Comparative Analysis of Duration of Postoperative Analgesia between Levobupivacaine and Levobupivacaine with Clonidine after Ultrasound-Guided Transversus Abdominis Plane Block in Patients Undergoing Lower Segment Cesarean Section.

BACKGROUND: Transversus abdominis plane (TAP) block in cesarean section is carried out by local anesthetics such as bupivacaine or ropivacaine with a limited duration of analgesia. The addition of adjuvants such as clonidine and dexmedetomidine has increased the duration of postoperative analgesia.

AIMS SETTINGS AND DESIGN: The aim of this study was to compare the duration of postoperative analgesia between clonidine and levobupivacaine (0.25%) versus levobupivacaine (0.25%) alone in the bilateral TAP block after lower segment cesarean section (LSCS).

MATERIALS AND METHODS: In this prospective randomized double-blind interventional study, 100 parturients undergoing elective LSCS were included in the study. Patients were randomly divided to receive either 20-ml levobupivacaine 0.25% (Group A; n = 50) or 20-mL levobupivacaine (0.25%) +1-μg/kg clonidine bilaterally (Group B; n = 50) in TAP block in a double-blind fashion. The total duration of analgesia, patient satisfaction score, postoperative visual analog scale score, total requirement of analgesics in the first 24 h, and the side effects of clonidine were observed.

STATISTICAL ANALYSIS: Statistical tests were conducted using SPSS. P < 0.05 was considered as statistically significant.

RESULTS: A total of 92 patients were analyzed. Duration of analgesia was significantly longer in Group B (17.94 ± 0.76 h) compared to Group A (7.16 ± 0.41 h) ( P < 0.001). Mean consumption of tramadol was 197.77 ± 14.90 mg and 8.889 ± 28.77 mg in Groups A and B ( P < 0.001), respectively. All patients in Group B were extremely satisfied while those in Group A were satisfied ( P < 0.01). None of the patients experienced hypotension or bradycardia.

CONCLUSION: The addition of clonidine 1 μg/kg to 20-ml levobupivacaine 0.25% in TAP block bilaterally for cesarean section significantly increases the duration of postoperative analgesia, decreases postoperative rescue analgesic requirement, and increases maternal comfort compared to 20 ml of levobupivacaine 0.25% alone.