Dexamethasone versus fentanyl as an adjuvant to ropivacaine in ilioinguinal and iliohypogastric nerve block for postoperative analgesia: A prospective randomized double-blind trial in lower-segment cesarean section

Background: Ilioinguinal and iliohypogastric (IIIH) nerve block for postoperative analgesia after lower-segment cesarean section (LSCS) is stated to have a short duration of action, and prolongation of its effect with adjuvants remains unexplored. We aimed to assess the efficacy of dexamethasone and fentanyl as adjuvants to ropivacaine in ultrasound-guided bilateral IIIH block. Methods: After approval from the Institutional Ethics Committee and informed consent, this prospective randomized double-blind study enrolled 40 American Society of Anesthesiologists II parturients, divided into two groups. Group I (n = 20) received IIIH block with 3 mg/kg of 0.75% ropivacaine and dexamethasone 8 mg whereas Group II (n = 20) received 3 mg/kg of 0.75% ropivacaine and fentanyl 50 μg. The primary outcome studied was the duration of analgesia (as defined by the requirement of first rescue analgesia). The secondary outcomes included total rescue analgesic consumption and the median number of times rescue analgesic requirement in 24 h postoperatively. Student's t-test and Mann–Whitney U-test were applied to compare the analgesic parameters among the groups. Results: Both the groups were comparable for the duration of analgesia (8.15 ± 0.95 vs. 7.55 ± 1.51 h, P = 0.142), the median number of times rescue analgesics required in 24 h (2.5 [2–3] in Group I vs. 3 [2–3] in Group II, P = 0.590), and total tramadol required in 24 h (125 ± 25.6 vs. 130 ± 25.1 mg, P = 0.540). Conclusion: Both dexamethasone and fentanyl as an adjuvant to ropivacaine for IIIH block were found to have a comparable duration of analgesia following LSCS.