Efficacy of epidural dexamethasone versus fentanyl on postoperative analgesia

Khafagy, Hanan F.; Refaat, Ahmed; El-Sabae, Hossam; Youssif, Maha A

doi:10.1007/s00540-010-0949-7

Cited by 55 publications

(65 citation statements)

References 34 publications

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“…Previous studies in humans showed that lower doses of epidural dexamethasone may be effective in surgical procedures associated with mild or moderate pain such as laparoscopy, orchiopexy and herniorrhaphy 1,10 .…”

Section: ■ Discussionmentioning

confidence: 99%

“…Corticosteroids are used clinically for their anti-inflammatory and immunosuppressive activity, and they have been shown to reduce postoperative pain when administered by the epidural route after various surgeries in human patients 10,11 . The exact mechanism of this analgesic effect is not understood 12 , but several mechanisms have been suggested to explain it 13,14 .…”

Section: ■ Introductionmentioning

confidence: 99%

“…In humans, lumbar epidural dexamethasone has been used to treat patients with postoperative pain resulting from lower abdominal surgeries 10,17 , hysterectomy 11 or orchiopexy and back pain 1,18,19 . The authors are unaware of any studies on the use of epidural dexamethasone in dogs to relieve pain and increase the duration of action of the lignocaine local anaesthetic in the postoperative period.…”

mentioning

confidence: 99%

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The effect of epidurally administered dexamethasone with lignocaine for post-operative analgesia in dogs undergoing ovariohysterectomy. A dose-response study

Hermeto

Rossi²,

Bicudo³

et al. 2017

Acta Cir. Bras.

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Purpose: To evaluate the postoperative analgesic and adverse effects of three doses of dexamethasone, administered epidurally in combination with lignocaine, in dogs undergoing ovariohysterectomy (OVH). Methods: Twenty-four female dogs undergoing ovariohysterectomy were pre-medicated with acepromazine and general anaesthesia was induced and maintained with propofol. Animals were randomly allocated into four groups of six. The control group was given lignocaine 2% (LI) and the treatment groups were given lignocaine with either 2 mg dexamethasone (LIDEX2), 4 mg dexamethasone (LIDEX4) or 8 mg dexamethasone (LIDEX8) administered at the lumbosacral epidural space. Duration of postoperative analgesia, first analgesic rescue, motor blockade, heart rate, blood pressure, respiratory rate, and rectal temperature were evaluated. Results: The duration of postoperative analgesia was 19.5 (SD 6) hours for LIDEX8 (p=0.001), 10 (SD 2) hours for LIDEX4 (p=0.002), 4 (SD 2) hours for LIDEX2 (p=0.074) treatments compared with values for the LI control treatment 2.2 (SD 1.6) hours. All treatments had significant cardiovascular and respiratory alterations but they were within acceptable range in these clinically healthy female dogs. Conclusion: Dexamethasone added to epidural lignocaine significantly extends the postoperative analgesia after ovariohysterectomy in female dogs.

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Section: ■ Discussionmentioning

confidence: 99%

Section: ■ Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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The effect of epidurally administered dexamethasone with lignocaine for post-operative analgesia in dogs undergoing ovariohysterectomy. A dose-response study

Hermeto

Rossi²,

Bicudo³

et al. 2017

Acta Cir. Bras.

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“…Additionally, epidural corticosteroids have been used safely for a long time in treating patients with radicular pain arising from nerve root irritation [24]. Dexamethasone in particular has been studied as an adjuvant to epidural local anaesthetics [25].…”

Section: Discussionmentioning

confidence: 99%

Dexamethasone as An Additive to Bupivacaine in Fascia Lliaca Compartment Block: A Prospective, Randomized and Double Blind Study

Kumar

Sebastian

2014

JCDR

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Background: Patients with fracture femur experience severe pain on movement during positioning for spinal anaesthesia. Fascia Iliaca Compartment Block (FICB) has been used effectively for providing analgesia during positioning of the patient for spinal anaesthesia. Aim:To test the hypothesis that, adding dexamethasone would significantly prolong the duration of Bupivacaine in FICB. Materials and Methods:Sixty patients aged 18 to 80 years posted for ORIF (Open Reduction and Internal Fixation) of fracture femur were included to receive FICB. This was a prospective, randomized, double blind study done at tertiary medical college hospital. Thirty patients received 38ml of 0.25 % bupivacaine with 2ml saline and another 30 patients received 38ml of 0.25 % bupivacaine with 2ml dexamethasone (8mg). Thirty minutes after FICB, patient satisfaction during positioning for spinal anesthesia was recorded. In the post-operative period, duration of analgesia and the total doses of rescue analgesics were recorded in both the groups. Results:Patients who received Bupivacaine with dexamethasone had significant prolongation of analgesia and required fewer doses of rescue analgesics as compared to patients who received Bupivacaine alone for FICB. However, the onset of analgesia, VAS scores and patient satisfaction during positioning for spinal anaesthesia were similar in both groups. Conclusion:Our study shows that adding Dexamethasone (8mg) to Bupivacaine for FICB significantly prolonged the duration of block and decreased the requirement of rescue analgesics as compared to patients who received Bupivacaine alone. FICB is relatively easy and safe to perform. In our study we did not encounter any complication while doing the procedures and also by adding dexamethasone.

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“…Hal lainnya yang membuat deksametason mempercepat mula kerja obat anestesia lokal adalah efek deksametason sebagai anestetik lokal yang bekerja dengan cara menghambat potensial aksi serabut saraf C. Penelitian lain menyatakan bahwa aksi kortikosteroid pada reseptor di medula spinalis akan memblokade aktivitas di kornu dorsalis yang ditimbulkan oleh serabut saraf tipe C. [10][11][12] Mekanisme kerja deksametason dalam memperpanjang lama kerja bupivakain pada anestesia epidural adalah melalui penurunan pelepasan bradikinin, tumor necrosis factor, interleukin-1, interleukin-2, interleukin-6, dan juga penurunan produksi prostaglandin. Penurunan prostaglandin berperanan dalam menghambat nyeri melalui penekanan sistem siklooksigenasi 1 dan juga 2 di jaringan perifer serta sistem saraf pusat.…”

Section: -11unclassified

Efek Penambahan Deksametason 5 mg pada Bupivakain 0,5% terhadap Mula dan Lama Kerja Blokade Sensorik Anestesia Epidural untuk Operasi Ortopedi Ekstremitas Bawah

Irwan¹,

Pradian²,

Bisri³

2015

jap

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AbstrakOperasi ortopedi ekstremitas bawah dengan anestesia regional epidural memiliki kelemahan yaitu mula kerja yang lama. Penelitian ini bertujuan melihat efek penambahan 5 mg deksametason pada bupivakain 0,5% terhadap mula kerja dan lama kerja blokade sensoris. Penelitian prospektif eksperimental menggunakan uji klinis acak buta ganda pada 32 pasien dengan American Society of Anesthesiologist (ASA) I-II yang menjalani operasi ortopedi ekstremitas bawah dengan anestesi epidural di RSUP Dr. Hasan Sadikin Bandung pada Februari-Mei 2014. Pengambilan sampel dilakukan secara consecutive sampling dan random blok permutasi. Kelompok I, deksametason 5 mg ditambahkan ke dalam bupivakain 0,5% 15 mL. Kelompok II, bupivakain 0,5% ditambah NaCl 0,9% 15 mL. Hasil penelitian diuji secara statistika menggunakan uji-t dan Uji Mann-Whitney. Hasil penelitian menunjukkan mula kerja blokade sensorik kelompok I tidak lebih cepat, yaitu 13,56 menit dibanding dengan kelompok II, yaitu 14,31 menit (p=0,27). Lama kerja blokade sensorik kelompok I lebih lama, yaitu 399,81 menit dibanding dengan kelompok II, yaitu 227,43 menit (p=0,00). Simpulan, penambahan deksametason 5 mg pada bupivakain 0,5% 15 mL tidak mempercepat mula kerja blokade sensorik tetapi memperpanjang lama kerja blokade sensorik bupivakain 0,5% yang diberikan secara epidural.Kata kunci: Anestesi epidural, blokade sensorik, bupivakain, deksametason, lama kerja, mula kerja Effect of Dexamethasone 5 mg Addition to Bupivacaine 0.5% on Onset and Duration of Sensory Blockade in Epidural Anesthesia for Lower Extremity Orthopedic Surgery AbstractLower extremity orthopedic surgery performed with regional epidural anesthesia was still have weakness which is long onset of time. This study was conducted to determine the onset time and duration time of sensory blockade epidural anesthesia between the use of dexamethasone 5 mg addition to 0.5% bupivacaine for lower limb orthophedic surgery. The study was using randomized controlled blind method on 32 ASA I-II patients undergoing lower limb orthopedic surgery under epidural anesthesia. Consecutive sampling and random allocation of block of permutation groups was applied. In group I, dexamethasone 5 mg was added to bupivacaine 0.5% 15 mL while in group II NaCl 1 mL was added to bupivacaine 0.5% 15 mL. The results were statistically tested using t-test and Mann-Whitney test. It was shown that the onset time of sensory blockade was not significantly faster when dexamethasone was added in bupivacaine 0.5%, 13.56 minutes versus 14.31 minutes (p=0.27). The duration time of sensory blockade in dexamethasone in bupivacaine 0.5% group was longer 399.81 minutes, compared to the bupivacaine 0.5% group, 227.43 minutes (p=0.00).In conclusions, the addition of dexamethasone 5 mg to bupivacaine 0.5% 15 mL does not produced faster onset time. However, the duration sensory blockade time is longer than bupivacaine 0,5% 15 mL is used

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Efficacy of epidural dexamethasone versus fentanyl on postoperative analgesia

Abstract: This study revealed that epidural bupivacaine-dexamethasone admixture had almost the same analgesic potency as bupivacaine-fentanyl with opioid-sparing and antiemetic effects. Further studies are required to evaluate the optimum dose of epidural dexamethasone for postoperative analgesia.

Cited by 55 publications

References 34 publications

The effect of epidurally administered dexamethasone with lignocaine for post-operative analgesia in dogs undergoing ovariohysterectomy. A dose-response study

The effect of epidurally administered dexamethasone with lignocaine for post-operative analgesia in dogs undergoing ovariohysterectomy. A dose-response study

Dexamethasone as An Additive to Bupivacaine in Fascia Lliaca Compartment Block: A Prospective, Randomized and Double Blind Study

Efek Penambahan Deksametason 5 mg pada Bupivakain 0,5% terhadap Mula dan Lama Kerja Blokade Sensorik Anestesia Epidural untuk Operasi Ortopedi Ekstremitas Bawah

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