To Study the Efficacy of Intravenous Dexamethasone in Prolonging the Duration of Spinal Anesthesia in Elective Cesarean Section

Priyanka Sunil Shalu, Poonam Sachin Ghodki, Priyanka Sunil Shalu, Poonam Sachin Ghodki

Abstract

Background and aims: Various additives have been evaluated for the purpose of enhancing quality of analgesia and prolonging duration of spinal anesthesia. This randomized, double-blind study was conducted to evaluate the efficacy of intravenous dexamethasone in spinal anesthesia.

Methods: A total of sixty patients scheduled for lower segment cesarean section under spinal anesthesia were randomly allocated into two groups, group SD and group SN, including thirty patients each. All the patients received injection bupivacaine 0.5% heavy 10 mg through spinal anesthesia. Group SD received injection dexamethasone 8 mg intravenously, and group SN received injection normal saline (NS) 2 cc immediately after spinal anesthesia. Duration of sensory block, motor block, postoperative analgesia, visual analog pain scale (VAS) score, time of rescue analgesia, total analgesic requirement in the first 24 h, intra- and post-operative hemodynamics, and side effects if any were recorded. Whenever demanded rescue analgesia was given in the form of injection tramadol 100 mg.

Results: The mean duration of sensory block (min) in group SD and group SN was 162.50 and 106.17, respectively which was highly significant. Similarly, time to the requirement of first rescue analgesia was prolonged in group SD (8.67 h) as compared to group SN (4.40 h). Significant changes were also seen in VAS score in postoperative period after 1 h of surgery in group SD and group SN. Duration of motor block, intra- and post-operative hemodynamic parameters were comparable in both the groups. No side effects were recorded in both the groups.

Conclusion: We concluded that administration of dexamethasone 8 mg intravenously prolongs the duration of postoperative analgesia and sensory block in patients undergoing lower segment cesarean section under spinal anesthesia.

Keywords: Dexamethasone; postoperative analgesia; spinal anesthesia.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Mean duration of sensory block (min)
Figure 2
Figure 2
Mean duration of motor block (min)
Figure 3
Figure 3
Mean time for first rescue anaigesia (hr)

References

    1. Kulenkampff D. Brachial plexus anaesthesia: Its indications, technique, and dangers. Ann Surg. 1928;87:883–91.
    1. Neal JM, Hebl JR, Gerancher JC, Hogan QH. Brachial plexus anesthesia: Essentials of our current understanding. Reg Anesth Pain Med. 2002;27:402–28.
    1. Patrick J. Technique of brachial plexus block anaesthesia. Br J Surg. 1940;27:734.
    1. Salerno A, Hermann R. Efficacy and safety of steroid use for postoperative pain relief. Update and review of the medical literature. J Bone Joint Surg Am. 2006;88:1361–72.
    1. De Oliveira GS, Jr, Almeida MD, Benzon HT, McCarthy RJ. Perioperative single dose systemic dexamethasone for postoperative pain: A meta-analysis of randomized controlled trials. Anesthesiology. 2011;115:575–88.
    1. Hong JY, Han SW, Kim WO, Kim EJ, Kil HK. Effect of dexamethasone in combination with caudal analgesia on postoperative pain control in day-case paediatric orchiopexy. Br J Anaesth. 2010;105:506–10.
    1. Movafegh A, Razazian M, Hajimaohamadi F, Meysamie A. Dexamethasone added to lidocaine prolongs axillary brachial plexus blockade. Anesth Analg. 2006;102:263–7.
    1. Cummings KC, 3rd, Napierkowski DE, Parra-Sanchez I, Kurz A, Dalton JE, Brems JJ, et al. Effect of dexamethasone on the duration of interscalene nerve blocks with ropivacaine or bupivacaine. Br J Anaesth. 2011;107:446–53.
    1. Desmet M, Braems H, Reynvoet M, Plasschaert S, Van Cauwelaert J, Pottel H, et al. I.V. and perineural dexamethasone are equivalent in increasing the analgesic duration of a single-shot interscalene block with ropivacaine for shoulder surgery: A prospective, randomized, placebo-controlled study. Br J Anaesth. 2013;111:445–52.
    1. Jain R, Dua CK. Comparative analgesic efficacy of different doses of dexamethasone during infraumbilical surgery: A Randomized controlled trial. Anesth Essays Res. 2015;9:34–8.
    1. Parveen S, Athaluri VV, Lakshmi BS. Effect of intravenous dexamethasone in prolonging the duration of supraclavicular brachial plexus block with 0.5% ropivacaine: A prospective, randomized, placebo controlled study. Int J Sci Study. 2015;2:56–60. [DOI: 10.17354/ijss/2015/13]
    1. Asad MV, Khan FA. Effect of a single bolus of dexamethasone on intraoperative and postoperative pain in unilateral inguinal hernia surgery. J Anaesthesiol Clin Pharmacol. 2015;31:339–43.
    1. Jehan MK, Abdel-Halim MD. The effect of preoperative single shot dose of epidural magnesium sulphate or dexamethasone as adjuvants to local anesthesia. Ain Shams J Anaesthesiol. 2011;4-3:83–91.
    1. Thomas S, Beevi S. Epidural dexamethasone reduces postoperative pain and analgesic requirements. Can J Anaesth. 2006;53:899–905.
    1. Bisgaard T, Klarskov B, Kehlet H, Rosenberg J. Preoperative dexamethasone improves surgical outcome after laparoscopic cholecystectomy: A randomized double-blind placebo-controlled trial. Ann Surg. 2003;238:651–60.
    1. Baxendale BR, Vater M, Lavery KM. Dexamethasone reduces pain and swelling following extraction of third molar teeth. Anaesthesia. 1993;48:961–4.
    1. Abdelmonem A, Rizk SN. Comparative study between intravenous and local dexamethasone as adjuvant to bupivacaine in perianal block. Egypt J Anaesth. 2011;27:163–8.
    1. Elhakim M, Ali NM, Rashed I, Riad MK, Refat M. Dexamethasone reduces postoperative vomiting and pain after pediatric tonsillectomy. Can J Anaesth. 2003;50:392–7.
    1. Bigat Z, Boztug N, Hadimioglu N, Cete N, Coskunfirat N, Ertok E. Does dexamethasone improve the quality of intravenous regional anesthesia and analgesia? A randomized, controlled clinical study. Anesth Analg. 2006;102:605–9.
    1. Nortcliffe SA, Shah J, Buggy DJ. Prevention of postoperative nausea and vomiting after spinal morphine for caesarean section: Comparison of cyclizine, dexamethasone and placebo. Br J Anaesth. 2003;90:665–70.

Source: PubMed

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