Article

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

Department of Anesthesiology, Babol University of Medical Sciences, Babol, Iran.
Saudi journal of anaesthesia 10/2011; 5(4):382-6. DOI: 10.4103/1658-354X.87267
Source: PubMed

ABSTRACT

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.
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.
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.
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.

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    • "Moreover, the analgesic dose administered for the group that received dexamethasone after the surgery was significantly lower than that used in the other two groups. More recent publications since the aforementioned review indicate that 8 mg dexamethasone added to perineural local anesthetic injections augments the duration of peripheral nerve block analgesia [17] [18] [19] [20] [21] [22]. On the contrary , it is reported that, in rats, dexamethasone alone or when combined with aqueous bupivacaine has no effect on the analgesic effects of a sciatic nerve block, but when combined with bupivacaine microspheres, the effects were significant [2] [23]. "
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    ABSTRACT: Aim. Regional analgesia has been introduced as better analgesic technique compared to using systemic analgesic agents, and it may decrease the adverse effects of them and increase the degree of satisfaction. Several additives have been suggested to enhance analgesic effect of local anesthetic agents such as opioids and steroids. We designed this randomized double-blind controlled study to compare the analgesic efficacy of the dexamethasone and fentanyl added to lidocaine using axillary block in patients undergoing operation of forearm fracture. Materials and Methods. Seventy-eight patients 20-60 years old were recruited in a prospective, double-blinded, randomized way. Axillary block was performed in the three groups by using 40 mL lidocaine and 2 mL distilled water (L group), 40 mL lidocaine and 2 mL dexamethasone (LD group), and 40 mL lidocaine and 2 mL fentanyl (LF group). The onset time of sensory and motor block, duration of sensory and motor block, the total analgesic dose administered during 6 hours after the surgery, and hemodynamic variables were recorded. Results. The duration of sensory and motor block was significantly longer in LD group compared to other groups (P < 0.001). Similarly, the total analgesic consumption in LD group was smaller compared to other groups (P < 0.001). Comparison of hemodynamic consequences of axillary block and surgery failed to reveal any statistically significant differences between all groups. Conclusion. Addition of dexamethasone to lidocaine significantly prolonged the duration of analgesia compared with fentanyl/lidocaine mixture or lidocaine alone using axillary block in patients undergoing forearm fracture surgery. This trial is registered with IRCT2012120711687N1.
    Full-text · Article · Dec 2013 · Pain Research and Treatment
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    • "Moreover, the analgesic dose administered for the group that received dexamethasone after the surgery was significantly lower than that used in the other two groups. More recent publications since the aforementioned review indicate that 8 mg dexamethasone added to perineural local anesthetic injections augments the duration of peripheral nerve block analgesia [17] [18] [19] [20] [21] [22]. On the contrary , it is reported that, in rats, dexamethasone alone or when combined with aqueous bupivacaine has no effect on the analgesic effects of a sciatic nerve block, but when combined with bupivacaine microspheres, the effects were significant [2] [23]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Aim. Regional analgesia has been introduced as better analgesic technique compared to using systemic analgesic agents, and it may decrease the adverse effects of them and increase the degree of satisfaction. Several additives have been suggested to enhance analgesic effect of local anesthetic agents such as opioids and steroids.We designed this randomized double-blind controlled study to compare the analgesic efficacy of the dexamethasone and fentanyl added to lidocaine using axillary block in patients undergoing operation of forearm fracture. Materials and Methods. Seventy-eight patients 20–60 years old were recruited in a prospective, double-blinded, randomized way. Axillary block was performed in the three groups by using 40mL lidocaine and 2mL distilled water (L group), 40mL lidocaine and 2mL dexamethasone (LD group), and 40mL lidocaine and 2mL fentanyl (LF group). The onset time of sensory and motor block, duration of sensory and motor block, the total analgesic dose administered during 6 hours after the surgery, and hemodynamic variables were recorded. Results. The duration of sensory and motor block was significantly longer in LD group compared to other groups (𝑃 < 0.001). Similarly, the total analgesic consumption in LD group was smaller comparedtoother groups (𝑃 < 0.001).Comparison of hemodynamic consequences of axillary block and surgery failed to reveal any statistically significant differences between all groups. Conclusion. Addition of dexamethasone to lidocaine significantly prolonged the duration of analgesia compared with fentanyl/lidocaine mixture or lidocaine alone using axillary block in patients undergoing forearm fracture surgery.This trial is registered with IRCT2012120711687N1.
    Full-text · Article · Dec 2013
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    • "Bani-hashem et al16 have demonstrated that in 50 patients who were scheduled for orthopedic surgery the addition of intrathecal dexamethasone (8 mg) to bupivacaine (15 mg) significantly improved the duration of sensory block in spinal anesthesia without any changes in onset time and complications. "
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    Full-text · Article · Apr 2013 · Pakistan Journal of Medical Sciences Online
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