Background: Transverse abdominis plane (TAP) block has emerged as an effective regional anesthesia technique for postoperative analgesia following lower abdominal surgeries. The addition of adjuvants to local anesthetics may enhance the duration and quality of analgesia.
Objective: To compare the efficacy and safety of tramadol versus dexmedetomidine as adjuvants to bupivacaine in ultrasound-guided TAP block for postoperative pain management in lower abdominal surgeries.
Methods: This prospective, randomized, double-blind study included 90 patients undergoing elective lower abdominal surgeries. Patients were randomly allocated into three groups: Group B (bupivacaine alone), Group BT (bupivacaine with tramadol), and Group BD (bupivacaine with dexmedetomidine). Primary outcomes included duration of analgesia, Visual Analog Scale (VAS) scores, and rescue analgesic requirements. Secondary outcomes assessed hemodynamic parameters and adverse effects.
Results: Group BD demonstrated significantly longer duration of analgesia (18.4 ± 2.3 hours) compared to Group BT (12.6 ± 1.8 hours) and Group B (8.2 ± 1.5 hours) (p<0.001). VAS scores were significantly lower in Group BD at all time points. Rescue analgesic requirement was lowest in Group BD. Both adjuvant groups showed stable hemodynamics with minimal side effects.
Conclusion: Dexmedetomidine as an adjuvant to bupivacaine in ultrasound-guided TAP block provides superior and prolonged postoperative analgesia compared to tramadol, with an acceptable safety profile.