Addition of intrathecal Dexamethasone to Bupivacaine for spinal anesthesia in orthopedic surgery

Nadia Bani-Hashem, Bahman Hassan-Nasab, Ebrahim Alijan Pour, Parviz Amri Maleh, Aliakbar Nabavi, Ali Jabbari, Nadia Bani-Hashem, Bahman Hassan-Nasab, Ebrahim Alijan Pour, Parviz Amri Maleh, Aliakbar Nabavi, Ali Jabbari

Abstract

Objectives: Spinal anesthesia has the advantage that profound nerve block can be produced in a large part of the body by the relatively simple injection of a small amount of local anesthetic. Intrathecal local anesthetics have limited duration. Different additives have been used to prolong spinal anesthesia. The effect of corticosteroids in prolonging the analgesic effects of local anesthetics in peripheral nerves is well documented. The purpose of this investigation was to determine whether the addition of dexamethasone to intrathecal bupivacaine would prolong the duration of sensory analgesia or not.

Methods: We conducted a randomized, prospective, double-blind, case-control, clinical trial. A total of 50 patients were scheduled for orthopedic surgery under spinal anesthesia. The patients were randomly allocated to receive 15 mg hyperbaric bupivacaine 0.5% with 2 cc normal saline (control group) or 15 mg hyperbaric bupivacaine 0.5% plus 8 mg dexamethasone (case group) intrathecally. The patients were evaluated for quality, quantity, and duration of block; blood pressure, heart rate, nausea, and vomiting or other complications.

Results: There were no signification differences in demographic data, sensory level, and onset time of the sensory block between two groups. Sensory block duration in the case group was 119±10.69 minutes and in the control group was 89.44±8.37 minutes which was significantly higher in the case group (P<0.001). The duration of analgesia was 401.92±72.44 minutes in the case group; whereas it was 202±43.67 minutes in the control group (P<0.001). The frequency of complications was not different between two groups.

Conclusion: This study has shown that the addition of intrathecal dexamethasone to bupivacaine significantly improved the duration of sensory block in spinal anesthesia without any changes in onset time and complications.

Keywords: Bupivacaine; dexamethasone; intrathecal; sensory block; spinal anesthesia.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Sensory block level in the bupivacaine-dexamethasone versus bupivacaine-normal saline group

References

    1. Brown D. Spinal, Epidural and caudal anesthesia. In: Miller RD, editor. Miller's Anesthesia. 7th ed. Philadelphia: Churchill living stone; 2010. pp. 1611–38.
    1. Murali KT, Panda NB, Batra YK, Rajeev S. Combination of low doses of intrathecal Ketamine and midazolam with bupivacaine improves postoperative analgesia in orthopedic surgery. Eur J Anesthesiol. 2008;25:299–306.
    1. Chakraborty S, Chakrabarti J, Bhattacharya D. Intrathecal tramadol added to bupivacaine as spinal anesthetic increases analgesic effect of the spinal blockade after major gynecological surgeries. Indian J pharmacol. 2008;40:180–2.
    1. Yu SC, Ngan Kee WD, Kwan AS. Addition of meperidine to bupivacaine for spinal anesthesia for cesarean section. Br j Anesth. 2002;88:379–83.
    1. Alhashemi JA, Kaki AM. Effect of intrathecal tramadol administration post operative pain after transurethral resection of prostate. Br J Anesth. 2003;91:536–40.
    1. Golwala MP, Swadia VN, Aditi A, Dhimar, Sridbar NV. Pain relief by dexamethasone as an adjuvant to local anesthetics in supraclavicular brachial plexus block. J Anesth Clin Pharmacol. 2009;25:285–8.
    1. Vieira PA, Pulai I, Tsao GC, Manikantan P, Keller B, Connelly NR. Dexamethasone with bupivacaine increases duration of analgesia in ultrasound-guided interscalene brachial plexus blockade. Eur J Anaesthesiol. 2010;27:285–8.
    1. Bromage PR. A comparison of the hydrochloride and carbon dioxide salts of lidocaine and prilocaine in epidural analgesia. Acta Anesthesiol Scand Suppl. 1965;16:55–69.
    1. Glasser RS, Knego RS, Delashaw JB, Fessler RG. The perioperative use of corticosteroids and bupivacaine in the management of lumbar disc disease. J Neurosurg. 1993;78:383–7.
    1. Castillo J, Curley J, Hotz J, Uezono M, Tigner J, Chasin M, et al. Glucocorticoids prolong rat sciatic nerve blockade in vivo from bupivacaine microspheres. Anesthesiology. 1996;85:1157–66.
    1. Droger C, Benziger D, Gao F, Berde CB. Prolonged intercostals nerve blockade in sheep using controlled-release of bupivacaine and dexamethasone from polymer microspheres. Anesthesiology. 1998;89:969–74.
    1. Kopacz DJ, Lacouture PG, Wu D, Nandy P, Swanton R, Landau C. The dose response and effects of dexamethasone on bupivacaine microcapsules for intercostals blockade (T9 to T11) in healthy volunteers. Anesth Analg. 2003;96:576–82.
    1. Movafegh A, Ghafari MH. A comparison of the sensory and motor blockade duration of intrathecal lidocaine 5% plus epinephrine and lidocaine 5% plus dexamethasone. Int J pharmacol. 2005;1:346–9.
    1. Marks R, Barlow JW, Funder JW. Steroid-induced vasoconstriction: Glucocorticoid antagonist studies. J Clin Endocrinol Metab. 1982;54:1075–7.
    1. Seidenari S, Di Nardo A, Mantovani L, Giannetti A. Parallel intraindividual evaluation of the vasoconstrictory action and the anti-allergic activity of topical corticosteroids. Exp Dermatol. 1997;6:75–80.
    1. Taguchi H, Shingu K, Okuda H, Matsumoto H. Analgesia for pelvic and perineal cancer pain by intrathecal steroid injection. Acta Anaesthesiol Scand. 2002;46:190–3.
    1. Mirzai H, Tekin I, Alincak H. Perioperative use of corticosteroid and bupivacaine combination in lumbar disc surgery. Spine. 2002;27:343–6.
    1. Kotani N, Kushikata T, Hashimoto H, Kimura F, Muraoka M, Yodono M, et al. Intrathecal methylprednisolone for intractable postherpetic neuralgia. N Engl J Med. 2000;343:1514–9.
    1. Taguchi H, Shingu K, Okuda H, Matsumoto H. Analgesia for pelvic and perineal cancer pain by intrathecal steroid injection. Acta Anaesthesiol Scand. 2002;46:190–3.
    1. Thomas S, Beevi S. Epidural dexamethasone reduces postoperative pain and analgesic requirements. Can J Anaesth. 2006;53:899–905.
    1. Kikuchi A, Kotani N, Sato T, Takamura K, Sakai I, Matsuki A. Comparative therapeutic evaluation intrathecal versus epidural methylprednisolone for long Term analgesia in patients with intractable post herpetic neuralgia. Reg Anesth Pain Med. 1999;24:287–93.
    1. McCormack K. The spinal actions of nonsteroidal anti-inflammatory drugs and the dissociation between their anti-inflammatory and analgesic effects. Drugs. 1994;47:28–45.
    1. Ahlgren SC, Wang JF, Levine JD. C-fiber mechanical stimulusresponse functions are different in inflammatory versus neuropathic hyperalgesia in the rat. Neuroscience. 1997;76:285–90.
    1. Yao XL, Cowan MJ, Glawin MT, Lawrence MM, Angus CW, Shelhamer JH. Dexamethasone alters arachidonate release from human epithelial cells by induction of P11 protein synthesis and inhibition of phospholipas A2 activity. J Biol Chem. 1999;274:17202–8.
    1. Baxendale BR, Vater M, Lavery KM. Dexamethasone reduces pain and swelling following extraction of third molar teeth. Anesthesia. 1993;48:961–4.
    1. Kopacz DJ, Lacouture PG, WU D, Nandy P, Swanton R. The dose response and effects of dexamethasone on bupivacaine microcapsules for intercostals blockade in healthy volunteers. Anesth Analg. 2003;96:576–82.
    1. Movafegh A, Razazian M, Hajimaohamadi F, Mysamie A. Dexamethasone added to lidocaine prolongs axillary bracial plexus blockage. Anesth Analg. 2006;102:263–7.
    1. Abram SE, Marsala M, Yaksh TL. Analgesic and neurotoxic effects of intrathecal corticosteroids in rats. Anesthesiology. 1994;81:1198–205.
    1. Latham JM, Fraser RD, Moore RJ, Blumbergs PC, Bogduk N. The pathologic effects of intrathecal betamethasone. Spine (Phila Pa 1976) 1997;22:1558–62.
    1. Dong Y, Zhang X, Tang F, Tian X, Zhao Y, Zhang F. Intrathecal injection with methotrexate plus dexamethasone in the treatment of central nervous system involvement in systemic lupus erythematosus. Chin Med J. 2001;114:764–6.
    1. Sugita K, Kobayashi S, Yokoko A, Inoue T. Intrathecal steroid therapy for post traumatic visual disturbance. Neuronchirurgia (Stuttg) 1983;26:112–7.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner