INTRATHECAL BETAMETHASONE;

Abstract

Objectives: The aim of our study to determine the use of intrathecal betamethasoneadministration as effective post-operative analgesic in gynecologic procedures. Study Design:Randomized control trial. Period: 6 months duration from April 2015 to end of September 2015.Setting: Tertiary Care Centre in Karachi, Pakistan. Method: The study population consisted ofn= 120 (divided into three groups using a random number generator) patients, who presentedto our setup either via emergency or through the outpatient. The patients belonged to ASAclass I and II, and underwent cesarean section. The group A was the control group, patientswho received 0.5ml normal saline IV with bupivacaine 0.5% in 3ml, with 0.5ml of normal salineintrathecally. Group B consisted of patients who received 0.5ml IV normal saline, with 0.5%in 3ml bupivacaine along with 0.5ml betamethasone as 4mg per ml. The last group, groupC consists of patients who received 0.5ml betamethasone IV (4ml/ml) along with 0.5% 3mlbupivacaine with 0.5ml of normal saline intrathecally. For the subjective measurement of painlevel a visual analog scale was used. Various time intervals as time of initial first analgesic effect,time between intrathecal injection and first administration of diclofenac as rescue analgesicand the total number of analgesics used in the first twenty four hour period were also recordedin the proforma. Various side effects such as nausea, vomiting and headache were noted.Data was analyzed using SPSS version 23. Results: The study population consisted of n=120 patients, divided into three groups using a random number generator, the demographicdata like age, whether the procedure performed was elective or emergency etc did not showany difference p value of >0.05. The Visual analog scales scores at the 4 hour and 6 hourmark showed statistically significant difference, the values being lower in the medication groupsversus the control group. But no difference was found between the control and medicationgroups in the VAS score measured at 12 hour and 24 hours respectively. The requirement foruse of Diclofenac as rescue analgesia was also lower in the intrathecal and intravenous (groupB and C) as compared to the control group at the 24 hour mark post operatively, and thedose required was even lower in the intrathecal group as compared to the intravenous grouphaving a p value of 0.014. N= 27 patients suffered nausea and vomiting during the procedure,N= 40 patients reported headache following the 24 hour period post operatively. Conclusion:According to the results of our study intrathecal betamethasone administration is an effectivemethod of post-operative pain reduction in cesarean section surgeries and it also decreases theneed for rescue analgesia required.