Addition of intrathecal dexamethasone to bupivacaine for spinal anesthesia in cesarean section

Abstract

Background: Post-caesarean section pain is an important issue in obstetrics. Several studies have shown the importance of adequate postoperative analgesia on mobilization, rehabilitation and decreasing the length of hospital stay. Large amounts of opioid analgesic drugs are often required in the management of intense post-operative pain. However, this option is associated with many side effects. Objective: The aim of the study was to assess the efficacy of adding dexamethasone to bupivacaine for spinal anesthesia in prolonging the duration and anesthetic effect in women undergoing cesarean section. Patients and Methods: Populations of the study were comprised of 100 pregnant full term female planed for cesarean section. All patients had cesarean section under spinal anesthesia. Pain was assessed using 10 cm visual analogue scale (VAS) after 0, 15, 30 min and 2, 4, 6 hours post-operatively and until the mother asked for an analgesic. The duration of sensory block as well as postoperative analgesia were calculated. The study population had been randomized into 2 groups: The 1 st group C (n=50 women) included 50 women receiving intrathecal dexamethasone added to bupivacaine. The 2 nd group B (n=50 women) included 50 women receiving placebo which was added to intrathecal bupivacaine. Results: This study has shown that the addition of intrathecal dexamethasone to bupivacaine significantly improved the duration of sensory block in spinal anesthesia as the duration of sensory block in the study group was 122 + 7.9 minutes while in the control group it was 91.8 + 10.8 minutes and p<0.001. Also, receiving time to VAS >6 and the first analgesic dose prescription in the case group was significantly longer than that in the control group (P<0.001) as the pain free period in the study group was 434.3 + 43.8 minutes while in the control group it was 215.3 + 40.3minutes. Also, the motor block duration in the study group was significantly prolonged when compared with control group (p<0.01).There was no difference in onset time between the two groups and the addition of dexamethasone cause no complications. 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, and has increased the pain free period statistically. Recommendations: Further studies are needed to evaluate the optimal dose of dexamethasone to be used in spinal anesthesia.

Effect of fentanyle versus dexamethasone on shoulder tip pain during laparoscopic ovarian cystectomy under spinal anaesthesia

“…Dexamethasone was nearly as effective fentanyl in reducing incidence and severity of shoulder pain and facilitating ovarian cystectomy under spinal anesthesia. Antinociceptive effects of dexamethasone could be explained by its neuro-antiinflammatory effects and its ability to prevent C fiber mediated nociception and blocking ectopic neuronal firing [11]. Furthermore, analgesic effects of intrathecal dexamethasone might be related to its ability to regulate the nuclear factor-kB at the spinal cord which is responsible for "central sensitization" inhibition [21].…”

“…Moreover, dexamethasone inhibits peripheral as well as central prostaglandin synthesis at the level of the spinal cord, minimizing the sensitization of both the inflammatory and the pain pathways [22]. Intrathecal use of both dexamethasone and fentanyle remains off label, however previous trials demonstrated that no serious complications were recorded from the intrathecal use of both drug [9], [23], [24], [25], [26], [27].…”

“…Various trials were carried out to minimize laparoscopic induced shoulder tip pain [4], [5], [6], [7], that has a recorded postoperative incidence of 35% to 80% [8]. Intrathecal dexamethasone has been used to improve quality of spinal anesthesia without serious side effects recorded [9], [10], [11]. Dexamethasone is thought to exert its analgesic activity through inhibiting inflammation and preventing C fiber mediated nociception and blocking ectopic neuronal firing [11].…”

“…Intrathecal dexamethasone has been used to improve quality of spinal anesthesia without serious side effects recorded [9], [10], [11]. Dexamethasone is thought to exert its analgesic activity through inhibiting inflammation and preventing C fiber mediated nociception and blocking ectopic neuronal firing [11]. Fentanyl is a lipophilic opioid famously used intrathecally with a relatively approved intraoperative antinociceptive effects [12], [13], [14].…”

Evaluation of the Effect of Intravenous Dexamethasone on the Duration of Spinal Anaesthesia in Parturients Undergoing Lower Segment Caesarean Section

“…Intrathecal administration of dexamethasone prolongs the duration of sensory block [ 12 , 13 ]. However, the effect of intravenous dexamethasone on the duration of spinal anesthesia has been assessed by a few studies with conflicting results [ 14 , 15 ].…”