: To compare bupivacaine and bupivacaine plus clonidine in transversus abdominis plane (TAP) block for postoperative analgesia in patients undergoing laparoscopic appendicectomy under spinal anaesthesia. Methods: Sixty ASA I and II patients in the age range of 18-60 years undergoinglaparoscopic appendicectomy were randomly divided into two groups, who were operated after giving spinal block using 2.5 ml of 0.5% hyperbaric bupivacine and 25ug of fentanyl. At the end of surgical procedure tranversus abdominis plane (TAP) block was given by giving 25 ml of injection bupivacaine 0.25% in group I and 25 ml of 0.25% of bupivacaine with 1 ug.kg-1 of clonidine in group II. SPSS (Version 22.0) was used for analysis. Results: Demographic characteristics like age, weight, sex, ASA class and diagnosis were comparable in both groups. SBP, DBP and HR were less in group II than in group I and was statistically significant (p-value<0.05). The overall mean VAS score in group I was 3.03 ± 1.57 and group II was 1.72 ± 1.02 with p-value of 0.0005 and hence better quality of analgesia in group II. The duration of analgesia which was calculated by mean time for first rescue analgesia in group I was 6.38 ± 2.56 hours and group II was 14.23 ± 4.63 hours with a p-value of <0.0001 and the difference was statistically significant. None of the patients had any episode of bradycardia or hypotension. Conclusions: Addition of clonidine 1 ug.kg-1 to 25 ml of 0.25% bupivacaine compared to 25 ml of 0.25% bupivacaine alone in transverse abdominis plane (TAP) block improves quality of analgesia, increases duration of postoperative analgesia and decreases postoperative analgesic requirements with minimal side effects.