SOTTIE, AKWANFO YAW DANIEL2025-01-282025-01-282022-04-01https://repository.gcps.edu.gh/handle/123456789/46INTRODUCTION Caesarean delivery (CD) is a common surgical procedure with associated significant post-operative pain. Adequate post caesarean analgesia enables the new mother to take care of the new born while preventing the debilitating effects of uncontrolled post-operative pain. The most frequent negative response to caesarean delivery in Ghanaian women is pain. Analgesic options following CD in Korle-Bu Teaching Hospital include the use of intrathecal opioids (fentanyl), parenteral opioids (intramuscular pethidine), intravenous paracetamol and rectal diclofenac. The addition of the bilateral transversus abdominis plane (TAP) block with dexamethasone as an adjunct to the existing pain management modalities will provide adequate post caesarean delivery analgesia and improve patient satisfaction. AIM The aim of this study was to assess the effectiveness and safety of perineural dexamethasone in ultrasound guided bilateral TAP block in providing post-operative analgesia in parturients who underwent caesarean delivery under spinal anaesthesia at Korle-Bu Teaching Hospital. METHODS This was a prospective, randomized, double blind study of 99 electively booked patients for caesarean delivery under spinal anaesthesia. These were divided into three groups of 33 each after meeting inclusion/exclusion criteria and giving informed consent. Ultrasound guided bilateral TAP block was administered immediately after caesarean delivery under spinal anaesthesia (using either bupivacaine + dexamethasone (group A), only bupivacaine (group B) or only saline (group C)). Time to request for first analgesia, systemic opioid consumption, numerical rating scale (NRS) pain scores, incidence of pruritus, nausea and vomiting and participants’ satisfaction were recorded. This was entered into Microsoft Excel spread sheet and Statistical Package for the Social Scientists (SPSS) software version 25 used for data analysis. RESULTS The time to first analgesic request was significantly prolonged in the bupivacaine group (327.5 ± 98.69 minutes) compared to the saline group (256.5 ± 72.33 minutes) (p-value = 0.023); with addition of dexamethasone resulting in further prolongation (485.2 ± 143.03 minutes) (p-value < 0.0001) of the time to first rescue analgesic. There was a significantly lower consumption of systemic opioids in the bupivacaine group (269.1 ± 64.44mg) compared to the saline group (380.6 ± 39.21mg) (p-value < 0.0001); with further significant lowering of opioid analgesic requirements (113.6 ± 81.58mg) on addition of dexamethasone (p-value < 0.0001). NRS pain scores at rest and on coughing were lower in the intervention groups compared to the control group. Lower NRS pain scores were recorded with addition of dexamethasone although they were not always significant. The incidence of adverse events of pruritus, nausea and vomiting and sedation was not significantly different amongst the three groups. Participants who had dexamethasone + bupivacaine had higher satisfaction scores than participants who had bupivacaine; who in turn had higher satisfaction scores than participants who had saline. CONCLUSION Addition of dexamethasone to bupivacaine for a TAP block is safe, has opioid sparing effect and provided better postoperative analgesia after Caesarean delivery compared to control and bupivacaine alone TAP at Korle-Bu Teaching Hospital.Caesarean DeliveryPost-operative analgesiaBilateral TAP Block