Comparison of bupivacaine versus bupivacaine-dexamethasone infiltration for postoperative analgesia in skin graft donor sites: a randomized trial

Abstract

Background Skin grafting, both partial and complete thickness, is frequently used in reconstruction of traumatic soft tissue defects. It is of great value not only for functional and anesthetic purposes in the field of plastic surgery, but also for other surgical specialties. Of all the problems in the early postoperative period, pain is considered the most important, ameliorating it can lead to significant reduction in postoperative morbidity and faster recovery of the skin donor site. Objective To evaluate use of dexamethasone as adjuvant for bupivacaine in subcutaneous local anesthesia infiltration for skin graft donor sites, on quality of pain relief and total dose of analgesic requirements in the early hours postoperatively. Methods Ninety-five patients were randomly allocated to receive local bupivacaine infiltration (group LB) (48 patients), or dexamethasone plus bupivacaine (group LB + D) (47 patients) in skin donor site after skin harvesting. In addition to basic demographic data, patients were compared for numerical rating scale (NRS), total dose of morphine including morphine equivalents, time to 1st breakthrough pain (over an observational period during the first 12 h postoperatively) and duration of surgery. Results Numerical rating scale figures were significantly better (P < 0.05) in group (LB + D) than group (LB) in the first 7 h postoperatively. Likewise, consumption of morphine or its equivalents was considerably less, as well as time to first breakthrough pain. Duration of surgery was not significantly different between both groups. Conclusion Addition of dexamethasone to bupivacaine provided effective analgesia for patients undergoing skin grafting surgery, with less need for rescue analgesia in the early postoperative period to bupivacaine alone.

Dexamethasone as Adjuvant to Ropivacaine in Wound Infiltration for Postoperative Analgesia Following Spinal Surgery: A Randomized, Double-Blinded, Controlled Trial

“…43 Additionally, our study found that adding dexamethasone to ropivacaine in infiltration of the laminectomy surgical wound reduced the total dose of morphine consumed during the first post-operative 48 hours compared to the R-group, thereby reducing its side effects. Several studies in the literature have shown similar results, including one conducted in Ain Shams University Hospitals in Egypt from October 2018 to February 2019, 44 which evaluated the efficacy of dexamethasone as an adjuvant for bupivacaine in subcutaneous local anesthesia infiltration for skin graft donor sites. The study found that the total morphine consumption was significantly lower in the bupivacaine plus dexamethasone group than in the bupivacaine only group.…”

“…Additionally, there was a lower wound infection rate in the RD-group (0%) versus the R-group (0.7%, one patient). 31,42,44,47,[53][54][55][56][57][58] Therefore, dexamethasone as an adjuvant to incision-site infiltration is a safe method for the prevention of incision-site pain after spinal surgery.…”

Complex Regional Pain Syndrome of the Foot and Ankle: Treatment at the Early Onset with an Anesthetic Ankle Block

“…A hypothesis, based on the early diagnosis and treatment of CRPS, combined with the potential beneficial effect of sympathetic blocks for the treatment of CRPS and the analgesic effects of adding dexamethasone to bupivacaine for nerve blocks, showed that early diagnosis of CRPS of the foot and/or ankle and immediate adjunctive treatment with a ring-type anesthetic block of of the ankle consisting of bupivacaine mixed with dexamethasone may be beneficial (26)(27)(28)(29)(30). No case series or study considering this treatment regimen for CRPS of the foot or ankle was found in the literature.…”