Background:Intrathecal morphine is commonly used for postcesarean analgesia. Its use is frequently associated with opioid-induced nausea, vomiting, and pruritus. Palonosetron (0.075 mg) combined with dexamethasone (8 mg) is postulated to have an additive effect over each drug alone. The study, therefore, compared the effect of intravenous (i.v.) palonosetron, dexamethasone, and palonosetron with dexamethasone combination in preventing intrathecal morphine-induced postoperative vomiting and pruritus in lower segment cesarean section (LSCS) patients.Settings and Design:Randomized, prospective, double-blinded, observational clinical study.Methods:Ninety pregnant women, American Society of Anesthesiologists physical status class I undergoing LSCS were included in the study. They were randomly assigned to three groups – Group P received 0.075 mg palonosetron i.v., Group D received dexamethasone 8 mg i.v., and Group PD received palonosetron 0.075 mg along with dexamethasone 4 mg i.v., just after spinal anesthesia with bupivacaine 2.2 ml (12 mg) and 150 μg morphine. The incidence of pruritus, nausea, vomiting, and need for rescue drug were recorded for 24 h.Statistical Analysis:Statistical analysis was performed using Student's t-test for categorical variables and Chi-square test for noncategorical variables.Results:The incidence of nausea, vomiting was significantly more in Group D (40%) than Group P (27%) and Group PD (20%) in 24 h. The incidence of pruritus was significantly more in Group D (6%) than Group P and PD (3%). The need of rescue antiemetic was more in Group D (30%) than Group P (6%) and Group PD (3%). No difference in three groups requiring rescue antipruritic drug.Conclusion:Prevention of intrathecal morphine-induced vomiting and pruritus was more effective with palonosetron alone or with dexamethasone combination than dexamethasone alone. Combination of palonosetron and dexamethasone proved no better than palonosetron alone.

Objective: In this advanced era of surgery, laparoscopic hysterectomy operations are very commonly practiced by surgeons. It reduces trauma, morbidity, and health-care costs, ensuring early discharge. However, the early post-operative pain experienced by patients may sometimes negate all the advantages of a laparoscopic procedure. Intraperitoneal (IP) instillation of local anesthetics has been proposed to decrease post-operative pain after laparoscopic surgeries. Additives to local anesthetics like α-2 agonists such as clonidine and dexmedetomidine prolong the duration of analgesia. Therefore, this randomized, prospective, controlled study was conducted to compare the analgesic efficacy of IP ropivacaine with or without dexmedetomidine for postoperative analgesia after total laparoscopy hysterectomy. Methods:At the end of laparoscopic hysterectomy, in a double-blind, randomized manner, one of the following injections was given intraperitoneally. The patients were allocated into the following two groups: The patients in ropivacaine group (R group) (N = 40) were given 38 ml of 0.2% ropivacaine plus 2 ml of normal saline (NS) and the patients in ropivacaine plus dexmedetomidine group (RD group) (N = 40) were given 38 ml of 0.2% ropivacaine combined with 0.5 µg/kg dexmedetomidine (diluted in 2 ml NS) through trocars. All the patients were given diclofenac sodium when they had a pain score of 4 on visual analog scale (VAS).Results: VAS score at different time intervals was significantly lower after the second postoperative hour, time to first request of analgesia (minutes) was longest (487.7±40.96 vs. 242.5±19.84), and the total analgesic consumption (mg) was lowest (61.88±37.55 vs. 183.75±44.78) in RD group than in R group. Conclusion:The antinociceptive effects of the IP instillation of ropivacaine in combination with dexmedetomidine are superior to ropivacaine alone in laparoscopic hysterectomy cases.

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