Abstract

Enhanced Recovery After Surgery (ERAS) protocols emphasize minimizing the administration and consumption of opioids through multimodal analgesia and regional anesthesia. The transversus abdominis plane (TAP) block provides reliable analgesia for lower abdominal procedures such as open hernia repairs. Dexmedetomidine, a selective alpha 2 adrenergic agonist, has been shown to enhance local anesthetic duration and quality while reducing postoperative opioid requirements. This case involved a 45-year-old female undergoing open inguinal hernia repair at a rural surgical mission site in Guatemala. The patient received spinal anesthesia with a unilateral left TAP block containing 0.25 % bupivacaine 20 mL, plus 25 mcg (0.5 mcg/kg) dexmedetomidine. The purpose was to examine whether dexmedetomidine as an adjunct would improve analgesia, reduce opioid requirements in the first 48 hours postoperatively, and enhance recovery postoperatively. This case exemplifies how anesthesia providers can apply current evidence to achieve opioid-sparing anesthesia within ERAS protocols. Utilizing dexmedetomidine in TAP blocks provides prolonged analgesia, supports early mobilization, and reduces opioid-related adverse effects such as respiratory depression, postoperative nausea and vomiting, and ileus. Despite its off-label perineural use, literature demonstrates a favorable safety profile when appropriate dosages are administered, and proper monitoring techniques are observed. CRNAs should ensure correct documentation, appropriate patient selection, such as avoiding patients who would not tolerate transient bradycardia or hypotension, and readiness to treat hemodynamic changes with appropriate pharmacologic interventions. Implementation into practice can include developing an ERAS-based protocol for open hernia repairs utilizing TAP blocks with 0.25 to 0.5 mcg/kg dexmedetomidine as a local anesthetic adjuvant. Standardizing hemodynamic monitoring and rescue vasopressor algorithms would enhance safety and provider readiness. Future research should compare dexmedetomidine with other adjuvants, evaluate dose optimization, study intravascular absorption and its effects, and investigate the long-term safety of its administration.

Author Details

Forrest Payne Solomon, DNP(c), BSN, RN, SRNA; Mary Beth Greenway, DNP, CRNA

Sigma Membership

Non-member

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Case Study/Series

Research Approach

Translational Research/Evidence-based Practice

Keywords:

Adrenergic Alpha-Agonists -- Therapeutic Use, Nerve Block -- Methods, Enhanced Recovery After Surgery, Dexmedetomidine, TAP Block, Opioid Reduction

Advisor

Mary Beth Greenway

Degree

DNP

Degree Grantor

Samford University

Degree Year

2026

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Proxy-submission

Date of Issue

2026-03-18

Full Text of Presentation

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Abstract.pdf (79 kB)

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