Efficacy of epidural dexamethasone versus fentanyl on postoperative analgesia

Purpose Dexamethasone has analgesic, anti-inflammatory, and antiemetic effects. This prospective, randomized, double-blind, controlled study was designed to evaluate the efficacy of adding dexamethasone versus fentanyl to epidural bupivacaine on postoperative analgesia. Methods Ninety patients ASA I-II scheduled for lower abdominal surgeries were randomly allocated into three groups to receive a total of 10 mL epidural plain bupivacaine 0.25% in the control group (group B), with either 50 µg fentanyl in group BF or 4 mg dexamethasone in group BD. Patients then received general anesthesia. Sedation, satisfaction, and visual analogue pain scores (VAS) were measured postoperatively. Meperidine was administered when VAS ≥ 4. Intraoperative fentanyl dose, postoperative meperidine consumption, and the time to first analgesic requirement were recorded. Results Intraoperative fentanyl requirements were comparable among groups. Time to first analgesic requirement was significantly prolonged (5.2 times) in the BF group and (4.8 times) in the BD group compared with group B (p < 0.01). There was significant reduction in postoperative meperidine consumption during the first 24 h in the BF and BD groups (65, 62.5% respectively) in comparison with group B (p < 0.01). VAS scores were significantly lower and patient satisfaction score was significantly higher in the BF and BD groups compared with group B (p < 0.01). Postoperative nausea was significantly lower in the BD group versus the B and BF groups (p < 0.05). Conclusions 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. Keywords Epidural * Dexamethasone * Fentanyl * Bupivacaine * Analgesia
Introduction Inadequate postoperative pain relief can delay recovery, increase health care costs, and reduce patient satisfaction [1]. Various adjuvants are used in regional anesthesia to enhance and prolong local anesthetic [...]