Perioperative analgesic effect of preemptive ultrasound-guided rectus sheath block and transversus abdominis plane block with dexmedetomidine versus dexamethasone for laparoscopic surgery in paediatrics: A randomised trial

Background: We aimed to assess the impact of the rectus sheath and transversus abdominis plane blocks on postoperative pain alleviation and recovery in children undergoing laparoscopic appendicectomies. Methods: Ninety patients got a transversus abdominis plane block and rectus sheath block and were randomly divided into three groups. Each patient had taken 2.5ml of 0.5% bupivacaine (1.25mg/kg). Group 1: 0.3mg/kg of dexamethasone was added to the bupivacaine. Group 2: 1μg/kg of dexmedetomidine was added to the bupivacaine. Group 3: received only bupivacaine. We recorded analgesic usage overall, postoperative pain score, time until initial analgesic use, side effects and satisfaction score. Results: The dexmedetomidine group had a significantly longer mean time to initial rescue analgesia (13.13 ± 2.81) compared to the control and dexamethasone groups (11.6 ± 2.99, 7.27 ± 2; p < 0.001). Within the first 24 hours following surgery, the dexmedetomidine group consumed considerably less rescue analgesia (490.5 ± 129) than the dexamethasone and control groups (556 ± 210.4, 811.5 ± 333.9; p < 0.0001). With better satisfaction, fewer analgesics were taken, and fewer side effects and lower postoperative pain levels were observed in the dexmedetomidine group. Conclusions: Dexmedetomidine in combined transversus abdominis plane and rectus sheath blocks can enhance postoperative pain relief, decrease analgesic use and hasten postoperative recovery.