Comparison of pain relief by bupivacaine with or without dexmedetomidine in transversus abdominis plane block for postoperative analgesia in patients undergoing abdominal surgeries

Abstract

Background & objective: Post-operative pain management is crucial for recovery and daily function. The transversus abdominis plane (TAP) block is a common regional anesthesia technique that effectively relieves abdominal wall pain. This study evaluates the effect of combining dexmedetomidine and bupivacaine in TAP blocks for pain control in abdominal surgery patients and the need for rescue analgesia. We assessed the effect of combining dexmedetomidine into bupivacaine in the TAP block on postoperative analgesia.

Methodology: A randomized controlled trial was conducted at Sheikh Zayed Hospital, Rahim Yar Khan, including 80 patients undergoing abdominal surgeries: exploratory laparotomy (20), ileostomy reversal (25), laparoscopic cholecystectomy (12), open cholecystectomy (10), and paraumbilical hernia mesh repair (13). Patients were randomized into Group A (20 mL of 0.25% bupivacaine with 0.25 mcg/kg dexmedetomidine) and Group B (20 mL of 0.25% bupivacaine alone). Ultrasound-guided TAP blocks were performed, and postoperative pain, hemodynamics, sedation, nausea, and rescue analgesia requirements were monitored.

Results: Age and gender were comparable between groups, while BMI was significantly lower in Group A (P = 0.001). Group A showed better pain control on VAS at 6 hours (P = 0.002) and 12 hours (P = 0.025). Sedation levels and rescue analgesia use were similar in both groups; however, patient satisfaction was higher in Group A (70.1% vs. 37.4%, P = 0.003), with a lower incidence of hypertension (10.0% vs. 25.0%, P = 0.011). Group A exhibited elevated SpO2 values prior to TAP block injection (P = 0.048), although no significant differences were seen at subsequent time intervals. The incorporation of dexmedetomidine did not influence postoperative nausea or sedation.

Conclusion: This study illustrates that the combination of dexmedetomidine and bupivacaine in TAP blocks yields improved analgesia and increased patient satisfaction relative to bupivacaine alone in individuals undergoing abdominal surgery.

Keywords: Abdominal Surgery; Anesthesia; Bupivacaine; Dexmedetomidine; Pain Management; TAP Block

Citation: Musharaf R, Sadaf S, Siddique A, Saeed T. Comparison of pain relief by bupivacaine with or without dexmedetomidine in transversus abdominis plane block for postoperative analgesia in patients undergoing abdominal surgeries. Anaesth. pain intensive care 2026;30(3):350-356. DOI: 10.35975/apic.v30i3.3174

Received: December 16, 2025; Revised: January 05, 2026; Accepted: January 06, 2026