Article Type

Original Study


Objective The objective of this study was to evaluate the effects of adding fentanyl or epinephrine to bupivacaine in ultrasound-guided transversus abdominis plane (TAP) block for lower abdominal surgeries. These effects include quality and duration of the analgesia and opioid consumption. Background TAP block provides analgesia to the anterior abdominal wall. Many adjuvants were used to improve the quality and duration of analgesia in various nerve blocks. Patients and methods Fifty-six adult patients undergoing elective lower abdominal surgeries under general anesthesia received TAP block with 20 ml of local anesthetic mixture bilaterally and were randomly allocated according to the local anesthetic mixture into three groups: group B (bupivacaine), group BE (bupivacaine + epinephrine), and group BF (bupivacaine + fentanyl). The primary outcomes were postoperative pain (evaluated by time to first analgesia request and visual analog scale) and opioid consumption (intraoperative fentanyl and morphine in 24 h postoperatively). The secondary outcomes were effect on hemodynamics, time of extubation, and side effects. Results Time to first analgesia request was longer in group BF, postoperative visual analog scale was lower in group BF after 4 h, the use of intraoperative fentanyl was lower in group BF, and morphine consumption 24 h postoperatively was lower in group BF. Time of extubation was shorter in group BF, and intraoperative mean arterial pressure decreased at 30 min in group B and group BF. Conclusion The addition of fentanyl to the local anesthetic in ultrasound-guided TAP block prolongs the analgesia, lowers postoperative pain, and decreases the opioid consumption. Adding epinephrine prevents reduction of mean arterial pressure without additional effects on the block characteristics.