Abstract

Background:Transversus abdominis plane (TAP) block is a well-established analgesic
technique for postoperative analgesia in abdominal surgeries.In our study, we
compared the analgesic efficacy of adjuvant fentanyl and tramadol with Bupivacaine in
TAP block following percutaneous nephrolithotomy.
Methods:In this randomized, prospective, controlled study, 90 patients of ASA grade I
and II were divided into three groups; Group A, Group B, and Group C. Surgical
procedure was done under spinal anesthesia.At the end of surgery, we introduced TAP
block unilaterally in the triangle of petit by feeling two pop technique. Group A
received 28 ml of 0.25% bupivacaine with 50 μg of Fentanyl;1 ml normal saline was
added to make total 30 ml, Group B received 28 ml of 0.25% bupivacaine with 100 mg
of tramadol (2ml), and Group C received 28 ml of 0.25% bupivacaine with 2 ml of
normal saline. The primary outcome wasduration of analgesia (time to first rescue
analgesia) and the secondary outcomes were total dose of rescue analgesics and visual
analog scale (VAS) score recorded at 0,2,6,4,8,12, and 24 hr. If VAS score >4 or patient
complained of pain, then injection diclofenac 75mg intravenous was given as rescue
analgesic.
Results:Duration of analgesia was higher with fentanyl than tramadol & normal saline.
It was 7.01±0.176 hrs., 4.89±0.713 hrs. and 3.01±0.125 hrs. respectively with fentanyl,
tramadol, and normal saline. The total dose of rescue analgesic was lower with fentanyl
than tramadol and higher with normal saline. VAS score was also lower with fentanyl in
comparison to tramadol and normal saline.
Conclusion:Postoperatively many adjuvants were added in TAP block to improve the
quality of analgesia but fentanyl prolonged the postoperative analgesia effectively in
comparison to tramadol or plain TAP block.