Effect of Perineural Dexamethasone With Bupivacaine in Single Space Paravertebral Block for Postoperative Analgesia in Elective Nephrectomy Cases: A Double-Blind Placebo-Controlled Trial.

Abstract

Various analgesic modalities have been tried to prolong the duration and to improve the quality of postoperative analgesia for the early rehabilitation and discharge from hospital after nephrectomy. Using local anaesthetic along with perineural steroids as adjuvant may prove promising for peripheral nerve block, especially paravertebral block (PVB). This article aims to assess the efficacy of dexamethasone with bupivacaine as adjuvant for single bolus injection of thoracic PVB in patients undergoing elective nephrectomy. Sixty patients of American Society of Anesthesiologists physical status I and II were randomly assigned to 2 groups of 30 patients each. Group D patients received 8 mg (2 mL) of dexamethasone mixed to 18 mL of 0.25% bupivacaine, whereas patients in group B received 18 mL of 0.25% bupivacaine and 2 mL of 0.9% saline as placebo to make a total volume of 20 mL infiltrated in PVB. Degree of analgesia achieved and duration of analgesia were recorded in each group along with total dose requirement of rescue analgesic and side effects in first 24 hours postoperatively. Group D patients with dexamethasone had VAS score of 0-3 after 09 minutes of block up to 610.48 ± 12.24 minutes and after 16 minutes up to 402.34 ± 28.12 minutes in another group B patient, respectively. The total dose of intravenous fentanyl in the first 24 hours postoperatively in group D was 98.6 ± 14.14 μg as compared with 147.6 ± 18.22 μg in group B. No other significant side effects were noted except for nausea and vomiting in 5 patients of placebo group. Dexamethasone, along with bupivacaine as adjunct for thoracic PVB, helps in improving the quality and enhancing the postoperative analgesia duration in patients undergoing nephrectomy.