Therapeutic efficacy of a preoperative epidural single shot of dexamethasone/levobupivacaine for postoperative analgesia ( a placebo-controlled comparative study against epidural neostigmine/levobupivacaine)

Abstract

Objectives The aim of the present study was to evaluate the postoperative (PO) outcome of epidural dexamethasone (D) or neostigmine (N) compared with epidural placebo at the time of induction of anesthesia in patients assigned for open abdominal hysterectomy. Patients and methods The study included 90 women classified under ASA I–II randomly allocated to three equal groups according to administration of an epidural adjuvant as only one preemptive shot of epidural injection: group L received plain levobupivacaine 0.1%; group L/D received a combination of levobupivacaine 0.1% and dexamethasone 8 mg; and group L/N received a combination of levobupivacaine 0.1% and neostigmine 500 μg. The intensity of PO pain was measured using a 100 mm visual analog scale (VAS), and rescue analgesia was given when the patient had a VAS score of 40. The duration of analgesia, postoperative nausea and vomiting (PONV), and its frequency and score were monitored. Results Preemptive epidural therapy provided PO analgesia without significant difference until 2 h postoperatively. Until 8 h postoperatively, pain VAS scores were significantly lower in groups L/D and L/N compared with group L; at 10 h postoperatively, pain VAS scores were significantly lower in the L/D group compared with the other groups. The total pain VAS score at the end of 24 h was significantly lower in the L/D group compared with the L/N and L groups, with significantly lower scores in the L/N group compared with group L. The mean duration of PO analgesia was significantly longer in the L/D group compared with groups L/N and L, with significantly longer duration in the L/N group compared with group L. Thirty-nine patients (43.3%) complained of PONV, of whom 19 patients (21.1%) requested for antiemetics with significantly reduced frequency and score in the L/D group compared with the other groups, which showed a nonsignificant difference. Conclusion Single-shot epidural dexamethasone and levobupivacaine is a safe and effective PO analgesic modality for patients assigned for open abdominal hysterectomy, with minimization of PONV frequency and severity.