Prospective randomized double blind comparison of analgesic efficacy of single shot epidural bupivacaine with or without dexamethasone in patients undergoing lower abdominal surgeries

Anuj Jung Rayamajhi,Balbrishna Bhattarai,Birendra Prasad Shah

doi:10.3126/jsan.v2i2.13529

Abstract

Background: Epidural block with local anaesthetic with or without additives is being used for perioperative analgesia. Various additives have been used to enhance the effect of regional blocks including epidural blocks. This study aimed to investigate the effect of adding a single shot epidural dexamethasone to bupivacaine on postoperative analgesia and dose of rescue analgesics used.Methods: A prospective, randomized, double blinded study was conducted in 90 adult patients undergoing lower abdominal surgery. The patients were randomized into two groups. Group 1 received 9ml of 0.5% bupivacaine plain with 1 ml of normal saline. Group 2 received 9ml of 0.5% bupivacaine plain 9 ml with 1 ml of dexamethasone (4mg). After standard balanced anesthesia technique, patients were observed in postoperative period for pain and hemodynamic variables accordingly.Results: Our study showed significantly longer duration of analgesia of 468 minutes (almost 8 hours) when dexamethasone was added to bupivacaine for single shot epidural injection compared to 271 minutes (approximately 4 and half hours) when bupivacaine alone was used (p<0.001). Consumption of rescue analgesic, Tramadol, was significantly lower in dexamethasone group in 24 hours (169.31±50.82 mg in Group 1 and 114.77±60.59mg in Group 2, p<0.001). No adverse events were noted.Conclusion: Addition of dexamethasone to bupivacaine for single shot epidural block almost doubled the duration of analgesia. Single shot epidural block using bupivacaine with addition of dexamethasone provides effective post operative analgesia and significantly reduced the postoperative rescue analgesic requirement.Journal of Society of Anesthesiologists of Nepal 2015; 2(2): 46-51

Highlights

The regional nerve blocks serve dual purpose of anaesthesia for operation as well as analgesia for postoperative pain for considerable amount of time
Duration of analgesia following the administration of epidural block and analgesic consumption in 24 hours are given in figure 1
Epidural analgesia with local anaesthetics combined with opioids has been shown to provide better analgesia and to improve post operative outcome., We chose bupivacaine as the local anaesthetic for both arms of our study as it has the best pharmacological profile for postoperative analgesia when used as single shot

Summary

Introduction

The regional nerve blocks serve dual purpose of anaesthesia for operation as well as analgesia for postoperative pain for considerable amount of time. Epidural anesthesia with a local anaesthetic is known to provide better quality of postoperative analgesia in comparison with systemic opioids. It lowers perioperative morbidity and mortality as compared to general anaesthesia alone. Data on use of dexamethasone in epidural space for acute postoperative pain relief in lower abdominal surgeries is scarce. This prospective, randomized, double blind comparative study was designed to find out analgesic effect and duration of action of single shot epidural bupivacaine with or without dexamethasone in patients undergoing lower abdominal surgeries. This study aimed to investigate the effect of adding a single shot epidural dexamethasone to bupivacaine on postoperative analgesia and dose of rescue analgesics used

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Discussion

Conclusion