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

Article · October 2011with500 Reads
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.
4 Figures
Page | 382
Vol. 5, Issue 4, October-December 2011 Saudi Journal of Anaesthesia
Nadia Bani‑hashem,
Bahman Hassan‑nasab,
Ebrahim Alijan Pour,
Parviz Amri Maleh,
Aliakbar Nabavi1, Ali Jabbari2
Department of Anesthesiology,
Babol University of Medical
Sciences, Babol, Iran 1Department
of Anesthesiology, Tehran, 2Babol
University of Medical Sciences
and Researcher of Deputy of
Treatment, Golestan University of
Medical Sciences, Golestan, Iran
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 signication 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 signicantly 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 signicantly improved the duration of sensory block in spinal anesthesia
without any changes in onset time and complications.
Key words: Bupivacaine, dexamethasone, intrathecal, sensory block, spinal anesthesia
Addition of intrathecal Dexamethasone to
Bupivacaine for spinal anesthesia in orthopedic
surgery
ORIGINAL ARTICLE
Address for correspondence:
Dr. Ali Jabbari,
Anesthesiology Department,
Flat 2, Rohani Hospital, Ganj,
Afroz Blv, Daneshgah Sq, Babol city,
Mazandaran Province, Iran.
Email: amir_a_78@yahoo.com
were added to local anesthetics.[2-5] The additions of
epinephrine to local anesthesia cause tachycardia, pallor,
and hypertension, which can be risky in patients with
cardiovascular disease.[1] Intrathecal opioid administration
has central and respiratory depression effects. Recently,
some studies reported the effects of corticosteroids in
quality and quantity of the sensory block in the peripheral
nerves.[3-5]
Dexamethasone relieves pain by reducing inammation
andblockingtransmissionof nociceptiveC-bersandby
suppressing ectopic neural discharge.[6] It has been shown
that the duration of postoperative analgesia was prolonged
when dexamethasone is given as an adjunct for peripheral
nerve blocks.[7,8] Although dexamethasone has been used
intrathecally for many years, it has not been evaluated when
it was given in conjunction with bupivacaine intrathecally.
The purpose of this investigation was to evaluate the effect
INTRODUCTION
Spinal anesthesia is the most consistent block for lower
abdomen and orthopedic surgery. Spinal anesthesia avoids
the risks of general anesthesia such as aspiration of
gastriccontentsanddifcultywithairwaymanagement.[1]
Bupivacaine is appropriate for procedures lasting up to
90-120 minutes.[1-3] Therefore, various additives such
as epinephrine, phenylephrine, clonidine, opioids, etc.
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DOI:
10.4103/1658-354X.87267
Page | 383
Saudi Journal of Anaesthesia Vol. 5, Issue 4, October-December 2011
Bani-hashem, et al.: Intrathecal dexamethazone
of conjugation of dexamethasone with bupivacaine on the
duration and onset time of spinal anesthesia.
METHODS
Fifty patients with class American Society of
Anesthesiologist (ASA) I-II, between 18 and 55 years
old, scheduled for orthopedic surgery under spinal
anesthesia, were included in this prospective, randomized,
double-blind clinical trial. The orthopedic procedures were
on lower limbs with surgery duration around 30-70 minutes.
After ethic committee approval, written informed consent
was obtained from each patient preoperatively.
Patients with history of long-term steroid therapy, allergy
to the drugs, uncontrolled hypertension, neurologic or
psychological disorders, spinal column surgery, low back
pain, alcohol abuse, opium addict or using any drug that
modiespainperceptionwereexcludedfromthestudy.
Patients were randomly allocated into two groups, intrathecal
bupivacaine- dexamethasone as the case group and
intrathecal bupivacaine- normal saline as the control group.
After IV line preparation, a 5 cc/kg lactated ringers
solution was infused to all patients. Patients received
no premedication, and upon arrival of patients into the
operating room, ECG, peripheral oxygen saturation
(SPO2), and noninvasive arterial blood pressure (NIBP)
were monitored and recorded at 5-minute intervals until
the end of surgery and vital signs were recorded every 15
minutes in the Post Anesthesia Care Unit (PACU).
Spinal anesthesia was performed in the sitting position at
L4-L5 level through a midline approach using a 25-gauge
Quincke spinal needle. Patients of the control group
received 15 mg (3 ml) of 0.5% hyperbaric bupivacaine
diluted in preservative free normal saline (2 ml) and
patients of the case group received 15 mg (3 ml) of
0.5% hyperbaric bupivacaine and 8 mg preservative
free dexamethasone with the Dexadic brand name (2
ml), overall 5 ml volume intrathecally. To facilitate the
double-blinding method, the medication was prepared
and injected by an anesthesiologist who was not involved
in the study. After performance of the spinal anesthesia
patients were kept in supine position and oxygen 3-5
L min-1 was given through a face mask. The sensory
block level was assessed by a pin prick test by a short
bevel needle along the mid-axillary line bilaterally. The
sensory block level was controlled every 30 seconds for
20 minutes; then it was evaluated every 5 minutes until a
4 sensory level regression from highest level or to the end
of thesurgery.Onsettimewasdenedfromthetimeof 
injection of drugs into the intrathecal space to the peak of
sensory and motor block (highest dermatome level) and
thedurationof sensoryblockwasdenedfrompeakof 
sensory block up to 4 sensory level regressions or when
thepatientsfeelpainintheeldof surgery.
Hypotension, a 30% decrease in systolic blood pressure from
base line or systolic blood pressure <100 mm Hg and
bradycardia, HR<50 beats/min was treated by IV ephedrine
5-10mg plus crystalloid uids;and IV atropine 0.5 mg
respectively. Nausea and vomiting were also evaluated and
were treated with 0.15 mg /kg IV metoclopramide.
After 4 dermatome block regression, pain assessment
intraoperatively or in PACU was done using the visual
analogue pain scale (VAS) between 0-10 (0 = no pain,
10 = the most severe pain) every 1 hour. If the postoperative
VAS was higher than 6, it was treated by morphine 2 mg IV.
Patients were observed at the time of discharge from hospital
and1monthlaterandaskedaboutanyneurologicdecit.
The demographic data of patients were studied for
each of the two groups. Continues covariates such as
age, weight, height, and BMI were compared using the
analysis of variance T-test. Onset time, sensory block
duration, and duration of analgesia were analyzed by a
T-test as appropriate, with the P value reported at the 95%
condenceinterval.Forcategoricalcovariates(sex,nausea/
vomiting, hypotension, bradycardia, use of ephedrine, the
use of atropine), the comparison was studied using a chi-
squared test or Fisher’s exact test. Sensory level compared
byMann-Whitneytest.Thesignicancelevelwasdened
as a P value less than 0.05. To calculate the sample size,
a power analysis of  α=0.05 and β=0.80 showed that
25 patients per study group were needed to detect the
difference between two groups.
RESULTS
All patients (n=50) completed the study; there was no
statistical difference in patients’ demographics [Table 1].
The onset time of sensory block was 11.2±2.0 minutes for
the case group and 10.9±1.8 minutes for the control Group
(P=0.57). The maximum sensory level was between T4 and
T10inbothgroupsandtherewasnosignicantdifference
(P=0.76) [Figure 1].
The duration of the sensory block was 119.1±10.6
minutes in the case group and 89.4±8.3 minutes in the
control group with a P value less than 0.001; also pain-
free period in the case group was more than that in the
control group(P<0.001). Receiving time to VAS >6 and
therstanalgesicdoseprescriptioninthecasegroupwas
Page | 384
Vol. 5, Issue 4, October-December 2011 Saudi Journal of Anaesthesia
Bani-hashem, et al.: Intrathecal dexamethazone
signicantlylongerthanthatinthecontrolgroup(P<0.001)
[Table 2]. Hypotension was mild to moderate in both
groups and was not different; except one patient in the
control group who had a mean arterial pressure less than
60 mmHg and required 20 mg IV ephedrine to restore his
blood pressure [Table 3].
Two patients in the case group and three patients in the
control group complained of postdural puncture headache
which was treated by hydration and simple analgesia. Other
complications such as bradycardia, nausea, and vomiting
were not different between the two groups [Table 3] and
noneurologicdecitwasobservedinanypatients.
DISCUSSION
Present results in this study showed that the supplementation
of spinalbupivacainewith8mgdexamethasonesignicantly
prolonged sensory block and postoperative analgesia
compared with intrathecal bupivacaine, without any effects
on the onset time of sensory block in orthopedic surgery.
Several experiments demonstrated analgesic effects of
steroids in neuroaxial and peripheral block.[9-12] Movafegh
et al. reported that the addition of dexamethasone (8 mg)
to lidocaine for spinal anesthesia provided signicant
prolongation of sensory and motor block in comparison
with plain lidocaine and there is no difference between
dexamethasone-lidocaine 5% and epinephrine (0.2 mg)
- lidocaine 5% in sensory and motor block duration.
Consequently, the onset time of sensory and motor
blockade were similar among these three groups.[13]
Corticosteroids cause skin vasoconstriction on topical
application. The vasoconstriction effects of topical steroids
are mediated by occupancy of classical glucocorticoid
receptors.[14,15] In our study, dexamethasone produced a
signicantprolongedsensoryblockwhichcanbeexplained
by vasoconstriction mechanism, in contrast with traditional
theory of steroid action; steroids bind to intracellular
receptors and modulate nuclear transcription.[16]
Mirzaie et al. reported that corticosteroids and bupivacaine
can diminish the incidence of back pain after laminectomy
in the immediately postoperative period.[17] Kotani
et al. administered methylprednisolone with bupivacaine
intrathecally in patients with postherpetic neuralgia. They
concluded that this combination induced excellent and
long-lasting analgesia.[18]
Taguchi et al. reported that intrathecal injection of
betamethasone successfully decreased the pain score in
three patients with intractable cancer pain [19] Another study
reported that epidural dexamethasone (5 mg) reduces
postoperative pain score and morphine consumption
following laparoscopic cholecystectomy with no apparent
side effects[20] Atsuhrio reported that intrathecal or
epidural methylprednisolone decreased continuous pain
and allodynia in patients with postherpetic neuralgia.
The analgesia was much greater in the intrathecal group
compared to the epidural group. Interleukin 8 in the CSF
Table 1: Patients' characteristics
Bupivacaine P value
Normal saline
n=25
Dexamethasone
n=25
Age (years) 35.08±11.33 37.8±12.53 0.42
Sex (F/M) 18.7 17.8 0.89
Weight (kg) 76.84±8.42 76.28±10.01 0.73
High (cm) 166.68±5.79 166.40±6.24 0.87
BMI 27.71±3.38 27.48±2.84 0.8
Table 2: Comparison of onset time, duration
of sensory block and pain free period
between two groups
Bupivacaine P value
Dexamethasone
n=25
Normal saline
n=25
Onset time (minutes) 11.27±2.08 10.95±1.87 P=0.57
Duration of sensory
block (minutes)
119.12±10.69 89.44±8.37 P<0.001
Duration of pain‑free
period
401.92±72.64 202.24±43.67 P<0.001
Table 3: Incidence of adverse events between
two groups during the study period
Bupivacaine P value
Normal saline Dexamethasone
Nausea and vomiting 5 (20) 2 (8) 0.41
Hypotension 7 (28) 7 (28) 1.00
Bradycardia 4 (16) 6 (24) 0.48
Shivering 8 (32) 9 (38) 0.76
Figures in parenthesis are in percentage
Figure 1: Sensory block level in the bupivacaine‑dexamethasone
versus bupivacaine‑normal saline group
T4 T6 T8 T10
Sensory level
0
2
4
6
8
10
12
Frequency
Bupivacaine
Bupivacaine-
Dexamethasone
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Saudi Journal of Anaesthesia Vol. 5, Issue 4, October-December 2011
Bani-hashem, et al.: Intrathecal dexamethazone
decreasedsignicantlyintheintrathecalgroupascompared
to the epidural group.[21]
Steroids have a powerful anti inammatory as well as
analgesic property but the mechanism of the analgesia
induced by corticosteroid is not fully understood.[22,23]
Epidural steroids were used for back pain treatment.
Intrathecal dexamethasone may influence intraspinal
prostaglandin production. Acute noxious stimulation of
peripheral tissues leads to sensitization of dorsal horn
neurons of the spinal cord by the release of substances
such as glutamate and aspartate. These amino acids activate
N-methyl-D-Aspartate receptors resulting in calcium ion
inux which leads to activation of  phospholipase A2,
which converts membrane phospholipase to arachidonic
acid. Corticosteroids are capable of reducing prostaglandin
synthesis by inhibition of phospholipase A2 through
the production of calcium-dependent phospholipid
binding proteins called annexins and by the inhibition of
cyclooxygenasesduringinammation.[24]
Some authors also believe that analgesic properties of
corticosteroids are the results of their systemic effects.[25]
The block prolonging effect may be due to its local
action on nerve bers.[26] Previous works demonstrated
that addition of dexamethasone to local anesthetics
prolonged duration of blockade of peripheral nerves. A
study in supra-clavicular block suggests that the addition
of dexamethasonetobupivacainesignicantlyprolonged
duration of analgesia.[6] Another study in axillary block
reported that dexamethasone when added to lidocaine
signicantly prolongs durationof  analgesia without any
change in onset.[27]
In animal experiments, triamcinolone[28] did not induce
spinal neurotoxicity, whereas repeated high-dose intrathecal
injections of betamethasone[29] caused histopathological
changes of the spinal cord. Intrathecal injection of
steroids was frequently used for the treatment of mumps
meningitis, chronic lymphocytic leukemia and central
nervous involvement in lupus erythematosus.[30] Like
our nding, some of  the studies did not reported any
considerable complication for intrathecal dexamethasone.
Kotani et al. found no complication in patients who
received intrathecal methyl prednisolone.[18] Also Sugita
didnotndcomplicationafterintrathecalinjectionsof 8
mg dexamethasone in patients with posttraumatic visual
disturbance.[31]
CONCLUSION
In our investigation, we utilized the combination of
bupivacaine and 8 mg dexamethasone intrathecally. We
found that the addition of  dexamethasone signicantly
prolongs the duration of sensory block and decreases
opioid requirements in postoperative management.
Further studies are needed to evaluate the optimal dose of
dexamethasone to be used in spinal anesthesia.
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How to cite this article: Bani‑hashem N, Hassan‑nasab B,
Pour EA, Maleh PA, Nabavi A, Jabbari A. Addition of intrathecal
Dexamethasone to Bupivacaine for spinal anesthesia in orthopedic
surgery. Saudi J Anaesth 2011;5:382-6.
Source of Support: Nil, Conict of Interest: None declared.
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    • study used the intrathecal route but found that it is not effective in the analgesic duration.[25]Our findings are similar to studies which did not report any complications from the use of intrathecal dexamethasone.[7,17]Lastly, concerning the neonatal outcome there were no harm recorded in this study.
    Article · Jul 2017
    • [2] Drugs like dexmedetomidine, dexamethasone have also been used successfully as an adjunct in spinal anesthesia along with local anesthetic. [3,4] Magnesium sulfate exerts its analgesic action as a noncompetitive N-Methyl-D-aspartate (NMDA) receptor antagonist, blocking ion channels in a voltage dependent manner when used intrathecally. The addition of magnesium reduces the activation of C-fi bers by inhibiting the slow excitatory postsynaptic currents produced by NMDA receptor activation.
    [Show abstract] [Hide abstract] ABSTRACT: Adjuvants are added to intrathecal local anesthetics to improve quality and duration of subarachnoid block. The present study was designed to compare the analgesic effi cacy and quality of anesthesia produced by midazolam (1 mg) versus magnesium sulfate (50 mg) when given as adjuncts to hyperbaric bupivacaine intrathecally. In our study, we compared 1 mg midazolam and 50 mg magnesium sulfate as an additive to bupivacaine intrathecally. Materials and Methods: We conducted our study on 124 patients with(ASA) I and II physical status undergoing elective lower abdominal and orthopedic surgeries after approval from Institutional Ethics Committee. There were two groups; group MZ which received 3 ml of 0.5% heavy bupivacaine with 1 mg of preservative free midazolam and group MG which received 3 ml of 0.5% heavy bupivacaine with 50 mg magnesium sulfate intrathecally. The onset and duration of sensory block, onset and duration of motor block, and duration of analgesia were recorded. Results: The onset and duration of sensory block was longer in MG group as compared to the MZ group. The onset and duration of motor block was longer in MG group as compared to MZ group. Also, the total duration of analgesia was more in MG group as compared to MZ group. Conclusion: We concluded that 50 mg of intrathecal magnesium sulfate prolonged the duration of sensory and motor block and also the duration of postoperative analgesia with low pain scores as compared to midazolam group. However, it delayed the onset of sensory and motor block. On the other hand 1 mg of intrathecal midazolam produced anearly onset of sensory and motor block but the duration of analgesia was less as compared to the magnesium group.
    Full-text · Article · Jan 2014
    • 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 analgesia171819202122 . 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 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
    • 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 analgesia171819202122 . 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 · The journal of pain: official journal of the American Pain Society
    • 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.
    [Show abstract] [Hide abstract] ABSTRACT: Objective: Inadequate postoperative pain relief after cesarean section can increase complications. In this study, we evaluated the effect of intrathecal betamethasone as an adjunct to bupivacaine on postoperative pain in patients undergoing cesarean section. Methodology: Ninety-nine patients undergoing cesarean section were assigned to one of three groups. Group 1 (Control) patients received intrathecal bupivacaine, Group 2 patients received intrathecal bupivacaine plus preservative free betamethasone and Group 3 patients received betamethasone intravenously with intrathecal bupivacaine. After surgery, diclofenac in suppository form was administered as needed for analgesia. Postoperative diclofenac requirements, time to first analgesic administration and visual analogue scale pain scores were recorded by a blinded observer. Results: Supplemental analgesic dose requirement with diclofenac for the first 24 hours were significantly less in both groups that received betamethasone compared to the control group (P <0.0001). The mean duration of postoperative analgesia was 336.8±86 min in Intrathecal group and 312.4±106 min in Intravenous group compared with 245.4±93 min in control group (P =0.001). Visual analogue scale scores were significantly less at 4 hours (P<0.0001) and 6 hours (P<0.0001) after surgery in groups that received betamethasone in comparison to control group. The pain scores at 6 hours after surgery were higher in the Intravenous group compared with the Intrathecal group (P = 0.001); However visual analogue scale was not different at 12 and 24 hours after surgery between groups (p > 0.05). Conclusion: Intrathecal betamethasone reduced pain and decreased the required dose of diclofenac in 24 hours after cesarean section.
    Full-text · Article · Apr 2013
  • [Show abstract] [Hide abstract] ABSTRACT: Unlabelled: Peripheral nerve injury generally results in spinal neuronal and glial plastic changes associated with chronic behavioral hypersensitivity. Spinal mitogen-activated protein kinases (MAPKs), eg, p38 or extracellular signal-regulated kinases (ERKs), are instrumental in the development of chronic allodynia in rodents, and new p38 inhibitors have shown potential in acute and neuropathic pain patients. We have previously shown that the cannabinoid type 2 receptor agonist JWH015 inhibits ERK activity by inducing MAPK phosphatase (MKP)-1 and MKP-3 (the major regulators of MAPKs) in vitro in microglial cells. Therefore, we decided to investigate the role of these phosphatases in the mechanisms of action of JWH015 in vivo using the rat L5 nerve transection model of neuropathic pain. We observed that peripheral nerve injury reduced spinal MKP-1/3 expression and activity and that intrathecal JWH015 reduced established L5 nerve injury-induced allodynia, enhanced spinal MKP-1/3 expression and activity, and reduced the phosphorylated form of p38 and ERK-1/2. Triptolide, a pharmacological blocker of MKP-1 and MKP-3 expression, inhibited JWH015's effects, suggesting that JWH015 exerts its antinociceptive effects by modulating MKP-1 and MKP-3. JWH015-induced antinociception and MKP-1 and MKP-3 expression were inhibited by the cannabinoid type 2 receptor antagonist AM630. Our data suggest that MKP-1 and MKP-3 are potential targets for novel analgesic drugs. Perspective: MAPKs are pivotal in the development of chronic allodynia in rodent models of neuropathic pain. A cannabinoid type 2 receptor agonist, JWH015, reduced neuropathic allodynia in rats by reducing MAPK phosphorylation and inducing spinal MAPK phosphatases 1 and 3, the major regulators of MAPKs.
    Article · Aug 2012
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