Effect of Dexamethasone as an Adjunct to Epidural Bupivacaine for Postoperative Analgesia Following Major Lower Abdominal Surgery

Abstract

Epidural analgesia is effective for postoperative pain. However, the unacceptable incidences of side effects such as hypotension and motor blockade have limited its use. This study aims to evaluate the effect of epidural dexamethasone as an adjunct to epidural bupivacaine for postoperative analgesia in major lower abdominal surgeries. This was a prospective, double-blinded, randomised controlled study where participants received either epidural bupivacaine alone or bupivacaine with one of two doses of dexamethasone. Participants were given either a bolus dose of 8 ml of 0.125% plain bupivacaine (group A), 8 ml of 0.125% plain bupivacaine + 4mg dexamethasone (group B), or 8 ml of 0.125% plain bupivacaine + 8 mg dexamethasone as an initial postoperative epidural analgesia. The main outcome measures are the VAS pain scores, time to first analgesic request, and analgesic consumption. VAS pain scores were significantly lower, and time to first analgesic request was significantly higher in the dexamethasone groups when compared to the control group, with a p-value of 0.000. Tramadol and bupivacaine consumption were significantly reduced in group C (p=0.000) but not in group B (p=1.000) compared to the control group. Both doses of epidural dexamethasone as an adjunct to plain bupivacaine reduced VAS pain scores. The 8 mg dose was more effective in increasing the duration of analgesia, as well as reducing tramadol and plain bupivacaine consumption