Dexmedetomidine Versus Ketamine in TAP Block for Postoperative Analgesia After Total Abdominal Hysterectomy

Total abdominal hysterectomy is associated with significant postoperative pain due to abdominal wall incision and tissue manipulation. Effective pain management after surgery helps improve patient comfort, early mobilization, and recovery while reducing the need for opioid medications and their related side effects. The transversus abdominis plane (TAP) block is a regional anaesthesia technique that provides pain relief by blocking sensory nerves supplying the abdominal wall. However, the duration of analgesia provided by local anaesthetic alone may be limited. Adding adjuvant drugs such as dexmedetomidine or ketamine may enhance and prolong the analgesic effect. This randomized controlled trial aims to compare the effectiveness of dexmedetomidine and ketamine as adjuvants to bupivacaine in ultrasound-guided bilateral TAP block for postoperative pain management following total abdominal hysterectomy. Participants undergoing elective total abdominal hysterectomy will be randomly assigned to receive either bupivacaine with dexmedetomidine or bupivacaine with ketamine during TAP block. Postoperative pain intensity, morphine consumption, time to first rescue analgesia, haemodynamic changes, sedation level and postoperative nausea and vomiting will be assessed during the first 24 hours after surgery. The findings of this study may help determine which adjuvant provides better postoperative analgesia when combined with bupivacaine for TAP block in patients undergoing total abdominal hysterectomy.

Inclusion Criteria: * Patients scheduled for elective total abdominal hysterectomy * ASA physical status I-II * Age 25-60 years Exclusion Criteria: * Allergy to local anaesthetics * Patient refusal * Local infection/inflammation at block site * Anatomical deformity * Coagulopathy or bleeding disorder * Chronic pain syndrome * Chronic opioid consumption (\>2 weeks) * Severe cardiac, hepatic, renal, or psychiatric disorders