"AN EVALUATION OF CLONIDINE AND FENTANYL AS AN ADJUNCT TO BUPIVACAINE IN ULTRASOUND GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCK FOR POSTOPERATIVE ANALGESIA IN BILATERAL INGUINAL HERNIOPLASTY".

Background: Inguinal hernioplasty is one of the most commonly performed surgical procedures associated with moderate to severe postoperative pain. Optimal postoperative analgesia is important to prevent negative outcomes. The Ultrasound guided transversus abdominis plane (TAP) block is a peripheral nerve block that involves innervations of the anterolateral abdominal wall derived from T6-L1 which increases duration of analgesia & prolongs the time to first analgesic request, reduces postoperative analgesic consumption and reduces opioids related side effects. Various adjuvants to bupivacaine have been used to extend the analgesic effect. Most commonly used are dexmedetomidine, clonidine, dexamethasone and fentanyl. In this study we used clonidine and fentanyl. Primary objective was to assess the duration of postoperative analgesia while secondary objectives were to compare the quality of analgesia as measured by VAS score, the total amount of rescue analgesics consumed in 24 hours, side effects, and complications if any between the adjuvants. Aims and Objectives: To assess the duration of postoperative analgesia with clonidine v/s fentanyl as adjuvant to bupivacaine (p). To compare the quality of analgesia as measured by Visual Analogue pain scale (VAS) score, the total amount of rescue analgesics consumed in 24 hours and side effects and complications if any between the adjuvants Materials and methods: An observational hospital based study was conducted at Gandhi Medical College, Bhopal comprising of 60 patients between age group 18-60 years, male, belonging to ASA grade I to II, scheduled for elective bilateral inguinal hernioplasty under the subarachnoid block (SAB) after informed consent. GROUP C (B+C) - 30 patients received bilateral TAP block using 22 ml solution--consisting of 20 ml 0.25% bupivacaine and 1 mcg/kg clonidine dissolved in 2 ml normal saline. GROUP F (B+F) - 30 patients received bilateral TAP block using 22 ml solution--consisting of 20 ml 0.25% bupivacaine and 1 mcg/kg fentanyl dissolved in 2 ml normal saline. Diclofenac 75mg was used as rescue analgesia. Post operative pain is evaluated by VAS score for pain at 0,2,4,8,12 and 24 hrs postoperatively, time to 1st analgesia, total analgesia and any complications were noted. Result: There was no statistical significant difference between the two groups in demographic characteristics (age and ASA), The overall p value of mean heart rate, mean systolic bp, mean diastolic bp between 2 group is less than 0.001, the difference was statistically significant which means the average hemodynamic parameter values of group F (B+F) were greater than group C (B+C), The VAS score of group C Was significantly lower than VAS score of group F during all the intervals of time (p<0.001), Significant difference was seen in post-operative Ramsay sedation score at 2 hour, at 4 hours, at 8 hours, between GROUP F and GROUP C (p value <0.05). GROUP F has higher Ramsay sedation score, No significant difference was seen at 12 and 24 hours (p value > 0.05), between GROUP F and GROUP C, time to 1st rescue analgesia is longer in group clonidine, Total analgesic consumption in the group C was lower compared to that of group F which was significant statistically(p < 0.05). The incidence of hypotension and bradycardia more in group C. Other adverse effects were comparable. Conclusion: Addition of clonidine to Bupivacaine in TAP Block prolongs the post-operative analgesia than fentanyl. It provides longer first analgesia request time and less total analgesia consumption with minimal side effects. Addition of fentanyl to Bupivacaine in TAP Block gives more hemodynamic stability. [ABSTRACT FROM AUTHOR]