![]() ![]() ![]() Patients were taught how to evaluate the visual analog scale (VAS) and QoR-40 questionnaire preoperatively. Exclusion criteria were as follows: bleeding diathesis, alcohol or drug abuse, opioid dependence, chronic pain, pain medication prior to surgery, infection at injection site, history of abdominal surgery or trauma, respiratory tract infection within 2 weeks, New York Heart Association class >II, and psychiatric illnesses that would interfere with perception and pain assessment ( Figure 1). All surgeries were performed with lower abdominal incision with the drainage tube inserted unilaterally. One hundred patients aged 18–60 years, with American Society of Anesthesiologists (ASA) class I–II status and body mass index (BMI) of 18.5–23.9, who were scheduled for open gynecological surgeries were enrolled in this study. This prospective randomized double-blind clinical trial was registered at under number ChiCTR-INR-17011160 after approval from the ethics committee of Chongqing University Cancer Hospital, Chongqing, China (2016-50), and it was conducted in accordance with the Declaration of Helsinki. 12 The objectives of this study were to evaluate the potential benefits of dexmedetomidine or fentanyl when added to ropivacaine in TAP block for postoperative pain management and patient recovery after lower abdominal surgery. 5, 6 Diverse adjuvants (dexmedetomidine, fentanyl, MgSO 4, etc.) were added to local anesthetics to prolong the analgesic duration of TAP block, 7 – 11 but the preferable regimen and optimal dosage of adjuvants to be added to local anesthetics still remain unclear. Unfortunately, a single-injection TAP block could provide effective abdominal wall analgesia for only up to 8 hours which limits its use. 1, 4 A large amount of related data have demonstrated the optimal abdominal area analgesia and the efficacy for providing perioperative analgesia with ultrasound-guided techniques. The safety of this block was also reported in patients with anticoagulant or coagulant defects. 2, 3 Recognized indications for a TAP block include open gastrointestinal surgery, gynecological surgery, and some urological surgeries. TAP block was designated to block the anterior branches of the spinal nerves from T7 to L1 which lie in the neurofascial plane between the internal oblique and transversus abdominis muscles and could anesthetize the median and lower abdominal wall. Transversus abdominis plane (TAP) block has been proved to be a useful and safe alternative technique to provide analgesia following abdominal surgeries. 1 Opioids are widely used, but their side effects and possible delay in postoperative recovery limit their application. Open abdominal surgeries are inevitably accompanied by considerable postoperative pain, which is a detrimental important variable in patient outcomes and postoperative complications. ![]()
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