L’administration péridurale de dexaméthasone réduit la douleur et la demande d’analgésiques postopératoires

Abstract

Purpose: Epidural steroids may have potential advantages for providing postoperative analgesia. We therefore undertook a study to evaluate the efficacy of epidurally administered dexamethasone in reducing postoperative morphine requirements, as a measure of analgesia following laparoscopic cholecystectomy. Methods:In a randomized, double-blind study, 94 patients undergoing laparoscopic cholecystectomy were randomly assigned to one of three groups. Group 1 (Control) patients received dexamethasone 5 mg iv with epidural injection of 0.25% bupivacaine 8 mL and normal saline 2 mL, Group 2 (D1) patients received normal saline 2 mL iv with epidural injection of 0.25% bupivacaine 8 mL and dexamethasone 5 mg in normal saline 2 mL, and Group 3 (D2) patients received normal saline 2 mL iv with epidural injection of dexamethasone 5 mg in normal saline 10 mL. After surgery, morphine 2-4 mg iv was administered as needed for analgesia. Postoperative morphine requirements, visual analogue scale (VAS) pain scores at rest and with effort, and time to first analgesic administration were recorded by a blinded observer. Results:Total morphine consumption for the first 24 hr following surgery was lower in both epidural dexamethasone groups (D1, D2) compared to the control group (P < 0.05). The percentage reduction in morphine consumption in Group D1 was 53.9% and in Group D2 was 52.9% in the first 24 hr. Postoperatively at 12 hr, 18 hr and 24 hr, the VAS scores at rest and during effort were also lower in the epidural dexamethasone groups (D1, D2) compared to the control group (P < 0.05). The percentage reductions in VAS scores with effort at 12 hr, 18 hr and 24 hr in Group D1 were 50%, 52.9% and 50% respectively, and in Group D2 percentage reductions in pain scores with effort were 54.8%, 58.8% and 55.5% at corresponding sampling intervals. Conclusion:Preoperative epidural administration of dexamethasone 5 mg, with or without bupivacaine, reduces postoperative pain and morphine consumption following laparoscopic cholecystectomy. Objectif

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

“…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 .…”

“…Inadequate postoperative pain relief can delay recovery and increase the incidence of adverse effects, such as delayed healing, lack of appetite and decreased immunity 1 . Female dogs undergoing ovariohysterectomy (OVH) suffer pain of varying severity (mild-tomoderate) depending on the degree of surgical trauma, requiring analgesic drugs in the first postoperative day 2 .…”

“…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.…”

Effect of Intravenous Dexamethasone on Spinal Anaesthesia With Bupivacaine Plus Fentanyl in Patients Undergoing Vaginal Hysterectomy

“…Acute noxious stimulation of peripheral tissues leads to sensitization of dorsal horn neurons of the spinal cord by the release of excitatory amino acids such as glutamate and aspartate. These amino acids activate N-methyl-Daspartate receptors resulting in calcium ion influx (24). The increased intracellular calcium leads to activation of phospholipase A2, the rate-limiting enzyme in prostaglandin synthesis, which converts membrane phospholipids to arachidonic acid.…”

Effects of Different Epidural Analgesic Compositions on Postoperative Pain Relief and Systemic Response to Surgery

“…Since patients complained about back pain after surgical interventions-mostly related to bad positioning or pre-existing discogenic disease-on the supposition that postoperative pain should be treated preventively, patients received 1 mg morphine with 80 mg of methylprednisolone epidurally directly after surgery (Joos et al, 1993). Preoperative epidural administration of dexamethasone 5 mg, with or without bupivacaine, reduced postoperative pain and morphine consumption following laparoscopic cholecistectomy (Thomas et al, 2006). Studies about epidural methylprednisolone-morphine compositions in orthopaedic knee surgery showed comparable or even superior analgesic effect with bupivacaine-morphine mixture .…”